Etiology, clinical presentation, diagnosis and management of lower gastrointestinal bleed in a Tertiary Care Hospital in India: A retro-prospective study

Abstract

Introduction: Lower gastrointestinal bleeding (LGIB) is one of the leading causes for hospital admissions in gastroenterology wards all over the world. Patients usually present with hematochezia or bloody diarrhea. Colonoscopy is usually the initial diagnostic intervention followed by other more sophisticated tests. Bleeding may stop spontaneously, but evaluation is important because patients may harbor a sinister lesion like cancer. Aim of the Study: To determine the various etiologies, clinical presentations, a diagnostic test used and treatments received by LGIB patients admitted in our department. Materials and Methods: A total of 300 cases were studied which included 180 retrospective cases and 120 prospective cases. For retrospective cases, all the information was obtained by analyzing their case records while as prospective patients were managed as per a predefined protocol and details of various investigations and treatments documented. Results: Most commonly affected was elderly population (>60 years), constituting 40% (120/300) of studied population. Males constituted 59% (177/300) and females 41% (123/300). The most common clinical presentation of LGIB in our patients was hematochezia (63.6%, 191/300). Growth/polyp was the most common finding on colonoscopic examination seen in 29.3% (n = 88) patients. Inflammatory lesions were seen in 77 out of 239 (25.7%) patients. Wireless capsule endoscopy was positive in 13 out of 24 patients (54%). Computed tomography (CT) enterography showed positive results in 6 out of 25 (24%) cases. Red blood cell scan was done in seven patients while as CT angiography in in four patients. Therapeutic endoscopy was successful in 115 out of 239 patients with positive colonoscopy, polypectomy was the commonest procedure performed. Medical management was carried out in 34.6% patients. Surgical treatment was offered to 21% patients. Conclusion: Colonoscopy is the initial and most common investigation used in the evaluation of GI bleed. A polyp is the most common diagnosis while as polypectomy the most common therapeutic procedure.

Etiological profile of patients presenting with lower gastrointestinal bleeding at tertiary care hospital at Belagavi: a cross sectional study

“…13 In a study by Dar IA et al, LGIB was more commonly seen in men as compared to women (59% versus 41%). 5 Which was also consistent with the findings of this study. In a study conducted by Alruzug IM et al, from Saudi Arabia showed predominantly a higher percentage of males with male to female ratio 1.5:1.…”

“…However, in the India, the etiology differs significantly. 5,10 Colonoscopy is the most convenient and effective preliminary investigation. Actual visualization during the acute episode is uncommon because the view is poor.…”

“…The overall mortality rate ranges from 2% to 4%. 5 The etiology and the epidemiology of LGIB varies according to the environmental conditions depending upon the life style, dietary habits, the prevalence of smoking, history of drug intake, age, longevity of the population, etc. Most of the data from the west suggests that colonic diverticula are the most frequent source of LGIB followed by angiodysplasias (angiectasias), colitis [ischemic, infectious, chronic inflammatory bowel disease (IBD)], neoplasms, small bowel bleeding and post-polypectomy bleeding.…”

“…While some authors advocate early colonoscopy in an unprepared bowel, others advise a more expectant approach. 5,11 Clinical factors predictive of severe colonic bleeding include aspirin use, at least two co-morbid illnesses, pulse greater than 100/minute, and systolic blood pressure <115 mmHg.…”

“…1 Hemorrhage from the lower gastrointestinal (GI) tract accounts for about 20% of all cases of acute GI bleeding. [2][3][4][5] Lower GI bleeding is that which occurs from the colon, rectum, or anus, and presenting as either hematochezia (bright red blood or red wine color stools) or malena, blood streaking of the stool.…”