Lower gastrointestinal bleeding: a review

Abstract

Lower gastrointestinal bleeding (LGIB) continues to be a problem for physicians. Acute LGIB is defined as bleeding that emanates from a source distal to the ligament of Treitz. Although 80% of all LGIB will stop spontaneously, the identification of the bleeding source remains challenging and rebleeding can occur in 25% of cases. Some patients with severe hematochezia require urgent attention to minimize further bleeding and complications. This article reviews the causes, diagnostic methods, and endoscopic treatment of LGIB.

Etiological profile, gender difference and age group patterns of 415 patients presenting with lower gastrointestinal bleeding in the western region of Nepal

“…1,2 Its spectrum of severity ranges from mild per rectal bleeding to life-threatening, massive hemorrhage. There has been a lot of studies about the epidemiology and time trends of upper GI bleeding, but the data about the incidence of LGIB is limited.…”

Surgical Treatment Concepts for Acute Lower Gastrointestinal Bleeding

“…Furthermore, there are different views and procedures in the various centers, sometimes even differences within the same hospital depending on the resources and preferences of the attending physician. For example, some authors recommend an initial colonoscopy in cases of severe hematochezia, 8,11,16 while others favor an early workup of the more easily accessible upper gastrointestinal tract by gastroduodenoscopy to exclude life-threatening bleeding from esophageal varices. 5,6,17 The diagnostic path established and standardized in our institute is shown in Fig.…”

“…10 Melena, in contrast, is defined as the passage of black stool resulting from oxygenation of hematin. 11 Elevated blood loss within a short time and failure of the organism to adapt makes acute bleeding often more fulminant and life-threatening than chronic bleeding. The identification of the source of bleeding still remains a challenging task today even where acute bleeding is concerned, in spite of the frequently intense passage of blood per rectum.…”

The diagnosis and treatment of lower gastrointestinal bleeding from the surgeon’s view

“…It is estimated that in Western societies their presence increases from 30% at the age of 50 to over 65% at the age of 85. Bleeding, which ranges from minor to severe, occurs in 10-25% of individuals with diverticulosis [3,6,9]. In the majority of patients (76%), bleeding stops spontaneously without any therapeutic intervention.…”

“…Diverticulosis, hemorrhoids, cancer, angiodysplasia, colonic polyps, ischemic colitis and inflammatory disease are among the commonest causes of LGIB [3,6,8].…”