Lower gastrointestinal bleeding causes: Difference between revisions

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==Overview==
==Overview==
Common causes of lower gastrointestinal tract bleeding include [[diverticulosis]], [[angiodysplasia]], [[ischemic colitis,]] [[colorectal cancer]], [[anorectal]] diseases, [[infectious colitis]] and [[inflammatory bowel disease]]. Less common causes of lower [[gastrointestinal tract]] include [[Colon polyps|colonic polyps]], [[radiation proctitis]], and [[rectal varices]].
==Causes==
==Causes==
===Common causes===
===Common causes===
*Colonic diverticulosis
Common causes of lower [[gastrointestinal]] bleeding inclue:<ref name="pmid21160643">{{cite journal |vauthors=Bresci G |title=Occult and obscure gastrointestinal bleeding: Causes and diagnostic approach in 2009 |journal=World J Gastrointest Endosc |volume=1 |issue=1 |pages=3–6 |year=2009 |pmid=21160643 |pmc=2999069 |doi=10.4253/wjge.v1.i1.3 |url=}}</ref><ref name="pmid23737154">{{cite journal |vauthors=Ghassemi KA, Jensen DM |title=Lower GI bleeding: epidemiology and management |journal=Curr Gastroenterol Rep |volume=15 |issue=7 |pages=333 |year=2013 |pmid=23737154 |pmc=3857214 |doi=10.1007/s11894-013-0333-5 |url=}}</ref><ref name="pmid6382833">{{cite journal |vauthors=Hillemeier C, Gryboski JD |title=Gastrointestinal bleeding in the pediatric patient |journal=Yale J Biol Med |volume=57 |issue=2 |pages=135–47 |year=1984 |pmid=6382833 |pmc=2589822 |doi= |url=}}</ref><ref name="pmid3872107">{{cite journal |vauthors=Clouse RE, Costigan DJ, Mills BA, Zuckerman GR |title=Angiodysplasia as a cause of upper gastrointestinal bleeding |journal=Arch. Intern. Med. |volume=145 |issue=3 |pages=458–61 |year=1985 |pmid=3872107 |doi= |url=}}</ref><ref name="pmid20351759">{{cite journal |vauthors=Rockey DC |title=Occult and obscure gastrointestinal bleeding: causes and clinical management |journal=Nat Rev Gastroenterol Hepatol |volume=7 |issue=5 |pages=265–79 |year=2010 |pmid=20351759 |doi=10.1038/nrgastro.2010.42 |url=}}</ref><ref name="urlHematemesis, Melena, and Hematochezia - Clinical Methods - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK411/ |title=Hematemesis, Melena, and Hematochezia - Clinical Methods - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid23997409">{{cite journal |vauthors=Navuluri R, Kang L, Patel J, Van Ha T |title=Acute lower gastrointestinal bleeding |journal=Semin Intervent Radiol |volume=29 |issue=3 |pages=178–86 |year=2012 |pmid=23997409 |pmc=3577586 |doi=10.1055/s-0032-1326926 |url=}}</ref><ref name="pmid24267497">{{cite journal |vauthors=Feinman M, Haut ER |title=Lower gastrointestinal bleeding |journal=Surg. Clin. North Am. |volume=94 |issue=1 |pages=55–63 |year=2014 |pmid=24267497 |doi=10.1016/j.suc.2013.10.005 |url=}}</ref><ref name="pmid18346680">{{cite journal |vauthors=Zuccaro G |title=Epidemiology of lower gastrointestinal bleeding |journal=Best Pract Res Clin Gastroenterol |volume=22 |issue=2 |pages=225–32 |year=2008 |pmid=18346680 |doi=10.1016/j.bpg.2007.10.009 |url=}}</ref><ref name="pmid23737154">{{cite journal |vauthors=Ghassemi KA, Jensen DM |title=Lower GI bleeding: epidemiology and management |journal=Curr Gastroenterol Rep |volume=15 |issue=7 |pages=333 |year=2013 |pmid=23737154 |pmc=3857214 |doi=10.1007/s11894-013-0333-5 |url=}}</ref><ref name="pmid24829660">{{cite journal |vauthors=Zahmatkeshan M, Fallahzadeh E, Najib K, Geramizadeh B, Haghighat M, Imanieh MH |title=Etiology of lower gastrointestinal bleeding in children:a single center experience from southern iran |journal=Middle East J Dig Dis |volume=4 |issue=4 |pages=216–23 |year=2012 |pmid=24829660 |pmc=3990129 |doi= |url=}}</ref>
**Colonic diverticulosisis the most common cause of acute LGIB in the western world, accounting for 15% to 55% of all LGIB
*[[Diverticulosis|Colonic diverticulosis]]
**Diverticula can occur anywhere in the gastrointestinal tract, but are most common in the sigmoid colon. However, approximately 60% of diverticular bleeds arise from diverticula in the right colon, highlighting a tendency for right-sided diverticula to bleed
* [[Vascular ectasia of the colon|Vascular ectasias]] ([[Angiodysplasia|angiodysplasias]]/[[Angioectasia|angioectasias]])
**Hemorrhage results from rupture of the intramural branches (vasa recta) of the marginal artery at the dome of a diverticulum and can give rise to a massive, life-threatening LGIB
* [[Iatrogenic]]
**This is by far the most common cause of bleeding in the elderly, as the prevalence of diverticular disease increases with age, being as high as 85% by the age of 85 years
* [[Ischemic colitis]]
* [[Colorectal cancer|Colorectal malignancy]]
* [[Anorectal]] abnormalities
* [[Inflammatory bowel disease]] (IBD)
* [[Infectious colitis]]


* Obesity has recently been recognized as a risk factor in the development of diverticular disease, and the risk of diverticular bleeding in this group of patients is higher than that in patients who are not obese
* Vascular ectasias (angiodysplasias/angioectasias):
** Tortuous dilated submucosal vessels that account for approximately 10% of LGIB.
** They appear endoscopically as small, flat lesions (5-10 mm) with ectatic capillaries radiating from a central vessel (Fig. 1)
** The prevalence of angiodysplasia in the gastrointestinal tract is not well known, but a pooled analysis of three colonoscopic cancer screening studies detected angiodysplasia in 0.8% of the patients The prevalence of angiodysplasia is higher in older populations and, in the past, has been linked to certain conditions such as end-stage renal disease, Von Willebrand disease , and aortic stenosis In one series, 37% of colonic dysplasias were found in the cecum, 17% in the ascending colon, 7% in the transverse colon, 7% in the descending colon, and 32% in rectosigmoid area
** Angiodysplasia can also be found throughout the small bowel and is responsible for up to 40% of small intestinal bleeding in patients older than 40 years.
** Angiodysplasia of the stomach and duodenum is responsible for up to 7% of UGIB I
* Iatrogenic:
** Bleeding is recognized as the most common complication of colonoscopy and polypectomy, occurring in 0.3% to 6.1% of polypectomies
** Risk factors for bleeding include polyp size greater than 1 cm, patient age older than 65 years, presence of comorbid disease, and polypectomy using the cutting mode of current
** The risk is also greater in patients taking anticoagulant or antiplatelet agents
* Ischemic colitis:
** Ischemic colitis accounts for approximately 20% of LGIB
** Ischemia results from a sudden reduction in blood flow to the mesenteric vessels as a result of hypotension, occlusion, or spasm of the mesenteric vessels
** Nonocclusive disease typically affects the watershed areas of the bowels, such as the splenic flexure and adjacent transverse colon due to the poor blood supply from the marginal artery.
** Occlusive disease is rarer but can occur as a result of thrombus formation or embolus.
** It is a recognized complication of aortic surgery
** Elderly patients with comorbid disease are at higher risk of developing ischemic colitis.
** There may be a history of ischemic heart disease
** The majority of patients with ischemic colitis improve following conservative management; however, approximately 20% will progress to develop colonic gangrene
** Other complications include chronic colitis and stricture formation
** Diagnosis requires a high index of suspicion
* Colorectal malignancy:
** Colorectal cancer accounts for approximately 10% of bleeds, either as occult bleeding presenting with anemia or as frank blood loss per rectum
** A family history of colorectal cancer is important to establish
* Anorectal abnormalities:
** Hemorrhoids, fissures, fistulae, and polyps can all present with bright red rectal bleeding, which may be intermittent in nature
** Hemorrhoids are the most common cause of rectal bleeding in adults younger than 50 years
** The finding of hemorrhoids in older patients with LGIB should not preclude further investigation, as hemorrhoids are an extremely common finding and may not be the cause of bleeding
* Inflammatory bowel disease (IBD):
** IBD refers to both Crohn disease and ulcerative colitis Accounts for 5% to 10% of bleeds.
** It is by far the most common cause of LGIB in Asian populations in whom the prevalence of diverticular disease is much lower
** A previous history of IBD in patients with LGIB is important, as these patients have a higher risk of developing colorectal malignancy than do the general population
* Infectious colitis:
** The most common organisms in the U.S. are species ofSalmonella,Campylobacter,Shigella, andYersinia
===Less common causes===
===Less common causes===
* Colonic polyps:
Less common causes of lower gastrointestinal bleeding include:
** These can occur in isolation or as part of an inherited polyposis syndrome
* [[Colon polyps|Colonic polyps]]
** Can cause occult or overt LGIB
* [[Radiation proctitis]]
 
* [[Rectal varices]]
* Radiation proctitis:
* [[Meckel's diverticulum|Meckel diverticulum]]
** This usually occurs a few months following ionizing radiation for pelvic malignancies (Fig. 2). In one study of patients with radiation proctitis following pelvic irradiation, 69% presented with bleeding within 1 year and 96% within 2 years
* [[Intussusception]]
 
* [[Henoch-Schönlein purpura]] (HSP)
* Rectal varices:
** Associated with portal hypertension; may result in massive bleeding
** Stercoral ulceration:
** Can cause significant fresh rectal bleeding in elderly constipated patients
 
* Meckel diverticulum:
** These small bowel diverticula may contain ectopic gastric mucosa that can ulcerate and cause bleeding
** They are the most common cause of massive LGIB in young children, and can be diagnosed with angiography, Meckel scans, and radionuclide imaging
 
* Intussusception :
** More common in children, with the highest incidence between the ages of 6 months and 2 years
* Henoch-Schönlein purpura (HSP):
** Most commonly affects children
** Bleeding may be a direct result of vasculitis or secondary to intussusception, which is associated with HSP
* Aortoenteric fistula:
 
* Abdominal aortic aneurysms, especially those of the inflammatory type, may fistulate into the small bowel, giving rise to a massive, life-threatening hemorrhage
 
* Peutz-Jeghers syndrome:
** Polyps may give rise to frank or occult bleeding
* Klippel-Trenaunay-Weber syndrome:
** Hemangiomas in the colon can cause significant bleeding
 
* Hereditary hemorrhagic telangiectasia:
** Blood loss from mucosal telangiectasia can be chronic or acute
* Neurofibromatosis :
** Neurofibromas within the lumen of the bowel can ulcerate, causing bleeding
* Blue rubber bleb syndrome:
** Bleeding can arise from hemangiomas in the bowel Usually occult in nature


==References==
==References==

Latest revision as of 22:52, 28 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Common causes of lower gastrointestinal tract bleeding include diverticulosis, angiodysplasia, ischemic colitis, colorectal cancer, anorectal diseases, infectious colitis and inflammatory bowel disease. Less common causes of lower gastrointestinal tract include colonic polyps, radiation proctitis, and rectal varices.

Causes

Common causes

Common causes of lower gastrointestinal bleeding inclue:[1][2][3][4][5][6][7][8][9][2][10]

Less common causes

Less common causes of lower gastrointestinal bleeding include:

References

  1. ↑ Bresci G (2009). "Occult and obscure gastrointestinal bleeding: Causes and diagnostic approach in 2009". World J Gastrointest Endosc. 1 (1): 3–6. doi:10.4253/wjge.v1.i1.3. PMC 2999069. PMID 21160643.
  2. ↑ 2.0 2.1 Ghassemi KA, Jensen DM (2013). "Lower GI bleeding: epidemiology and management". Curr Gastroenterol Rep. 15 (7): 333. doi:10.1007/s11894-013-0333-5. PMC 3857214. PMID 23737154.
  3. ↑ Hillemeier C, Gryboski JD (1984). "Gastrointestinal bleeding in the pediatric patient". Yale J Biol Med. 57 (2): 135–47. PMC 2589822. PMID 6382833.
  4. ↑ Clouse RE, Costigan DJ, Mills BA, Zuckerman GR (1985). "Angiodysplasia as a cause of upper gastrointestinal bleeding". Arch. Intern. Med. 145 (3): 458–61. PMID 3872107.
  5. ↑ Rockey DC (2010). "Occult and obscure gastrointestinal bleeding: causes and clinical management". Nat Rev Gastroenterol Hepatol. 7 (5): 265–79. doi:10.1038/nrgastro.2010.42. PMID 20351759.
  6. ↑ "Hematemesis, Melena, and Hematochezia - Clinical Methods - NCBI Bookshelf".
  7. ↑ Navuluri R, Kang L, Patel J, Van Ha T (2012). "Acute lower gastrointestinal bleeding". Semin Intervent Radiol. 29 (3): 178–86. doi:10.1055/s-0032-1326926. PMC 3577586. PMID 23997409.
  8. ↑ Feinman M, Haut ER (2014). "Lower gastrointestinal bleeding". Surg. Clin. North Am. 94 (1): 55–63. doi:10.1016/j.suc.2013.10.005. PMID 24267497.
  9. ↑ Zuccaro G (2008). "Epidemiology of lower gastrointestinal bleeding". Best Pract Res Clin Gastroenterol. 22 (2): 225–32. doi:10.1016/j.bpg.2007.10.009. PMID 18346680.
  10. ↑ Zahmatkeshan M, Fallahzadeh E, Najib K, Geramizadeh B, Haghighat M, Imanieh MH (2012). "Etiology of lower gastrointestinal bleeding in children:a single center experience from southern iran". Middle East J Dig Dis. 4 (4): 216–23. PMC 3990129. PMID 24829660.

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