Lower gastrointestinal bleeding causes: Difference between revisions
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==Overview== | ==Overview== | ||
Common causes of lower gastrointestinaltract bleeding include diverticulosis, angiodysplasia, ischemic colitis, colorectal cancer, anorectal diseases, infectious colitis and inflammatory bowel disease. Less common cuases of lower gastrointestinaltract include colonic polyps, radiation proctitis, and rectal varices. | |||
==Causes== | ==Causes== | ||
===Common causes=== | ===Common causes=== | ||
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Less common causes of lower gastrointestinal bleeding include: | Less common causes of lower gastrointestinal bleeding include: | ||
* Colonic polyps | * Colonic polyps | ||
* Radiation proctitis | * Radiation proctitis | ||
* Rectal varices | * Rectal varices | ||
* Stercoral ulceration | * Stercoral ulceration | ||
* Meckel diverticulum | * Meckel diverticulum | ||
* Intussusception | * Intussusception | ||
* Henoch-Schönlein purpura (HSP) | * Henoch-Schönlein purpura (HSP) | ||
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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 gastrointestinaltract bleeding include diverticulosis, angiodysplasia, ischemic colitis, colorectal cancer, anorectal diseases, infectious colitis and inflammatory bowel disease. Less common cuases of lower gastrointestinaltract 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]
- Colonic diverticulosis
- Colonic diverticulosis is the most common cause of acute LGIB, accounting for 15% to 55% of all LGIB.
- 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.
- Diverticulosis is 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.
- Vascular ectasias (angiodysplasias/angioectasias):
- Tortuous dilated submucosal vessels that account for approximately 10% of LGIB.
- The prevalence of angiodysplasia is higher in older populations.
- 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.
- 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
- Colorectal malignancy:
- Colorectal cancer accounts for approximately 10% of bleeds, either as occult bleeding presenting with anemia or as frank blood loss per rectum
- 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
- 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.
- Infectious colitis:
- The most common organisms in the U.S. are species of Salmonella, Campylobacter, Shigella, and Yersinia.
Less common causes
Less common causes of lower gastrointestinal bleeding include:
- Colonic polyps
- Radiation proctitis
- Rectal varices
- Stercoral ulceration
- Meckel diverticulum
- Intussusception
- Henoch-Schönlein purpura (HSP)
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ Hillemeier C, Gryboski JD (1984). "Gastrointestinal bleeding in the pediatric patient". Yale J Biol Med. 57 (2): 135–47. PMC 2589822. PMID 6382833.
- ↑ 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.
- ↑ 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.
- ↑ "Hematemesis, Melena, and Hematochezia - Clinical Methods - NCBI Bookshelf".
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.