Lower gastrointestinal bleeding causes
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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
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.