Lower gastrointestinal bleeding natural history, complications and prognosis

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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

If left untreated lower gastrointestinal bleeding is usually self-limited (90% of the time bleeding stops on its own). Massive blood loss can result in a severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death. Hypovolemic shock and symptomatic anemia are the most common direct complications of LGIB. Prognosis is generally good, and the 1-year mortality rate of patients with lower gastrointestinal bleeding is less than 3%.

Natural History, Complications, and Prognosis

Natural History

If left untreated lower gastrointestinal bleeding is usually self-limited (90% of the time bleeding stops on its own). Massive blood loss can result in a severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death. Chronic blood loss if left untreated results in anemia.

Complications

Common complications of LGIB include:

• Hypovolemic shock and symptomatic anemia are the most common direct complications of LGIB.
• Rebleeding following treatment is not uncommon
• All treatment modalities have potential adverse affects:
  • Endoscopy carries a risk of bowel perforation
  • Angiography and superselective embolization can result in bowel ischemia
  • Surgery is associated with the highest complication rates and should only be considered in patients who have ongoing bleeding that cannot be controlled by other methods

Prognosis

• Prognosis is generally good, and the 1 year mortality rate of patients with lower gastrointestinal bleeding is approximately <3%.
• With definitive intervention to treat or remove the source of blood loss, rebleeding rates are low.
• Without definitive treatment, rebleeding rates can be appreciable, as high as 38%.