A Prospective Study of Acute Lower Gastrointestinal Bleeding

Abstract

Background: While the etiology of acute lower gastrointestinal bleeding is obscure in few cases, in most cases it is possible to identify the cause and the source of bleeding. We performed a prospective study of lower gastrointestinal bleeding at a tertiary referral University Centre in Greece. Patients - Methods: From January 2002 to June 2003, we collected all patients who were referred to the Outpatient Gastroenterology Unit or admitted to the Internal Medicine Department due to acute lower gastrointestinal bleeding with obvious blood loss. Patients presented with fresh red blood loss in the stool, changed blood in the stool (dark or melena), hematochezia or bloody diarrhea. All patients underwent hemoccult test for confirmation of blood loss (in case of changed blood). In case of melena, all patients underwent an upper endoscopy to exclude a bleeding source in the upper gastrointestinal tract. If a bleeding site was found in the upper gastrointestinal tract the patients were excluded from the study. All patients of the study underwent colonoscopy within 24-48 hours after the presentation of bleeding. The findings of the endoscopic examination were recorded, biopsies were taken as appropriate and we followed up the patients until a final diagnosis was made and appropriate treatment was recommended or applied. Results: During the study time, we identified 268 (132 males, median age 65 years, age range 3-97 years) patients with obvious acute lower gastrointestinal bleeding according to the predefined criteria. Colonoscopic examination identified a potential source of bleeding in all but three patients (265/268, 99%). Some patients had more than one potential bleeding sources. Active bleeding during the procedure was seen in 84 out of 268 patients (31%). The potential sources of bleeding were hemorrhoids in 44.0% (118/268), diverticulosis in 14.9% (40/268), angiodysplasias in 1.9% (5/268), adenocarcinoma in 10.8% (29/268), polypoid lesions in 21.2% (47/268), inflammatory bowel disease in 9.3% (25/268), ischemic colitis in 3.0% (8/268) and infectious colitis in 1.5% (4/268) of patients. Patients with polyps were treated with polypectomy during or after the procedure and patients with adenocarcinoma were referred for surgery. Patients with hemorrhoids were treated with band ligation or hemorrhoidectomy. Conclusions: The most frequent cause of lower gastrointestinal bleeding was hemorroids in all age groups. While diverticulosis is a significant cause of acute lower gastrointestinal bleeding, it seems that tumors and polyps might have a more significant role as a cause of acute lower gastrointestinal bleeding than previously described.