Investigating Rectal Bleeding

Abstract

Purpose: Few studies are available that describe the pattern of lower GI pathology in the third world. It is generally believed that such pathology including IBD is uncommon. We conducted this study with the following objectives 1) To review the etiological patterns on diagnostic evaluation of patients presenting with rectal bleeding. 2) To study the association of rectal bleeding with age and gender Methods: We conducted a retrospective chart review of existing clinical data to compare patterns of GI pathology in patients presenting with rectal bleeding and subsequently undergoing flexible sigmoidoscopies and colonoscopies. Outcomes of interest included depth examined, nature of clinical findings and association of these with rectal bleeding. Furthermore, association of rectal bleeding with age and gender were also found. Results: A total of 261 patients, 131 (51%) males and 130 (49%) females, mean age 41 years (S.D 21, Range 4–93) were included in the study. 160/261 (61%) presented with rectal bleeding (82 males and 78 females) of which majority 83/261 (32%) were examined up to the hepatic flexure followed by 79/261 (30%) till the terminal ileum. A total of 27/160 (16%) had a single or multiple polyp, 47/160 (29%) had Inflammatory bowel disease (P-value 0.000), 17/160 had malignant lesions while 37/160 (23%) had hemorrhoids (P-value 0.003). Flexible sigmoidoscopy was performed on 61/261 patients and 46 (75%) of these had presented with rectal bleeding. It was found that 4/46 (0.1%) had a single or multiple polyps with significant association found between absence of rectal bleeding and presence of polyp (P-value = 0.03). IBD was diagnosed in 16/46 (35%) (P-value = 0.047) while 5/46 (0.1%) had malignancies. Of those (200/261) who underwent colonoscopic examination, 114/200 (57%) presented with rectal bleeding. Diagnosis of polyp was made on 23/114 (20%), IBD 31/114 (27%) (P-value < 0.001) while 13/114 (11%) were found to have malignant lesions. Conclusion: 1) Rectal bleeding seems to be presenting below 40 years of age in our patient population and has a strong association with IBD. 2) Hemorrhoids are significantly associated with bleeding per rectum. 3) Polyps seem to have an inverse statistical association with rectal bleeding in the patient population that underwent flexible sigmoidoscopy. 4) Malignancy does not seem to be significantly associated with bleeding per rectum in our set-up.Table: Association of Rectal Bleeding with Major Diagnoses