Chronic Lower Gastrointestinal Bleeding: Etiological Profile and Role of Colonoscopy among Children from sub‑Himalayan Ranges of North India

Background: Most patients with chronic lower gastrointestinal (GI) bleeding warrant endoscopic examination of the lower GI tract. This study was done to determine the etiological profile of chronic lower GI bleeding and the role of colonoscopy in its diagnosis, as well as the prognosis among children from sub‑Himalayan ranges of North India. Methods: In this study, we did a retrospective review of the clinical notes of children between 2 and 15 years of age who presented with chronic lower GI bleeding and underwent diagnostic and therapeutic colonoscopy in the Department of Gastroenterology, Indira Gandhi Medical College and Hospital, Shimla, from January 2012 to October 2017. Patient demographics, clinical features, and endoscopic and histopathological findings were recorded. Results: Of the total 57 patients reviewed, 22 (38.59%) were female and 35 (61.40%) were male, with a male‑to‑female ratio of 1.62:1.0. The highest incidence of lower GI bleeding was between the ages of 6 and 10 years (43.85%). The presenting symptoms were hematochezia in 50 (87.71%), bloody diarrhea in 5 (8.77%), and positive stool occult blood test in 2 (3.50%) patients. The most common accompanying symptom was constipation in 16 (28.07%), abdominal pain in 14 (24.56%), fever in 5 (8.77%), and weight loss in 5 (8.77%) patients. The most common colonoscopy finding was rectosigmoid polyps (36 cases, 63.15%) followed by internal hemorrhoids (9 cases, 15.78%), rectal ulcers (5 cases, 8.77%), findings suggestive of colitis of left colon (5 cases, 8.77%), and findings suggestive of ileocecal tuberculosis (2 cases, 3.50%). The most common histopathological finding was juvenile colorectal polyps (35 cases, 61.40%) followed by solitary rectal ulcer (5 cases, 8.77%), ulcerative colitis (5 cases, 8.77%), tuberculosis (2 cases, 3.50%), and Peutz–Jegher polyp (1 case, 1.75%). Conclusion: Juvenile colorectal polyps constitute the most common cause of chronic lower GI bleeding in children from sub‑Himalayan ranges of North India followed by hemorrhoids, solitary rectal ulcer, inflammatory bowel disease, and ileocolonic tuberculosis. Colonoscopy remains a useful and safe procedure in children for evaluation of lower GI bleeding both from the diagnostic and therapeutic points of view.

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Solitary Rectal Ulcer Syndrome with a Visible Vessel: An Uncommon Cause of Lower GI Bleeding

The American Journal of Gastroenterology ◽

10.14309/00000434-201610001-01577 ◽

2016 ◽

Vol 111 ◽

pp. S735

Author(s):

John Vizuete ◽

Allan Parker

Keyword(s):

Rectal Ulcer ◽

Gi Bleeding ◽

Solitary Rectal Ulcer ◽

Solitary Rectal Ulcer Syndrome ◽

Visible Vessel ◽

Lower Gi Bleeding

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LOWER GASRTOINTESTINAL BLEEDING

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.08.1158 ◽

2015 ◽

Vol 22 (08) ◽

pp. 1064-1070

Author(s):

Zahra Nazish ◽

Muhammad Inayatullah ◽

Muhammad Younus Khan

Keyword(s):

Ulcerative Colitis ◽

Rectal Prolapse ◽

Rectal Ulcer ◽

Gi Bleeding ◽

Polyposis Coli ◽

Multiple Polyposis ◽

Solitary Rectal Ulcer ◽

Lower Gi Bleeding ◽

History Of ◽

Gastroenterology Unit

Objectives: To determine the etiology of lower GI bleeding based oncolonoscopic findings Study design: Retrospective study. Place and Duration of study: Thisstudy was conducted at gastroenterology unit of Nishtar Hospital Multan from Feb 2013 toAugust 2014. Patients and methods: Two hundred and fifty four patients, ≥ 14 years old whopresented with history of lower GI bleeding to the gastroenterology unit of Nishtar HospitalMultan Results: Out of 254 patients, 59.05% were males and 40.95% were females. Mean ageof patients was 37.22±10.68 years. Most common findings were haemorrhoids (40.9% cases),ulcerative colitis(35.4%), no abnormality (8.2%), solitary rectal ulcer (7.5%), growth (7.1%),proctitis (3.5%), polyps(2%), rectal varix (1.2%), infective colitis (0.8%), uremic colopathy(0.8%), rectal prolapse (0.8%), multiple polyposis coli (0.8%), petechiae (0.8%), stricture (0.8%),diverticula(0.4%)and fissure (0.4%). Conclusion: Colonoscopy is the investigation of choice forpatients of lower gastrointestinal bleeding. More common colonoscopic findings in our studywere haemorrhoids, ulcerative colitis, solitary rectal ulcer, malignancy and proctitis. Polyps anddiverticula which are common in the west were uncommon in our patients. Rectal prolapse,petechiae, stricture, uremic colopathy and multiple polyposis coli were rare causes.

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Lower Gastrointestinal Bleeding

10.2310/tywc.5436 ◽

2020 ◽

Author(s):

Jennifer Nayor ◽

John R. Saltzman

Keyword(s):

Differential Diagnosis ◽

Ischemic Colitis ◽

Ileocecal Valve ◽

Radiation Proctitis ◽

Gi Bleeding ◽

Older Individuals ◽

Diverticular Bleeding ◽

Endoscopic Techniques ◽

Internal Hemorrhoids ◽

Lower Gi Bleeding

Of patients who present with major gastrointestinal (GI) bleeding, 20 to 30% will ultimately be diagnosed with bleeding originating from a lower GI source. Lower GI bleeding has traditionally been defined as bleeding originating from a source distal to the ligament of Treitz; however, with the advent of capsule endoscopy and deep enteroscopy allowing for visualization of the entire small bowel, the definition has been updated to GI bleeding originating from a source distal to the ileocecal valve. Lower GI bleeding can range from occult blood loss to massive bleeding with hemodynamic instability and predominantly affects older individuals, with a mean age at presentation of 63 to 77 years. Comorbid illness, which is a risk factor for mortality from GI bleeding, is also more common with increasing age. Most deaths related to GI bleeding are not due to uncontrolled hemorrhage but exacerbation of underlying comorbidities or nosocomial complications. This review covers the following areas: evaluation of lower GI bleeding (including physical examination and diagnostic tests), initial management, and differential diagnosis. Disorders addressed in the differential diagnosis include diverticulosis, arteriovenous malformations (AVMs), ischemic colitis, anorectal disorders, radiation proctitis, postpolypectomy bleeding, and colorectal neoplasms. Figures show an algorithm for management of patients with suspected lower GI bleeding, tagged red blood cell scans, diverticular bleeding, colonic AVM, ischemic colitis, bleeding hemorrhoid, chronic radiation proctitis, and ileocolonic valve polyp. Tables list descriptive terms for rectal bleeding and suggested location of bleeding, imaging modalities and differential diagnosis for lower GI bleeding, endoscopic techniques for hemostasis, and an internal hemorrhoids grading system. This review contains 9 figures, 8 tables, and 103 references.

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Rectal Ulcer: Can it be a Cause of Massive Lower GI Bleeding?

The American Journal of Gastroenterology ◽

10.14309/00000434-201210001-01221 ◽

2012 ◽

Vol 107 ◽

pp. S486

Author(s):

Hari Sayana ◽

Osama Yousef ◽

Rana Al-Zoubi ◽

Esmat Sadeddin

Keyword(s):

Rectal Ulcer ◽

Gi Bleeding ◽

Lower Gi Bleeding

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Solitary rectal ulcer syndrome—The role of autofluorescence colonoscopy

Photodiagnosis and Photodynamic Therapy ◽

10.1016/j.pdpdt.2007.03.002 ◽

2007 ◽

Vol 4 (3) ◽

pp. 179-183 ◽

Cited By ~ 6

Author(s):

Wojciech Latos ◽

Aleksandra Kawczyk-Krupka ◽

Aleksandra Ledwoń ◽

Karolina Sieroń-Stołtny ◽

Aleksander Sieroń

Keyword(s):

Rectal Ulcer ◽

Solitary Rectal Ulcer ◽

Solitary Rectal Ulcer Syndrome

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Use of Estrogen Therapy in a Patient with Gastrointestinal Bleeding Secondary to arteriovenous malformations

Annals of Pharmacotherapy ◽

10.1177/106002809703101107 ◽

1997 ◽

Vol 31 (11) ◽

pp. 1311-1314 ◽

Cited By ~ 3

Author(s):

Jolene F Siple ◽

Carol L Joseph ◽

Keith J Pagel ◽

Sharon Leigh

Keyword(s):

Arteriovenous Malformations ◽

Ethinyl Estradiol ◽

Estrogen Therapy ◽

Recurrent Bleeding ◽

Gi Bleeding ◽

Gi Tract ◽

Lower Gi Bleeding ◽

Pharmacologic Management ◽

Bleeding Episodes

OBJECTIVE: To describe a patient with gastrointestinal (GI) bleeding caused by arteriovenous malformations (AVMs) that was treated with estrogen therapy. CASE SUMMARY: A 70-year-old white man was diagnosed with multiple AVMs in the cecum, duodenum, and stomach. Pharmacologic management included the use of ferrous sulfate; however, the patient continued to have recurrent bleeding that required multiple transfusions and endoscopic cauterization. Therapy was initiated with ethinyl estradiol 0.05 mg po qd; no further transfusions have been required for 10 months. DISCUSSION: It is estimated that AVMs of the GI tract account for 1–8% of upper GI bleeding episodes and up to 6% of lower GI bleeding episodes. Hormonal agents have been reported to decrease bleeding in patients with both hereditary and acquired AVMs. CONCLUSIONS: The role of estrogen therapy in treating AVMs of the GI tract is unclear and supported by only one clinical study.

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Esophageal varices presenting as lower GI bleed in an infant: a rare presentation

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20202160 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1428

Author(s):

Anmol Choudaha ◽

Rajeev Kumar Banzal ◽

Gunjan Kela Mehrotra ◽

Nandini Sodha

Keyword(s):

Esophageal Varices ◽

Rectal Ulcer ◽

Gi Bleeding ◽

Rare Presentation ◽

Primary Care Settings ◽

Common Causes ◽

Lower Gi Bleeding ◽

Inflammatory Bowel ◽

Gi Bleed ◽

Lymphoid Nodular Hyperplasia

GI Bleeding is a common problem encountered in the emergency department and in the primary care settings. Lower GI Bleeding is relatively rare as compared to upper GI bleeding. Common causes of lower GI Bleeding are Polyp (32.5%), chronic nonspecific colitis (20.7%), lymphoid nodular hyperplasia (20%), Proctitis (18.2%), Solitary rectal ulcer (10%), Inflammatory bowel disease (6.5%).Among the various causes of lower GI Bleeding, esophageal varices is a rare cause. One such case presented to us with lower GI bleeding, on further evaluation was found to having esophageal varices due to portal hypertension. Child improved after conservative and definitive management.

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