Causes and Management of Lower Gastro-Intestinal Bleeding

Gastrointestinal (GI) bleeding from the colon is a communal reason for hospitalization and is being more frequent in older patients. Gastrointestinal bleeding is known as any bleeding that takes place in the GIT from mouth to anus. Lower GI bleeding is defined as bleeding distal to the ligament of Treitz. Lower GI bleed is typically presented as hematochezia which is the passing of bright red blood clots or burgundy stools through the rectum. The causes of lower GI bleeding are changing over the past several decades from diverticulosis (which is the protrusion of the colon wall at the site of penetrating vessels), infectious colitis, ischemic colitis, angiodysplasia, inflammatory bowel disease, colon cancer, hemorrhoids, anal fissures, rectal varices, dieulafoy lesion, radiation-induced damage following cancer treatment to post-surgical. Management of lower GI bleeding is done through assessing the severity of symptoms and the condition of the overall case.

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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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Special Considerations in the GI Bleeding Patient

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0039-1695036 ◽

2019 ◽

Vol 33 (01) ◽

pp. 035-041

Author(s):

Haniee Chung ◽

Matthew G. Mutch

Keyword(s):

Anticoagulation Therapy ◽

Bleeding Risk ◽

The Elderly ◽

Lower Gastrointestinal Bleeding ◽

Intestinal Bleeding ◽

Gi Bleeding ◽

Comorbid Conditions ◽

Rectal Varices ◽

Bleeding Patient ◽

Radiation Induced

AbstractLower gastrointestinal bleeding (LGIB) is an increasingly common problem in patients with comorbid medical conditions that place them at higher bleeding risk. This discussion of some special considerations in the GI bleeding patient encompasses an overview of the elderly patient, and selects comorbid conditions that place patients at higher risk of developing intestinal bleeding. The discussion lends itself to exploring the challenges of and new advancements in anticoagulation therapy. Radiation induced proctitis and rectal varices as sources of LGIB will also be addressed.

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ETIOLOGICAL PROFILE OF LOWER GASTROINTESTINAL BLEED IN A TERTIARY CARE HOSPITAL IN NORTHERN INDIA

10.36106/ijar/6301547 ◽

2019 ◽

pp. 1-2

Author(s):

Bansal Arpit

Keyword(s):

Dietary Habits ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Smoking History ◽

Care Hospital ◽

Gi Bleeding ◽

Study Results ◽

Lower Gi Bleeding ◽

History Of ◽

Gi Bleed

NTRODUCTION - Lower Gastrointestinal(GI) bleeding refers to blood loss of recent onset originating from a site distal to the ligament of Treitz.1It usually presents as hematochezia i.e. passage of maroon or bright red blood or blood clots per rectum. Lower GI bleeding ( LGIB) accounts for almost 20% of all cases of acute GI bleeding.2 The etiology and the epidemiology of LGIB varies according to the environmental conditions depending upon the life style, dietary habits, the prevalence of smoking, history of drug intake, age and longevity of the population etc.2 Most of the studies pertaining to the etiologies of Lower GI bleeding are from the West. Data relating to the incidence and etiologies of Lower GI bleed in India is scarce hence this study was undertaken to identify the etiological profile of patients presenting with Lower GI bleeding in a tertiary care hospital in the northern part of India. MATERIALS AND METHODS - It is a Cross-sectional study done over a period of 1 year from January, 2018 to December, 2018. All the patients above 18 years of age with first presentation of Lower GI bleeding to the Department of Medicine, SRMS- IMS, Bareilly, Uttar Pradesh during the period of study are included in the study. RESULTS - A total of 232 patients meeting the inclusion criteria were included in the study. Majority of the patients were males (69.8%). Hematochezia (86%) was the most common presenting feature and was commonly associated with constipation (46%), abdominal pain (32%) and loss of weight (11%). 8% of the patients had a history of Diabetes. Alcohol consumption was seen in 17% of the patients while 26% of the patients had a history of smoking. The most common etiology of Lower GI bleed seen was Hemorrhoids (35.3%), followed by Inflammatory Bowel disease(16.3%), Malignancy(12%) and Radiation proctosigmoiditis (11.2%). CONCLUSION - LGIB is a common and alarming presenting condition in the practice of gastroenterology. It was found that Lower GI bleed is more common in males, usually in the 3rd to 4th decade of life and most commonly presents with hematochezia. Haemorrhoids, IBD and Malignancy were the major causes of Lower GI bleed.

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Yield of colonoscopy with special reference to lower gastrointestinal bleeding in a tertiary referral center in Eastern India

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.165700 ◽

2015 ◽

Vol 6 (03) ◽

pp. 110-114

Author(s):

Gautam Ray

Keyword(s):

Clinical Symptoms ◽

Deficiency Anemia ◽

Gi Bleeding ◽

Tertiary Referral Center ◽

Upper Gi ◽

Predominant Symptom ◽

Comparison Results ◽

Lower Gi Bleeding ◽

Upper Gi Endoscopy ◽

Gi Bleed

Abstract Background: Little data exist on the yield of colonoscopy in its different indications, especially gastrointestinal (GI) bleeding. Furthermore, there are no formal guidelines regarding the timing of its performance in the work up for lower GI bleeding. Methods: In a retrospective study, spanning from January 2007 to December 2013, the clinical data of all the patients undergoing colonoscopy were retrieved from the hospital records including the predominant symptom which mandated colonoscopy and results of the other tests done before colonoscopy including upper GI endoscopy (esophagogastroduodenoscopy [EGD]). The type of GI bleed (overt or occult) along with the presence or absence of iron deficiency anemia (IDA) was noted. The yield of EGD in the corresponding years in those having a presentation with lower GI bleed and/or IDA was also noted for comparison. Results: Overall yield of colonoscopy was low (25.7%) like for all its indications except lower GI bleed where its yield was highest (45.2%). 81.2% of the cases with a diagnosis presented with lower GI bleed, highest for colon cancer (90%), and polyps (86.1%). Cases of occult bleed more often had a positive diagnosis than overt bleed (P = 0.02). EGD yielded positive findings in more cases (43.2%, P = 0.00) than colonoscopy (except piles). Colonic cancers and polyps were presented with hematochezia when compared to gastric cancer which presented more often with occult bleed and other clinical symptoms. Conclusion: EGD should be done first in lower GI bleeding to exclude upper GI source and select subsequent colonoscopy. For hematochezia and occult bleed, colonoscopy is important whether IDA is present or not.

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Successful Control of Massive Gastrointestinal Bleeding Following Umbilical Cord Blood Transplantation (UCBT) by Use of Recombinant Activated Factor VII (rFVIIa) and Octreotide Infusion

Blood ◽

10.1182/blood.v112.11.4336.4336 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4336-4336

Author(s):

Satya Prakash Yadav ◽

Anupam Sachdeva ◽

Madasu Anjan ◽

Nita Radhakrishnan ◽

Sunil Bhat ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Factor Viia ◽

Fresh Frozen Plasma ◽

Gi Bleeding ◽

Blood Products ◽

Fresh Frozen ◽

Life Threatening ◽

Lower Gi Bleeding ◽

Gi Bleed ◽

Frozen Plasma

Abstract Post stem cell transplantation (SCT) bleeding is a dreaded complication especially gastrointestinal (GI). Platelet refractoriness is another but rare cause of bleeding post SCT. Use of rFVIIa for bleeding in setting of SCT was tested by Pihusch et al in 100 patients. Despite no overall effect of rFVIIa treatment on primary endpoint, post hoc analysis showed an improvement in the control of bleeding for 80 ug kg rFVIIa vs. standard haemostatic treatment. There were 38 patients with GI bleeding but none with massive bleeding. There are only 8 other case reports of use of rFVIIa for massive lower GI bleeding post allogeneic SCT with only one patient showing partial response and none of the patients surviving. The role of octreotide is less clear in gastrointestinal bleeding unrelated to portal hypertension. Y. Eroglu reported that, the response rate of gastrointestinal bleeding to octreotide in patients without portal hypertension was 50%. We present a 10 month-old female child, who had three episodes of life threatening lower GI bleeding post unrelated UCBT controlled successfully each time by use of rFVIIa and octerotide infusion. Patient underwent an unrelated UCBT for Thalassemia Major with a 4/6 matched cord unit and was conditioned with Busulfan 14 mg/kg, Cyclophosphamide120 mg/kg and Anti- Thymocyte Globulin. Cyclosporine and Methotrexate was given for Graft vs. host Disease prophylaxis. Cell dose infused was 7 × 107 nucleated cell/kg. She failed to engraft and also developed refractory thrombocytopenia. On Day + 48 post UCBT she developed massive lower GI bleed (passing big clots per rectum) with hypotension. Her platelets were 8,000/mm3, Hb of 4.5 gm/dl. Her coagulation parameters were normal. She was given packed cells, platelets (random donor and apheresis), Fresh Frozen Plasma (FFP) and tranexamic acid (250 mg IV 8 hrly). She was also started on injection octreotide infusion (1μg/kg bolus followed by 1μg/kg/hr infusion). Patient continued to have life threatening lower GI bleed (bleeding score-4) with no rise in platelets so a decision was made to administer rFVIIa (once she was repleted with packed cells, platelets and fresh frozen plasma) using the bolus dose of 90 μg/kg IV 3 doses 2 hrly. Autologous marrow was infused with CD34 cell dose 7 million/kg in view of non-engraftment. The bleeding subsided completely (within 6 hrs) after three doses of rFVIIa and the blood pressure normalized. Octreotide infusion was stopped after 12 hrs of bleeding free interval. After a 24 hr bleeding free period on Day +50 post UCBT, patient again bled with hypotension and again required factor VIIa (two doses) along with blood products and octreotide infusion and again showed excellent response. Again on Day+59 post UCBT she had another episode of massive lower GI bleed with hypotension and again required activated factor VIIa (two doses only) along with blood products and octreotide infusion) and bleeding stopped in next 8 hr. There was no further episode of lower GI bleed. No adverse effects due to rFVIIa were observed. She was discharged after 2 weeks with recovery of neutrophills and platelets and continues to be well Day +100 post transplant. Following this case we suggest that rVIIa with octerotide be considered as a mode of additional therapy for life-threatening GI bleeding in the face of severe thrombocytopenia and platelet refractoriness, where platelet transfusions and other haemostatic agents have failed.

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SSRIs May Be Tied to Upper, Lower GI Bleeding

Ob Gyn News ◽

10.1016/s0029-7437(05)70704-7 ◽

2005 ◽

Vol 40 (14) ◽

pp. 25

Author(s):

TIMOTHY F. KIRN

Keyword(s):

Gi Bleeding ◽

Lower Gi Bleeding

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Burden of major gastrointestinal bleeding among oral anticoagulant-treated non-valvular atrial fibrillation patients

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284821997352 ◽

2021 ◽

Vol 14 ◽

pp. 175628482199735

Author(s):

Steven Deitelzweig ◽

Allison Keshishian ◽

Amiee Kang ◽

Amol D. Dhamane ◽

Xuemei Luo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Major Bleeding ◽

Oral Anticoagulant ◽

Proportional Hazards ◽

Bleeding Event ◽

Cox Proportional Hazards ◽

High Rate ◽

Gi Bleeding ◽

Increased Risk ◽

Gi Bleed

Background: Gastrointestinal (GI) bleeding is the most common type of major bleeding associated with oral anticoagulant (OAC) treatment. Patients with major bleeding are at an increased risk of a stroke if an OAC is not reinitiated. Methods: Non-valvular atrial fibrillation (NVAF) patients initiating OACs were identified from the Centers for Medicare and Medicaid Services ( CMS) Medicare data and four US commercial claims databases. Patients who had a major GI bleeding event (hospitalization with primary diagnosis of GI bleeding) while on an OAC were selected. A control cohort of patients without a major GI bleed during OAC treatment was matched to major GI bleeding patients using propensity scores. Stroke/systemic embolism (SE), major bleeding, and mortality (in the CMS population) were examined using Cox proportional hazards models with robust sandwich estimates. Results: A total of 15,888 patients with major GI bleeding and 833,052 patients without major GI bleeding were included in the study. Within 90 days of the major GI bleed, 58% of patients discontinued the initial OAC treatment. Patients with a major GI bleed had a higher risk of stroke/SE [hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.42–1.74], major bleeding (HR: 2.79, 95% CI: 2.64–2.95), and all-cause mortality (HR: 1.29, 95% CI: 1.23–1.36) than patients without a major GI bleed. Conclusion: Patients with a major GI bleed on OAC had a high rate of OAC discontinuation and significantly higher risk of stroke/SE, major bleeding, and mortality after hospital discharge than those without. Effective management strategies are needed for patients with risk factors for major GI bleeding.

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Longitudinal Microbiome Analysis in a Dextran Sulfate Sodium-Induced Colitis Mouse Model

Microorganisms ◽

10.3390/microorganisms9020370 ◽

2021 ◽

Vol 9 (2) ◽

pp. 370

Author(s):

Hyunjoon Park ◽

Soyoung Yeo ◽

Seokwon Kang ◽

Chul Sung Huh

Keyword(s):

Mouse Model ◽

Dextran Sulfate ◽

Dextran Sulfate Sodium ◽

Intestinal Bleeding ◽

Cross Sectional ◽

Microbiome Analysis ◽

Inflammatory Bowel ◽

Factor Design ◽

The Individual

The role of the gut microbiota in the pathogenesis of inflammatory bowel disease (IBD) has been in focus for decades. Although metagenomic observations in patients/animal colitis models have been attempted, the microbiome results were still indefinite and broad taxonomic presumptions were made due to the cross-sectional studies. Herein, we conducted a longitudinal microbiome analysis in a dextran sulfate sodium (DSS)-induced colitis mouse model with a two-factor design based on serial DSS dose (0, 1, 2, and 3%) and duration for 12 days, and four mice from each group were sacrificed at two-day intervals. During the colitis development, a transition of the cecal microbial diversity from the normal state to dysbiosis and dynamic changes of the populations were observed. We identified genera that significantly induced or depleted depending on DSS exposure, and confirmed the correlations of the individual taxa to the colitis severity indicated by inflammatory biomarkers (intestinal bleeding and neutrophil-derived indicators). Of note, each taxonomic population showed its own susceptibility to the changing colitis status. Our findings suggest that an understanding of the individual susceptibility to colitis conditions may contribute to identifying the role of the gut microbes in the pathogenesis of IBD.

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