Diagnosis and management of lower gastrointestinal bleeding

Department of Internal Medicine III, Klinikum Augsburg, Augsburg, Germany.
Nature Reviews Gastroenterology &#38 Hepatology (Impact Factor: 12.61). 11/2009; 6(11):637-46. DOI: 10.1038/nrgastro.2009.167
Source: PubMed


Lower gastrointestinal bleeding (LGIB) can present as an acute and life-threatening event or as chronic bleeding, which might manifest as iron-deficiency anemia, fecal occult blood or intermittent scant hematochezia. Bleeding from the small bowel has been shown to be a distinct entity, and LGIB is defined as bleeding from a colonic source. Acute bleeding from the colon is usually less dramatic than upper gastrointestinal hemorrhage and is self-limiting in most cases. Several factors might contribute to increased mortality, a severe course of bleeding and recurrent bleeding, including advanced age, comorbidity, intestinal ischemia, bleeding as a result of a separate process, and hemodynamic instability. Diverticula, angiodysplasias, neoplasms, colitis, ischemia, anorectal disorders and postpolypectomy bleeding are the most common causes of LGIB. Volume resuscitation should take place concurrently upon initial patient assessment. Colonoscopy is the diagnostic and therapeutic procedure of choice, for acute and chronic bleeding. Angiography is used if colonoscopy fails or cannot be performed. The use of radioisotope scans is reserved for cases of unexplained intermittent bleeding, when other methods have failed to detect the source. Embolization or modern endoscopy techniques, such as injection therapy, thermocoagulation and mechanical devices, effectively promote hemostasis. Surgery is the final approach for severe bleeding.

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    • "Nevertheless, inappropriate performance to detect advanced adenomas (AA) mainly due to the intermittent and infrequent bleeding of lesions is a limitation of FIT (Terhaar sive Droste et al, 2012; Chiu et al, 2013; Ng et al, 2013), including its dependence on localisation, resulting more useful for distal lesions compared with proximal ones (Morikawa et al, 2005; Ciatto et al, 2007; Haug et al, 2011; Khalid-de Bakker et al, 2011). Moreover, as bleeding from the lower intestinal tract is a symptom related to conditions like diverticular disease, colitis, Crohn's disease and anorectal disorders , false-positive results may be increased (Barnert and Messmann, 2009). Therefore, there is an imperative need for the identification of non-invasive, blood-based markers that can help in the detection of cancer and AA. "
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    • "However, this also carries substantial morbidity and mortality. Thus, with refinements in interventional radiological procedures, arterial embolization has become a more attractive therapeutic option [51]. "
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