Skip to main content
SpringerLink
Log in

Lower GI Bleeding: Epidemiology and Management

  • Large Intestine (B Cash, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Gastrointestinal (GI) bleeding from the colon is a common reason for hospitalization and is becoming more common in the elderly. While most cases will cease spontaneously, patients with ongoing bleeding or major stigmata of hemorrhage require urgent diagnosis and intervention to achieve definitive hemostasis. Colonoscopy is the primary modality for establishing a diagnosis, risk stratification, and treating some of the most common causes of colonic bleeding, including diverticular hemorrhage which is the etiology in 30 % of cases. Other interventions, including angiography and surgery, are usually reserved for instances of bleeding that cannot be stabilized or allow for adequate bowel preparation for colonoscopy. We discuss the colonoscopic diagnosis, risk stratification, and definitive treatment of colonic hemorrhage in patients presenting with severe hematochezia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Laine L, Yang H, Chang SC, Datto C. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol. 2012;107:1190–5.

    Article  PubMed  Google Scholar 

  2. Strate LL, Orav EJ, Syngal S. Early predictors of severity in acute lower intestinal tract bleeding. Arch Intern Med. 2003;163:838–43.

    Article  PubMed  Google Scholar 

  3. Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin Gastroenterol Hepatol. 2008;6:1004–10.

    Article  PubMed  Google Scholar 

  4. Zuckerman GR, Trellis DR, Sherman TM, Clouse RE. An objective measure of stool color for differentiating upper from lower gastrointestinal bleeding. Dig Dis Sci. 1995;40:1614–21.

    Article  PubMed  CAS  Google Scholar 

  5. Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia - the role of urgent colonoscopy after purge. Gastroenterology. 1988;95:1569–74.

    PubMed  CAS  Google Scholar 

  6. Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342:78–82.

    Article  PubMed  CAS  Google Scholar 

  7. • Villanueva C, Colomo A, Bosch A. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;361:11–21. Study suggesting that lower-risk patients may not need to be transfused with red blood cells as aggressively as previously thought. This study only evaluated upper GI bleeding patients, however.

    Article  Google Scholar 

  8. Gayer C, Chino A, Lucas C, et al. Acute lower gastrointestinal bleeding in 1,112 patients admitted to an urban emergency medical center. Surgery. 2009;146:600–7.

    Article  PubMed  Google Scholar 

  9. Chavalitdhamrong D, Jensen DM, Kovacs TOG, et al. Ischemic colitis is a common cause of severe hematochezia and patient outcomes are worse than with other colonic diagnoses. Gastrointest Endosc. 2011;74:852–7.

    Article  PubMed  Google Scholar 

  10. Strate LL, Syngal S. Timing of colonoscopy: impact on length of hospital stay in patients with acute lower intestinal bleeding. Am J Gastroenterol. 2003;98:317–22.

    PubMed  Google Scholar 

  11. Jensen DM, Machicado GA. Colonoscopy for diagnosis and treatment of severe lower gastrointestinal bleeding: routine outcomes and cost analysis. Gastrointest Endosc Clin N Am. 1997;7:477–98.

    PubMed  CAS  Google Scholar 

  12. Bloomfeld RS, Rockey DC, Shetzline MA. Endoscopic therapy of acute diverticular hemorrhage. Am J Gastroenterol. 2001;96:2367–72.

    Article  PubMed  CAS  Google Scholar 

  13. •• Jensen DM, Ohning GV, Kovacs TOG, et al. Natural history of definitive hemorrhage based upon stigmata of recent hemorrhage and Doppler blood flow monitoring. Gastroenterology. 2012;142:S-577–8. Large case series report showing that stigmata of hemorrhage associated with diverticula have a poorer prognosis compared to those of peptic ulcer hemorrhage.

    Google Scholar 

  14. Jensen DM, Ohning GV, Kovacs, et al. How to find, diagnose and treat definitive diverticular hemorrhage during urgent colonoscopy in patients with severe hematochezia: results & outcomes of a large prospective study. Gastrointest Endosc. 2012;75:AB179.

    Article  Google Scholar 

  15. Jensen DM, Ohning GV, Kovacs TO, et al. Natural history of definitive diverticular hemorrhage based upon stigmata of recent hemorrhage & Doppler blood flow monitoring. Gastrointest Endosc; In press for DDW 2013.

  16. Jensen DM. The ins and outs of diverticular bleeding. Gastrointest Endosc. 2012;75:388–91.

    Article  PubMed  Google Scholar 

  17. Setoyama T, Ishii N, Fujita Y. Endoscopic band ligation (EBL) is superior to endoscopic clipping for the treatment of colonic diverticular hemorrhage. Surg Endosc. 2011;25:3574–8.

    Article  PubMed  Google Scholar 

  18. Ishii N, Setoyama T, Deshpande GA, et al. Endoscopic band ligation for colonic diverticular hemorrhage. Gastrointest Endosc. 2012;75:382–7.

    Article  PubMed  Google Scholar 

  19. Manner H, Plum N, Pech O, et al. Colon explosion during argon plasma coagulation. Gastrointest Endosc. 2008;67:1123–7.

    Article  PubMed  Google Scholar 

  20. Jutabha R, Jensen DM, Chavalitdhamrong D. Randomized prospective study of endoscopic rubber band ligation compared with bipolar coagulation for chronically bleeding internal hemorrhoids. Am J Gastroenterol. 2009;104:2057–64.

    Article  PubMed  Google Scholar 

  21. Olds GD, Cooper GS, Chak A, et al. The yield of bleeding scans in acute lower gastrointestinal hemorrhage. J Clin Gastroenterol. 2005;39:273–7.

    Article  PubMed  Google Scholar 

  22. Strate LL, Naumann CR. The role of colonoscopy and radiologic procedures in the management of acute lower intestinal bleeding. Clin Gastroenterol Hepatol. 2010;8:333–43.

    Article  PubMed  Google Scholar 

  23. Silver A, Bendick P, Wasvary H. Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage. Am J Surg. 2005;189:361–3.

    Article  PubMed  Google Scholar 

  24. Camus M, Jensen DM, Ohning GV, et al. Urgent capsule endoscopy for bleeding site localization & lesion diagnosis of patients with severe hematochezia. Gastrointest Endosc; In press for DDW 2013.

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Kevin A. Ghassemi and Dennis M. Jensen declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Division of Digestive Diseases, Center for Esophageal Disorders, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 700, Los Angeles, CA, 90095, USA

    Kevin A. Ghassemi

  2. Departments of Medicine at UCLA and West Los Angeles VA Medical Centers and CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, CURE Hemostasis Research Unit- Bldg 115, Rm 318 11301 Wilshire Blvd, Los Angeles, CA, 90073-1003, USA

    Dennis M. Jensen

Authors
  1. Kevin A. Ghassemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dennis M. Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin A. Ghassemi.

Additional information

This article is part of the Topical Collection on Large Intestine

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ghassemi, K.A., Jensen, D.M. Lower GI Bleeding: Epidemiology and Management. Curr Gastroenterol Rep 15, 333 (2013). https://doi.org/10.1007/s11894-013-0333-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-013-0333-5

Keywords

Search

Navigation