Lower GI Bleeding: Epidemiology and Diagnosis
Section snippets
Incidence
Acute LGIB is one of the most common gastrointestinal indications for hospital admission. The annual incidence of hospitalization for LGIB was estimated to be 20 to 30 per 100,000 persons in a large, southern California health maintenance organization [1]. This rate increased dramatically with advancing age [1]. Consequently, the impact of this disorder promises to increase as the population ages. In comparison, in the same population, the annual incidence of hospitalization for acute upper
Diagnostic Criteria
Multiple factors make the identification of a precise bleeding source in LGIB challenging. These include the diversity of potential sources, the length of bowel involved, the need for colon cleansing, and the intermittent nature of bleeding. In up to 40% of patients with LGIB, more than one potential bleeding source will be noted [31], and stigmata of recent bleeding in LGIB are infrequently identified (see Refs. [12], [13], [17]). As a result, no definitive source will be found in a large
Colonoscopy
Advances in endoscopic technology have brought colonoscopy to the forefront of the management of LGIB. Recent studies have shown that colonoscopy, particularly when performed early (within 12 to 24 hours of admission), is safe and effective (see Refs. [7], [9], [12], [13], [31]). Colonoscopy is undoubtedly the best test for confirming the source of LGIB and for excluding ominous diagnoses, such as malignancy. The diagnostic yield of colonoscopy ranges from 45% to 95% (Table 2) [6], [13].
Sources of Bleeding
Lower gastrointestinal bleeding arises from a diverse range of sources. Table 6 displays the breakdown of sources from a number of large studies. The spectrum of sources appears to be changing over time [16], [89]. In the early 20th century, neoplasia was reported as the predominant source of LGIB, and diverticular bleeding was presumably rare [16]. Angiodysplasia were increasingly recognized as a source of LGIB in the 1960s and 1970s [16]. Currently, diverticular bleeding is the leading source
Summary
Lower gastrointestinal bleeding is one of the most common gastrointestinal indications for hospital admission, particularly in the elderly. Diverticulosis accounts for up to 50% of cases, followed by ischemic colitis and anorectal lesions. Though most patients stop bleeding spontaneously and have favorable outcomes, long-term recurrence is a substantial problem for patients with bleeding from diverticulosis and angiodysplasia. The management of LGIB is challenging because of the diverse range
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The author is supported by a grant (K08 HS014062-01) from the Agency for Healthcare Research and Quality, Rockville, MD.