Acute lower intestinal bleedingPart II: Etiology, therapy, and outcomes☆,☆☆
Section snippets
ETIOLOGY AND RISK FACTORS
Validating that a lesion found during diagnostic testing is the definite source of blood loss is a problem that characterizes much of the literature about lower intestinal bleeding. Attempts have been made to separate a “proved” from a “potential” source,1, 2, 3 but these criteria are not standardized and not always applied. In many cases the localization of bleeding to the colon relies on circumstantial evidence (e.g., diverticula found in a patient with hematochezia). One study reported a 9%
THERAPY
As with upper GI bleeding, resuscitation of the patient should take precedence over diagnostic or therapeutic procedures that could place the patient at higher risk. Frequently resuscitation and diagnostic endeavors will overlap. The majority of patients with lower tract hemorrhage will stop bleeding spontaneously, but when necessary management may involve colonoscopic, angiographic, or surgical therapy or any combination of these techniques.
OUTCOMES
Overall mortality rates for lower intestinal bleeding have been consistently low, usually <5%,3, 12, 49, 152 and historically have been lower than mortality rates for upper GI bleeding.153, 154, 155, 156 However, there are a few recent studies in which the mortality rates for lower and upper bleeding are more comparable, although still consistently <5% for lower bleeding. An evaluation of patients with GI bleeding enrolled in a health maintenance organization found similarly low mortality rates
SUMMARY
Upper GI bleeding has usually been accorded “top billing” compared with lower intestinal bleeding, probably related to various factors including evidence that lower bleeding is only one fifth to one third as common as upper bleeding. Lower intestinal bleeding generally has a less severe clinical presentation and course and has other unique aspects in relation to etiology, diagnosis, and management (Table 4), which have been reviewed in this two-part series.102
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