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Erschienen in: Current Gastroenterology Reports 7/2013

01.07.2013 | Large Intestine (B Cash, Section Editor)

Lower GI Bleeding: Epidemiology and Management

verfasst von: Kevin A. Ghassemi, Dennis M. Jensen

Erschienen in: Current Gastroenterology Reports | Ausgabe 7/2013

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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.
Literatur
1.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
2.
Zurück zum Zitat Strate LL, Orav EJ, Syngal S. Early predictors of severity in acute lower intestinal tract bleeding. Arch Intern Med. 2003;163:838–43.PubMedCrossRef Strate LL, Orav EJ, Syngal S. Early predictors of severity in acute lower intestinal tract bleeding. Arch Intern Med. 2003;163:838–43.PubMedCrossRef
3.
Zurück zum Zitat Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin Gastroenterol Hepatol. 2008;6:1004–10.PubMedCrossRef Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin Gastroenterol Hepatol. 2008;6:1004–10.PubMedCrossRef
4.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
5.
Zurück zum Zitat Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia - the role of urgent colonoscopy after purge. Gastroenterology. 1988;95:1569–74.PubMed Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia - the role of urgent colonoscopy after purge. Gastroenterology. 1988;95:1569–74.PubMed
6.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
7.
Zurück zum Zitat • 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.CrossRef • 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.CrossRef
8.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
9.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
10.
Zurück zum Zitat 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 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
11.
Zurück zum Zitat 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 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
12.
Zurück zum Zitat Bloomfeld RS, Rockey DC, Shetzline MA. Endoscopic therapy of acute diverticular hemorrhage. Am J Gastroenterol. 2001;96:2367–72.PubMedCrossRef Bloomfeld RS, Rockey DC, Shetzline MA. Endoscopic therapy of acute diverticular hemorrhage. Am J Gastroenterol. 2001;96:2367–72.PubMedCrossRef
13.
Zurück zum Zitat •• 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. •• 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.
14.
Zurück zum Zitat 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.CrossRef 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.CrossRef
15.
Zurück zum Zitat 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. 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.
17.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
18.
Zurück zum Zitat Ishii N, Setoyama T, Deshpande GA, et al. Endoscopic band ligation for colonic diverticular hemorrhage. Gastrointest Endosc. 2012;75:382–7.PubMedCrossRef Ishii N, Setoyama T, Deshpande GA, et al. Endoscopic band ligation for colonic diverticular hemorrhage. Gastrointest Endosc. 2012;75:382–7.PubMedCrossRef
19.
Zurück zum Zitat Manner H, Plum N, Pech O, et al. Colon explosion during argon plasma coagulation. Gastrointest Endosc. 2008;67:1123–7.PubMedCrossRef Manner H, Plum N, Pech O, et al. Colon explosion during argon plasma coagulation. Gastrointest Endosc. 2008;67:1123–7.PubMedCrossRef
20.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
21.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
22.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
23.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
24.
Zurück zum Zitat 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. 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.
Metadaten
Titel
Lower GI Bleeding: Epidemiology and Management
verfasst von
Kevin A. Ghassemi
Dennis M. Jensen
Publikationsdatum
01.07.2013
Verlag
Springer US
Erschienen in
Current Gastroenterology Reports / Ausgabe 7/2013
Print ISSN: 1522-8037
Elektronische ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-013-0333-5

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