What roles does colitis play in the pathophysiology of lower GI bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Massive hemorrhage due to inflammatory bowel disease (IBD) is rare. Ulcerative colitis causes bloody diarrhea in most cases. In up to 50% of patients with ulcerative colitis, mild to moderate LGIB occurs, and approximately 4% of patients with ulcerative colitis have massive hemorrhage.

LGIB in patients with Crohn disease is not as common as in patients with ulcerative colitis; 1%-2% of patients with Crohn disease may experience massive bleeding. The frequency of bleeding in patients with Crohn disease is significantly more common with colonic involvement than with small bowel involvement alone. The mucosal pattern of injury is similar to that found in patients with infectious and ischemic colitis, with the mucosa appearing friable, erythematous, edematous, and ulcerated. In severe Crohn disease, the inflammatory process may extend into the serosa, leading to colonic perforation.

Ischemic colitis is a disease of the elderly population and is commonly observed after the sixth decade of life. This condition is the most common form of ischemic injury to the digestive system, frequently involves the watershed areas, including the splenic flexure and the rectosigmoid junction. Ischemia causes mucosal and partial-thickness colonic wall sloughing, edema, and bleeding. In most cases, the precipitating event cannot be identified. However, although abdominal pain and bloody diarrhea are the main clinical manifestations, ischemic colitis is not associated with significant blood loss or hematochezia.

The pathophysiologic mechanism of infectious colitis may be due to either colonic tissue invasion by bacteria, such as Salmonella and Shigella, or toxin-mediated damage, as with Escherichia coli 0157:H7.

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