What are less common causes of lower gastrointestinal (GI) bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Answer

Infection with human immunodeficiency virus (HIV) is an infrequent cause of LGIB. Most of the LGIB in such cases is caused by HIV-related opportunistic infections and associated etiologies, including cytomegalovirus (CMV) colitis, idiopathic colon ulcers, Kaposi sarcoma, and lymphoma. [19] Patients with HIV can also bleed from hemorrhoids and anal fissures, in which situations there is an increased likelihood of bleeding due to concomitant coagulopathy.

Drug-induced bleeding is caused mainly by NSAID and aspirin use, and it is more common in the elderly. Although the risk of bleeding increases at higher doses of these agents, even low-dose aspirin given for cardiovascular prophylaxis can produce bleeding. Using the lowest effective dose for both short and long-term users is recommended. [20] Aspirin or anticoagulants can potentiate or aggravate hemorrhage from preexisting lesions. Oral anticoagulants, antiplatelet agents, and NSAIDs should be used with caution in patients at risk of GIB. [5]

Benign small intestinal neoplasms are usually asymptomatic, but up to 10% may cause small intestinal bleeding. Small intestinal adenomatous polyps, leiomyomas, Peutz-Jeghers syndrome, and hemangiomas may cause occult or frank LGIB.

Other uncommon causes of LGIB include stercoral ulcers.


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