Colonoscopic Evaluation of Lower Gastrointestinal Bleeding (LGIB): Practical Approach

Abstract

Background: Haematochesia (Lower Gastrointestinal Bleeding (LGIB) is the most common reason for endoscopic examination. Generaly it is caused by hemorrhoids and diverticular disease, but other anorectal conditions can also lead to LGIB. Recurrent bleeding may result in secondary iron deficiency anemia. Colonoscopy is the primary diagnostic option for establishing a diagnosis of colonic bleeding. Objective: This study aimed to analyze symptoms and endoscopic finding (specialy hemorrhoids) who may be sources of LGIB.Second goal of this study is to estimate time from onset of symptoms to performance of a colonoscopy. Methods: A retrospective study included 603 adult patients who underwent colonoscopy in General Hospital “Sv. Apostol Luka“, Doboj, Bosnia and Herzegovina, between 1.1.2020 and 31.12.2020. Results: Average age of the examined population was 62±13,3years. According to the gender they were mostly men. To be exact,by percentage it was 53.7% of men and 46,3% of women, or by number: 324 men and 279 women. The most common indications for colonoscopy were LGIB (48,8%), abdominal pain and irregular stool. Most frequent endoscopic findings were hemorrhoids 42%. Normal findings had almost one third of all examinated patients. Combined findings-presence of more clinical entities in one patient were presented in 95 cases. In the group with hemorrhoids were almost two thirds of males, but there was no gender difference noted in between group with LGIB and without LGIB. More than half patients were older than 61 years. Anemia was presented in almost 20% of cases. Significantly it is higher frequency of abdominal pain, irregular stool and weight loss observed on the group without LGIB. Also, significantly more frequently patients with LGIB underwent colonoscopy in 0-30 days when compared with patients without LGIB (p=0,016). Conclusion: In patients with haematochezia, taking a careful medical history is mandatory. Hemorrhoids, diverticular disease and colorectal cancers are the most common causes of bleeding. Patients with LGIB and abdominal pain were previously examined with colonoscopy. Completely colonoscopy is advocated to detect probable proximal lesions.

Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients

“…Previously, a reduction in the amount of connective tissue collagen was shown in HD. Other authors have reported a decrease in the ratio of type I to III collagen leading to the impaired mechanical stability of the perivascular tissue in HD patients [30,31,49,61]. However, approval of whether changes in collagen formation in HD are caused by external factors and metabolic changes or are influenced by genetic factors remains unsolved.…”

“…Van Gieson's and Picro Sirius red staining were used for the assessment of collagen. The sections stained in Picro Sirius red were further observed under interference and polarized light that improves the visualization and assessment of collagen fibers using a Biolar microscope (BIOLAR, Warsaw, Poland) [30,31,49]. The density of connective tissue fibers appearing in Van Gieson's and Picro Sirius red staining was graded semiquantitatively from 0 to 4, where: 0-loose, 1-minimally dense, 2moderately dense, 3-markedly dense, and 4-very dense.…”

“…For the upper gastrointestinal tract, oral mucosal bleeding, peptic ulcer disease, erosive disease, and cirrhosis-associated gastroesophageal variceal bleeding are recognized as the most common causes of bleeding [31]. Although some evidence suggests an association between ABO blood type and bleeding from hemorrhoids, most often confirmed in patients with blood group 0 and the least common in B and AB blood group individuals [44,49], current understanding of the relationship between the development of hemorrhoids and different ABO blood groups is incomplete. Therefore, several research questions appeared to be addressed in the given study, as follows: (i) what are the clinical manifestations of HD in patients of different ABO blood groups?…”

The Association between Colorectal Cancer and Colonoscopic Conditions in Saudi Patients: A 10-Year Cross-Sectional-Retrospective Study

“…A study has suggested that patients with hemorrhoids had a roughly two-fold greater chance of developing CRC and highlighted the urge to screen colonoscopy for patients with hemorrhoids ( 29 ). Furthermore, colonoscopy was recommended for patients with hemorrhoids because CRC and hemorrhoids share similar lifestyle-associated risk factors, including low fiber consumption, obesity, and insufficient exercise ( 39 ).…”