Insides Aren't Supposed to Bleed

Gastrointestinal bleeding rates higher than ever

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Bleeding is never a good sign. Though it may not come with pain, having blood in your stools could mean some bigger problem is happening inside and new research is finding more people are getting hospitalized for this problem.

A recently published study found short-term cases of bleeding along the gastrointestinal tract are being reported more than ever with 87 out of 100,000 patients diagnosed each year.

Researchers said the bloody stools and intestinal bleeding "is a major health issue in most parts of the world."

"If stools or vomit look like coffee grounds, see a doctor."

Johann Hreinssona, PhD, from the Department of Internal Medicine, and researchers from Skane University Hospital in Sweden, looked at how often bleeding occurred among 1,134 adult patients suspected of having gastrointestinal bleeding. Bright red blood is passed in the fecal matter of patients with acute lower gastrointestinal bleeding (ALGIB).

Researchers also looked at how drug treatments, including non-steroidal anti-inflammatory drugs (NSAIDS) and aspirin, affect bleeding inside. Those who took NSAIDS already used them daily for at least five days. Patients who had been hospitalized for bleeding collectively had 1,275 colonoscopies at the National University Hospital of Iceland in 2010. The median age was 69 and a little more than half were female.

Healthy patients undergoing a colonoscopy who did not have the bleeding problem were matched with each of the study's patients to compare symptoms. Blood transfusions were tracked, as well as platelet and hemoglobin levels in the blood.

Researchers found that 163 patients had short-term bleeding along the lower part of their gastrointestinal tract.

About 23 percent of patients with this bleeding had diverticulosis, in which sacs develop in the intestines. Another 16 percent had ischemic colitis where blood flow is reduced or blocked from the large intestine.

"In this prospective population-based study, the incidence of ALGIB is, to our knowledge, the highest reported to date," researchers wrote in their report. "Interestingly, the incidence of ALGIB and acute upper gastrointestinal bleeding was the same."

A little more than 7 percent of the patients had endoscopic therapy to treat their conditions and none had surgery. Two patients who had other serious illnesses related to the stomach problems died because of the intestinal bleeding.

Among bleeding and non-bleeding patients, 19 and 9 percent respectively were using non-steroidal anti-inflammatory drugs. Low-dose aspirin was used among 37 and 25 percent within those same groups. Though the rates of NSAID use were higher among bleeders, the authors note this may not necessarily cause the condition.

About 40 percent of patients received blood transfusions. Among them, almost a third had diverticulosis, another 14 percent had colon cancer and 6 percent had ischemic colitis.

Maxwell Chait, MD, a gastroenterologist for ColumbiaDoctors Medical Group and dailyRx Contributing Expert, says that getting a colonoscopy is the best method to check for gastro bleeding and to treat it.

"For persistent bleeding not amenable to control by colonoscopic methods, [x-rays of the blood vessels in the abdomen] and even surgery may be necessary in some patients with massive bleeding," Dr. Chait said.

"With appropriate evaluation and management, including withdrawal of offending agents …there will be a successful outcome in the majority of patients with LGIB."

The authors note they did not compare the drug treatments as they affect the bleeding rates. The findings do not take into account people who were not hospitalized. No conflicts of interest were reported. The National University Hospital of Iceland Research Fund supported the study, which will be published in the January issue of the European Journal of Gastroenterology & Hepatology.

Reviewed by: 
Review Date: 
December 5, 2012
Last Updated:
February 16, 2013