Changing Trends in Lower Gastrointestinal Hemorrhage: A Rise in Frequency of Ischemic Colitis

Abstract

The range and distribution of sources of lower gastrointestinal bleeding (LGIB) seem to be evolving over time. Ischemic colitis (IC) has long been recognized as a common cause of LGIB. Due to a variety of contributing factors, we suspect that IC may be implicated in an increasing proportion of inpatient cases of lower GI bleeding compared to previously published rates. We examined the medical records of 464 patients admitted to the Methodist Hospital from 2005 to 2013. Patients with LGIB admitted to the hospital with a diagnostic colonoscopy were eligible for the study. Demographics and diagnoses were grouped and categorized for ease of comparison and compatibility with prior studies. Statistical analysis was used to summarize disease distribution and calculate probability outcomes based on pooled mean values obtained from 6 previously published epidemiological studies of LGIB. Anorectal bleeding including hemorrhoids, fissures, and stercoral ulcers was the most frequent diagnosis overall (20%) followed by ischemic colitis (16%) and diverticulosis (14%). There were a significantly higher proportion of IC cases observed in our population compared to the expected proportion of cases (p < 0.01, 95%). When stratified by sex, IC was the leading overall cause in females.