Lower gastrointestinal bleeding in patients with cirrhosis.

Lower gastrointestinal bleeding (LGIB) in patients with cirrhosis may be associated with life-threatening complications similar to upper GI bleeding (UGIB). The data on LGIB in patients with cirrhosis is surprisingly small. The true incidence, diagnoses, risks of bleeding and results of treatment remain poorly defined, since there are no large epidemiologic studies available. Much of the data are from small studies and studies from the general population [1-3] LGIB in patients with cirrhosis occurs more often in younger patients than in the general population. This helps explain the variation in LGIB causes and why the age of the patient is such an important consideration, especially when a patient may have mild cirrhosis [4]. The most common causes of LGIB in patients with cirrhosis are portal hypertensive colopathy, colorectal varices and hemorrhoids. Whereas the most common causes of LGIB in the general population are diverticulosis coli and vascular ectasia [4]. LGIB is less common than UGIB in patients with cirrhosis. LGIB is a source of bleeding in 15-20% of cases of GI bleeding as compared to 80-85% of cases that occur from an upper GI source. In a longitudinal study by Brescia in which patients with cirrhosis were followed for two years, UGIB occurred in 34% and LGIB occurred in 6% of cases [5]. In the general, the incidence of LGIB increases with age and is more common in men than women [4]. In the United States the incidence of LGIB in the general population ranges from 20.5 to 27 per 100,000 persons per year with a greater than 200 fold increase from the third to the ninth decade of life [4].