Inflammatory bowel disease–associated bleeding

Abbreviations

Introduction

Bloody bowel movement is a common presentation of active ulcerative colitis (UC). In contrast, brisk bleeding in Crohn’s disease (CD) is uncommon. Rather, patients with CD often present with iron-deficiency anemia or anemia of chronic disease. The patterns of gastrointestinal (GI) hemorrhage in inflammatory bowel disease (IBD) ranges from obscure bleeding to massive, life-threatening bleeding . Reported frequency of bleeding in UC was 17% of patients with UC , while the reported frequency of severe GI bleeding as a main presenting symptom in CD ranged from 0.6% to 4% . Exacerbation factors for GI bleeding include the use of nonsteroidal antiinflammatory drugs or thrombocytopenia, deficiency in coagulating factors, and portal hypertension in conditions such as primary sclerosing cholangitis. Selective cyclooxygenase-2 inhibitors, such as rofecoxib, may also be associated with GI bleeding in CD . Active localized bleeding can be managed endoscopically with modalities, such as endoclips and topical spray or injection.

Bleeding conditions in IBD is summarized and categorized in Table 36.1 .