Endoscopic Findings in Patients Presented With Lower GIT Bleeding in Assiut University Hospitals, a Single-centre Study

Lower gastrointestinal bleeding (LGIB) refers to hematochezia or bright blood passing per rectum of colorectal source distal to ileocecal valve. This differs from the old definition of LGIB which involved small intestine distal to the ligament of Treitz. The new definition of LGIB aligns with current clinical practice and the reality that the majority of LGIB cases come from colorectal origin . In north America, LGIB is one fifth to one third as common as upper gastrointestinal bleeding (UGIB) and represents 30-40 % of all gastrointestinal bleeding cases . 20.5 - 27 cases per 100,000 adults are diagnosed to have LGIB with 21 to 40 cases per 100,000 adults are hospitalized . LGIB has a wide range of aetiologies, presentation and severity. The clinical picture of LGIB depends on patient's age, aetiology and associated comorbidities . Patients can present with overt bleeding in the form of hematochezia which is defined as passage of bright blood per rectum. This should be differentiated from melena (the passage of dark, offensive and digested blood with stool) associated with UGIB . However, 10-15 % of patients with severe acute UGIB can present with hematochezia . In addition, Occult LGIB can present in the form of iron deficiency anaemia or faecal occult bleeding . Causes of LGIB vary significantly according to patient age, lifestyle, dietary habits and geography or race. Some of the most common causes of LGIB include haemorrhoids, colorectal polyps, malignancy, colitis (infective, inflammatory, ischemic, etc.) as well as diverticular disease . However, there are limited data about the common causes of LGIB in upper Egypt.