Inflammatory Bowel Disease: Intestinal Problems (cont.)
Does gastrointestinal bleeding occur in IBD?
Bleeding from the intestinal tract, or gastrointestinal (GI) bleeding, may
complicate the course of both ulcerative colitis and Crohn's disease. GI bleeding is often referred to as
rectal bleeding when the blood comes out of the rectum, usually with the stools.
If the source of bleeding is in the colon, the blood is usually a red color. The
longer the blood the remains in the intestine, however, the darker it becomes.
Thus, rectal bleeding originating from higher up in the intestinal tract is
usually black, except for very rapid bleeding, which can still be red.
Patients with ulcerative colitis usually experience some degree of chronic (long duration) rectal
bleeding, which can be continuous or intermittent. The bleeding may be mild, as
when it is limited to occasional drops on the toilet paper or streaks of blood
around the stools. At times, however, the bleeding may be more severe or acute,
with the passage of greater amounts of blood or large blood clots. The more
severe rectal bleeding is most likely due to more severe inflammation and
extensive ulceration of the colon. In Crohn's disease, mild or severe intestinal inflammation
also may occur, but the ulcers and bleeding are less frequent than in ulcerative
colitis.
Because of the deep nature of ulcers in Crohn's disease, however, the GI bleeding tends to be
acute (sudden and brief) and sporadic. Furthermore, in Crohn's disease, the site of bleeding
can be anywhere in the GI tract, including the colon.
How is gastrointestinal bleeding in IBD diagnosed and treated?
Intestinal bleeding in IBD is usually diagnosed by EGD for the upper GI tract
or colonoscopy for the lower GI tract. These methods allow for direct
visualization of the bleeding site, which can be particularly helpful.
Additionally, special instruments can be used through the upper GI endoscopes or
colonoscopes, which may effectively treat the bleeding lesions and stop ongoing
blood loss. Sometimes, if the bleeding is severe and the bleeding site is
suspected to be in the small intestine, other tests may be needed. One of these
tests is a special x-ray study called an angiogram, which uses a dye to
visualize the intestinal blood vessels that may be bleeding. Another test is a
nuclear medicine study called a tagged red blood cell scan, which tracks the red
blood cells from the blood stream to the gut. Each of these tests can help
identify the site of bleeding. Pinpointing the bleeding site becomes
additionally important if surgery is ultimately needed.
No medications as yet
have been shown to specifically stop acute GI bleeding in IBD. Nevertheless, the
initial approach to IBD-associated GI bleeding is aggressive medical treatment
of the underlying inflammation and ulceration. Chronic bleeding might respond to
medications if the inflammation resolves and the ulcers heal. If the medications
or endoscopic treatments do not stop acute or severe chronic bleeding, however,
surgical removal (resection) of the bleeding area of the gut may be necessary.
Next: How do intestinal strictures form in IBD? »
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