Inflammatory Bowel Disease: Intestinal Problems (cont.)
Lori Kam, MD
Leslie J. Schoenfield, MD, PhD
Leslie J. Schoenfield, MD, PhD
Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
In this Article
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?
Gastrointestinal bleeding diagnosis
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.
Gastrointestinal bleeding treatment
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.
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