From the Guidelines
Colitis with hematochezia is typically caused by inflammation of the colon lining, which can result from several conditions, including inflammatory bowel diseases, infections, ischemic colitis, radiation therapy, and certain medications. The most common causes of colitis with blood in stool include:
- Inflammatory bowel diseases (such as ulcerative colitis and Crohn's disease)
- Infections (bacterial, viral, or parasitic)
- Ischemic colitis from reduced blood flow to the colon
- Radiation therapy to the abdomen
- Certain medications like NSAIDs According to the most recent study 1, the workup of blood and stool should be performed for the initial presentation, and also considered for immunosuppressant refractory cases. Key points to consider in the diagnosis and management of colitis with hematochezia include:
- Testing for fecal lactoferrin and calprotectin to determine disease activity and follow-up
- Screening labs, such as HIV, hepatitis A and B, and TB testing, repeated annually in patients who require biologic treatment
- Reviewing concomitant medications that could alter the gut microbiome and their indications for prolonged use
- Imaging, such as CT scan of abdomen and pelvis, to rule out colitis-related complications
- GI endoscopy or colonoscopy with biopsy for patients who have positive stool inflammatory markers or colitis-related symptoms The treatment of colitis with hematochezia depends on the underlying cause, and may include antibiotics for bacterial infections, anti-inflammatory medications like mesalamine or corticosteroids for inflammatory bowel disease, or discontinuation of offending medications 1. It is essential to evaluate blood in stool promptly, as it can indicate serious conditions requiring prompt medical attention, and the inflammation can damage blood vessels in the intestinal wall, causing them to leak blood that mixes with stool, resulting in the visible blood that patients observe.
From the Research
Causes of Colitis with Hematochezia
- Ischemic colitis is a common cause of colitis with hematochezia, which occurs due to decreased arterial blood flow to the colon 2
- Ulcerative colitis (UC) is a chronic inflammatory condition that can also cause hematochezia, resulting from the dysregulation of the normal immune system against an antigenic trigger 3
- The clinical presentation of ischemic colitis varies upon the severity of deprivation of the intestinal blood flow, and the development of the microvasculature plexus 2
- Massive haemorrhage in ulcerative colitis can occur as a result of exacerbated disease, usually acute or even fulminant colitis 4
Types of Colitis
- Ischemic colitis: attributed to an elderly with multiple comorbidities, but can also occur in young or middle-aged individuals 2
- Ulcerative colitis: a chronic inflammatory condition of unclear etiology affecting the large bowel, most commonly the rectum and extending proximally in a continuous fashion 3
Clinical Presentation
- Ischemic colitis: presents with acute onset of abdominal pain followed by bloody diarrhea, with involvement of the left side of the colon being more common 5
- Ulcerative colitis: diagnosed by combining the clinical picture, tissue biopsy with the endoscopic appearance of mucosal ulceration, friable, edematous, erythematous granular appearing mucus 3
- Hematochezia can occur in both ischemic colitis and ulcerative colitis, with massive haemorrhage being a life-threatening complication 4