| Background and ObjectiveMiddle and Lower Gastrointestinal Bleeding is an acute and critical illness,with complex and diverse causes,and the length of the middle and lower gastrointestinal tract is much longer than that of the upper gastrointestinal tract.Therefore,diagnosis is difficult and there are often more complications.This study retrospectively analyses the etiology,treatment and efficacy of patients with previously diagnosed middle and lower gastrointestinal bleeding through large sample data,which will help us further diagnose and treat middle and lower gastrointestinal bleeding.Research materials and MethodsThis study included complete clinical data of patients with diagnosed middle and lower gastrointestinal bleeding admitted to the Gastroenterology Department of Southern Hospital from January 2006 to December 2020 as case group,with a total of 579 cases.In the meantime,579 cases of non-gastrointestinal bleeding were included as control group.All data were statistically analyzed using spss22.0 software.Results1.The main causes of middle and lower gastrointestinal bleeding were 86 cases of vascular diseases(14.9%),69 cases of diverticulosis(11.9%),65 cases of hemorrhoids or anal fissures(11.2%),and 59 cases of raised lesions(11.2%),54 cases of colorectal cancer,41 cases of postoperative bleeding(7.1%),40 cases of CD(6.9%),39 cases of erosions or ulcers(3.7%),13 cases of UC(3.7%),13cases of hematological diseases(3.7%),10 cases of infectious enteritis(1.7%),10 cases of drugs or toxins(1.7%),10 cases of autoimmune diseases(1.7%),9 cases of surgical diseases(1.6%),5 cases of intestinal tuberculosis(0.9%),4 cases of lymphangiopathy(0.7%),4 cases of mucosal ectopic diseases(0.7%),2 cases of extra-intestinal diseases(0.3%).2.The percentage of the male middle and lower GI bleeding patients(60.8%)was more than female(39.2%)(P<0.05).3.Rank all the causes according to age and the top causes are infectious enteritis(62.4±15.1 years old),colorectal cancer(58.6±16.7 years old),drugs or toxins(57.5±18.8 years old),intestinal tuberculosis(54.8±14.8 years old),and vascular diseases(53.4±17.3 years old).4.The first symptoms were 357 cases of blood stool(61.7%),and 109 cases of abdominal pain(18.3%),83 cases of tarry stool(14.3%),12 cases of abdominal bloating(2.1%),and 10 cases of other symptoms(1.7%).5.166 cases(28.7%)occurred in the colon,142 cases(24.5%)occurred in the ileum,137 cases(23.7%)occurred in the rectum and anal canal,70 cases(12.1%)occurred in the jejunum,and 32 cases(5.5%)occurred in multiple locations,20 cases(3.5%)occurred in the ileocecal area and 12 cases(2.0%)occurred below the duodenal papilla;6.There were 337 cases(58.2%)with a bleeding volume of 400 to 800 mL,145 cases(25.0%)with a bleeding volume above 800 mL,and 97 cases(16.8%)with a bleeding volume less than 400 mL;7.The positive rates of colonoscopy,capsule endoscopy,enteroscopy,anoscopy,gastrointestinal radiography,CTA/CTE,DSA,and ECT were separately 66.6%,64.9%,88.7%,100.0%(for hemorrhoids or anal fissures),83.3%,79.0%,39.3%,33.3%;8.There are significant differences in the choice of treatment methods for different age groups,causes,bleeding locations or bleeding volume(P<0.05).9.347 cases(59.9%)were treated with drugs alone,133 cases(23.0%)were treated with drugs and endoscopic surgery,and 97 cases(17.1%)were treated with drugs and intervention/surgery,but there are no significant differences in the effectiveness of various treatment methods(P>0.05).Conclusions1.The top five causes of middle and lower GI bleeding are vascular disease,diverticulosis,hemorrhoids or anal fissures,raised lesions,and colorectal cancer;2.The incidence of diverticulosis,hemorrhoids or anal fissures in female is higher than those of in male,while the incidence of raised lesions,colorectal cancer,postoperative bleeding,CD,erosions or ulcers and the obscure in male is higher than those of in female.3.The top five causes according to age are infectious enteritis,colorectal cancer,drugs or toxins,intestinal tuberculosis,and vascular diseases.4.The first symptoms of lower bleeding locations are mostly blood stool,while upper are mostly abdominal pain and tarry stool;5.The overall positive rate of small colonoscopy is the highest,while the overall positive rate of ECT is the lowest,and the obscure gastrointestinal bleeding is more easily diagnosed by CTA and enteroscopy;6.The choice of treatment depends on the age,etiology,bleeding locations,and bleeding volumn;7.The treatment of drugs alone,drugs and endoscopic surgery,drugs and intervention/surgery,which should be selected as needed,are all very effective,but there is no significant difference;8.Risk factors of middle and lower GI bleeding include antiplatelet drugs or anticoagulants in the last month,history of cardiovascular and cerebrovascular diseases,history of gastrointestinal surgery,and history of cancer. |
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