Common colonoscopic findings in patients with lower gastrointestinal bleeding

Submission: 11 October 2025 | Acceptance: 05 November | Publication: 27 November

¹Ahmed Ali, ²Asma Iqbal, ³Dr M Imran, ⁴Athar Nayeem, ⁵Dr Muhammad Imran. 

1General Practitioner, Fellow Royal College of General Practitioners

2Fellow College of Physician and Surgeons Pakistan.

3Consultant Physician, Services hospital Lahore

3Assistant Prof Medicine, Narowal Medical College

5Associate Professor Medicine. Mohiuddin Islamic Medical College and Teaching Hospital. Mirpur Azad Kashmir.

Abstract

Lower gastrointestinal (LGI) bleeding traditionally has been defined as bleeding distal to the ligament of Treitz. It is common, accounting for one quarter to one third of all hospital admissions for overall GI bleeding, most patients are older than 70 years.

.Lower GI bleeding is associated with significant mortality, health care costs and increased length of hospitalization, emphasizing the need for effective evaluation and treatment.

The clinical presentation of gastrointestinal hemorrhage varies with the location of the bleeding source, the intensity of the bleed, and the presence of comorbidities that affect the ability to tolerate blood loss. Lower GI bleeding classically presents with hematochezia, however bleeding from the right colon or the small intestine can present with melena.

Common causes of lower GI bleeding include diverticulosis, hemorrhoids, ischemic colitis, inflammatory bowel disease, colon cancer polyp, rectal ulcer, vascular ectasia and post-polypectomy bleeding. Colonoscopy is the main modality used for the diagnosis of lower GI bleeding.

Objective: To determine the frequency of common colonoscopic findings in patients with lower GI bleed.

Subjects and methods: Departments of Gastroenterology and Hepatology, Ayub Teaching Hospital, Abbottabad.Study was conducted from January to December 2024. It isDescriptive Cross-sectional study.A total of 136 patients with lower GI bleeding of age between 20 to 65 years and either gender were included in the study on the basis of non-probability consecutive sampling.

Colonoscopy was performed on each patient and their findings were documented. The data was collected through a structured proforma and analyzed using SPSS 20.

Results: A total of 136 patients with lower GI bleed were included in this study. There were 66 males (48.5%) and 70 females (51.5%).The most common colonoscopic finding was hemorrhoids (30.1%, n=41) with male and female distribution of 30.3% and 30% respectively. Followed by polyp (24.3%, n=33) with male and female distribution of 25.8% and 22.9% respectively .Polyp was more common among age group 20 to 35 years (30%, n=21).Next common endoscopic finding was rectal ulcer and inflammatory bowel disease found in 16.2% of patients. Colonic carcinoma was found in 18 patients (13.2%).Colonic carcinoma was more common among age group above 50 years (26.9%).

Key Words: Lower GI bleed, ligament of treitz, hematochezia, hemorrhoids, polyp, inflammatory bowel disease.