Main Characteristics of Lower Gastrointestinal Bleeding in Patients Treated at a Reference Hospital

Abstract

Lower gastrointestinal bleeding (LGB) originates below the angle of Treitz and can result from vascular, inflammatory, neoplastic, or traumatic causes. This study analyzed the clinical and epidemiological profiles of LGB patients treated at Hospital Regional do Mato Grosso do Sul from 2017 to 2022, exploring the relationship between LGB etiology and colonoscopy performance. A retrospective analysis of 303 patients examined variables such as year of service, management approach, hospital stay, Oakland score, age, sex, and race. Most patients were hospitalized between 2018 and 2019, with hospitalization being the primary management strategy. The majority were male (59.4%), over 60 years old (55.1%), and mixed race (53.5%). The mean length of hospital stay was 10.6 days, and the average Oakland score was 20.28. Clinical findings showed 64.7% had no prior LGB history, with an average systolic blood pressure of 91.24 mmHg and a heart rate of 129.61 bpm. Colonoscopy revealed diverticular disease as the most common finding (39.6%), and the most frequent bleeding types were enterorrhagia (47.5%) and melena (37.0%). Significant associations were found between bleeding type, hemoglobin levels, and outcomes, with melena linked to lower hemoglobin levels and higher mortality. Colonoscopy results were also associated with outcomes, showing higher mortality in colitis patients. These findings emphasize the impact of clinical and demographic factors in LGB management and suggest further research into targeted interventions.

Keywords

gastrointestinal bleeding - gastroenterology - colonoscopy

Introduction

Lower gastrointestinal bleeding (LGB) refers to bleeding originating below the angle of Treitz, which marks the transition between the duodenum and jejunum. It can arise from the small intestine, colon, or rectum, and is associated with a variety of causes, including vascular, inflammatory, neoplastic, traumatic, and iatrogenic factors. The most common etiologies include diverticular disease, angiodysplasia, colorectal cancer, inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis, as well as benign anorectal lesions like hemorrhoids, anal fissures, and rectal ulcers as Lenhart, 2018.[1] LGB constitutes approximately 15% of all gastrointestinal bleeding cases, making it less common and generally less severe compared to upper gastrointestinal bleeding (UGIB), with 80-85% of cases being self-limiting. The overall mortality rate ranges from 2% to 4%, with most cases not having an identifiable bleeding source in 25% of instances like Schilioma Zaterka & Eisig, 2016.[2]

The clinical manifestations of LGB vary widely, including occult blood in stool, melena (dark tarry stools), hematochezia (bright red blood per rectum), hemodynamic instability, iron deficiency anemia, and abdominal pain. In acute cases, hemoglobin levels typically remain stable at baseline initially, but they decline as bleeding persists, often being diluted by extravascular fluid influx second Schilioma Zaterka & Eisig, 2016.[2] Age and gender play significant roles in the incidence of LGB, with the condition being more common in elderly individuals, especially those between 63 and 77 years, and more frequently affecting men, who tend to have a higher prevalence of risk factors such as diverticulosis and angiodysplasia as Kim, 2014.[3]

LGB can be classified into acute or chronic forms. Acute LGB typically lasts less than three days and may lead to clinical instability, anemia, and the need for blood transfusions. Chronic LGB occurs over a longer period and may present with intermittent or slow bleeding. Given the complexity of diagnosing the source of LGB, colonoscopy is the preferred diagnostic tool for this condition, allowing for direct visualization of the colon and rectum and providing crucial diagnostic information for managing LGB second Silva, E.J, 2003.[4] Alternative diagnostic techniques such as computed tomography angiography, scintigraphy with labeled red blood cells, and capsule endoscopy are increasingly being used, especially for investigating small intestinal sources of bleeding. Capsule endoscopy, in particular, has significantly improved our understanding of the etiological profile of LGB, especially in cases where the source is elusive as Kim, 2014.[3]

Once the source of bleeding is identified, treatment strategies are tailored to the underlying cause. In many cases, endoscopic procedures such as polypectomy, hemostasis for bleeding lesions, and dilation of strictures may be performed. For cases with more severe bleeding, conservative treatments like oral or intravenous iron infusion or somatostatin analogues may be used. In certain cases, antiangiogenic therapy may be considered, and surgical intervention may be necessary, particularly for preventing recurrence or addressing more complex cases of LGB as Kim, 2014.[3]

This retrospective study aimed to evaluate the timing between the onset of bleeding and the performance of colonoscopy in a general hospital proctology service, based on the symptoms presented by patients. The study analyzed various factors, including the most common etiologies, the clinical manifestations of LGB, the time between symptom onset and colonoscopy, the number of bleeding episodes, and the age demographics of those affected by LGB. By assessing these parameters, the study aimed to draw insights that could rationalize the indications for colonoscopy and improve clinical decision-making in managing LGB.

Methods

A quantitative exploratory retrospective study of medical records of patients with lower gastrointestinal bleeding was carried out at the Regional Hospital of Mato Grosso do Sul (HRMS), in the period from 2017 to 2022. The project was submitted and approved by the Research Ethics Committee under opinion number 6,266,724, CAAE protocol: 71264023.7.0000.0199 and the ethics committee of HRMS.

The sample consisted of medical records of patients diagnosed with lower gastrointestinal bleeding at the Regional Hospital of Mato Grosso do Sul from 2017 to 2022. All medical records whose data were incomplete and did not meet the criteria investigated were excluded from the research.

The materials used as a source for collecting data from individuals were medical records, which are archived under the responsibility of the hospital's Medical Archive Service. For the research, we used the names of lower digestive hemorrhage classified according to the International Classification of Diseases (ICD - K92.2), and melena (ICD-K92.1). From the grouping of words, the hospital's computerized archive system produced a list of medical records, which was considered the population of the present study. The variables analyzed include sex, age, etiology of LGB, associated comorbidities, clinical manifestations, hemodynamic repercussions, time between the onset of bleeding and the performance of the colonoscopy, number of bleeding episodes and the performance of the colonoscopy, and demographic data.

The comparison between patients with different types of bleeding, about the hemoglobin level at admission, was performed using the one-way ANOVA test, followed by Tukey's post-test. The evaluation of the association between the type of bleeding or the result of the colonoscopy, with the variables hemoglobin level at admission and patient outcome, was performed using the chi-square test. The same test was also used to evaluate the association between the variables race, age group, and sex of the patients. The other results of this study were presented in the form of descriptive statistics or the form of tables and graphs. The statistical analysis was performed using the statistical program SPSS, version 23.0, considering a significant level of 5%.

Results

The characterization of patients with lower gastrointestinal bleeding (LGB) assessed in this study, according to the variables year of service, management, length of hospital stays, Oakland score, age range, sex, and race, is presented in [Table 1]. Of the 303 patients evaluated in this study, most were attended between the years 2018 and 2019 (63.4% - n = 192), with hospitalization as the main management approach (99.3% - n = 301). The average length of hospital stay was 10.61 ± 0.70 days (mean ± standard error), and the average Oakland score was 20.28 ± 0.57 points. Most of the patients were over 60 years old (55.1% - n = 167), male (59.4% - n = 180), and identified as mixed race (53.5% - n = 162).

Table 1 Characterization of patients with lower gastrointestinal bleeding (LGB) assessed in this study, according to the variables: time of service, management, length of hospitalization, Oakland score, age group, sex, and race

Variable	% (n) or Mean ± EPM
Time of service
2017	6.3 (19)
2018	24.8 (75)
2019	38.6 (117)
2020	5.9 (18)
2021	13.5 (41)
2022	10.9 (33)
Conduct
Hospitalization	99.3 (301)
Outpatient care	0.7 (2)
(days)	10.61 ± 0.70
Oakland Score	20.28 ± 0.57
Age group (years)
Up Until 20	5.9 (18)
Between 21 e 60	38.9 (118)
More than 60	55.1 (167)
Sex
Masculine	59.4 (180)
Feminine	40.6 (123)
Race
Mixed-race	53.5 (162)
White	42.6 (129)
Black	2.0 (6)
Asians	1.3 (4)
No Information	0.7 (2)

SEM, Standard error of the mean.

[Table 2] presents the characterization of patients with lower gastrointestinal bleeding (LGB) evaluated in this study, according to the variables previous LGB, systolic blood pressure and heart rate on admission, time between admission and colonoscopy, presence of blood on digital rectal examination, performance of arteriography or angiotomography, and the need for packed red blood cells. Most patients had no history of previous lower gastrointestinal bleeding (64.7% - n = 196).

Table 2 Characterization of patients with lower gastrointestinal bleeding (LGB) assessed in this study, according to the variables: previous LGB, systolic blood pressure and heart rate at admission, time between admission and colonoscopy, rectal blood on examination, arteriography or angiography, and need for red blood cell concentrate

Variable	% (n) or
	Mean ± EPM
Previous lower gastrointestinal bleeding
No	64.7 (196)
Yes	34.7 (105)
No information	0.7 (2)
Systolic blood pressure at admission (mmHg)	91.24 ± 1.32
Heart rate at admission (bpm)	129.61 ± 1.93
Time between admission and colonoscopy (days)	2.09 ± 0.15
Rectal blood on examination
No	28.1 (85)
Yes	34.7 (105)
No information/Not performed	37.3 (113)
Hemoglobin at admission (mg/dl)	8.92 ± 0.17
Less than 8	39.9 (121)
Between 8 and 10	25.7 (78)
More than 10	33.0 (100)
No Information	1.3 (4)
Arteriography/Angiotomography
No	99.3 (301)
Yes	0.7 (2)
Need for red blood cell concentrate
No	60.1 (182)
Yes	39.9 (121)

SMP, Standard Mean Pattern.

The average systolic blood pressure was 91.24 ± 1.32 mmHg, the average heart rate was 129.61 ± 1.93 beats per minute, and the average time between patient admission and colonoscopy was 2.09 ± 0.15 days. Among the 303 patients evaluated, 105 of them had blood on digital rectal examination. The mean hemoglobin level on admission was 8.92 ± 0.17 mg/dL, with 39.9% of patients (n = 121) presenting hemoglobin levels below 8 mg/dL. Most patients had not undergone arteriography or angiotomography (99.3% - n = 301), and the majority also did not require the use of packed red blood cells (60.1% - n = 182). The characterization of patients with lower gastrointestinal bleeding assessed in this study, according to colonoscopy results, endoscopy results, type of bleeding, and outcomes, is presented in [Table 3].

Table 3 Characterization of patients with lower gastrointestinal bleeding (LGB) assessed in this study, according to colonoscopy results, endoscopy results, type of bleeding, and outcomes

Variable	% (n)
Colonoscopy
Normal	11.6 (35)
Diverticular Disease	39.6 (120)
Polyps	8.9 (27)
Angiodysplasia	7.9 (24)
Neoplasia	6.9 (21)
Colitis	6.9 (21)
Hemorrhoids	4.3 (13)
Crohn's disease	0.7 (2)
Ulcer	0.7 (2)
Fistula	0.3 (1)
Fecaloma	0.3 (1)
No information/Not performed/Not concluded	12.2 (37)
Endoscopy
Normal	31.0 (94)
Altered, but without bleeding	38.9 (118)
Altered, but with bleeding	8.3 (25)
Not performed/No information/Not Concluded	21.1 (64)
Type of bleeding
Enterorragy	47.5 (144)
Melena	37.0 (112)
Hematochezia	19.8 (60)
Hematemeseis	1.7 (5)
Outcome
Discharge	91.1 (276)
Death	8.9 (27)

Only 11.6% (n = 35) of the patients had normal colonoscopy results. The most frequent findings on colonoscopy were diverticular disease (39.6% - n = 120), polyps (8.9% - n = 27), angiodysplasia (7.9% - n = 24), neoplasia (6.9% - n = 21), and colitis (6.9% - n = 21). In endoscopy, 31.0% of patients (n = 94), there were no alterations, while 38.9% of them (n = 118) presented alterations but without bleeding, and only 8.3% (n = 25) had alterations with bleeding.

The most frequently observed types of bleeding in patients were enterorrhagia (47.5% - n = 144) and melena (37.0% - n = 112). In terms of outcomes, 8.9% (n = 27) died, while the remaining 91.1% (n = 276) were discharged.

There was a significant difference between patients with different types of bleeding regarding hemoglobin levels on admission (one-way ANOVA test, p = 0.009), with levels being lower among those with melena compared to those with enterorrhagia or hematochezia (Tukey post-test, p < 0.05), presented in [Table 4].

Table 4 Results of the comparison between patients with different types of bleeding, in relation to the hemoglobin rate on admission

Type of bleeding	Hemoglobin on admission (mg/dl)
Enterorragy	9.28 ± 0.24a
Melena	8.22 ± 0.27b
Hematochezia	9.54 ± 0.36a
Hematemesis	9.12 ± 1.66ab
P Value	0.009

Results are presented as mean ± standard error of the mean. p-value in one-way ANOVA test. Different letters in the column indicate significant difference between patients with different types of bleeding (Tukey post-test, p < 0.05).

[Table 5] presents the results of the evaluation of the association between types of bleeding and the variables hemoglobin level on admission and patient outcome, with both variables being associated with type of bleeding (chi-square test, Hb: p = 0.034; outcome: p = 0.042). The percentage of patients with melena who had hemoglobin levels below 8 (50.5% - n = 56) was higher than among those with enterorrhagia (36.2% - n = 51) and hematochezia (31.7% - n = 19). On the other hand, the percentage of patients with enterorrhagia and hematochezia with hemoglobin levels above 10 (40.4% - n = 57; 41.7% - n = 25, respectively) was higher than that among patients with melena with hemoglobin levels above 10 (21.6% - n = 24). Regarding patient outcomes, the percentage of deaths among patients with enterorrhagia (25.0% - n = 11) was higher than that among patients with melena and hematochezia (10.7% - n = 12; 8.3% - n = 5, respectively).

Table 5 Results of the assessment of the association between the type of bleeding and the variables hemoglobin level at admission and patient outcome

	Type of bleeding				p-value
	Enterorragy	Melena	Hematochezia	hematemesis
input hemoglobin (mg/dl)
<8	36.2 (51)b	50.5 (56)a	31.7 (19)b	60.0 (3)ab	0.034
8 a 10	23.4 (33)a	27.9 (31)a	26.7 (16)a	20.0 (1)a
>10	40.4 (57)a	21.6 (24)b	41.7 (25)a	20.0 (1)ab
outcome
discharge	75.0 (33)b	89.3 (100)a	91.7 (55)a	100.0 (5)ab	0.042
death	25.0 (11)a	10.7 (12)b	8.3 (5)b	0.0 (0)ab

Results are presented as relative frequency (absolute frequency). P-value in chi- square test. Different letters in the row indicate significant difference between patients with different colonoscopy results (chi-square test, p < 0.05).

The results of the evaluation of the association between colonoscopy results and the variables of bleeding and patient outcome are presented in [Table 6], with no association between colonoscopy results and type of bleeding (chi-square test, p = 0.841). However, there was an association between colonoscopy results and patient outcomes (p = 0.009), with the percentage of deaths among patients with colitis (23.8% - n = 5) being higher than among patients with diverticular disease (4.2% - n = 5).

Table 6 Results of the assessment of the association between the result of colonoscopy and the variables type of bleeding and patient outcome

	Colonoscopy result					p-value
	Diverticular Disease	Polyps	Angiodys plasia	Neoplasia	Colitis
Type of bleeding
Enterorragy	51.3 (61)	51.9 (14)	39.1 (9)	38.1 (8)	52.4 (11)	0.841
Melena	35.3 (42)	44.4 (12)	43.5 (10)	33.3 (7)	23.8 (5)
Hematochezia	16.0 (19)	18.5 (5)	17.4 (4)	33.3 (7)	28.6 (6)
hematemesis	0.8 (1)	0.0 (0)	0.0 (0)	0.0 (0)	0.0 (0)
outcome
discharge	95.8 (115)a	96.3 (26)ab	87.5 (21)ab	81.0 (17)ab	76.2 (16)b	0.009
death	4.2 (5)b	3.7 (1)ab	12.5 (3)ab	19.0 (4)ab	23.8 (5)a

Results are presented as relative frequency (absolute frequency). P-value in chi- square test. Different letters in the row indicate significant difference between patients with different colonoscopy results (chi-square test, p < 0.05).

[Table 7] presents the results of the evaluation of the association between patient race and the variables age range and sex, with a significant association between race and age range (chi-square test, p = 0.047). The percentage of black patients aged 21-60 (83.3% - n = 5) was significantly higher than that among white patients in the same age range (32.6% - n = 42). Conversely, the percentage of white patients over 60 years old (63.6% - n = 82) was higher than that of mixed-race patients also over 60 years old (48.8% - n = 79).

Table 7 Results of the assessment of the association between the race of patients and the variables of age group and sex

Variable	Race				p-value
	yellow	white	mixed	black
Age
Until 20	0.0 (0)a	3.9 (5)a	8.0 (13)a	0.0 (0)a	0.047
between 21–60	25.0 (1)ab	32.6 (42)b	43.2 (70)ab	83.3 (5)a
Plus 60	75.0 (3)ab	63.6 (82)a	48.8 (79)b	16.7 (1)ab
Sex
Feminine	50.0 (2)	44.2 (57)	37.7 (61)	50.0 (3)	0.654
Masculine	50.0 (2)	55.8 (72)	62.3 (101)	50.0 (3)

The results are presented in relative frequency (absolute frequency). P-value in the chi-square test.

There was no association between patient race and sex (chi-square test, p = 0.654). There was a significant association between patient sex and age range (chi-square test, p = 0.023), with the percentage of men aged 21-60 (45.0% - n = 81) being higher than that of women in the same age range (30.1% - n = 37), presented in [Table 8].

Table 8 Results of the assessment of the association between the sex of patients and their age group

Age	Gender		p- value
	Feminine	Masculine
Until 20	8.1 (10)a	4.4 (8)a	0.023
Between 21–60	30.1 (37)b	45.0 (81)a
Plus 60	61.8 (76)a	50.6 (91)a

The results are presented in relative frequency (absolute frequency). P-value in the chi-square test.

Discussion

The findings of the present research provide significant insights into lower gastrointestinal bleeding, enriching our understanding of both the demographic and clinical aspects of this condition in Mato Grosso do Sul.

The prevalence of enterorrhagia as the most common type of gastrointestinal bleeding, as observed in this study, with 47.5% prevalence, is in line with findings in previous studies that also identified this type of bleeding as predominant in patients with lower gastrointestinal bleeding, ranging from 40-50% as American Society for Gastrointestinal Endoscopy, 2021.[5] This suggests a consistency in the clinical presentation patterns of this condition in different contexts and study populations.

Unlike the second most common form of presentation, melena (37.0%), usually found in bleeding related to the upper gastrointestinal tract, according to Mayo Clinic, is uncommon in LGB. In large studies, the form of presentation is usually hematochezia, with a prevalence of 20%. In the present article, this bleeding has a prevalence of 19.8%, coming in as the third most common type. A comprehensive study carried out by Strate et al., 2013[6] indicated that hematochezia was present in approximately 15-20% of cases of LGB. This study analyzed a large cohort of patients with lower gastrointestinal bleeding highlighted the importance of colonoscopy as a diagnostic tool to identify the source of bleeding, often related to conditions such as diverticulosis and angiodysplasia.

The incidence of lower gastrointestinal tract bleeding increases with age, making the elderly especially vulnerable to its complications. This population faces not only a higher risk of gastrointestinal bleeding but may also have comorbidities that increase the complexity of treatment and influence the clinical outcome as Furtado, 2023.[7] This is consistent with the results found in our research, with more than 55% of patients being over 60 years old, which 59,4% are male. The prevalence of LGB in men may be linked to factors such as a higher incidence of predisposing conditions, such as diverticulosis and angiodysplasia, both associated with aging. The literature suggests that the likelihood of hospitalization for LGB is higher in men due to the greater presence of these conditions in the male population, Walter Bushnell Healthcare Foundation, 2024.[8]

Regarding the analysis of previous bleeding history, this study highlights the importance of assessing the risk of recurrence of these events as an integral part of clinical management, since 64.7% of patients present it. Previous studies have shown that the presence of previous lower gastrointestinal bleeding is a significant risk factor for recurrent bleeding, with recurrence rates ranging from 10% to 40% as Gralnek; Neeman; Strate, 2017.[9] Therefore, identifying patients with a history of previous bleeding may allow early intervention and more intensive surveillance, aiming to reduce the risk of recurrent bleeding events and improve long-term outcomes.

The findings regarding hemoglobin levels at admission and the importance of colonoscopy and endoscopy exams in the diagnosis and management of gastrointestinal hemorrhage are consistent with several studies published in the literature. Studies such as that by Coelho et al. 2014[10] highlight the relationship between hemoglobin levels and the severity of gastrointestinal hemorrhage, emphasizing the importance of evaluating these parameters at patient admission. In addition, research by Passos, Chaves, and Chaves-Junior, 2018[11] emphasizes the fundamental role of colonoscopy and endoscopy in identifying underlying diseases, such as diverticular disease and rectal neoplasms, in patients with gastrointestinal hemorrhage.

Regarding the need for packed red blood cell transfusion, studies such as that of Coelho et al., 2014[10] corroborate the results of this study, showing that most patients with acute gastrointestinal hemorrhage require blood transfusions to correct acute anemia and stabilize hemoglobin levels. However, it is important to consider the limitations of the current study, such as the retrospective nature of the data and the potential selection bias, as discussed by Clerc D, 2017[12] in their critical review of methodological approaches in clinical studies of gastrointestinal hemorrhage.

Colonoscopy plays a fundamental role in the diagnostic investigation of lower gastrointestinal bleeding (LGB), providing crucial information about the origin and cause of bleeding. According to a study by OAKLAND, K. et al. 2017[13], “colonoscopy is considered the gold standard method for identifying the source of bleeding in patients with LGB, allowing direct visualization of the colon and rectum, as well as the performance of therapeutic interventions.” This ability of colonoscopy to provide a direct and accurate assessment of the lower gastrointestinal tract is essential for the appropriate diagnosis and treatment of LGB. In a systematic review conducted by Silva et al., 2020,[4] it was observed that “the most common findings on colonoscopy in patients with LGB include lesions such as bleeding diverticula, angiodysplasias, ischemic colitis, and bloody polyps.” The study by Strate et al., 2013,[6] in a large cohort study in the United States, found that diverticular disease was responsible for approximately 30-50% of LGB cases. Their study highlighted diverticular disease as the most common cause of significant colonic bleeding and reinforces the high frequency of this condition as an etiology of LGB. This also reinforces the high findings found in this study, with 39.6% of patients being diagnosed with diverticular disease.

However, in relation to angiodysplasia, this study presented a prevalence of 7.9%, a much lower percentage than those observed in other studies, such as a study carried out by Sami et al. 2014[14] evaluated the prevalence of vascular lesions in patients with gastrointestinal bleeding and found that angiodysplasia represented approximately 20% of LGB cases in a general population of adults.

Early colonoscopy proved to be an important factor for quickly assessing the bleeding source, allowing for more effective interventions. Other clinical factors, such as blood pressure and heart rate, were also helpful in assessing the severity of the condition. The presence of comorbidities, use of medications like NSAIDs and aspirin, and advanced age should be considered in the management of these patients. These findings emphasize the importance of combining clinical factors, early diagnostic exams, and an individualized approach for treating LGB, as Bounds & Kelsey, 2007.[15]

The findings of this study provide relevant contributions to the understanding of lower gastrointestinal bleeding in Mato Grosso do Sul, especially about demographic and clinical aspects. Enterorrhagia was the most common type of bleeding observed, with a prevalence of 47.5%, which agrees with previous studies that indicate an occurrence rate between 40-50%, according to the American Society for Gastrointestinal Endoscopy, 2021.[5] This similarity in percentages suggests consistency in the clinical patterns of lower gastrointestinal bleeding, reinforcing enterorrhagia as one of the most frequent manifestations of this condition.

In addition, the observed prevalence of enterorrhagia as the main clinical manifestation points to the need for continuous surveillance of this symptom in patients with suspected lower gastrointestinal bleeding. The presence of enterorrhagia in a high percentage of cases reinforces its role as a relevant clinical marker, being essential for the early diagnosis and effective management of LGB. Thus, screening and diagnostic practices that prioritize the detection of enterorrhagia can contribute to a more targeted and effective clinical approach.

The results of this research, when aligned with data from previous studies, indicate that the patterns of presentation of LGB in Mato Grosso do Sul follow a trend observed in other regions and population contexts. This reinforces the importance of regional studies, which complement and validate findings from international literature, while providing specific data for public health strategies and local clinical approaches. Thus, the research contributes to a more solid base of knowledge and clinical practices on LGB, with the potential to improve patient care in this region.

Conclusions

In conclusion, Lower Gastrointestinal Bleeding (LGB) was more prevalent in elderly males, with enterorrhagia as the most common manifestation and diverticular disease as the primary cause. Enterorrhagia was associated with higher hemoglobin levels compared to melena, which was linked to more severe blood loss and worse outcomes, including higher mortality. While most patients were discharged, those with enterorrhagia had a higher death rate, emphasizing the need for careful monitoring and prompt intervention. Colonoscopy results did not correlate with bleeding type but were associated with outcomes, particularly in colitis cases. Demographic analysis showed racial differences, with more black patients under 60 compared to white patients.

Conflict of Interest

None declared.

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Publication History

Received: 16 November 2024

Accepted: 05 February 2025

Article published online:
22 April 2025