What are the common causes of blood in stool. How to identify the symptoms of gastrointestinal bleeding. When should you seek medical attention for bloody stools. What are the treatment options for blood in stool. How can you prevent gastrointestinal bleeding at home.

Understanding Gastrointestinal Bleeding: A Comprehensive Guide

Gastrointestinal bleeding, often manifesting as blood in stool, is a concerning symptom that can indicate various underlying health issues. This comprehensive guide delves into the causes, symptoms, and treatment options for this condition, providing valuable insights for those experiencing or seeking to understand this medical concern.

Common Causes of Blood in Stool: From Hemorrhoids to Colorectal Cancer

Blood in stool can be caused by a range of conditions, varying from minor issues to more serious medical problems. Here are some of the most common causes:

• Hemorrhoids: Swollen blood vessels in the rectum or anus
• Anal fissures: Small tears in the lining of the anus
• Peptic ulcers: Sores in the lining of the stomach or small intestine
• Inflammatory bowel disease (IBD): Including Crohn’s disease and ulcerative colitis
• Diverticular disease: Small pouches that form in the colon wall
• Polyps: Abnormal tissue growths in the colon or rectum
• Colorectal cancer: Malignant tumors in the colon or rectum

Are certain foods linked to gastrointestinal bleeding? Some spicy or acidic foods may irritate the digestive tract and exacerbate existing conditions, potentially leading to bleeding. However, food itself is rarely the primary cause of significant gastrointestinal bleeding.

Identifying Symptoms: Beyond Blood in Stool

While blood in stool is the primary symptom of gastrointestinal bleeding, it’s often accompanied by other signs that can help identify the severity and location of the bleeding. These symptoms may include:

1. Abdominal pain or cramping
2. Changes in bowel habits
3. Fatigue or weakness
4. Shortness of breath
5. Pale skin
6. Dizziness or fainting
7. Nausea or vomiting (especially if the vomit contains blood)

Is the color of blood in stool significant? The color can indeed provide clues about the source of bleeding. Bright red blood typically indicates bleeding in the lower gastrointestinal tract, while dark, tarry stools (melena) suggest bleeding in the upper GI tract.

Diagnostic Procedures: Pinpointing the Source of Bleeding

Accurate diagnosis is crucial for effective treatment of gastrointestinal bleeding. Healthcare providers may use various diagnostic procedures to identify the source and severity of the bleeding:

• Colonoscopy: Examination of the entire colon using a flexible, lighted tube
• Endoscopy: Similar to colonoscopy, but used to examine the upper GI tract
• Capsule endoscopy: A swallowed camera pill that takes images of the digestive tract
• CT scan or MRI: Imaging tests to visualize the digestive organs
• Stool tests: To check for occult (hidden) blood or other abnormalities
• Blood tests: To assess blood count, clotting factors, and other indicators

How long does it take to diagnose the cause of blood in stool? The time frame can vary depending on the complexity of the case and the required tests. Some causes may be identified quickly through a physical exam and basic tests, while others may require more extensive investigation.

Treatment Options: From Lifestyle Changes to Surgery

Treatment for gastrointestinal bleeding depends on the underlying cause and severity of the condition. Options may include:

1. Medications: To treat infections, reduce inflammation, or manage underlying conditions
2. Endoscopic treatments: Such as cauterization or injection of medications to stop bleeding
3. Lifestyle changes: Including dietary modifications and increased fiber intake
4. Surgery: For severe cases or conditions that don’t respond to other treatments
5. Blood transfusions: In cases of significant blood loss

Can gastrointestinal bleeding resolve on its own? Minor cases, such as those caused by hemorrhoids or anal fissures, may improve with home care and lifestyle changes. However, it’s crucial to consult a healthcare provider to rule out more serious conditions.

Lifestyle Modifications for Managing Gastrointestinal Health

Implementing certain lifestyle changes can help manage and prevent gastrointestinal bleeding:

• Increasing fiber intake to promote regular bowel movements
• Staying hydrated to soften stools and prevent constipation
• Exercising regularly to improve overall digestive health
• Managing stress through relaxation techniques or counseling
• Avoiding irritants such as alcohol, caffeine, and spicy foods
• Quitting smoking to reduce the risk of various gastrointestinal conditions

How much fiber should one consume daily for optimal digestive health? The recommended daily intake is about 25 to 30 grams for adults. This can be achieved through a diet rich in fruits, vegetables, whole grains, and legumes.

When to Seek Medical Attention: Recognizing Urgent Symptoms

While some cases of blood in stool may be minor, certain symptoms warrant immediate medical attention:

• Large amounts of blood in stool or on toilet paper
• Black, tarry stools
• Severe abdominal pain
• Fever above 101°F (38.3°C)
• Dizziness, fainting, or rapid heartbeat
• Persistent bleeding lasting more than a few days

Should you go to the emergency room for blood in stool? If you experience severe symptoms or significant blood loss, it’s advisable to seek emergency care. For less urgent cases, scheduling an appointment with your primary care physician is appropriate.

Prevention Strategies: Minimizing the Risk of Gastrointestinal Bleeding

While not all cases of gastrointestinal bleeding can be prevented, certain strategies can help reduce the risk:

1. Maintain a healthy diet rich in fiber and low in processed foods
2. Stay hydrated by drinking plenty of water throughout the day
3. Exercise regularly to promote overall digestive health
4. Manage stress through relaxation techniques or counseling
5. Avoid excessive use of NSAIDs (non-steroidal anti-inflammatory drugs)
6. Limit alcohol consumption and quit smoking
7. Attend regular check-ups and screenings, especially if you have a family history of gastrointestinal disorders

Do probiotics help prevent gastrointestinal bleeding? While probiotics can support overall gut health, there’s limited evidence suggesting they directly prevent gastrointestinal bleeding. However, maintaining a healthy gut microbiome may reduce the risk of certain conditions that can lead to bleeding.

The Role of Diet in Gastrointestinal Health

A balanced diet plays a crucial role in maintaining gastrointestinal health and potentially reducing the risk of bleeding. Consider incorporating these elements into your diet:

• High-fiber foods: Whole grains, legumes, fruits, and vegetables
• Probiotic-rich foods: Yogurt, kefir, sauerkraut, and other fermented foods
• Omega-3 fatty acids: Found in fish, flaxseeds, and walnuts
• Antioxidant-rich foods: Berries, leafy greens, and colorful vegetables
• Lean proteins: Chicken, fish, tofu, and legumes

Can a vegetarian or vegan diet help prevent gastrointestinal bleeding? While these diets can be healthy when well-planned, there’s no definitive evidence that they specifically prevent gastrointestinal bleeding. However, plant-based diets are often high in fiber, which can promote overall digestive health.

Understanding the Impact: Long-term Effects of Gastrointestinal Bleeding

Chronic or recurrent gastrointestinal bleeding can have significant long-term effects on an individual’s health. These may include:

1. Anemia: Due to chronic blood loss
2. Malnutrition: If bleeding interferes with nutrient absorption
3. Increased risk of infections: Due to weakened immune system
4. Psychological impact: Stress and anxiety related to the condition
5. Complications from underlying conditions: If left untreated

Is it possible to fully recover from chronic gastrointestinal bleeding? With proper treatment and management of the underlying cause, many individuals can achieve remission or significant improvement in their condition. However, ongoing medical care and lifestyle adjustments may be necessary.

Psychological Support for Individuals with Chronic Gastrointestinal Issues

Living with chronic gastrointestinal bleeding or related conditions can take a toll on mental health. Consider these strategies for psychological support:

• Joining support groups for individuals with similar conditions
• Seeking counseling or therapy to manage stress and anxiety
• Practicing mindfulness and relaxation techniques
• Maintaining open communication with healthcare providers about mental health concerns
• Educating family and friends about the condition to foster understanding and support

How does chronic gastrointestinal bleeding affect quality of life? It can significantly impact daily activities, work performance, and social interactions. However, with proper management and support, many individuals can maintain a good quality of life despite their condition.

Emerging Research: New Frontiers in Gastrointestinal Bleeding Treatment

Medical research continues to advance our understanding and treatment of gastrointestinal bleeding. Some promising areas of research include:

1. Novel endoscopic techniques for more precise diagnosis and treatment
2. Gene therapy for hereditary conditions that can cause gastrointestinal bleeding
3. Improved biologic therapies for inflammatory bowel diseases
4. Advanced imaging technologies for early detection of gastrointestinal abnormalities
5. Personalized medicine approaches based on individual genetic profiles

Are there any new medications on the horizon for treating gastrointestinal bleeding? While specific medications are still in development, researchers are exploring new classes of drugs that target the underlying mechanisms of gastrointestinal inflammation and bleeding.

The Role of Artificial Intelligence in Gastrointestinal Diagnostics

Artificial intelligence (AI) is increasingly being utilized in the field of gastroenterology, offering potential improvements in diagnosis and treatment planning:

• AI-assisted endoscopy for more accurate detection of abnormalities
• Machine learning algorithms to predict disease progression and treatment outcomes
• Automated analysis of medical imaging to support radiologists
• Natural language processing to extract relevant information from medical records
• AI-powered decision support systems for healthcare providers

How accurate is AI in diagnosing gastrointestinal conditions? While AI shows promising results in research settings, it’s currently used as a supportive tool rather than a replacement for human expertise. Ongoing studies aim to further validate and improve AI applications in gastroenterology.

Blood in stool in adults

About this Symptom Checker

Blood in stool in adults

Find possible causes of blood in stool based on specific factors. Check one or more factors on this page that apply to your symptom.

Blood appears

• 
  In or on the stool




• 
  In toilet bowl or on toilet tissue

Triggered or worsened by

• 
  Drinking alcohol or caffeine




• 
  Eating certain foods

• 
  Straining during bowel movements

Relieved by

• 
  Drinking more water




• 
  Eating certain foods

• 
  Eating more fiber

Accompanied by

• 
  Abdominal pain or cramping




• 
  Anal itching




• 
  Change in bowel habits that lasts longer than four weeks




• 
  Change in your bowel habits




• 
  Constipation




• 
  Diarrhea




• 
  Fatigue or weakness




• 
  Fever

• 
  Frequent urge to have bowel movement




• 
  Narrow stools




• 
  Nausea or vomiting




• 
  Painful bowel movements




• 
  Persistent abdominal discomfort, such as cramps, gas or pain




• 
  Rectal pain




• 
  Unintended weight loss

1. Walls RM, et al. , eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 30, 2017.
2. Palmer J, et al. Abdominal pain mimics. Emergency Medicine Clinics of North America. 2016;34:409.
3. UpToDate. https://www.uptodate.com/contents/search. Accessed Oct. 30, 2017.
4. Zeiter D. Abdominal pain in children. Pediatric Clinics of North America. 2017;64:525.
5. Palmer J, et al. Abdominal pain mimics. Emergency Medicine Clinics of North America. 2016;34:409.
6. Feldman M, et al. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed Oct. 30, 2017.
7. Merck Manual Professional Version. https://www.merckmanuals.com/professional. Accessed Oct. 30, 2017.
8. AskMayoExpert. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
9. Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Nov. 2, 2017.
10. Zitelli BJ, et al., eds. Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Nov. 11, 2017.
11. Ferri FF. Ferri’s Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Nov. 11, 2017.
12. Muncie HL, et al. Dizziness: Approach to evaluation and management. American Family Physician. 2017;95:154.
13. American College of Emergency Physicians. https://www.acep.org. Accessed Nov. 11, 2017.
14. U.S. Food and Drug Administration. http://www.fda.gov. Accessed Nov. 11, 2017.
15. Schmitt BD. Fever. In: Pediatric Telephone Protocols: Office Version 15th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2015.
16. Mannenbach MS (expert opinion). Mayo Clinic, Rochester, Minn. June 14, 2017.
17. Goyal DG (expert opinion). Mayo Clinic, Rochester, Minn. June 14, 2017.
18. Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 28, 2017.
19. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org. Accessed Nov. 20, 2017.
20. Petty RE, et al., eds. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Nov. 20, 2017.
21. Elsevier Point of Care. https://www.clinicalkey.com.  Accessed Nov. 20, 2017.
22. Kasper DL, et al., eds. Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed Nov. 20, 2017.
23. Wein AJ, et al., eds. Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com.. Accessed Dec. 2, 2017.
24. National Eye Institute. https://nei.nih.gov. Accessed Dec. 5, 2017.
25. Wilkinson JM (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 8, 2017.

Advertisement

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

Advertising & Sponsorship

• Policy
• Opportunities
• Ad Choices

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.

• Mayo Clinic on Incontinence – Mayo Clinic PressMayo Clinic on Incontinence
• NEW – Future Care – Mayo Clinic PressNEW – Future Care
• Mayo Clinic on Hearing and Balance – Mayo Clinic PressMayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment – Mayo Clinic PressFREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter – FREE book – Mayo Clinic PressMayo Clinic Health Letter – FREE book

.

ITT-20009075

What causes gastrointestinal bleeding and how serious is it really?

• By

  Dana Sparks

  October 12, 2020

Gastrointestinal (GI) bleeding is a symptom of a disorder in your digestive tract. The blood often appears in stool or vomit but isn’t always visible, though it may cause the stool to look black or tarry. The level of bleeding can range from mild to severe and can be life-threatening.

Sophisticated imaging technology, when needed, can usually locate the cause of the bleeding. Treatment depends on the source of the bleeding.

Symptoms

Signs and symptoms of GI bleeding can be either obvious (overt) or hidden (occult). Signs and symptoms depend on the location of the bleed, which can be anywhere on the GI tract, from where it starts — the mouth — to where it ends — the anus — and the rate of bleeding.

Overt bleeding might show up as:

• Vomiting blood, which might be red or might be dark brown and resemble coffee grounds in texture
• Black, tarry stool
• Rectal bleeding, usually in or with stool

With occult bleeding, you might have:

• Lightheadedness
• Difficulty breathing
• Fainting
• Chest pain
• Abdominal pain

Symptoms of shock

If your bleeding starts abruptly and progresses rapidly, you could go into shock. Signs and symptoms of shock include:

• Drop in blood pressure
• Not urinating or urinating infrequently, in small amounts
• Rapid pulse
• Unconsciousness

When to see a health care provider

If you have symptoms of shock, you or someone else should call 911 or your local emergency medical number. If you’re vomiting blood, see blood in your stools or have black, tarry stools, seek immediate medical care. For other indications of GI bleeding, make an appointment with your health care provider.

Causes

Gastrointestinal bleeding can occur either in the upper or lower gastrointestinal tract. It can have a number of causes.

Upper GI bleeding

Causes can include:

• Peptic ulcer. This is the most common cause of upper GI bleeding. Peptic ulcers are sores that develop on the lining of the stomach and upper portion of the small intestine. Stomach acid, either from bacteria or use of anti-inflammatory drugs, damages the lining, leading to formation of sores.
• Tears in the lining of the tube that connects your throat to your stomach (esophagus). Known as Mallory-Weiss tears, they can cause a lot of bleeding. These are most common in people who drink alcohol to excess.
• Abnormal, enlarged veins in the esophagus (esophageal varices). This condition occurs most often in people with serious liver disease.
• Esophagitis. This inflammation of the esophagus is most commonly caused by gastroesophageal reflux disease (GERD).

Lower GI bleeding

Causes can include:

• Diverticular disease. This involves the development of small, bulging pouches in the digestive tract (diverticulosis). If one or more of the pouches become inflamed or infected, it’s called diverticulitis.
• Inflammatory bowel disease (IBD). This includes ulcerative colitis, which causes inflammation and sores in the colon and rectum, and Crohn’s disease, and inflammation of the lining of the digestive tract.
• Tumors. Noncanerous (benign) or cancerous tumors of the esophagus, stomach, colon or rectum can weaken the lining of the digestive tract and cause bleeding.
• Colon polyps. Small clumps of cells that form on the lining of your colon can cause bleeding. Most are harmless, but some might be cancerous or can become cancerous if not removed.
• Hemorrhoids. These are swollen veins in your anus or lower rectum, similar to varicose veins.
• Anal fissures. These are small tears in the lining of the anus.
• Proctitis. Inflammation of the lining of the rectum can cause rectal bleeding.

Complications

A gastrointestinal bleed can cause:

• Shock
• Anemia
• Death

Prevention

To help prevent a GI bleed:

• Limit your use of nonsteroidal anti-inflammatory drugs.
• Limit your use of alcohol.
• If you smoke, quit.
• If you have GERD, follow your health care provider’s instructions for treating it.

____________________________________

This article is written by Mayo Clinic staff. Find more health and medical information on mayoclinic.org.

Related articles

Mayo Clinic researchers link environmental exposures to liver disease

Mayo Clinic researchers have identified a diverse range of environmental chemicals in human bile in patients with primary sclerosing cholangitis, a rare, chronic liver disease …

By Colette Gallagher • May 23, 2023

Mayo Clinic Minute: How to cope with irritable bowel syndrome

Irritable bowel syndrome (IBS) can significantly disrupt a person’s daily life. Some people suffer in silence because of painful stomach cramps, diarrhea and constipation. These …

By Sonya Goins • April 27, 2023

Treatment of ulcerative colitis (page 8)

Page 8 of 10

Treatment of ulcerative colitis

014

improving the patient’s quality of life.

The results of treatment largely depend not only on the efforts and qualifications of the doctor, but also on the willpower of the patient, who strictly follows medical recommendations. The modern medicines available in the doctor’s arsenal allow many patients to return to normal life.

Complex of therapeutic measures includes:

• diet (diet therapy)
• taking medications (drug therapy)
• surgical intervention (operative treatment)
• lifestyle changes.

Diet therapy. Usually, patients with UC during an exacerbation are recommended a slag-free (with a sharp restriction of fiber) diet, the purpose of which is to mechanically, thermally and chemically spare the inflamed intestinal mucosa. Fiber is limited by exclusion from the diet of fresh vegetables and fruits, legumes, mushrooms, hard, sinewy meat, nuts, seeds, sesame, poppy. With good tolerance, juices without pulp, canned (preferably at home) vegetables and fruits without seeds, ripe bananas are acceptable. Only bakery products and pastries made from refined flour are allowed. With diarrhea, dishes are served warm, wiped, limit foods with a high sugar content. The use of alcohol, spicy, salty foods, dishes with spices is highly undesirable. In case of intolerance to whole milk and lactic acid products, they are also excluded from the patient’s diet.

In severe course of the disease with weight loss, a decrease in the level of protein in the blood, increase the daily amount of protein in the diet, recommending lean meat of animals and birds (beef, veal, chicken, turkey, rabbit), lean fish (perch, pike, pollock ), buckwheat and oatmeal, chicken egg protein. In order to make up for protein losses, artificial nutrition is also prescribed: special nutrient solutions are injected through a vein (more often in a hospital setting) or special nutritional mixtures are administered through the mouth or probe, in which the main food ingredients have been subjected to special processing for their better digestibility (the body does not need to spend its forces to process these substances). Such solutions or mixtures can complement or replace natural nutrition. At present, special nutritional mixtures have already been created for patients with inflammatory bowel diseases, which also contain anti-inflammatory substances.

Non-compliance with the principles of therapeutic nutrition during an exacerbation can lead to an aggravation of clinical symptoms (diarrhea, abdominal pain, the presence of pathological impurities in the stool) and even provoke the development of complications. In addition, it should be remembered that the reaction to various products in different patients is individual. If the deterioration of health after eating any product draws attention, then after consultation with the attending physician, it should also be eliminated from the diet (at least during the period of exacerbation).

Drug therapy is determined by:

• prevalence of colon lesions;
• the severity of UC, the presence of complications of the disease;
• the effectiveness of the previous course of treatment;
• individual patient tolerance to drugs.

Mild to moderate disease can be treated on an outpatient basis. Patients with severe UC require hospitalization. The choice of the necessary medicines by the attending physician is carried out step by step.

In mild to moderate disease, treatment usually begins with 5-aminosalicylates (5-ASA) . These include sulfasalazine and mesalazine. Depending on the extent of the inflammatory process in UC, these drugs are recommended in the form of suppositories, enemas, foams administered through the anus, tablets, or a combination of topical and tablet forms. The drugs reduce inflammation in the colon during a flare-up, are used to maintain remission, and are proven to prevent colon cancer when taken long-term. Side effects often occur while taking sulfasalazine in the form of nausea, headache, increased diarrhea and abdominal pain, and impaired renal function.

If there is no improvement or the disease has a more severe course, then the patient with UC is prescribed hormonal preparations – systemic glucocorticoids (prednisolone, methylprednisolone, dexamethasone). These drugs quickly and effectively cope with the inflammatory process in the intestines. In severe UC, glucocorticoids are administered intravenously. Due to serious side effects (edema, increased blood pressure, osteoporosis, increased blood glucose levels, etc.), they must be taken according to a certain scheme (with a gradual decrease in the daily dose of the drug to a minimum or up to complete withdrawal) under the strict guidance and control of the attending physician. doctor. In some patients, phenomena of steroid refractoriness (lack of response to glucocorticoid treatment) or steroid dependence (resumption of clinical symptoms of exacerbation of UC when trying to reduce the dose or shortly after hormone withdrawal) are noted. It should be noted that during the period of remission, hormonal drugs are not a means of preventing new exacerbations of UC, so one of the goals should be to maintain remission without glucocorticoids.

With the development of steroid dependence or steroid refractoriness, severe or often relapsing course of the disease, the appointment of immunosuppressants (cyclosporine, tacrolimus, methotrexate, azathioprine, 6-mercaptopurine) is indicated. The drugs of this group suppress the activity of the immune system, thereby blocking inflammation. Along with this, affecting the immune system, they reduce the resistance of the human body to various infections, and have a toxic effect on the bone marrow.

Cyclosporine, tacrolimus are fast-acting drugs (results are evident in 1-2 weeks). Their timely use in 40-50% of patients with severe UC avoids surgical treatment (removal of the colon). The drugs are administered intravenously or are prescribed in the form of tablets. However, their use is limited by high cost and significant side effects (convulsions, kidney and liver damage, high blood pressure, gastrointestinal disorders, headache, etc.).

Methotrexate is a drug for intramuscular or subcutaneous administration. Its action unfolds in 8 to 10 weeks. When using methotrexate, one also has to reckon with its high toxicity. The drug is prohibited for use in pregnant women, as it causes malformations and fetal death. The effectiveness of the use in patients with UC is being specified.

Azathioprine, 6-mercaptopurine are slow acting drugs. The effect of their reception develops not earlier than in 2-3 months. Drugs can not only cause, but also maintain remission with prolonged use. In addition, the appointment of azathioprine or 6-mercaptopurine allows you to gradually stop taking hormonal drugs. They have fewer side effects compared to other immunosuppressants, they are well combined with 5-ASA preparations and glucocorticoids. However, due to the fact that thiopurines have a toxic effect on the bone marrow in some patients, patients should definitely perform a clinical blood test to monitor this side effect and take timely therapeutic measures.

At the end of the 20th century, a revolution in the treatment of patients with inflammatory bowel diseases (Crohn’s disease, UC) was the use of fundamentally new drugs – biological (anticytokine) drugs. Biologics are proteins that selectively block certain cytokines, key players in the inflammatory process. This selective action contributes to a faster onset of a positive effect and causes fewer side effects compared to other anti-inflammatory drugs. Currently, active work is underway around the world to create and improve new and existing biological drugs (adalimumab, certolizumab, etc.), and their large-scale clinical trials are being carried out.

In Russia, the only drug of this group, infliximab (trade name Remicade) , has been registered for the treatment of patients with inflammatory bowel diseases (UC and Crohn’s disease). Its mechanism of action is to block the multiple effects of the central pro-inflammatory (inflammation-supporting) cytokine, tumor necrosis factor-α. First, in 1998, the drug was licensed in the US and Europe as a reserve drug for the treatment of refractory and fistulous forms of Crohn’s disease. In October 2005, based on the accumulated experience of high clinical efficacy and safety of the use of infliximab in the treatment of patients with UC, a round table devoted to the development of new standards for the treatment of UC and CD in the EU and the USA decided to include infliximab and UC in the list of indications for treatment with infliximab and UC. Since April 2006, infliximab (Remicade) has been recommended for the treatment of patients with severe ulcerative colitis in Russia as well.

Infliximab has become a real breakthrough in modern medicine and is considered the “gold standard”, with which most of the new drugs (adalimumab, certolizumab, etc.) currently under clinical trials are compared.

For UC, infliximab (Remicade) is prescribed:

• for patients who have failed traditional therapy (hormones, immunosuppressants)
• patients dependent on hormonal drugs (cancellation of prednisolone is not possible without the resumption of exacerbation of UC)
• patients with moderate to severe disease accompanied by damage to other organs (extraintestinal manifestations of UC)
• patients who would otherwise require surgical treatment
• patients in whom successful treatment with infliximab caused remission (to maintain it).

Infliximab is given as an intravenous infusion in a treatment room or anticytokine therapy center. Side effects are rare and include fever, joint or muscle pain, and nausea.

Infliximab is faster than prednisolone in terms of symptom relief. So, some patients already feel better within the first 24 hours after the administration of the drug. Abdominal pain, diarrhea, bleeding from the anus are reduced. There is a restoration of physical activity, appetite increases. For some patients, for the first time, hormone withdrawal becomes possible, for others, saving the colon from surgical removal. Due to the positive effect of infliximab on the course of severe forms of UC, the risk of complications and deaths is reduced.

This drug is not only indicated to achieve remission of UC, but can also be administered as an intravenous infusion over a long period of time as maintenance therapy.

Infliximab (Remicade) is currently one of the best studied drugs with an optimal benefit/risk profile. Infliximab (Remicade) is even approved for use in children over 6 years of age.

However, biologics are not without side effects. By suppressing the activity of the immune system, as well as other immunosuppressants, they can lead to an increase in infectious processes, in particular tuberculosis. Therefore, before prescribing infliximab, patients should undergo chest x-ray and other studies for the timely diagnosis of tuberculosis (for example, the quantiferon test is the “gold standard” for detecting latent tuberculosis abroad).

A patient treated with infliximab, as with any new agent, should be monitored closely by their physician or anticytokine specialist.

Prior to the first infliximab (Remicade) infusion, patients undergo the following tests:

• chest X-ray
• Mantoux skin test
• blood test.

Chest x-ray and Mantoux skin test are done to rule out latent TB. A blood test is necessary to assess the general condition of the patient and rule out liver disease. If an active severe infection (eg, sepsis) is suspected, other investigations may be required.

Infliximab (Remicade) is injected directly into a vein, by drip, as an intravenous infusion, slowly. The procedure takes approximately 2 hours and requires constant monitoring by medical personnel.

The standard recommended single dose dose of infliximab in patients with UC is 5 mg/kg body weight.

An example of calculating the single dose of infliximab required for a single infusion. For a patient weighing 60 kg, a single dose of infliximab is: 5 mg x 60 kg = 300 mg (3 x 100 mg Remicade vials).

Infliximab (Remicade), in addition to therapeutic efficacy, provides patients with a sparing regimen of therapy. In the first 1.5 months at the initial, so-called induction stage of therapy, the drug is administered intravenously only 3 times with a gradually increasing interval between subsequent injections carried out under the supervision of a doctor. At the end of the induction period, the doctor evaluates the effectiveness of treatment in this patient and, if there is a positive effect, recommends continuing therapy with infliximab (Remicade), usually according to the scheme once every 2 months (or every 8 weeks). It is possible to adjust the dose and mode of administration of the drug, depending on the individual course of the disease in a particular patient. Infliximab is recommended to be used throughout the year, and if necessary, longer.

The future in the treatment of inflammatory bowel disease (UC and Crohn’s disease) looks very promising. The fact that infliximab (Remicade) is included in the public assistance scheme for patients with UC and Crohn’s disease means that more patients can access the most modern treatment.

If conservative (drug) therapy fails, the issue of the need for surgical intervention is decided.

• Back

• Forward

Nonspecific ulcerative colitis, symptoms – Clinic Zdorovye 365 Yekaterinburg

Nonspecific ulcerative colitis (NUC) is an inflammatory bowel disease (IBD) that, like Crohn’s disease, causes chronic inflammation of the digestive tract. The symptoms of non-specific ulcerative colitis are primarily abdominal pain and diarrhea. In addition, in severe ulcerative colitis, the patient may have fever, tachycardia (rapid heartbeat), as well as weight loss and malnutrition. Sometimes NUC leads to life-threatening complications.

The pathological process in ulcerative colitis usually affects only the mucous membrane of the large intestine. Unlike UC, in Crohn’s disease the affected area can be anywhere in the digestive tract and often spreads gradually into the deeper layers of the intestinal wall.

There is currently no known cure for ulcerative colitis, but available therapies can significantly reduce symptoms and even lead to long-term remission.

The large intestine consists of the caecum, colon and rectum. The colon is made up of four sections: the ascending colon, the transverse colon, the descending colon, and the sigmoid colon.

1 – caecum

2 – ascending colon

3 – transverse colon

4 – descending colon

5 – sigmoid colon

6 – rectum

Symptoms of ulcerative colitis 06 depend on the severity of inflammation of the intestinal wall and its localization.

Classification of ulcerative colitis according to the severity of the course:

• Mild course – blood is observed in less than 4 portions of feces per day.
• Average course – an admixture of blood is observed in more than 4 servings of feces per day.
• Severe course – an admixture of blood is noted in more than 4 servings of feces per day, a decrease in the level of albumin (blood protein fraction) is less than 30 g / l.

In addition, doctors classify ulcerative colitis in accordance with the location of pathological foci

Symptoms with non -specific ulcer colitis, depend on the localization of the pathological process:

Ulcerative proctitis . In this form of ulcerative colitis, inflammation is limited to the lining of the rectum, and for some people, rectal (rectal) bleeding may be the only sign of the disease. Also, the patient may feel pain in the rectum, tenesmus (painful urge to defecate without passing feces). This form of ulcerative colitis is usually mild.

Proctosigmoiditis . This type of UC involves inflammation of the rectum and lower colon, i.e. sigmoid colon. It is characterized by symptoms such as loose stools with blood, abdominal pain and tenesmus.

Left-sided colitis . As the name suggests, inflammation extends to the rectum, sigmoid colon, and descending colon. With left-sided colitis, the patient is disturbed by: diarrhea mixed with blood, spastic pain in the left side of the abdomen, weight loss.

Pancolit . With this type of UC, the pathological process captures the entire colon, the characteristic symptoms are: frequent diarrhea mixed with blood, abdominal pain, fatigue, and significant weight loss.

Fulminant colitis (rapidly progressive, acute). This is a rare, life-threatening form of UC in which inflammation spreads throughout the large intestine. This pathological process causes severe abdominal pain, profuse diarrhea (loose stools), and sometimes dehydration and shock. People with acute colitis are at risk for serious complications, including rupture of the intestine and toxic megacolon. These complications occur when the loops of the colon are severely swollen.

In UC, periods of exacerbation of the disease alternate with periods of remission, the patient’s symptoms depend on the stage of the disease at the moment. But over time, the severity of the disease tends to remain the same. Most people with mild disease (such as ulcerative proctitis) will never develop severe colonic disease, such as pancolitis.

When to see a doctor.

See your doctor if you have persistent bowel changes or if you have any of the signs and symptoms of ulcerative colitis, such as:

• Abdominal pain
• Blood in stool
• An episode of diarrhea (loose stools) that does not respond to conventional over-the-counter medications.