Focal ulcerationAlthough bloody diarrhea is common with ischemic colitis, significant LGI hemorrhage is unusual. Different types of ischemic episodes must be considered. Acute occlusive ischemic mesenteric episodes usually present as pain and, therefore, are seldom confused with other more common causes of LGI hemorrhage. Presentation is sudden and severe; the patient often has a history of cardiac disease. Nonocclusive types of acute ischemia present with vague and nonspecific symptoms but rarely significant LGI hemorrhage. Early angiography and surgical intervention improve the opportunity for intestinal salvage. Chronic ischemia involving the small bowel may present with diarrhea secondary to malabsorption, but because only 5% of patients with colonic ischemia experience recurrent episodes, chronic colonic ischemia is rare.
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The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been shown to result in significant morbidity from deleterious effects on the UGI tract, but their effect on the LGI tract is often forgotten. Profuse diarrhea, chronic blood loss, iron deficiency anemia and increased risk of bleeding from diseased regions (eg, diverticula) have all been attributed to NSAID use (25,94,95). NSAIDs may increase the risk of bleeding in patients with known abnormalities within the colon through platelet inhibition. Patients with any history of gastrointestinal hemorrhage, including colonic, should be cautioned regarding the use of these drugs.