the Causes of Persistent Blood in Stool: A Patient's Journey - Gastroenterology and Hepatology

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Understanding the causes of persistent blood in stool can be a complex and concerning issue, especially when initial examinations, such as colonoscopy and endoscopy, do not reveal any obvious abnormalities. In your father's case, the presence of bright red blood in the stool, known as hematochezia, can arise from various sources in the gastrointestinal tract, and the persistence of this symptom despite multiple investigations warrants a thorough exploration of potential causes.

Firstly, it is important to understand that bright red blood typically indicates bleeding from the lower gastrointestinal tract, which includes the colon, rectum, or anus. However, it can also originate from the upper gastrointestinal tract, where the blood may be digested and appear darker. Given that both upper and lower endoscopies have not identified any lesions, we must consider other possibilities.

1. Vascular Issues: Conditions such as angiodysplasia, which are abnormal blood vessels in the gastrointestinal tract, can lead to intermittent bleeding. These lesions may not always be visible during standard endoscopic procedures, especially if they are small or located in areas that are difficult to visualize.

2. Inflammatory Conditions: Inflammatory bowel diseases (IBD) such as Crohn's disease or ulcerative colitis can cause bleeding. These conditions may not always present with visible lesions during endoscopy, particularly if the inflammation is subtle or localized.

3. Ischemic Colitis: This occurs when blood flow to a part of the colon is reduced, often due to narrowed or blocked blood vessels. It can lead to abdominal pain and bloody stools, and may not always be detected through standard imaging.

4. Medications and Supplements: Certain medications, including non-steroidal anti-inflammatory drugs (NSAIDs), can cause gastrointestinal bleeding. Additionally, herbal supplements or alcohol consumption, such as the homemade herbal liquor mentioned, may irritate the gastrointestinal lining and contribute to bleeding.

5. Diverticular Disease: Diverticulosis, which involves the formation of small pouches in the colon wall, can lead to diverticulitis or bleeding. This condition may not always be evident during endoscopic examinations.

6. Malignancies: Although less likely given the age and health history, colorectal cancer or other malignancies can present with intermittent bleeding. Further imaging studies, such as a CT scan or MRI, may be warranted if there is a high suspicion.

Given the ongoing symptoms and the lack of definitive findings, it is crucial for your father's healthcare team to continue investigating. This may involve additional imaging studies, such as a CT angiogram, which can help visualize blood vessels and identify sources of bleeding that may not be apparent through endoscopy.
Moreover, it is essential to monitor for any changes in symptoms, such as increased abdominal pain, changes in bowel habits, or signs of anemia (fatigue, pallor), which could indicate a more serious underlying condition.
In conclusion, while the initial investigations have not revealed a clear cause for your father's symptoms, it is important to remain vigilant and continue working closely with healthcare providers. A multidisciplinary approach, possibly involving gastroenterologists, surgeons, and radiologists, may be necessary to arrive at a diagnosis and develop an appropriate treatment plan. Your family's concerns are valid, and advocating for thorough and ongoing evaluation is key to ensuring your father's health and well-being.