Lower Gastrointestinal Bleeding: Current State of Diagnosis and Treatment and Interpretation of the Clinical Guidelines
Abstract
Lower gastrointestinal bleeding (LGIB) is a common clinical emergency. However, most of the published findings on LGIB were of retrospective or observational studies, and the relevant clinical guidelines and consensuses were not published until quite recently. In clinical practice, LGIB treatment is not as standardized as the treatment of upper gastrointestinal bleeding. Herein, on the basis of the latest clinical research findings on and guidelines for LGIB, we summarized and analyzed the existent diagnosis and treatment of LGIB from the perspectives of patient assessment and endoscopic, interventional and medication treatment, intending to provide more references to support the clinical practice.
Keywords: Lower gastrointestinal bleeding, Diagnosis, Treatment
Full Text:
PDFReferences
OAKLAND K, CHADWICK G, EAST J E, et al. Diagnosis and management of acute lower gastrointestinal bleeding: Guidelines from the British Society of Gastroenterology. Gut,2019,68(5): 776–789.
LANAS A, GARCIA-RODRIGUEZ L A, POLO-TOMAS M, et al. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol,2009,104(7): 1633–1641.
DEVANI K, RADADIYA D, CHARILAOU P, et al. Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding. Endosc Int Open, 2021, 9(6): e777−e789[2021-09-25]. https://doi.org/10.1055/a-1352-3204.
WILLIAMS J G, ROBERTS S E, ALI M F, et al. Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: A review of the evidence. Gut,2007,56 Suppl 1(Suppl 1): 1–113.
OAKLAND K, GUY R, UBEROI R, et al. Acute lower GI bleeding in the UK: Patient characteristics, interventions and outcomes in the first nationwide audit. Gut,2018,67(4): 654–662.
STRATE L L, AYANIAN J Z, KOTLER G, et al. Risk factors for mortality in lower intestinal bleeding. Clin Gastroenterol Hepatol,2008, 6(9): 1004–1010.
OAKLAND K. Changing epidemiology and etiology of upper and lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol, 2019, 42-43: 101610[2021-09-25]. https://doi.org/10.1016/j.bpg.2019.04.003.
BRENNER H, SCHROTZ-KING P, HOLLECZEK B, et al. Declining bowel cancer incidence and mortality in Germany. Dtsch Arztebl Int, 2016,113(7): 101–106.
OLAUSSEN A, BLACKBURN T, MITRA B, et al. Shock index for prediction of critical bleeding post-trauma: A systematic review. Emerg Med Australas,2014,26(3): 223–228.
RODRIGUES A, CARRILHO A, ALMEIDA N, et al. Interventional algorithm in gastrointestinal bleeding—An expert consensus multimodal approach based on a multidisciplinary team. Clin Appl ThrombHemost, 2020, 26: 1076029620931943[2021-09-25]. https://doi.org/10.1177/ 1076029620931943.
NAKASONE Y, IKEDA O, YAMASHITA Y, et al. Shock index correlates with extravasation on angiographs of gastrointestinal hemorrhage: A logistics regression analysis. Cardiovasc Intervent Radiol, 2007,30(5): 861–865.
OAKLAND K, JAIRATH V, UBEROI R, et al. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: A modelling study. Lancet Gastroenterol Hepatol,2017,2(9): 635–643.
TRIANTAFYLLOU K, GKOLFAKIS P, GRALNEK I M, et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 2021,53(8): 850–868.
KOLLEF M H, O'BRIEN J D, ZUCKERMAN G R, et al. BLEED: A classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage. Crit Care Med,1997,25(7): 1125–1132.
STRATE L L, SALTZMAN J R, OOKUBO R, et al. Validation of a clinical prediction rule for severe acute lower intestinal bleeding. Am J Gastroenterol,2005,100(8): 1821–1827.
DAS A, BEN-MENACHEM T, COOPER G S, et al. Prediction of outcome in acute lower-gastrointestinal haemorrhage based on an artificial neural network: Internal and external validation of a predictive model. Lancet,2003,362(9392): 1261–1266.
BLATCHFORD O, MURRAY W R, BLATCHFORD M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet,2000,356(9238): 1318–1321.
UR-RAHMAN A, GUAN J, KHALID S, et al. Both full Glasgow-Blatchford score and modified Glasgow-Blatchford score predict the need for intervention and mortality in patients with acute lower gastrointestinal bleeding. Dig Dis Sci,2018,63(11): 3020–3025.
STRATE L L, GRALNEK I M. ACG clinical guideline: Management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol, 2016,111(4): 459–474.
NIIKURA R, NAGATA N, YAMADA A, et al. Efficacy and safety of early vs elective colonoscopy for acute lower gastrointestinal bleeding. Gastroenterology, 2020, 158(1): 168–175.e166[2021-09-25]. https://doi. org/10.1053/j.gastro.2019.09.010.
TSAY C, SHUNG D, STEMMER FRUMENTO K, et al. Early colonoscopy does not improve outcomes of patients with lower gastrointestinal bleeding: Systematic review of randomized trials. Clin Gastroenterol Hepatol, 2020, 18(8): 1696–1703.e1692[2021-09-25]. https://doi.org/10.1016/j.cgh.2019.11.061.
VAN RONGEN I, THOMASSEN B J W, PERK L E. Early versus standard colonoscopy: A randomized controlled trial in patients with acute lower gastrointestinal bleeding: results of the BLEED Study. J Clin Gastroenterol,2019,53(8): 591–598.
GREEN B T, ROCKEY D C, PORTWOOD G, et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: A randomized controlled trial. Am J Gastroenterol,2005, 100(11): 2395–2402.
LAINE L, SHAH A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol, 2010,105(12): 2636–2641.
CAREY E J, LEIGHTON J A, HEIGH RI, et al. A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding. Am J Gastroenterol,2007,102(1): 89–95.
HEO H M, PARK C H, LIM J S, et al. The role of capsule endoscopy after negative CT enterography in patients with obscure gastrointestinal bleeding. Eur Radiol,2012,22(6): 1159–1166.
SAPERAS E, DOT J, VIDELA S, et al. Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal bleeding. Am J Gastroenterol,2007,102(4): 731–737.
REDONDO-CEREZO E, PEREZ-VIGARA G, PEREZ-SOLA A, et al. Diagnostic yield and impact of capsule endoscopy on management of patients with gastrointestinal bleeding of obscure origin. Dig Dis Sci, 2007,52(5): 1376–1381.
SINGH A, MARSHALL C, CHAUDHURI B, et al. Timing of video capsule endoscopy relative to overt obscure GI bleeding: Implications from a retrospective study. Gastrointest Endosc,2013,77(5): 761–766.
YAMADA A, WATABE H, KOBAYASHI Y, et al. Timing of capsule endoscopy influences the diagnosis and outcome in obscure-overt gastrointestinal bleeding. Hepatogastroenterology,2012,59(115): 676–679.
GOENKA M K, MAJUMDER S, KUMAR S, et al. Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding. World J Gastroenterol,2011,17(6): 774–778.
APOSTOLOPOULOS P, LIATSOS C, GRALNEK I M, et al. Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding. Gastrointest Endosc,2007,66(6): 1174–1181.
PENNAZIO M, SPADA C, ELIAKIM R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy,2015,47(4): 352–376.
NIIKURA R, NAGATA N, SHIMBO T, et al. Adverse events during bowel preparation and colonoscopy in patients with acute lower gastrointestinal bleeding compared with elective non-gastrointestinal bleeding. PLoS One, 2015, 10(9): e0138000[2021-09-25]. https://doi.org/ 10.1371/journal.pone.0138000.
CHAUDHRY V, HYSER M J, GRACIAS V H, et al. Colonoscopy: The initial test for acute lower gastrointestinal bleeding. Am Surg,1998,64(8): 723–728.
Refbacks
- There are currently no refbacks.



