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How to manage lower gastrointestinal bleeding in 2022?

M Boullier1, A Fohlen2, S Viennot3

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Lower gastrointestinal bleeding (LGIB) often affects older adults and may resolve spontaneously. Prompt diagnosis and management, including hemodynamic correction and source identification, are crucial for patient outcomes.

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Area of Science:

  • Gastroenterology
  • Internal Medicine
  • Emergency Medicine

Background:

  • Lower gastrointestinal bleeding (LGIB) is common in older patients, often with comorbidities and anticoagulant use.
  • Spontaneous resolution occurs in most cases, but recurrence is possible.
  • Common causes include diverticular disease, vascular disorders, and colitis, with a significant percentage presenting in hypovolemic shock.

Purpose of the Study:

  • To outline the diagnostic and therapeutic strategies for managing lower gastrointestinal bleeding.
  • To emphasize the importance of identifying the bleeding source and patient's hemodynamic status.

Main Methods:

  • Initial management involves hemodynamic stabilization, coagulation correction, and transfusions.
  • Diagnostic tools include digital rectal examination, upper endoscopy for severe LGIB, and CT angiography to localize the source.
  • Therapeutic options depend on bleeding source and patient condition, including colonoscopy, embolization, or surgery.

Main Results:

  • CT angiography can pinpoint bleeding sources, guiding subsequent interventions.
  • Therapeutic decisions are tailored to the cause of bleeding and patient's overall health.
  • Ambulatory colonoscopy is recommended within 14 days for stable patients (Oakland score ≤10).

Conclusions:

  • Effective management of LGIB requires prompt assessment of hemodynamic status and bleeding source.
  • Treatment strategies should be individualized, considering patient comorbidities and medication use.
  • Careful consideration of anticoagulant/antiplatelet therapy is necessary on a case-by-case basis.