Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Guidelines

Background:

• Acute lower gastrointestinal bleeding (LGIB) is a frequent cause of hospitalization in the US.
• LGIB is associated with substantial healthcare resource use, morbidity, and mortality.

Purpose of the Study:

• To provide updated, evidence-based recommendations for managing acute lower gastrointestinal bleeding (LGIB).
• To incorporate the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology into clinical practice guidelines.

Main Methods:

• Systematic review and guideline development using the GRADE methodology.
• Focus on risk stratification, transfusion thresholds, anticoagulant reversal, diagnostic imaging (CTA), endoscopic therapy, and post-discharge medication management.

Main Results:

• Recommends risk stratification tools to identify low-risk patients for reduced intervention.
• Highlights the role of reversal agents for anticoagulated patients with life-threatening LGIB.
• Supports the use of computed tomography angiography (CTA) in severe LGIB and outlines management of positive CTA findings.
• Suggests nonurgent colonoscopy for most inpatients, as urgent procedures do not improve outcomes like rebleeding.

Conclusions:

• Revised guidelines offer a structured approach to LGIB management, integrating risk assessment and targeted interventions.
• Emphasizes optimizing diagnostic strategies and therapeutic interventions, including medication management post-discharge.
• Aims to improve clinical outcomes and resource allocation for patients experiencing acute lower gastrointestinal bleeding.