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Review article: Advances in the management of lower gastrointestinal bleeding
Ali A Alali1, Majid A Almadi2,3, Alan N Barkun3,4
1Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
Insights
Lower gastrointestinal bleeding (LGIB) management has evolved, prioritizing radiology for unstable patients and colonoscopy for stable cases. A multidisciplinary approach optimizes outcomes for this common emergency.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Emergency Medicine
Background:
- Lower gastrointestinal bleeding (LGIB) is a frequent emergency associated with significant morbidity and mortality.
- Advances in LGIB management necessitate a review of current practices.
- Radiology plays a critical role in acute LGIB, complementing elective colonoscopy.
Purpose of the Study:
- To offer a comprehensive and updated overview of advancements in managing patients with lower gastrointestinal bleeding.
- To synthesize current data and expert opinions on LGIB treatment strategies.
Main Methods:
- A comprehensive literature search was conducted.
- The review is a narrative synthesis supplemented by expert opinion.
Main Results:
- The incidence of LGIB is rising globally, influenced by an aging population and increased antithrombotic use.
- Diverticulosis remains the leading cause of LGIB; risk stratification tools like the Oakland score aid triage.
- Radiology is vital for acute LGIB diagnosis and treatment, particularly in unstable patients, while colonoscopy is the gold standard for stable, elective cases.
Conclusions:
- LGIB management has shifted towards interventional radiology for unstable patients and elective colonoscopy for stable ones.
- A multidisciplinary strategy is crucial for optimizing patient outcomes in LGIB.
Background:
Lower gastrointestinal bleeding (LGIB) is a common emergency with substantial associated morbidity and mortality. Elective colonoscopy plays an essential role in management, with an even more important role for radiology in the acute setting. Recent advances in the management of patients with LGIB warrant review as the management has recently evolved.
Aims:
To provide a comprehensive and updated overview of advances in the approach to patients with LGIB METHODS: We performed a comprehensive literature search to examine the current data for this narrative review supplemented by expert opinion.
Results:
The incidence of LGIB is increasing worldwide, partly related to an ageing population and the increasing use of antithrombotics. Diverticulosis continues to be the most common aetiology of LGIB. Pre-endoscopic risk stratification tools, especially the Oakland score, can aid appropriate patient triage. Adequate resuscitation continues to form the basis of management, while appropriate management of antithrombotics is crucial to balance the risk of worsening bleeding against increased cardiovascular risk. Radiological imaging plays an essential role in the diagnosis and treatment of acute LGIB, especially among unstable patients. Colonoscopy remains the gold-standard test for the elective management of stable patients.
Conclusions:
The management of LGIB has evolved significantly in recent years, with a shift towards radiological interventions for unstable patients while reserving elective colonoscopy for stable patients. A multidisciplinary approach is essential to optimise the outcomes of patients with LGIB.
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