Initial management for acute lower gastrointestinal bleeding

Abstract

Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospital admission. Patients with LGIB often experience persistent or recurrent bleeding and require blood transfusions and interventions, such as colonoscopic, radiological, and surgical treatments. Appropriate decision-making is needed to initially manage acute LGIB, including emergency hospitalization, timing of colonoscopy, and medication use. In this literature review, we summarize the evidence for initial management of acute LGIB. Assessing various clinical factors, including comorbidities, medication use, presenting symptoms, vital signs, and laboratory data is useful for risk stratification of severe LGIB, and for discriminating upper gastrointestinal bleeding. Early timing of colonoscopy had the possibility of improving identification of the bleeding source, and the rate of endoscopic intervention, compared with elective colonoscopy. Contrast-enhanced computed tomography before colonoscopy may help identify stigmata of recent hemorrhage on colonoscopy, particularly in patients who can be examined immediately after the last hematochezia. How to deal with nonsteroidal anti-inflammatory drugs (NSAIDs) and antithrombotic agents after hemostasis should be carefully considered because of the risk of rebleeding and thromboembolic events. In general, aspirin as primary prophylaxis for cardiovascular events and NSAIDs were suggested to be discontinued after LGIB. Managing acute LGIB based on this information would improve clinical outcomes. Further investigations are needed to distinguish patients with LGIB who require early colonoscopy and hemostatic intervention.

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

“…In Western countries, HD is one of the most frequent causes of severe acute lower gastrointestinal bleeding [8,9]. Nevertheless, rectal bleeding is a common early symptom of colorectal cancer [24], as well as of other colorectal diseases such as IBD, diverticular disease, and angiodysplasia.…”

“…Recurrent bleeding may result in secondary iron deficiency anemia. Sometimes, HD may cause massive hemorrhage requiring urgent hospitalization and blood transfusions [8,9]. Other symptoms to consider are swelling, prolapse, soiling, perianal skin irritation, itching, and discomfort.…”

Colonic Diverticular Bleeding: A Case Report and Review of the Literature

“…Typically, gastrointestinal bleeding (GIB) was divided into two categories: upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB) [5]. LGIB is less common than UGIB, with an annual incidence of hospitalization of approximately 36/100,000 population.…”

“…While approximately 67/100,000 population for the UGIB [6,7]. Due to the aging of the population and with the application of antithrombotic agents, acute LGIB is becoming more common in the elderly men than elderly women [5,8], with mortality rates of 2.5%-3.9% during hospitalization [9,10] and rebleeding rates of 13%-19% after 1 year [11,12]. Hospitalization rate of diverticulum hemorrhage and diverticulitis in Japan has been increased in recent years [1,2].…”

Biocompatible and antibacterial soy protein isolate/quaternized chitosan composite sponges for acute upper gastrointestinal hemostasis

“…In the clinic, patients with AUGB are conventionally given gastroscopy and antishock treatments, such as an intravenous injection of a balanced salt solution or normal saline (N.S.) [ 4 , 5 ]. Gastroscopy can be used to easily inspect the bleeding sites, and a titanium clip can be used to stop bleeding [ 6 , 7 ].…”