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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2022; 13(01): 014-018
DOI: 10.1055/s-0042-1742694
Review Article

Lower Gastrointestinal Bleeding

Nitin Jagtap 
1   Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
D. Nageshwar Reddy
1   Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Manu Tandan
1   Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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Abstract

Lower gastrointestinal (LGI) bleeding indicates bleeding from colon or anorectum. Typically, patients with LGI bleeding present with bright red blood per rectum or hematochezia, although rarely they can present with melena as well. Alternatively, LGI bleeding is also defined as bleeding from a source within potential reach of a colonoscope, that is, colon and terminal ileum. LGI bleedings have more favorable outcomes than upper GI (UGI) bleeding and less common than UGI bleeding. Any patient presenting with GI bleeding should undergo a detailed history and physical examination for clues that may suggest source and possible etiology. Colonoscopy remains the most widely used and preferred instrument of choice for both diagnosis and therapy. This review will discuss in brief the causes, triaging, and role of colonoscopy in the management of LGI bleeding.

Keywords

colonoscopy - hematochezia - hemostasis - lower gastrointestinal bleeding


Publication History

Article published online:
20 April 2022

© 2022. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Barnert J, Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol 2009; 6 (11) 637-646
    CrossrefPubMedGoogle Scholar
  • 2 Farrell JJ, Friedman LS. Gastrointestinal bleeding in the elderly. Gastroenterol Clin North Am 2001; 30 (02) 377-407 , viii viii.
    CrossrefPubMedGoogle Scholar
  • 3 Bramley PN, Masson JW, McKnight G. et al. The role of an open-access bleeding unit in the management of colonic haemorrhage. A 2-year prospective study. Scand J Gastroenterol 1996; 31 (08) 764-769
    CrossrefPubMedGoogle Scholar
  • 4 Zuckerman GR, Prakash C. Acute lower intestinal bleeding. Part II: etiology, therapy, and outcomes. Gastrointest Endosc 1999; 49 (02) 228-238
    CrossrefPubMedGoogle Scholar
  • 5 Kollef MH, Canfield DA, Zuckerman GR. Triage considerations for patients with acute gastrointestinal hemorrhage admitted to a medical intensive care unit. Crit Care Med 1995; 23 (06) 1048-1054
    CrossrefPubMedGoogle Scholar
  • 6 Farrell JJ, Friedman LS. Review article: the management of lower gastrointestinal bleeding. Aliment Pharmacol Ther 2005; 21 (11) 1281-1298
    CrossrefPubMedGoogle Scholar
  • 7 Strate LL, Orav EJ, Syngal S. Early predictors of severity in acute lower intestinal tract bleeding. Arch Intern Med 2003; 163 (07) 838-843
    CrossrefPubMedGoogle Scholar
  • 8 Quach DT, Nguyen NT, Vo UP. et al. Development and validation of a scoring system to predict severe acute lower gastrointestinal bleeding in Vietnamese. Dig Dis Sci 2021; 66 (03) 823-831
    CrossrefPubMedGoogle Scholar
  • 9 Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin Gastroenterol Hepatol 2008; 6 (09) 1004-1010 , quiz 955
    CrossrefPubMedGoogle Scholar
  • 10 Laursen SB, Oakland K, Laine L. et al. ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study. Gut 2021; 70 (04) 707-716
    CrossrefPubMedGoogle Scholar
  • 11 Sue-Chue-Lam C, Castelo M, Baxter NN. Factors associated with mortality after emergency colectomy for acute lower gastrointestinal bleeding. JAMA Surg 2020; 155 (02) 165-167
    CrossrefPubMedGoogle Scholar
  • 12 Patel P, Nigam N, Sengupta N. Lower gastrointestinal bleeding in patients with coronary artery disease on antithrombotics and subsequent mortality risk. J Gastroenterol Hepatol 2018; 33 (06) 1185-1191
    CrossrefPubMedGoogle Scholar
  • 13 Triantafyllou K, Gkolfakis P, Gralnek IM. et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53 (08) 850-868
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol 2016; 111 (04) 459-474
    CrossrefPubMedGoogle Scholar
  • 15 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 , quiz 2642
    CrossrefPubMedGoogle Scholar
  • 16 Wortman JR, Landman W, Fulwadhva UP, Viscomi SG, Sodickson AD. CT angiography for acute gastrointestinal bleeding: what the radiologist needs to know. Br J Radiol 2017; 90 (1075): 20170076
    CrossrefPubMedGoogle Scholar
  • 17 Tew K, Davies RP, Jadun CK, Kew J. MDCT of acute lower gastrointestinal bleeding. AJR Am J Roentgenol 2004; 182 (02) 427-430
    CrossrefPubMedGoogle Scholar
  • 18 Hawks MK, Svarverud JE. Acute lower gastrointestinal bleeding: evaluation and management. Am Fam Physician 2020; 101 (04) 206-212
    PubMedGoogle Scholar
  • 19 Oakland K, Chadwick G, East JE. et al. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut 2019; 68 (05) 776-789
    CrossrefPubMedGoogle Scholar
  • 20 Tsay C, Shung D, Stemmer Frumento K, Laine L. Early colonoscopy does not improve outcomes of patients with lower gastrointestinal bleeding: systematic review of randomized trials. Clin Gastroenterol Hepatol 2020; 18 (08) 1696-1703.e2
    CrossrefPubMedGoogle Scholar
  • 21 Kherad O, Restellini S, Almadi M. et al. Systematic review with meta-analysis: limited benefits from early colonoscopy in acute lower gastrointestinal bleeding. Aliment Pharmacol Ther 2020; 52 (05) 774-788
    CrossrefPubMedGoogle Scholar
  • 22 Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol 2016; 111 (05) 755
    CrossrefPubMedGoogle Scholar
  • 23 Greco L, Zhang J, Ross H. Surgical options and approaches for lower gastrointestinal bleeding: when do we operate and what do we do?. Clin Colon Rectal Surg 2020; 33 (01) 10-15
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Goenka MK, Nagi B, Kochhar R, Bhasin DK, Singh A, Mehta SK. Colonic diverticulosis in India: the changing scene. Indian J Gastroenterol 1994; 13 (03) 86-88
    PubMedGoogle Scholar
  • 25 Cañamares-Orbís P, Lanas Arbeloa Á. New trends and advances in non-variceal gastrointestinal bleeding-series II. J Clin Med 2021; 10 (14) 10
    CrossrefPubMedGoogle Scholar
  • 26 Lock J, Wiegering A, Germer CT. [Indications for surgical treatment of diverticular disease]. Chirurg 2021; 92 (08) 694-701
    CrossrefPubMedGoogle Scholar
  • 27 Kim HS, Kim TI, Kim WH. et al. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol 2006; 101 (06) 1333-1341
    CrossrefPubMedGoogle Scholar
  • 28 Jagtap N, Singh AP, Inavolu P. et al. Detection of colon polyps in India—a Large Retrospective Cohort Study (DoCPIr). J Digest Endosc 2021; 12: 63-66
    Article in Thieme ConnectGoogle Scholar
  • 29 Chen YI, Barkun A, Nolan S. Hemostatic powder TC-325 in the management of upper and lower gastrointestinal bleeding: a two-year experience at a single institution. Endoscopy 2015; 47 (02) 167-171
    PubMedGoogle Scholar
  • 30 Wong Kee Song LM, Baron TH. Endoscopic management of acute lower gastrointestinal bleeding. Am J Gastroenterol 2008; 103 (08) 1881-1887
    CrossrefPubMedGoogle Scholar
  • 31 Mourad FH, Leong RW. Role of hemostatic powders in the management of lower gastrointestinal bleeding: a review. J Gastroenterol Hepatol 2018; 33 (08) 1445-1453
    CrossrefPubMedGoogle Scholar