Clinical assessment and treatment algorithm for lower gastrointestinal bleeding

• Main Author: Soo-Kyung Park
• Format: Article
• Language: English
• Published: Society of Gastrointestinal Intervention 2018-10-01
• Series: Gastrointestinal Intervention
• Subjects: Hemorrhage; Intestines; Therapeutics
• Online Access: https://doi.org/10.18528/gii180024

Lower gastrointestinal bleeding (LGIB) is diagnosed in 20% to 30% of all patients presenting with major gastrointestinal (GI) bleeding. Although most patients with acute LGIB stop bleeding spontaneously and have favorable outcomes, morbidity and mortality ranges from 2% to 4%, and is higher in older patients and those with comorbid medical conditions. Common etiologies of LGIB are diverticular bleeding, ischemic colitis, angioectasia bleeding and hemorrhoid. Patients presenting with acute severe hematochezia should undergo a focused evaluation simultaneous with hemodynamic resuscitation. An upper GI bleeding source must be excluded in patients with hematochezia and hemodynamic instability. Colonoscopy following a colon preparation is the initial test of choice in most patients presenting with acute hematochezia and hemodynamic stability.