Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline
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- Neil Sengupta
- Section of Gastroenterology, University of Chicago Medicine, Chicago, Illinois, USA;
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- Joseph D. Feuerstein
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
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- Vipul Jairath
- Department of Medicine, Western University, London, Ontario, Canada;
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- Amandeep K. Shergill
- Department of Clinical Medicine, San Francisco VA Medical Center, University of California, San Francisco, California, USA;
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- Lisa L. Strate
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA;
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- Robert J. Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA;
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- David Wan
- Department of Clinical Medicine, Weill Cornell Medicine, New York City, New York, USA.
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説明
<jats:p>Acute lower gastrointestinal bleeding (LGIB) is a common reason for hospitalization in the United States and is associated with significant utilization of hospital resources, as well as considerable morbidity and mortality. These revised guidelines implement the Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the use of risk stratification tools, thresholds for red blood cell transfusion, reversal agents for patients on anticoagulants, diagnostic testing including colonoscopy and computed tomography angiography (CTA), endoscopic therapeutic options, and management of antithrombotic medications after hospital discharge. Important changes since the previous iteration of this guideline include recommendations for the use of risk stratification tools to identify patients with LGIB at low risk of a hospital-based intervention, the role for reversal agents in patients with life-threatening LGIB on vitamin K antagonists and direct oral anticoagulants, the increasing role for CTA in patients with severe LGIB, and the management of patients who have a positive CTA. We recommend that most patients requiring inpatient colonoscopy undergo a nonurgent colonoscopy because performing an urgent colonoscopy within 24 hours of presentation has not been shown to improve important clinical outcomes such as rebleeding. Finally, we provide updated recommendations regarding resumption of antiplatelet and anticoagulant medications after cessation of LGIB.</jats:p>
収録刊行物
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- American Journal of Gastroenterology
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American Journal of Gastroenterology 118 (2), 208-231, 2022-09-21
Ovid Technologies (Wolters Kluwer Health)