Management of Acute Lower Gastrointestinal Bleeding
Summary
Acute lower gastrointestinal bleeding is a potentially life-threatening event requiring prompt assessment of haemodynamic status, localisation of the bleeding source and targeted intervention. Initial management centres on resuscitation with crystalloid fluids and blood products, alongside correction of coagulopathy. Risk stratification tools guide decisions on inpatient monitoring versus outpatient management, while early diagnostic approaches combine colonoscopy and computed tomography angiography to optimise detection of active haemorrhage. Endoscopic haemostasis techniques—such as through-the-scope clipping, band ligation and over-the-scope clip placement—enable minimally invasive control of bleeding, reducing reliance on surgery. When endoscopic methods are insufficient or rapid rebleeding occurs, transcatheter arterial embolisation by interventional radiology provides an effective alternative. Surgical resection remains reserved for refractory cases or when endoscopic and radiological approaches fail. Multidisciplinary coordination between gastroenterology, radiology and surgery teams is essential to tailor the approach to each patient’s risk profile, comorbidities and resource availability. Ongoing innovations in imaging protocols, haemostatic devices and predictive algorithms aim to refine timing of intervention, shorten hospital stay and lower rebleeding rates, with the ultimate goal of improving patient outcomes worldwide.
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Management of Acute Lower Gastrointestinal Bleeding publication trend
The graph below shows the total number of articles in management of acute lower gastrointestinal bleeding across all publications each year (not limited to Nature Index journals).
Technical terms
Haemostasis: The process of stopping bleeding via physiological or therapeutic means.
Colonoscopy: Endoscopic examination of the colon used for diagnosis and treatment of lower gastrointestinal bleeding.
Computed tomography angiography (CTA): Imaging technique that visualises blood vessels by detecting contrast extravasation to localise active bleeding.
Diverticular bleeding: Haemorrhage originating from colonic diverticula, often managed endoscopically or radiologically.
Risk stratification score: A numerical tool combining clinical and laboratory variables to predict adverse outcomes and guide management.
References
- Lower gastrointestinal bleeding—Computed Tomographic Angiography, Colonoscopy or both?. World Journal of Emergency Surgery (2017).
- Timing of colonoscopy in acute lower GI bleeding: a multicenter retrospective cohort study. Gastrointestinal Endoscopy (2022).
- Efficacy of Over-The-Scope Clip Method as a Novel Hemostatic Therapy for Colonic Diverticular Bleeding. Journal of Clinical Medicine (2021).
- External Validation of the Oakland Score to Assess Safe Hospital Discharge Among Adult Patients With Acute Lower Gastrointestinal Bleeding in the US. JAMA Network Open (2020).
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