Lower GI bleeding: a review of current management, controversies and advances

Purpose Lower gastrointestinal (GI) bleeding is defined as bleeding distal to the ligament of Treitz. In the UK, it represents approximately 3 % of all surgical referrals to the hospital. This review aims to provide review of the current evidence regarding the management of this condition. Methods L...

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Bibliographic Details
Published in:International journal of colorectal disease 2016-02, Vol.31 (2), p.175-188
Main Authors: Moss, Andrew J., Tuffaha, Hussein, Malik, Arshad
Format: Article
Language:English
Subjects:
Angiography
Colonoscopy
Diagnostic Imaging
Embolization, Therapeutic
Gastroenterology
Gastrointestinal Hemorrhage - diagnosis
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - therapy
Health aspects
Hemostatics - therapeutic use
Hepatology
Humans
Internal Medicine
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Proctology
Recurrence
Review
Surgery
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Summary:Purpose Lower gastrointestinal (GI) bleeding is defined as bleeding distal to the ligament of Treitz. In the UK, it represents approximately 3 % of all surgical referrals to the hospital. This review aims to provide review of the current evidence regarding the management of this condition. Methods Literature was searched using Medline, Pubmed, and Cochrane for relevant evidence by two researchers. This was conducted in a manner that enabled a narrative review of the evidence covering the aetiology, clinical assessment and management options of continuously bleeding patients. Findings The majority of patients with acute lower GI bleeding can be treated conservatively. In cases where ongoing bleeding occurs, colonoscopy is still the first line of investigation and treatment. Failure of endoscopy and persistent instability warrant angiography, possibly preceded by CT angiography and proceeding to superselective embolisation. Failure of embolisation warrants surgical intervention. Conclusions There are still many unanswered questions. In particular, the development of a more reliable predictive tool for mortality, rebleeding and requirement for surgery needs to be the ultimate priority. There are a small number of encouraging developments on combination therapy with regard to angiography, endoscopy and surgery. Additionally, the increasing use of haemostatic agents provides an additional tool for the management of bleeding endoscopically in difficult situations.
ISSN:0179-1958
1432-1262
DOI:10.1007/s00384-015-2400-x