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Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology
  1. Kathryn Oakland1,
  2. Georgina Chadwick2,
  3. James E East3,
  4. Richard Guy4,
  5. Adam Humphries5,
  6. Vipul Jairath6,7,
  7. Simon McPherson8,
  8. Magdalena Metzner9,
  9. A John Morris10,
  10. Mike F Murphy11,
  11. Tony Tham12,
  12. Raman Uberoi13,
  13. Andrew McCulloch Veitch14,
  14. James Wheeler15,
  15. Cuthbert Regan16,
  16. Jonathan Hoare17
  1. 1 London Digestive Centre, HCA Healthcare UK, London, UK
  2. 2 Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
  3. 3 Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, UK
  4. 4 Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  5. 5 St Mark’s Hospital, London, UK
  6. 6 Robarts Clinical Trials, Inc., London, Ontario, Canada
  7. 7 Medicine and Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
  8. 8 Department of Radiology, Leeds General Infirmary, Leeds, UK
  9. 9 Department of Gastroenterology, Hutt Valley District Health Board, Lower Hutt, New Zealand
  10. 10 Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
  11. 11 NHS Blood and Transplant, Oxford, UK
  12. 12 Division of Gastroenterology, Ulster Hospital, Dundonald, UK
  13. 13 Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  14. 14 Gastroenterology, New Cross Hospital, Wolverhampton, UK
  15. 15 Department of Colorectal Surgery, Addenbrooke’s Hospital, Cambridge, UK
  16. 16 British Society of Gastroenterology, London, UK
  17. 17 Department of Surgery and Cancer, Imperial College, London, UK
  1. Correspondence to Dr Jonathan Hoare, Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK; j.hoare{at}ic.ac.uk

Abstract

This is the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB) and has been commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). The Guidelines Development Group consisted of representatives from the BSG Endoscopy Committee, the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, NHS Blood and Transplant and a patient representative. A systematic search of the literature was undertaken and the quality of evidence and grading of recommendations appraised according to the GRADE(Grading of Recommendations Assessment, Development and Evaluation) methodology. These guidelines focus on the diagnosis and management of acute LGIB in adults, including methods of risk assessment and interventions to diagnose and treat bleeding (colonoscopy, computed tomography, mesenteric angiography, endoscopic therapy, embolisation and surgery). Recommendations are included on the management of patients who develop LGIB while receiving anticoagulants (including direct oral anticoagulants) or antiplatelet drugs. The appropriate use of blood transfusion is also discussed, including haemoglobin triggers and targets.

  • lower gastrointestinal bleeding
  • haematochezia
  • colonoscopy
  • embolisation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors Working subgroups with specific areas of expertise were formed to critically appraise the literature supporting the following areas of clinical management: initial assessment, risk stratification and resuscitation (KO, VJ, MFM); medical management (AMV); diagnostic and therapeutic radiology (RU, SM); the exclusion of upper gastrointestinal bleeding and capsule endoscopy (MM); colonoscopy (AH, JEE, AJM); surgery (RG, JW). KO created the first draft of the guideline and all authors critically revised the paper.

  • Funding KO was supported by funding from NHS Blood and Transplant, Bowel Disease Research Foundation and a research fellowship from the Royal College of Surgeons of England. JEE was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests JEE is a member of the Clinical Advisory Board for Lumendi and has received support for departmental research from Olympus; AJM participates in training courses and is on the advisory boards for Cook, Boston Scientific, Vifor, Ferring, Shire and Abbvie; AMV has received fees from Olympus for educational presentations; MFM is on the editorial board for Transfusion Medicine Reviews for which he receives an annual fee and KO has received editorial fees for reviews on the same topic.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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