Emergency Management of Acute Lower Gastrointestinal Bleeding
Main Article Content
Abstract
Acute episodes of lower GI bleeding normally generate attendance at hospital emergency departments and require admission depending on bleeding severity. The differential diagnoses are extensive so diagnosis can be challenging but modern radiological, endoscopic and medical techniques have transformed diagnosis, treatment and outcomes. In modern practice, very few patients presenting with acute lower gastrointestinal haemorrhage now require surgical intervention as endoscopic or interventional radiological techniques have high success rates. Outcomes depend more significantly on co-morbidities, especially for elderly patients on anticoagulant drugs, as well as the ease of access to early diagnostic and therapeutic facilities. This review outlines the evidence base for the diagnosis and optimal management of acute lower gastrointestinal bleeding with reference to modern national and international guidelines.
Article Details
How to Cite
DUNCKLEY, Matthew G..
Emergency Management of Acute Lower Gastrointestinal Bleeding.
Medical Research Archives, [S.l.], v. 14, n. 4, apr. 2026.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7268>. Date accessed: 01 may 2026.
doi: https://doi.org/10.18103/mra.v14i4.7268.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Rockey DC. Occult gastrointestinal bleeding. N Engl J Med. 1999; 341:38-46.
3. Zuckerman GR, Prakash C, Askin MP, Lewis BS. (2000). AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology. 2000; 118(1):201-21.
4. Oakland K, Guy R, Uneroi R, Hogg R, Mortensen N, et al. Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit. Gut 2018; 67:654-662.
5. Lanas A, Garcia-Rodriquez LA, Polo-Tomas M, Ponce M, Alonso-Abreu I, Perez-Aisa MA, Perez-Gisbert J, Bujanda L, Castro M, Munoz M, Rodrigo L, Calvet X, Del-Pino D, Garcia S. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol. 2009; 104(7):1633-1641.
6. Moss AJ, Tuffaha H, Malik A. Lower GI bleeding: a review of current management, controversies and advances. Int J Colorectal Dis. 2016; 31(2):175-188.
7. Singh M, Chiang J, Seah A, Liu N, Mathew R, Mathur S. A clinical predictive model for risk stratification of patients with severe acute lower gastrointestinal bleeding. World J Emerg Surg. 2021; 16(1):58
8. Siebenhüner K, Blaser J, Nowak A, Cheetham M, Mueller BU, Battegay E, Beeler PE. Comorbidities associated with worse outcomes among inpatients admitted for acute gastrointestinal bleeding. Dig Dis Sci. 2022; 67(8):3938-3947.
9. Newman J, Fitzgerald JEF, Gupta S, von Roon AC, Sigurdsson HH, Allen-Mersh TG. Outcome predictors in acute surgical admissions for lower gastrointestinal bleeding. Colorectal Dis. 2012; 14:1020-1026.
10. Nagata N., Niikura R., Aoki T. et al. Risk factors for adverse in-hospital outcomes in acute colonic diverticular haemorrhage. World J Gastroenterol. 2015; 21:10697-10703.
11. Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin Gastro Hepatol. 2008; 6:1004-1010.
12. Fujita M, Manabe N, Murao T, Suehiro M, Tanikawa T, Nakamura J, Ishii K, Monden S, Uji E, Misawa H, Ninomiya T, Sasahira M, Chikaishi M, Yo S, Osawa M, Katsumata R, Ayaki M, Ishii M, Kawamoto H, Shiotani A, Hata J, Haruma K. Differences between patients with inpatient-onset and outpatient-onset acute lower gastrointestinal bleeding: an observational study. J Gastroenterol Hepatol. 2023; 38(5):775-782.
13. Khan A, Kanters AE. Management of acute haemorrhoidal crisis: evaluation, treatment, and special considerations. Clin Colon Rectal Surg. 2023; 37(6):381-386.
14. Al Khalloufi K, Laiyemo AO. Management of rectal varices in portal hypertension. World J Hepatol. 2015; 7(30):2992-2998.
15. Inayat F, Hussain A, Yahya S, Weissman S, Sarfraz N, Faisal MS, Riaz I, Saleem S, Saif MW. Rectal Dieulafoy's lesion: a comprehensive review of patient characteristics, presentation patterns, diagnosis, management, and clinical outcomes. Transl Gastroenterol Hepatol. 2022; 7(10): doi:10.21037/tgh.2020.02.17.
16. Ilyas MIM, Szilagy EJ. Management of diverticular bleeding: evaluation, stabilisation, intervention, and recurrence of bleeding and indications for resection after control of bleeding. Clin Colon Rectal Surg. 2018; 31(4):243-250.
17. Shimomura A, Nagata N, Shimbo T, Sakurai T, Moriyasu S, Okubo H, Watanabe K, Yokoi C, Akiyama J, Uemara N. New predictive model for acute gastrointestinal bleeding in patients taking oral anticoagulants: a cohort study. J Gastroenterol Hepatol.
18. Sato Y, Aoki T, Sadashima E, Nakamoto Y, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Kishino T, Ishii N, Sawada T, et al. Long-term risks of recurrence after hospital discharge for acute lower gastrointestinal bleeding: A large nationwide cohort study. Clin Gastroenterol Hepatol. 2023; 21(13):3258-3269.
19. Cirrochi R, Grassi V, Cavaliere D, Renzi C, Tabola R, Poli G, Avenia S, Farinella E, Arezzo A, Vettoretto N, D'Andrea V, Binda GA, Fingerhut A. New Trends in Acute Management of Colonic Diverticular Bleeding: A Systematic Review. Medicine. 2015; 94(44):1710.
20. Mosli M, Aldabbagh A, Aseeri H, Alqusair S, Jawa H, Alsahafi M, Qari Y. The diagnostic yield of urgent colonoscopy in acute lower gastrointestinal bleeding. Acta Gastroenterol Belg. 2020; 83(2):265-270.
21. Meine GC, Santo P, Delgado LM, Brennan GT. Endoscopic therapies for colonic diverticular bleeding: a systematic review and meta-analysis. Surg Endosc. 2025; doi: 10.1007/s00464-025-12520-8.
22. Newman J, Cooper MA. Lower gastrointestinal bleeding and ischaemic colitis. Can J Gastroenterol. 2002; 16(9):597-600.
23. Kim DS, Yoon J, Kim YJ, Lee JW, Hong SW, Hwang HW, Park SH, Yang DH, Ye BD, Byeon JS, Myung SJ, Yang SK. Risk factors for rebleeding in Crohn’s disease patients with acute severe lower gastrointestinal bleeding: with special reference to the role of anti-tumour necrosis factor therapy. J Gastroenterol Hepatol. 2021; 36(9):2455-2462.
24. Tu T, Chen M, Zeng Z, Lin J, Chen L, Liu C, Zhuang X. A comprehensive review and update on acute severe lower gastrointestinal bleeding in Crohn’s disease: a management algorithm. Gastroenterol Report. 2024; doi.org/10.1093/gastro/goae099
25. Bermont A, Abu-Freha N, Cohen DL, Galion FA, Aminov R, Shirin H. Epidemiology and risk factors for angiodysplasia of the upper and lower gastrointestinal tract: a large population-based study. Dig Liver Dis. 2025; 57(1):220-224.
26. Tsoutsouki J, Faidon-Marios L, Mason S, Smith M, Sinha L. A rare cause of GI bleeding in a patient with cutaneous vascular malformations. Gut 2016; 65:1792.
27. Li JA, Zhong LL, Li B, Jiang DQ, Zhao YL. Diffuse telangiectasia of the colon: a case report. Medicine. 2020; 99(34):21106.
28. Kwon MJ, Kim YS, Bae SI, Park YI, Lee KJ, Min JH, Jo SW, Kim MY, Jung HJ, Jo SY, Kim MY, Jung HJ, Jeong SY, Yoon WJ, Kim JN, Moon JS. Risk factors for delayed post-polypectomy bleeding. Intest Res. 2015; 13(2):160-165.
29. Nishad N, Thoufeeq MH. Post-polypectomy colorectal bleeding: current strategies and the way forward. Clinical Endoscopy 2025; 58(2): 191-200.
30. Wilcox CM, Alexander LN, Cotsonis G. A prospective characterisation of upper gastrointestinal haemorrhage presenting with haematochezia. Am J Gastroenterol. 1997: 92(2): 231-235.
31. Kollef MH, O'Brien JD, Zuckerman GR, Shannon, W. BLEED: A classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage. Crit Care Med. 1997; 25:1125-1132.
32. Huchannavar S, Puttannavar G, Hebsur NI. BLEED: a classification tool to predict outcomes in patients with upper and lower gastrointestinal haemorrhage. Int Surg J. 2017; 4:2683-2688.
33. Oakland, Kathryn; Jairath, Vipul; Uberoi, Raman; Guy, Richard; Ayaru, Lakshmana; Mortensen, Neil; Murphy, Mike F; Collins, Gary S. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. Lancet Gastroenterol & Hepatol. 2017; 2(9):635-643.
34. Aoki T, Nagata N, Shimbo T, Niikura R, Sakurai T, Moriyasu S, Okubo H, Sekine K, Watanabe K, Yokoi C, Yanase M, Akiyama J, Mizokami M, Uemura N. Development and validation of a risk scoring system for severe acute lower gastrointestinal bleeding. Clin Gastro Hepatol. 2016; 14:1562-70.
35. Prasitvarakul K, Attanath N, Chang A. Comparison of scoring systems for predicting clinical outcomes of acute lower gastrointestinal bleeding: a prospective cohort study. World J Surg. 2024; 48(2):474-483.
36. Currie GM, Kiat H, Wheat JM. Scintigraphic evaluation of acute lower gastrointestinal haemorrhage: current status and future directions. J Clin Gastroenterol. 2011; 45(2):92-99.
37. Geffroy Y, Rodallec MH, Boulay-Coletta I, Jullès MC, Ridereau-Zins C, Zins M. Multidetector CT angiography in acute gastrointestinal bleeding: why, when, and how. Radiographics. 2011; 31(3):E35-46.
38. Snelling S, Ghaffar R, Ward ST. CT angiograms for lower GI bleeding: the experience of a large UK teaching hospital. Ann R Coll Surg Engl. 2022; 104(2):100-105.
39. Hsu M, Shah N, Bernal-Fernandez M, HonShideler C, Soto J, Anderson S, Ramakingam V. CTA measurements of acute lower gastrointestinal bleeding size predict subsequent positive catheter angiography. Abdom Radiol. 2020; 45(3):615-622.
40. Martí M, Artigas JM, Garzón G, Álvarez-Sala R, Soto JA. Acute Lower Intestinal Bleeding: Feasibility and Diagnostic Performance of CT Angiography. Radiology. 2012; 262(1):109-116.
41. Karuppasamy K, Kapoor BS, Fidelman N, and ACR Expert Panel on Interventional Radiology. ACR appropriateness criteria radiologic management of lower gastrointestinal tract bleeding: 2021 update. J Am Coll Radiol. 2021; 18(5S):S139-S152.
42. Li H, Yu Z, Wang JD, Zhang Z, Zhang G, Lu Z, Lv J, Tao F, Jin Q. Arteriocolonic fistula of inferior mesenteric artery aneurysm: a case with lower gastrointestinal and intra-abdominal haemorrhage. Heliyon. 2023; 9:e13667.
43. Long B, Kerim SM, Gottlieb M, Schaver SG, Schmalz G. Is intravenous contrast associated with increased risk of acute kidney injury? J Emerg Med. 2025; 72:129-136.
44. Hosse C, Moos M, Becker LS, Sieren M, Muller L, Stoehr F, et al. Trans-arterial embolization for treatment of acute lower gastrointestinal bleeding – a multicentre analysis. Eur Radiol. 2025; 35(5):2746-2754.
45. Sun Q, Cheng J, Zhang XL, Hing X, Tang L, Li J, Ren D, Xu X, Cheng D. Efficacy and safety of transcatheter arterial embolization for lower gastrointestinal bleeding: a systematic review and meta-analysis of 58 clinical trials. Eur J Med Res. 2025; 31:33-48.
46. Christodoulidis G, Tsagkidou K, Bartzi D, Prisacariu IA, Agko ES. Endoscopic management of non-variceal and lower gastrointestinal bleeding: where do we stand? World J Gastrointest Endosc. 2025; 17(5):105580.
47. Schmulewitz N, Fisher DA, Rockey DC. Early colonoscopy for acute lower GI bleeding predicts shorter hospital stay: a retrospective study of experience in a single centre. Gastroenterol Endoscopy. 2003; 58 841-846.
48. Niikura R, Nagata N, Yamada A, Honda T, et al. Efficacy and safety of early vs elective colonoscopy for acute lower gastrointestinal bleeding. Gastroenterology. 2020; 158(1):168-175.
49. Tsay C, Shung D, Stemmer-Frumento K, Laine L. Early colonoscopy does not improve outcomes of patients with lower gastrointestinal bleeding: systematic review of randomised trials. Clin Gastroenterol Hepatol. 2020; 18(8):1696-1703.
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