British Society of Gastroenterology: diagnosis and management of acute lower gastrointestinal bleeding

New guidelines have been produced through collaborative work between the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, National Health Service Blood and Transplants and patient representatives. This is the first UK national guidance for lower gastrointestinal bleeding (LGIB). The focus is the in-hospital management of adult patients presenting with acute LGIB. LGIB refers to patients presenting with bright or dark red blood per rectum, clots per rectum or blood mixed with stool. We provide a commentary and overview of the key features, with a particular focus on risk assessment, management, investigations, and radiological and endoscopic intervention.

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708 Examining the Management of Acute Lower GI Bleeds in Order to Improve Policies and Reflect Safe and Updated Guidance

British Journal of Surgery ◽

10.1093/bjs/znab134.474 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

L Han ◽

H White ◽

K Bosch ◽

M Nair

Keyword(s):

Gastrointestinal Bleeding ◽

Surgical Intervention ◽

Lower Gastrointestinal Bleeding ◽

University Hospital ◽

British Society ◽

Shock Index ◽

Surgical Department ◽

Upper Gi ◽

Cardiovascular Comorbidities ◽

New Guidelines

Abstract Introduction Acute lower gastrointestinal bleeding (LGIB) tends to occur in elderly patients with complex comorbidities. At North Middlesex University Hospital (NMUH), LGIB patients are primarily managed by the surgical department. We amended local policies by integrating aspects of new guidelines published by the British Society of Gastroenterology (BSG). Method Handover documentation between November 2019 and January 2020 established patients admitted with LGIB (n = 45). Further data regarding the management of these patients was collated from clinical software and compared to standards set from BSG guidelines. Results We found NMUH to be efficient in ruling out upper GI bleeds via 24-hour OGDs and had low surgical intervention rates (0.02%). 40% of patients were transfused with an admission haemoglobin above suggested NICE thresholds, accounting for cardiovascular comorbidities. 56% of patients were discharged without a documented anticoagulation plan. Over 50% of patients did not have BSG recommended inpatient investigations. Conclusions Updated Trust guidelines aim to uphold areas that NMUH were shown to excel in, while reiterating NICE transfusion thresholds and include guidance regarding anticoagulant and antiplatelet medications. The Oakland score and shock index have been integrated into local protocols and will aid clinicians in making safe decisions in the management of LGIB patients.

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EFFICACY OF EMERGENCY ENDOSCOPIC HEMOSTASIS IN PATIENTS WITH ACUTE LOWER GASTROINTESTINAL BLEEDING AND FACTORS ASSOCIATED WITH NECESSITY OF ENDOSCOPIC INTERVENTION

10.1055/s-0039-1681813 ◽

2019 ◽

Author(s):

G Diamantopoulou ◽

C Konstantakis ◽

C Tsolias ◽

M Kalafateli ◽

G Theocharis ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Lower Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

Endoscopic Intervention ◽

Factors Associated

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Guideline review: British Society of Gastroenterology/UK-PBC Primary Biliary Cholangitis treatment and management guidelines

Frontline Gastroenterology ◽

10.1136/flgastro-2018-101109 ◽

2019 ◽

Vol 10 (3) ◽

pp. 316-319 ◽

Cited By ~ 4

Author(s):

Jorn C Goet ◽

Gideon M Hirschfield

Keyword(s):

Liver Disease ◽

Disease Management ◽

Ursodeoxycholic Acid ◽

British Society ◽

Primary Biliary Cholangitis ◽

Obeticholic Acid ◽

Management Guidelines ◽

Associated Symptoms ◽

Key Features ◽

New Guidelines

New guidelines have been produced for the management of primary biliary cholangitis, an infrequent but nonetheless important autoimmune liver disease. We provide a succient commentary and overview of the key features of disease management that arise from these recent guideline recommendations, with a focus on therapy with licensed agents (ursodeoxycholic acid and obeticholic acid) as well as personalised management of disease complications and associated symptoms.

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Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Gut ◽

10.1136/gutjnl-2018-317807 ◽

2019 ◽

Vol 68 (5) ◽

pp. 776-789 ◽

Cited By ~ 39

Author(s):

Kathryn Oakland ◽

Georgina Chadwick ◽

James E East ◽

Richard Guy ◽

Adam Humphries ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Lower Gastrointestinal Bleeding ◽

Evaluation Methodology ◽

British Society ◽

Diagnosis And Management ◽

Assessment Development ◽

Guidelines Development

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.

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