The management of lower gastrointestinal bleeding

Marion, Yoann; Lebreton, Gil; Pennéc, V. Le; Hourna, E.; Viennot, Stéphanie; Alvès, Arnaud

doi:10.1016/j.jviscsurg.2014.03.008

Cited by 43 publications

(30 citation statements)

References 49 publications

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“…It can be caused by colorectal polyps, colorectal cancer (CRC), or colonic diverticulum (2) and can be lethal in some patients, particularly the elderly (3). It is diagnosed and treated with colonoscopy (4,5).…”

Section: Introductionmentioning

confidence: 99%

Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding

et al. 2016

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Abstract. Lower gastrointestinal (GI) bleeding can be caused by colorectal polyps or cancer. The aim of the present study was to identify blood test variables and medications that can predict lower GI bleeding, which would allow for appropriate colonoscopy. The medical records of patients who underwent colonoscopy from September 2014 to September 2015 were retrospectively analyzed. The selected patients included 278 men (mean age, 67.0±11.5 years) and 249 women (mean age, 69.6±12.0 years). The diagnosis, medications, and blood test variables were compared between patients with and without bleeding. Logistic regression analysis was performed to determine the factors associated with lower GI bleeding. The presence of colorectal polyp and cancer was associated with lower GI bleeding (P=0.0044) with an odds ratio of 6.71 (P=0.0148). No lower GI bleeding was observed in patients taking non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or anticoagulants. The C-reactive protein (CRP) levels were significantly higher in patients with lower GI bleeding (P=0.0227). The Hb levels were lower in patients with lower GI bleeding, however this finding was not statistically significant (P>0.05). No blood test variable was associated with lower GI bleeding. Elevated CRP was associated with lower GI bleeding, while there was no association between the medications and lower GI bleeding. IntroductionLower gastrointestinal (GI) bleeding occurs if the bleeding source is located distally to the Treitz ligament (1). It can be caused by colorectal polyps, colorectal cancer (CRC), or colonic diverticulum (2) and can be lethal in some patients, particularly the elderly (3). It is diagnosed and treated with colonoscopy (4,5).Lower GI bleeding is usually chronic and stops spontaneously (6). The identification of the bleeding site is important in its management (7). Lower GI bleeding is usually diagnosed with screening colonoscopy. If the risk factors are known, it is be possible to perform colonoscopy for such patients. The risk factors of patients hospitalized for severe lower GI bleeding include medication with non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants (8). It is not clear whether NSAIDs and anticoagulants are related to lower GI bleeding diagnosed using screening colonoscopy. Corticosteroids, used in the treatment of autoimmune disease such as rheumatoid arthritis (9), are associated with bleeding from peptic ulcer (1). However, whether corticosteroids are associated with lower GI bleeding remains to be determined.Blood test variables are easy to obtain and quantitate. These variables can be useful in distinguishing upper from lower GI bleeding, which can aid the clinical diagnosis (10).In this study, we analyzed the diagnosis of screening colonoscopy and compared medication intake (i.e., NSAIDs, corticosteroids, and anticoagulants) between patients with or without lower GI bleeding. Blood test variables were also analyzed. Materials and methodsEthics statement. The National Hospital Organization Shi...

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Section: Introductionmentioning

confidence: 99%

Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding

et al. 2016

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“…Unos pocos del intestino delgado (leiomioma o divertículo de Meckel) y el resto no son diagnosticados (12). Las principales causas de SDB son originadas en el colon y son divertículos, angiodisplasia, colitis isquémica, colitis inflamatoria, y del intestino delgado angiodisplasias y divertículo de Meckel (13).…”

Section: Discussionunclassified

Uso de complejo de protrombina en sangrado digestivo bajo en el paciente crítico anticoagulado. Reporte de caso

Mulett-Vásquez¹,

Marín-Marmolejo²,

Marín-Uribe

2017

Rev Med Hered

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Se presenta el caso de un varón de 66 años en post-operatorio de cirugía de Bentall y reemplazo de válvula aórtica por prótesis metálica, anticoagulación con warfarina, que presenta un episodio de sangrado digestivo bajo secundario a colitis isquémica localizada con INR elevado, sufriendo descompensación hemodinámica. Se realizó tratamiento con concentrado de protrombina humana con adecuada respuesta.

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“…Upper and lower GIB disproportionately affect patients with advanced age and multiple comorbidities, complicating the management of these conditions (4, 6, 7). Apart from the initial objective of ruling out upper gastrointestinal hemorrhage as the source of blood in the lower gastrointestinal tract, there is no clear consensus regarding management of patients who present with GIB (5, 8-12). In some cases, there are multiple teams of doctors interacting with the patient, ordering tests, and performing procedures without communicating with one another.…”

Section: Introductionmentioning

confidence: 99%

Improved outcomes following implementation of an acute gastrointestinal bleeding multidisciplinary protocol

Loftus

Hughes

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background Effective multidisciplinary management of gastrointestinal bleeding (GIB) requires effective communication. We instituted a protocol to standardize communication practices with the hypothesis that outcomes would improve following protocol initiation. Methods We performed a retrospective cohort analysis of 442 patients who required procedural management of acute GIB at our institution during a 50 month period spanning 25 months before and 25 months after implementation of a multidisciplinary communication protocol. The protocol stipulates that when a patient with severe GIB is identified, a conference call is coordinated among the Gastroenterology, Interventional Radiology, and Acute Care Surgery teams. A consensus plan is generated and then reassessed following procedural interventions and changes in patient status. Patient characteristics, management strategies, and outcomes were compared before and after protocol initiation. Results Patient populations before and after protocol initiation were similar in terms of age, comorbidities, outpatient use of antiplatelet/anticoagulant medications, admission vital signs, and admission laboratory values. The median interval between admission and the first procedure was significantly shorter in the protocol group (40 vs. 47 hours, p = 0.046). The proportion of patients who received packed red blood cell (PRBC) transfusions decreased following protocol initiation (41% vs. 50%, p = 0.018). Median hospital length of stay was significantly shorter in the protocol group (5.0 vs. 6.0 days, p = 0.014). Readmissions with GIB were decreased after protocol implementation (8% vs. 15%, p = 0.023). Conclusions Implementation of a multidisciplinary protocol for management of acute GIB was associated with earlier intervention, fewer PRBC transfusions, shorter hospital length of stay, and fewer readmissions with GIB. Future research should seek to establish causal relationships between communication practices and outcomes. Level of Evidence Therapeutic study, level IV

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The management of lower gastrointestinal bleeding

Cited by 43 publications

References 49 publications

Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding

Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding

Uso de complejo de protrombina en sangrado digestivo bajo en el paciente crítico anticoagulado. Reporte de caso

Improved outcomes following implementation of an acute gastrointestinal bleeding multidisciplinary protocol

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