Research Summary

New Guidelines for Acute Lower Gastrointestinal Bleeding Highlight Management Strategies

Jessica Ganga

The American College of Gastroenterology (ACG) has updated its guidelines on the management of patients with acute lower gastrointestinal bleeding.1 According to the new guidelines, acute lower gastrointestinal bleeding is a common reason for hospitalization in the United States with considerable morbidity and mortality risk for patients.

“In 2018, there were 271,575 emergency department visits and 113,020 hospital admissions for [acute lower gastrointestinal bleeding] listed as a primary diagnosis,” the authors wrote. “Compared with previous years, management of patients who are hospitalized for [acute lower gastrointestinal bleeding] is more complex, with increasing age and comorbidities, higher transfusion requirements, and longer lengths of hospital stay.”

The guidelines are an update to the previous guidelines published in 20162 and include new recommendations for risk stratification tools, diagnostic testing, endoscopic therapeutic options, and more.

The following recommendations are included in the guidelines:

  • The use of risk stratification tools can identify patients who are low risk with acute lower gastrointestinal bleeding so they can be discharged early and continue with outpatient evaluation.
  • Antifibrinolytic agents—such as tranexamic acid—should not be administered to patients.
  • A CT angiography (CTA) should be the initial diagnostic test for patients. If the CTA test demonstrates extravasation, patients should be referred to interventional radiology for transcatheter arteriography and possible embolization
  • A nonemergent inpatient colonoscopy should be performed—rather than an urgent colonoscopy—on hospitalized patients with acute lower gastrointestinal bleeding who require a colonoscopy.
  • After cessation of acute lower gastrointestinal bleeding, patients should resume anticoagulation as it has been shown to decrease the risk of postbleeding thromboembolism.

Further, the authors believe more research on acute lower gastrointestinal bleeding is necessary as there is a lack of high-quality randomized trial data on its management and diagnosis.

“Given how frequently clinicians manage patients who are hospitalized with [acute lower gastrointestinal bleeding] and the overall high burden of colonoscopy performed for this condition, the panel wanted to provide guidance and evidence-based recommendations whenever possible,” the authors concluded. “Future research in [acute lower gastrointestinal bleeding] should be focused on a few key areas, in which further data are urgently needed.” 



  1. Sengupta N, Feuerstein JD, Jairath V, et al. Management of patients with acute lower gastrointestinal bleeding: an updated ACG guideline. Am J Gastroenterol. 2023;118(2):208-231. doi:10.14309/ajg.0000000000002130
  2. Strate LL, Gralneck IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(4):459-474. doi: 10.1038/ajg.2016.41