Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan.
Division of Advanced Genome Medicine, the Institute of Medical Science, the University of Tokyo, Tokyo 108-8639, Japan.
World J Gastroenterol. 2019 Jan 7;25(1):69-84. doi: 10.3748/wjg.v25.i1.69.
Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospital admission. Patients with LGIB often experience persistent or recurrent bleeding and require blood transfusions and interventions, such as colonoscopic, radiological, and surgical treatments. Appropriate decision-making is needed to initially manage acute LGIB, including emergency hospitalization, timing of colonoscopy, and medication use. In this literature review, we summarize the evidence for initial management of acute LGIB. Assessing various clinical factors, including comorbidities, medication use, presenting symptoms, vital signs, and laboratory data is useful for risk stratification of severe LGIB, and for discriminating upper gastrointestinal bleeding. Early timing of colonoscopy had the possibility of improving identification of the bleeding source, and the rate of endoscopic intervention, compared with elective colonoscopy. Contrast-enhanced computed tomography before colonoscopy may help identify stigmata of recent hemorrhage on colonoscopy, particularly in patients who can be examined immediately after the last hematochezia. How to deal with nonsteroidal anti-inflammatory drugs (NSAIDs) and antithrombotic agents after hemostasis should be carefully considered because of the risk of rebleeding and thromboembolic events. In general, aspirin as primary prophylaxis for cardiovascular events and NSAIDs were suggested to be discontinued after LGIB. Managing acute LGIB based on this information would improve clinical outcomes. Further investigations are needed to distinguish patients with LGIB who require early colonoscopy and hemostatic intervention.
急性下消化道出血（LGIB）是住院的常见指征。LGIB 患者常出现持续性或复发性出血，需要输血和介入治疗，如结肠镜、放射学和手术治疗。需要适当的决策来初步处理急性 LGIB，包括紧急住院、结肠镜检查的时机和药物使用。在这篇文献综述中，我们总结了急性 LGIB 初步管理的证据。评估各种临床因素，包括合并症、药物使用、症状、生命体征和实验室数据，有助于对严重 LGIB 进行风险分层，并对鉴别上消化道出血有帮助。与择期结肠镜检查相比，早期进行结肠镜检查有可能提高对出血源的识别率和内镜干预率。结肠镜检查前进行增强 CT 检查可能有助于识别结肠镜检查时近期出血的迹象，特别是在最后一次血便后可以立即检查的患者中。止血后如何处理非甾体抗炎药（NSAIDs）和抗血栓药物应仔细考虑，因为有再出血和血栓栓塞事件的风险。一般来说，建议在 LGIB 后停止阿司匹林作为心血管事件的一级预防和 NSAIDs。根据这些信息管理急性 LGIB 可以改善临床结局。需要进一步研究来区分需要早期结肠镜检查和止血干预的 LGIB 患者。
