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Cited by 324Gastrointestinal Bleeding Diagnosis and TreatmentAbdominal vascular conditions and treatmentsGastrointestinal disorders and treatments

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

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Oakland, Kathryn, Chadwick, Georgina, East, James E, Guy, Richard, Humphries, Adam, Jairath, Vipul, McPherson, Simon, Metzner, Magdalena +8 more·2019·Gut
DOI 10.1136/gutjnl-2018-317807
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Abstract

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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  • This policy does not increase postoperative complication risk compared to conventional care.

    “Furthermore, this policy 1618 does not increase postoperative complication risk when compared to conventional care [218].”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [218]

    The Surgery section discusses emergency surgery outcomes but does not compare postoperative complication risk under a policy with conventional care. Searches for postoperative complications and conventional care found no passage making that comparison; page numbers were not available in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • A faster time to first flatus was recorded in all four studies in the early feeding group.

    “A faster time 1617 to first flatus was recorded in all four studies in the early feeding group.”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [218]

    The Timing of colonoscopy section discusses early colonoscopy for acute lower gastrointestinal bleeding, not early feeding. Searches for first flatus and postoperative passage of gas found no passage reporting that outcome in four studies. The indexed passages have no page numbers. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • In all four studies of a meta-analysis, early oral feeding was associated with a decreased length of hospital stay ranging from -1.3 to -2.5 days compared to conventional care.

    “In all four studies, early oral feeding was associated with a decreased length of 1616 hospital stay ranging from -1.3 to -2.5 days when compared to conventional care.”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [218]

    The Timing of colonoscopy section discusses shorter hospital stays after early colonoscopy, not early oral feeding. Searches for early oral feeding and the claimed −1.3 to −2.5-day range found no passage addressing the four-study comparison with conventional care. (LLM, conf=0.76)

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Authors
Oakland, K., Chadwick, G., East, J. E., Guy, R., Humphries, A., Jairath, V., McPherson, S., Metzner, M., Morris, A. J., Murphy, M. F., Tham, T., Uberoi, R., Veitch, A. M., Wheeler, J., Regan, C., & Hoare, J.
Affiliations
  • Royal College of Surgeons of England (GB)
  • John Radcliffe Hospital (GB)
  • University of Oxford (GB)
  • St Mark's Hospital (GB)
  • Western University (CA)
  • Leeds General Infirmary (GB)
  • Hutt Hospital (NZ)
  • Glasgow Royal Infirmary (GB)
  • NHS Blood and Transplant (GB)
  • Ulster Hospital (GB)
  • Oxford University Hospitals NHS Trust (GB)
  • New Cross Hospital (GB)
  • Addenbrooke's Hospital (GB)
  • Imperial College Healthcare NHS Trust (GB)
Corresponding author
Hoare, Jonathan
ORCID
Venue
Gut
Publisher
BMJ
Published
2019-02-12
Volume
68
Issue
5
Pages
776-789
ISSN
  • 0017-5749 (ISSN-L)
  • 1468-3288
DOI
10.1136/gutjnl-2018-317807
OpenAlex
W2912157468
Cited by
324
References
2
Citations by year
2026: 30 · 2025: 40 · 2024: 42 · 2023: 59 · 2022: 47 · 2021: 58 · 2020: 29 · 2019: 18
FWCI
34.62
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Gut (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institute for Health Research
  • Bowel Disease Research Foundation
  • NHS Blood and Transplant
  • Royal College of Surgeons of England
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Surgery › Gastrointestinal disorders and treatments
Keywords
acute lower gastrointestinal bleeding, diagnosis, management, risk assessment, colonoscopy, computed tomography, mesenteric angiography, endoscopic treatment, embolization, anticoagulants, direct oral anticoagulants, antiplatelet agents, blood transfusion, hemoglobin target
MeSH terms
Adult, Aged, Algorithms, Female, Gastroenterology, United Kingdom, Gastrointestinal Hemorrhage, Humans, Male, Middle Aged, Societies, Medical

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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