ACG guideline on managing acute lower gastrointestinal bleeding

Clinical Question

What is the optimal approach to managing acute lower gastrointestinal bleeding?

Bottom line

The ACG found limited evidence for most recommendations for managing acute lower gastrointestinal bleeding. They recommend risk stratification, nonurgent colonoscopy, and a restrictive policy on transfusions. For patients with severe bleeding, the ACG recommends CT angiography. (LOE = 5)

Overuse alert: This POEM aligns with the Canadian Society for Transfusion Medicine’s Choosing Wisely Canada recommendations. The Choosing Wisely Canada Why Give Two When One Will Do toolkit provides tools for reducing unnecessary red blood cell transfusions.

Study design: Practice guideline

Funding: Foundation

Setting: Various (guideline)


Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI

Discuss this POEM


Pieter Richard Verbeek

Guidelines for LGI bleeding

It is always sobering to learn how little of what we do for even common conditions has a strong evidence base. Thanks for the summary. Looking forward to reviewing the article.


Impact assessment

Very good


Acute lower GI Bleeding

How reliable are 'conditional recommendations based on low-quality evidence'?