208CLINICAL GUIDELINESCMEManagement of Patients With Acute LowerGastrointestinal Bleeding:An Updated ACG GuidelineNeil Sengupta,MD,Joseph D.Feuerstein,MD2,Vipul Jairath,MD,PhD3,Amandeep K.Shergill,MD4,Lisa L.Strate,MD,MPH5.Robert J.Wong,MD,MS(GRADE Methodologist)7 and David Wan,MDSAcute lower gastrointestinal bleeding(LGIB)is a common reason for hospitalization in the United States and isassociated with significant utilization of hospital resources,as well as considerable morbidity and mortality.Theserevised guidelines implement the Grading of Recommendations,Assessment,Development,and Evaluationmethodology to propose recommendations for the use of risk stratification tools,thresholds for red blood cell transfusion,reversal agents for patients on anticoagulants,diagnostic testing including colonoscopy and computed tomographyangiography(CTA),endoscopic therapeutic options,and management of antithrombotic medications after hospitaldischarge.Important changes since the previous iteration of this guideline include recommendations for the use of riskstratification tools to identify patients with LGIB at low risk of a hospital-based intervention,the role for reversal agents inpatients with life-threatening LGIB on vitamin K antagonists and directoral anticoagulants,the increasing role for CTA inpatients with severe LGIB,and the management of patients who have a positive CTA.We recommend that most patientsrequiring inpatient colonoscopy undergo a nonurgent colonoscopy because performing an urgent colonoscopy within 24hours of presentation has not been shown to improve important clinical outcomes such as rebleeding.Finally,we provideupdated recommendations regarding resumption of antiplatelet and anticoagulant medications after cessation of LGIB.KEYWORDS:lower gastrointestinal bleeding,hematochezia,colonoscopySUPPLEMENTARY MATERIAL accompa nies this paper at http://inks.lww.com/AJG/C827,http://inks.lww.com/AJG/C828Am J Gastroenterol 2023;118:208-231.https://doi.org/10.14309/ajg.0000000000002130:published online September 21,2022INTRODUCTIONand computed tomography angiography(CTA),and the data onAcute lower gastrointestinal bleeding (LGIB)is one of the mosturgent vs elective inpatient colonoscopy.We will conclude bycommon reasons for hospitalization in the United States due to areviewing endoscopic hemostatic options and risk and benefits ofdigestive disorder,accounting for over 100,000 admissions an-resumption of antithrombotic medications after cessation ofnually (1).Although historically LGIB has referred to a bleedingbleeding.We will focus the discussion on updates to managementsource originating distal to the ligament of Treitz,small bowelsince the previous guideline was published.bleeding is considered a separate entity,with a distinct diagnosticand therapeutic algorithm(2).For the purposes of this dinicalMETHODSpractice guideline,LGIB refers to hematochezia or bright redThe panel members formulated dinically pertinent questionsblood per rectum orig
