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acg-clinical-guideline-management-of-patients-with-acute-lower-gastrointestinal-bleeding
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<h1>ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding.</h1>
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<table><tr><td>Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016 Apr;111(4):459-74. [140 references] <a href="https://web.archive.org/web/20180712205110/http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=26925883" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/web/20180712205110im_/https://www.guideline.gov/UI/images/icon_externallink.gif"/></td></tr></table> <p><a href="/web/20180712205110/https://www.guideline.gov/Home/Disclaimer?id=51048&contentType=fulltextlink&redirect=http%253a%252f%252fgi.org%252fwp-content%252fuploads%252f2016%252f03%252fACGGuideline-Acute-Lower-GI-Bleeding-03012016.pdf">View the original guideline documentation</a> <img alt="External Web Site Policy" src="/web/20180712205110im_/https://www.guideline.gov/UI/images/icon_externallink.gif"/></p>
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<p><div class="content_para"><p>This is the current release of the guideline. </p>
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<h4>UMLS Concepts <a href="/web/20180712205110/https://www.guideline.gov/help-and-about/search-browse/umls-concepts" class="what-is">(what is this?)</a></h4>
<div class="field">
<h5 class="field-label">ICD9CM</h5>
<div class="field-content">
<a href="/web/20180712205110/https://www.guideline.gov/search?f_ICD9CM_CUI=C0009378&fLockTerm=Colonoscopy">Colonoscopy</a>
(45.23), <a href="/web/20180712205110/https://www.guideline.gov/search?f_ICD9CM_CUI=C0031809&fLockTerm=General+physical+examination">General physical examination</a>
(89.7), <a href="/web/20180712205110/https://www.guideline.gov/search?f_ICD9CM_CUI=C0017181&fLockTerm=Hemorrhage+of+gastrointestinal+tract%2c+unspecified">Hemorrhage of gastrointestinal tract, unspecified</a>
(578.9), <a href="/web/20180712205110/https://www.guideline.gov/search?f_ICD9CM_CUI=C0086818&fLockTerm=Transfusion+of+platelets">Transfusion of platelets</a>
(99.05) </div>
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</div>
<!-- /.field -->
<div class="field">
<h5 class="field-label">MSH</h5>
<div class="field-content">
<a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0002978&fLockTerm=Angiography">Angiography</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0003211&fLockTerm=Anti-Inflammatory+Agents%2c+Non-Steroidal">Anti-Inflammatory Agents, Non-Steroidal</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0004057&fLockTerm=Aspirin">Aspirin</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0085430&fLockTerm=Blood+Component+Transfusion">Blood Component Transfusion</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0376583&fLockTerm=Clinical+Laboratory+Techniques">Clinical Laboratory Techniques</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0180022&fLockTerm=Colonoscopes">Colonoscopes</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0009378&fLockTerm=Colonoscopy">Colonoscopy</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C1536105&fLockTerm=Computed+Tomography+Angiography">Computed Tomography Angiography</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0038898&fLockTerm=Digestive+System+Surgical+Procedures">Digestive System Surgical Procedures</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0752152&fLockTerm=Endoscopes%2c+Gastrointestinal">Endoscopes, Gastrointestinal</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0086252&fLockTerm=Erythrocyte+Transfusion">Erythrocyte Transfusion</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0016286&fLockTerm=Fluid+Therapy">Fluid Therapy</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0017181&fLockTerm=Gastrointestinal+Hemorrhage">Gastrointestinal Hemorrhage</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0019010&fLockTerm=Hemodynamics">Hemodynamics</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0085148&fLockTerm=Hemostasis%2c+Endoscopic">Hemostasis, Endoscopic</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0025084&fLockTerm=Medical+History+Taking">Medical History Taking</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0030679&fLockTerm=Patient+Care+Team">Patient Care Team</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0031809&fLockTerm=Physical+Examination">Physical Examination</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0032177&fLockTerm=Platelet+Aggregation+Inhibitors">Platelet Aggregation Inhibitors</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0086818&fLockTerm=Platelet+Transfusion">Platelet Transfusion</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MSH_CUI=C0034606&fLockTerm=Radionuclide+Imaging">Radionuclide Imaging</a>
</div>
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</div>
<!-- /.field -->
<div class="field">
<h5 class="field-label">MTH</h5>
<div class="field-content">
<a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0002978&fLockTerm=angiogram">angiogram</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0003211&fLockTerm=Anti-Inflammatory+Agents%2c+Non-Steroidal">Anti-Inflammatory Agents, Non-Steroidal</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0004057&fLockTerm=Aspirin">Aspirin</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0085430&fLockTerm=Blood+Component+Transfusion">Blood Component Transfusion</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0009378&fLockTerm=Colonoscopy">Colonoscopy</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C1322687&fLockTerm=Endoscopes%2c+Gastrointestinal+Tract%2c+Upper+Tract">Endoscopes, Gastrointestinal Tract, Upper Tract</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0948899&fLockTerm=Erythrocyte+scintigraphy">Erythrocyte scintigraphy</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0079304&fLockTerm=Esophagogastroduodenoscopy">Esophagogastroduodenoscopy</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0016286&fLockTerm=Fluid+Therapy">Fluid Therapy</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0017181&fLockTerm=Gastrointestinal+Hemorrhage">Gastrointestinal Hemorrhage</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0019010&fLockTerm=Hemodynamics">Hemodynamics</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0024050&fLockTerm=Lower+gastrointestinal+hemorrhage">Lower gastrointestinal hemorrhage</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0031809&fLockTerm=physical+examination">physical examination</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0032177&fLockTerm=Platelet+Aggregation+Inhibitors">Platelet Aggregation Inhibitors</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0034606&fLockTerm=Radionuclide+Imaging">Radionuclide Imaging</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0086252&fLockTerm=Red+Blood+Cell+Transfusion">Red Blood Cell Transfusion</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C0086930&fLockTerm=Risk+Assessment">Risk Assessment</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_MTH_CUI=C4050234&fLockTerm=Surgical+procedures+of+gastrointestinal+system">Surgical procedures of gastrointestinal system</a>
</div>
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</div>
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<div class="field">
<h5 class="field-label">PDQ</h5>
<div class="field-content">
<a href="/web/20180712205110/https://www.guideline.gov/search?f_PDQ_CUI=C0004057&fLockTerm=acetylsalicyclic+acid">acetylsalicyclic acid</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_PDQ_CUI=C0002978&fLockTerm=angiography">angiography</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_PDQ_CUI=C0009378&fLockTerm=colonoscopy">colonoscopy</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_PDQ_CUI=C0086818&fLockTerm=platelet+transfusion">platelet transfusion</a>
, <a href="/web/20180712205110/https://www.guideline.gov/search?f_PDQ_CUI=C0034606&fLockTerm=radionuclide+imaging">radionuclide imaging</a>
</div>
<!-- /.field-content -->
</div>
<!-- /.field -->
<div class="field">
<h5 class="field-label">SNOMEDCT_US</h5>
<div class="field-content">
<a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0266811&fLockTerm=Acute+lower+gastrointestinal+hemorrhage">Acute lower gastrointestinal hemorrhage</a>
(85521005), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0002978&fLockTerm=Angiography">Angiography</a>
(77343006), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0004057&fLockTerm=Aspirin">Aspirin</a>
(387458008), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0004057&fLockTerm=Aspirin">Aspirin</a>
(7947003), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0180022&fLockTerm=Colonoscope">Colonoscope</a>
(90412006), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0009378&fLockTerm=Colonoscopy">Colonoscopy</a>
(73761001), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C1536105&fLockTerm=CT+angiography">CT angiography</a>
(418272005), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0079304&fLockTerm=Esophagogastroduodenoscopy">Esophagogastroduodenoscopy</a>
(387596007), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0079304&fLockTerm=Esophagogastroduodenoscopy">Esophagogastroduodenoscopy</a>
(76009000), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0752152&fLockTerm=Gastrointestinal+endoscope">Gastrointestinal endoscope</a>
(705509004), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0017181&fLockTerm=Gastrointestinal+hemorrhage">Gastrointestinal hemorrhage</a>
(74474003), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C3251803&fLockTerm=Hemodynamic+care">Hemodynamic care</a>
(722484006), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0204901&fLockTerm=Hemodynamic+measurements">Hemodynamic measurements</a>
(44324008), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0024050&fLockTerm=Lower+gastrointestinal+hemorrhage">Lower gastrointestinal hemorrhage</a>
(87763006), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0003211&fLockTerm=Non-steroidal+anti-inflammatory+agent">Non-steroidal anti-inflammatory agent</a>
(16403005), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0003211&fLockTerm=Non-steroidal+anti-inflammatory+agent">Non-steroidal anti-inflammatory agent</a>
(372665008), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0034606&fLockTerm=Nuclear+medicine+imaging+procedure">Nuclear medicine imaging procedure</a>
(373205008), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0038898&fLockTerm=Operative+procedure+on+digestive+system">Operative procedure on digestive system</a>
(107907001), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0031809&fLockTerm=Physical+examination">Physical examination</a>
(302199004), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0031809&fLockTerm=Physical+examination">Physical examination</a>
(5880005), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0031809&fLockTerm=Physical+examination">Physical examination</a>
(81375008), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0086818&fLockTerm=Platelet+transfusion">Platelet transfusion</a>
(12719002), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0086818&fLockTerm=Platelet+transfusion">Platelet transfusion</a>
(180208003), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0086930&fLockTerm=Risk+assessment">Risk assessment</a>
(225338004), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C1319406&fLockTerm=Specialist+multidisciplinary+team">Specialist multidisciplinary team</a>
(408458006), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0085430&fLockTerm=Transfusion+of+blood+component">Transfusion of blood component</a>
(54790000), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0278347&fLockTerm=Transfusion+of+plasma">Transfusion of plasma</a>
(13569004), <a href="/web/20180712205110/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0086252&fLockTerm=Transfusion+of+red+blood+cells">Transfusion of red blood cells</a>
(116863004) </div>
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</div>
<!-- /.field -->
<div class="field">
<h5 class="field-label">SPN</h5>
<div class="field-content">
<a href="/web/20180712205110/https://www.guideline.gov/search?f_SPN_CUI=C0180022&fLockTerm=COLONOSCOPE%2c+GENERAL+%26+PLASTIC+SURGERY">COLONOSCOPE, GENERAL & PLASTIC SURGERY</a>
</div>
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</div>
<!-- /.field -->
<div class="field">
<h5 class="field-label">UMD</h5>
<div class="field-content">
<a href="/web/20180712205110/https://www.guideline.gov/search?f_UMD_CUI=C0180022&fLockTerm=Colonoscopes">Colonoscopes</a>
(10-950), <a href="/web/20180712205110/https://www.guideline.gov/search?f_UMD_CUI=C1322687&fLockTerm=Endoscopes%2c+Gastrointestinal+Tract%2c+Upper+Tract">Endoscopes, Gastrointestinal Tract, Upper Tract</a>
(20-478) </div>
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</div>
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</div>
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<div id="neats-tab" class="content-tab-panel">
<p id="NeatsDescription">
National Guideline Clearinghouse (NGC) has assessed this guideline's adherence to standards of trustworthiness, derived from the Institute of Medicine's report
<a href="/web/20180712205110/https://www.guideline.gov/disclaimer?id=51048&contentType=summary&redirect=http%3A%2F%2Fnationalacademies.org%2Fhmd%2FReports%2F2011%2FClinical-Practice-Guidelines-We-Can-Trust.aspx"><i>Clinical Practice Guidelines We Can Trust</i></a> <img alt="External Web Site Policy" src="/web/20180712205110im_/https://www.guideline.gov/UI/images/icon_externallink.gif">.
</p>
<div class="ratings" aria-hidden="true">
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-1.png" alt="Poor"/> = Poor</span>
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-2.png" alt="Fair"/> = Fair</span>
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-3.png" alt="Good"/> = Good</span>
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-4.png" alt="Very Good"/> = Very Good</span>
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-5.png" alt="Excellent"/> = Excellent</span>
</div>
<table aria-describedby="NeatsDescription">
<thead>
<tr>
<th id="section">NEATS Assessment <a class="icon-info" href="/web/20180712205110/https://www.guideline.gov/help-and-about/summaries/determining-extent-adherence-to-the-iom-standards-in-ngc"><span class="screen-reader-text">More about NGC's appraisal</span></a></th>
<th id="standard">Standard of Trustworthiness</th>
</tr>
</thead>
<tbody>
<tr>
<td class="topborderme" headers="section">Yes</td>
<td class="greenboldme topborderme" headers="standard">Disclosure of Guideline Funding Source</td>
</tr>
<tr>
<td class="topborderme" headers="section"> <span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-3.png" alt="Good"/></span>
</td>
<td class="greenboldme topborderme" headers="standard">Disclosure and Management of Financial Conflict of Interests</td>
</tr>
<tr>
<td class="topborderme" id="blank"></td>
<th class="greenboldme topborderme" id="185" headers="standard">Guideline Development Group Composition</th>
</tr>
<tr>
<td headers="section">
No
</td>
<td class="leftpadme" headers="185">Multidisciplinary Group</td>
</tr>
<tr>
<td headers="section">
Unknown
</td>
<td class="leftpadme" headers="186">Methodologist Involvement</td>
</tr>
<tr>
<td headers="section">
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-1.png" alt="Poor"/></span>
</td>
<td class="leftpadme" headers="187">Patient and Public Perspectives</td>
</tr>
<tr>
<td class="topborderme" id="blank"></td>
<th class="greenboldme topborderme" id="188" headers="standard">Use of a Systematic Review of Evidence</th>
</tr>
<tr>
<td headers="section">
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-4.png" alt="Very Good"/></span>
</td>
<td class="leftpadme" headers="188">Search Strategy</td>
</tr>
<tr>
<td headers="section">
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-3.png" alt="Good"/></span>
</td>
<td class="leftpadme" headers="189">Study Selection</td>
</tr>
<tr>
<td headers="section">
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-4.png" alt="Very Good"/></span>
</td>
<td class="leftpadme" headers="190">Synthesis of Evidence</td>
</tr>
<tr>
<td class="topborderme" id="blank"></td>
<th class="greenboldme topborderme" id="191" headers="standard">Evidence Foundations for and Rating Strength of Recommendations</th>
</tr>
<tr>
<td headers="section">
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-5.png" alt="Excellent"/></span>
</td>
<td class="leftpadme" headers="191">Grading the Quality or Strength of Evidence</td>
</tr>
<tr>
<td headers="section">
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-5.png" alt="Excellent"/></span>
</td>
<td class="leftpadme" headers="192">Benefits and Harms of Recommendations</td>
</tr>
<tr>
<td headers="section">
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-5.png" alt="Excellent"/></span>
</td>
<td class="leftpadme" headers="193">Evidence Summary Supporting Recommendations</td>
</tr>
<tr>
<td headers="section">
<span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-5.png" alt="Excellent"/></span>
</td>
<td class="leftpadme" headers="194">Rating the Strength of Recommendations</td>
</tr>
<tr>
<td class="topborderme" headers="section"> <span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-5.png" alt="Excellent"/></span>
</td>
<td class="greenboldme topborderme" headers="standard">Specific and Unambiguous Articulation of Recommendations</td>
</tr>
<tr>
<td class="topborderme" headers="section"> <span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-1.png" alt="Poor"/></span>
</td>
<td class="greenboldme topborderme" headers="standard">External Review</td>
</tr>
<tr>
<td class="topborderme" headers="section"> <span class="rating"><img src="/web/20180712205110im_/https://www.guideline.gov/UI/images/rating-1.png" alt="Poor"/></span>
</td>
<td class="greenboldme topborderme" headers="standard">Updating</td>
</tr>
</tbody>
</table>
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<li><a href="#424" class="section-mark">Evidence Supporting the Recommendations</a></li>
<li><a href="#427" class="section-mark">Benefits/Harms of Implementing the Guideline Recommendations</a></li>
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<p class="text-label"><label for="citation">Citation: </label></p>
<textarea id="citation">National Guideline Clearinghouse (NGC). Guideline summary: ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2016 Apr 01. [cited 2018 Jul 12]. Available: https://www.guideline.gov</textarea>
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<h2 id="420" class="accordion-title section-420 is-active" role="tab" aria-expanded="true"><a href="#">Recommendations</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">Major Recommendations</a></h3>
<p><div class="content_para"><p>Definitions of the quality of evidence (<strong>high, moderate, low, </strong>and <strong>very low</strong>) and strength of recommendations (<strong>strong</strong> and <strong>conditional</strong>) are provided at the end of the "Major Recommendations" field.</p>
<p><strong><span style="text-decoration: underline;">Initial Assessment</span></strong></p>
<p><strong>Evaluation and Risk Stratification </strong></p>
<ol style="list-style-type: decimal;" start="1">
<li>A focused history, physical examination, and laboratory evaluation should be obtained at the time of patient presentation to assess the severity of bleeding and its possible location and etiology. Initial patient assessment and hemodynamic resuscitation should be performed simultaneously (<strong>Strong recommendation, very-low-quality evidence</strong>). </li>
<li>Hematochezia associated with hemodynamic instability may be indicative of an upper gastrointestinal bleeding (UGIB) source, and an upper endoscopy should be performed. A nasogastric aspirate/lavage may be used to assess a possible upper gastrointestinal (GI) source if suspicion of UGIB is moderate (<strong>Strong recommendation, low-quality evidence</strong>). </li>
<li>Risk assessment and stratification should be performed to help distinguish patients at high and low risks of adverse outcomes and assist in patient triage including the timing of colonoscopy and the level of care (<strong>Conditional recommendation, low-quality evidence</strong>). </li>
</ol>
<p><strong>Hemodynamic Resuscitation</strong></p>
<ol style="list-style-type: decimal;" start="4">
<li>Patients with hemodynamic instability and/or suspected ongoing bleeding should receive intravenous fluid resuscitation with the goal of normalization of blood pressure and heart rate prior to endoscopic evaluation/intervention (<strong>Strong recommendation, very-low-quality evidence</strong>). </li>
<li>Packed red blood cells should be transfused to maintain the hemoglobin above 7 g/dl. A threshold of 9 g/dl should be considered in patients with massive bleeding, significant comorbid illness (especially cardiovascular ischemia), or a possible delay in receiving therapeutic interventions (<strong>Conditional recommendations, low-quality evidence</strong>). </li>
</ol>
<p><strong>Management of Anticoagulant Medications</strong></p>
<ol style="”list-style-type: ;" start="6">
<li>Endoscopic hemostasis may be considered in patients with an international normalized ratio (INR) of 1.5–2.5 before or concomitant with the administration of reversal agents. Reversal agents should be considered before endoscopy in patients with an INR >2.5 (<strong>Conditional recommendation, very-low-quality evidence</strong>). </li>
<li>Platelet transfusion should be considered to maintain a platelet count of 50×10/l in patients with severe bleeding and those requiring endoscopic hemostasis (<strong>Conditional recommendation, very-low-quality evidence</strong>). </li>
<li>Platelet and plasma transfusions should be considered in patients who receive massive red blood cell transfusions (<strong>Conditional recommendation, very-low-quality evidence</strong>). </li>
<li>In patients on anticoagulant agents, a multidisciplinary approach (e.g., hematology, cardiology, neurology, and gastroenterology) should be used when deciding whether to discontinue medications or use reversal agents to balance the risk of ongoing bleeding with the risk of thromboembolic events (<strong>Strong recommendation, very-low-quality evidence</strong>). </li>
</ol>
<p><strong><span style="text-decoration: underline;">Colonoscopy</span></strong></p>
<p><strong>Colonoscopy as a Diagnostic Tool </strong></p>
<ol style="”list-style-type: ;" start="10">
<li>Colonoscopy should be the initial diagnostic procedure for nearly all patients presenting with acute lower gastrointestinal bleeding (LGIB) (<strong>Strong recommendation, low-quality evidence</strong>). </li>
<li>The colonic mucosa should be carefully inspected during both colonoscope insertion and withdrawal, with aggressive attempts made to wash residual stool and blood in order to identify the bleeding site. The endoscopist should also intubate the terminal ileum to rule out proximal blood suggestive of a small bowel lesion (<strong>Conditional recommendation, very-low-quality evidence</strong>). </li>
</ol>
<p><strong>Bowel Preparation</strong></p>
<ol style="list-style-type: decimal;" start="12">
<li>Once the patient is hemodynamically stable, colonoscopy should be performed after adequate colon cleansing. Four to six liters of a polyethylene glycol (PEG)-based solution or the equivalent should be administered over 3 to 4 h until the rectal effluent is clear of blood and stool. Unprepped colonoscopy/sigmoidoscopy is not recommended (<strong>Strong recommendation, low-quality evidence</strong>). </li>
<li>A nasogastric tube can be considered to facilitate colon preparation in high-risk patients with ongoing bleeding who are intolerant to oral intake and are at low risk of aspiration (<strong>Conditional recommendation, low-quality evidence</strong>). </li>
</ol>
<p><strong>Timing of Colonoscopy </strong></p>
<ol style="list-style-type: decimal;" start="14">
<li>In patients with high-risk clinical features and signs or symptoms of ongoing bleeding, a rapid bowel purge should be initiated following hemodynamic resuscitation and a colonoscopy performed within 24 h of patient presentation after adequate colon preparation to potentially improve diagnostic and therapeutic yield (<strong>Conditional recommendation, low-quality evidence</strong>). </li>
<li>In patients without high-risk clinical features or serious comorbid disease or those with high-risk clinical features without signs or symptoms of ongoing bleeding, colonoscopy should be performed next available after a colon purge (<strong>Conditional recommendation, low-quality evidence</strong>). </li>
</ol>
<p><strong>Endoscopic Hemostasis Therapy </strong></p>
<ol style="list-style-type: decimal;" start="16">
<li>Endoscopic therapy should be provided to patients with high-risk endoscopic stigmata of bleeding: active bleeding (spurting and oozing); non-bleeding visible vessel; or adherent clot (<strong>Strong recommendation, low-quality evidence</strong>). </li>
<li>Diverticular bleeding: through-the-scope endoscopic clips are recommended as clips may be safer in the colon than contact thermal therapy and are generally easier to perform than band ligation, particularly for right-sided colon lesions (<strong>Conditional recommendation, low-quality evidence</strong>). </li>
<li>Angioectasia bleeding: noncontact thermal therapy using argon plasma coagulation is recommended (<strong>Conditional recommendation, low-quality evidence</strong>). </li>
<li>Post-polypectomy bleeding: mechanical (clip) or contact thermal endotherapy, with or without the combined use of dilute epinephrine injection, is recommended (<strong>Strong recommendation, low-quality evidence</strong>). </li>
<li>Epinephrine injection therapy (1:10,000 or 1:20,000 dilution with saline) can be used to gain initial control of an active bleeding lesion and improve visualization but should be used in combination with a second hemostasis modality including mechanical or contact thermal therapy to achieve definitive hemostasis (<strong>Strong recommendation, very-low-quality evidence</strong>). </li>
</ol>
<p><strong><span style="text-decoration: underline;">Role of Repeat Colonoscopy in the Setting of Early Recurrent Bleeding</span></strong></p>
<ol style="list-style-type: decimal;" start="21">
<li>Repeat colonoscopy, with endoscopic hemostasis if indicated, should be considered for patients with evidence of recurrent bleeding (<strong>Strong recommendation, very-low-quality evidence</strong>). </li>
</ol>
<p><strong><span style="text-decoration: underline;">Non-colonoscopy Interventions</span> </strong></p>
<ol style="list-style-type: decimal;" start="22">
<li>A surgical consultation should be requested in patients with high-risk clinical features and ongoing bleeding. In general, surgery for acute LGIB should be considered after other therapeutic options have failed and should take into consideration the extent and success of prior bleeding control measures, severity and source of bleeding, and the level of comorbid disease. It is important to very carefully localize the source of bleeding whenever possible before surgical resection to avoid continued or recurrent bleeding from an unresected culprit lesion (<strong>Conditional recommendation, very-low-quality evidence</strong>). </li>
<li>Radiographic interventions should be considered in patients with high-risk clinical features and ongoing bleeding who have a negative upper endoscopy and do not respond adequately to hemodynamic resuscitation efforts and are therefore unlikely to tolerate bowel preparation and urgent colonoscopy (<strong>Strong recommendation, very-low-quality evidence</strong>). </li>
<li>If a diagnostic test is desired for localization of the bleeding site before angiography, computed tomography (CT) angiography should be considered (<strong>Conditional recommendation, very-low-quality evidence</strong>). </li>
</ol>
<p><strong><span style="text-decoration: underline;">Prevention of Recurrent Lower Gastrointestinal Bleeding</span></strong></p>
<ol style="list-style-type: decimal;" start="25">
<li>Non-aspirin non-steroidal anti-inflammatory drug (NSAID) use should be avoided in patients with a history of acute LGIB, particularly if secondary to diverticulosis or angioectasia (<strong>Strong recommendation, low-quality evidence</strong>). </li>
<li>In patients with established high-risk cardiovascular disease and a history of LGIB, aspirin used for secondary prevention should not be discontinued. Aspirin for primary prevention of cardiovascular events should be avoided in most patients with LGIB (<strong>Strong recommendation, low-quality evidence</strong>). </li>
<li>In patients on dual antiplatelet therapy or monotherapy with non-aspirin antiplatelet agents (thienopyridine), non-aspirin antiplatelet therapy should be resumed as soon as possible and at least within 7 days based on multidisciplinary assessment of cardiovascular and GI risk and the adequacy of endoscopic therapy (as above, aspirin use should not be discontinued). However, dual antiplatelet therapy should not be discontinued in patients with an acute coronary syndrome within the past 90 days or coronary stenting within the past 30 days (<strong>Strong recommendation, low-quality evidence</strong>). </li>
</ol>
<p><strong><span style="text-decoration: underline;">Definitions</span></strong></p>
<p>The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence and strength of recommendation. </p>
<p><strong>Quality of Evidence </strong></p>
<p><strong>High</strong>: Further research is very unlikely to change confidence in the estimate of effect. </p>
<p><strong>Moderate</strong>: Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate. </p>
<p><strong>Low</strong>: Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. </p>
<p><strong>Very Low</strong>: Any estimate of effect is very uncertain. </p>
<p><strong>Strength of Recommendations </strong></p>
<p><strong>Strong</strong>: The desirable effects of an intervention clearly outweigh the undesirable effects or clearly do not. </p>
<p><strong>Conditional</strong>: The tradeoffs are less certain between the desirable and undesirable effects of an intervention.</p></div></p>
<h3><a href="#">Clinical Algorithm(s)</a></h3>
<p><div class="content_para"><p>An algorithm titled "Algorithm for the management of patients presenting with acute LGIB stratified by bleeding severity" is provided in the original guideline document. </p></div></p>
</div>
<h2 id="396" class="accordion-title section-396 is-active" role="tab" aria-expanded="true"><a href="#">Scope</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">Disease/Condition(s)</a></h3>
<p><div class="content_para"><p>Acute overt lower gastrointestinal bleeding (LGIB)</p>
<p class="Note"><strong>Note</strong>: For the purposes of this guideline, LGIB is defined as the onset of hematochezia originating from either the colon or the rectum.</p></div></p>
<h3><a href="#">Guideline Category</a></h3>
<p>Evaluation</p>
<p>Management</p>
<p>Prevention</p>
<p>Risk Assessment</p>
<p>Treatment</p>
<h3><a href="#">Clinical Specialty</a></h3>
<p>Colon and Rectal Surgery</p>
<p>Gastroenterology</p>
<p>Hematology</p>
<p>Internal Medicine</p>
<h3><a href="#">Intended Users</a></h3>
<p>Physicians</p>
<h3><a href="#">Guideline Objective(s)</a></h3>
<p><div class="content_para"><p>To provide recommendations for the management of patients with acute overt lower gastrointestinal bleeding (LGIB)</p></div></p>
<h3><a href="#">Target Population</a></h3>
<p><div class="content_para"><p>Patients with acute overt lower gastrointestinal bleeding (LGIB)</p></div></p>
<h3><a href="#">Interventions and Practices Considered</a></h3>
<p><div class="content_para"><p><strong><span style="text-decoration: underline;">Initial Assessment</span></strong></p>
<p>Assessment of hemodynamic status </p>
<ul style="list-style-type: disc;">
<li>Focused history, physical examination, and laboratory evaluation </li>
<li>Upper endoscopy </li>
<li>Risk assessment and stratification </li>
</ul>
<p><strong><span style="text-decoration: underline;">Management/Treatment</span></strong></p>
<ol style="list-style-type: decimal;" start="1">
<li>Hemodynamic resuscitation (performed simultaneously with initial assessment)
<ul style="list-style-type: disc;">
<li>Intravenous fluid resuscitation </li>
<li>Red blood cell (RBC) transfusion </li>
</ul>
</li>
<li>Management of coagulation defects
<ul style="list-style-type: disc;">
<li>Endoscopic hemostasis </li>
<li>Platelet and plasma transfusion </li>
<li>Use of multidisciplinary approach </li>
</ul>
</li>
<li>Colonoscopy
<ul style="list-style-type: disc;">
<li>Performed within 24 hours of presentation, following bowel preparation, for high-risk patients and at next available for low-risk patients </li>
<li>Endoscopic hemostasis therapy (mechanical, thermal, injection, or combination) </li>
<li>Repeat colonoscopy (as indicated) </li>
</ul>
</li>
<li>Non-colonoscopy interventions
<ul style="list-style-type: disc;">
<li>Surgical consultation </li>
<li>Radiographic interventions (i.e., tagged red blood cell scintigraphy, computed tomographic angiography, angiography) </li>
<li>Computed tomography (CT) angiography </li>
</ul>
</li>
</ol>
<p><strong><span style="text-decoration: underline;">Prevention</span></strong></p>
<ol style="list-style-type: decimal;" start="1">
<li>Non-steroidal anti-inflammatory drugs (NSAIDs) (not recommended) </li>
<li>Aspirin (as indicated) </li>
<li>Non-aspirin antiplatelet therapy </li>
</ol></div></p>
<h3><a href="#">Major Outcomes Considered</a></h3>
<p><ul style="list-style-type: disc;">
<li>Incidence and severity of complications </li>
<li>Rebleeding or ongoing bleeding </li>
<li>Need for treatment </li>
<li>Adverse events </li>
<li>Morbidity </li>
<li>Mortality </li>
</ul></p>
</div>
<h2 id="405" class="accordion-title section-405 is-active" role="tab" aria-expanded="true"><a href="#">Methodology</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">Methods Used to Collect/Select the Evidence</a></h3>
<p>Hand-searches of Published Literature (Primary Sources)</p>
<p>Hand-searches of Published Literature (Secondary Sources)</p>
<p>Searches of Electronic Databases</p>
<h3><a href="#">Description of Methods Used to Collect/Select the Evidence</a></h3>
<p><div class="content_para"><p>With the assistance of a health sciences librarian, a systematic search of the literature was conducted covering the years 1 January 1968 through 2 March 2015 in the PubMed and EMBASE databases and the Cochrane Library including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effect, and Cochrane Central Register of Controlled Trials (CENTRAL). The PubMed search used a combination of Medical Subject Headings (MeSH), as well as terms appearing in titles and abstracts. The final group was limited to English language and human studies. Citations dealing with children and prostatic neoplasms were excluded. Refer to the original guideline document for the search strategy used to cover the lower gastrointestinal tract. </p>
<p>Search strategies in EMBASE and the Cochrane Library databases replicated the terms, limits, and features used in the PubMed search strategy. </p>
<p>In addition to the literature search, the authors reviewed the references of identified articles for additional studies. The authors also performed targeted searches on topics for which there is relevant literature for upper gastrointestinal bleeding (UGIB) but not lower gastrointestinal bleeding (LGIB) including hemodynamic resuscitation/blood product transfusions and management of anticoagulant and antiplatelet medications.</p></div></p>
<h3><a href="#">Number of Source Documents</a></h3>
<p><div class="content_para"><p>A total of 2,576 studies were identified, and 133 studies were included in the evidence base. </p></div></p>
<h3><a href="#">Methods Used to Assess the Quality and Strength of the Evidence</a></h3>
<p>Weighting According to a Rating Scheme (Scheme Given)</p>
<h3><a href="#">Rating Scheme for the Strength of the Evidence</a></h3>
<p><div class="content_para"><p><strong><span style="text-decoration: underline;">Quality of Evidence</span></strong></p>
<p><strong>High</strong>: Further research is very unlikely to change confidence in the estimate of effect. </p>
<p><strong>Moderate</strong>: Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate. </p>
<p><strong>Low</strong>: Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. </p>
<p><strong>Very Low</strong>: Any estimate of effect is very uncertain.</p></div></p>
<h3><a href="#">Methods Used to Analyze the Evidence</a></h3>
<p>Review of Published Meta-Analyses</p>
<p>Systematic Review with Evidence Tables</p>
<h3><a href="#">Description of the Methods Used to Analyze the Evidence</a></h3>
<p><div class="content_para"><p>The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the quality of evidence. See the "Rating Scheme for the Strength of the Evidence" field.</p>
<p>In the GRADE system, randomized trials are considered high-quality evidence but can be downrated depending on the size, quality, and consistency of studies. Observational studies are generally rated as low-quality studies.</p></div></p>
<h3><a href="#">Methods Used to Formulate the Recommendations</a></h3>
<p>Expert Consensus (Nominal Group Technique)</p>
<h3><a href="#">Description of Methods Used to Formulate the Recommendations</a></h3>
<p><div class="content_para"><p>The GRADE system was used to rate the strength of each recommendation. See the "Rating Scheme for the Strength of the Recommendations" field.</p>
<p>The strength of a recommendation is graded as strong when the desirable effects of an intervention clearly outweigh the undesirable effects and is graded as conditional when uncertainty exists about the trade-offs. Other factors affecting the strength of recommendation include variability in values and preferences of patients and whether an intervention represents a wise use of resources.</p></div></p>
<h3><a href="#">Rating Scheme for the Strength of the Recommendations</a></h3>
<p><div class="content_para"><p><strong><span style="text-decoration: underline;">Strength of Recommendations</span></strong></p>
<p><strong>Strong</strong>: The desirable effects of an intervention clearly outweigh the undesirable effects or clearly do not. </p>
<p><strong>Conditional</strong>: The tradeoffs are less certain between the desirable and undesirable effects of an intervention.</p></div></p>
<h3><a href="#">Cost Analysis</a></h3>
<p><div class="content_para"><p>A formal cost analysis was not performed and published analyses were not reviewed.</p></div></p>
<h3><a href="#">Method of Guideline Validation</a></h3>
<p>Internal Peer Review</p>
<h3><a href="#">Description of Method of Guideline Validation</a></h3>
<p><div class="content_para"><p>The American College of Gastroenterology created a special guideline review process, involving members of the Board of Trustees, Practice Parameters Committee and the <em>American Journal of Gastroenterology</em>. It is their goal to review the guideline, allow the Practice Parameters Committee to revise the guideline, and re-review the guideline within 6 months of first submission. Therefore the entire process should take 1 year from commission to finished, accepted guideline.</p></div></p>
</div>
<h2 id="424" class="accordion-title section-424 is-active" role="tab" aria-expanded="true"><a href="#">Evidence Supporting the Recommendations</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">Type of Evidence Supporting the Recommendations</a></h3>
<p><div class="content_para"><p>The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field). </p></div></p>
</div>
<h2 id="427" class="accordion-title section-427 is-active" role="tab" aria-expanded="true"><a href="#">Benefits/Harms of Implementing the Guideline Recommendations</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">Potential Benefits</a></h3>
<p><div class="content_para"><p>Appropriate management of patients with acute lower gastrointestinal bleeding (LGIB)</p>
<p>Refer to the "Summary of Evidence" sections of the original guideline documentation for benefits associated with specific interventions.</p></div></p>
<h3><a href="#">Potential Harms</a></h3>
<p><ul style="list-style-type: disc;">
<li>Large observational studies and a meta-analysis of three small trials of upper gastrointestinal bleeding (UGIB) suggest that blood transfusion compared with no transfusion is associated with an increased risk of rebleeding and possibly death. </li>
<li>Complications of colon preparation with polyethylene glycol are rare but include aspiration pneumonia, as well as fluid and electrolyte abnormalities. </li>
<li>The risk of early rebleeding in the setting of antiplatelet or anticoagulant use may be higher with thermal contact hemostasis methods than with mechanical methods (clips). In a pooled analysis by no early rebleeding was reported after endoscopic clipping of diverticular bleeding; however, late rebleeding occurred in 17%. </li>
<li>When performing computed tomography (CT) angiography, standard precautions should be taken to avoid contrast-induced nephropathy, particularly as patients may undergo subsequent angiography with administration of arterial contrast. Because angiography relies on active bleeding and has the potential for serious complications, it should be reserved for patients with very brisk, ongoing bleeding. </li>
<li>Caution should be exercised when contemplating using band ligation for a right side colonic diverticular bleed. <em>Ex vivo</em> colon specimen data have demonstrated serosal entrapment and inclusion of the muscularis propia post band ligation in the right colon. </li>
</ul>
<p>Refer to the "Summary of Evidence" sections of the original guideline documentation for harms associated with specific interventions.</p></p>
</div>
<h2 id="430" class="accordion-title section-430 is-active" role="tab" aria-expanded="true"><a href="#">Contraindications</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">Contraindications</a></h3>
<p><div class="content_para"><p>Non-aspirin nonsteroidal anti-inflammatory drugs (NSAID) use should be avoided in patients with a history of acute lower gastrointestinal bleeding (LGIB) particularly if secondary to diverticulosis or angioectasia.</p></div></p>
</div>
<h2 id="434" class="accordion-title section-434 is-active" role="tab" aria-expanded="true"><a href="#">Implementation of the Guideline</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">Description of Implementation Strategy</a></h3>
<p><div class="content_para"><p>An implementation strategy was not provided.</p></div></p>
<h3><a href="#">Implementation Tools</a></h3>
<p>Clinical Algorithm</p>
<p><div class="general-block">For information about availability, see the <i>Availability of Companion Documents</i> and <i>Patient Resources</i> fields below.</div></p>
</div>
<h2 id="439" class="accordion-title section-439 is-active" role="tab" aria-expanded="true"><a href="#">Institute of Medicine (IOM) National Healthcare Quality Report Categories</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">IOM Care Need</a></h3>
<p>Getting Better</p>
<h3><a href="#">IOM Domain</a></h3>
<p>Effectiveness</p>
</div>
<h2 id="442" class="accordion-title section-442 is-active" role="tab" aria-expanded="true"><a href="#">Identifying Information and Availability</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">Bibliographic Source(s)</a></h3>
<p><table><tr><td>Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016 Apr;111(4):459-74. [140 references] <a href="https://web.archive.org/web/20180712205110/http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=26925883" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/web/20180712205110im_/https://www.guideline.gov/UI/images/icon_externallink.gif"/></td></tr></table></p>
<h3><a href="#">Adaptation</a></h3>
<p><div class="content_para"><p>This guideline was not adapted from another source.</p></div></p>
<h3><a href="#">Date Released</a></h3>
<p>2016 Apr</p>
<h3><a href="#">Guideline Developer(s)</a></h3>
<p>American College of Gastroenterology - Medical Specialty Society</p>
<h3><a href="#">Source(s) of Funding</a></h3>
<p><div class="content_para"><p>This research was supported in part by grants from the National Institutes of Health R01 DK095964 and DK084157.</p></div></p>
<h3><a href="#">Guideline Committee</a></h3>
<p><div class="content_para"><p>Not stated</p></div></p>
<h3><a href="#">Composition of Group That Authored the Guideline</a></h3>
<p><div class="content_para"><p><em>Authors</em>: Lisa L. Strate, MD, MPH, FACG; Ian M. Gralnek, MD, MSHS</p></div></p>
<h3><a href="#">Financial Disclosures/Conflicts of Interest</a></h3>
<p><div class="content_para"><p><strong>Potential Competing Interests</strong>: Ian M. Gralnek has served as a consultant for EndoChoice, Motus GI, and EndoAid GI View, and is a member of the Data Safety Monitoring Board for Intec Pharma. Lisa L. Strate declares no conflict of interest.</p></div></p>
<h3><a href="#">Guideline Status</a></h3>
<p><div class="content_para"><p>This is the current release of the guideline. </p>
<p>This guideline meets NGC's 2013 (revised) inclusion criteria.</p></div></p>
<h3><a href="#">Guideline Availability</a></h3>
<p><div class="content_para"><p>Available from the <a href="/web/20180712205110/https://www.guideline.gov/Home/Disclaimer?id=51048&contentType=summary&redirect=http%3a%2f%2fgi.org%2fwp-content%2fuploads%2f2016%2f03%2fACGGuideline-Acute-Lower-GI-Bleeding-03012016.pdf" title="American College of Gastroenterology (ACG) Web site">American College of Gastroenterology (ACG) Web site</a> <img alt="External Web Site Policy" src="/web/20180712205110im_/https://www.guideline.gov/UI/images/icon_externallink.gif"/>.</p></div></p>
<h3><a href="#">Availability of Companion Documents</a></h3>
<p><div class="content_para"><p>The following is available:</p>
<ul style="list-style-type: disc;">
<li>American College of Gastroenterology Practice Parameters Committee. Guideline development policies. [internet]. Bethesda (MD): American College of Gastroenterology; 2010 Jan. Available from the <a href="/web/20180712205110/https://www.guideline.gov/Home/Disclaimer?id=51048&contentType=summary&redirect=http%3a%2f%2fgi.org%2fclinical-guidelines%2fguideline-development-policies%2f" title="American College of Gastroenterology (ACG) Web site">American College of Gastroenterology (ACG) Web site</a> <img alt="External Web Site Policy" src="/web/20180712205110im_/https://www.guideline.gov/UI/images/icon_externallink.gif"/>. </li>
</ul></div></p>
<h3><a href="#">Patient Resources</a></h3>
<p><div class="content_para"><p>None available</p></div></p>
<h3><a href="#">NGC Status</a></h3>
<p><div class="content_para"><p>This NGC summary was completed by ECRI Institute on July 31, 2017. The information was verified by the guideline developer on August 16, 2017.</p>
<p>This NEATS assessment was completed by ECRI Institute on August 3, 2017. The information was verified by the guideline developer on August 16, 2017.</p></div></p>
<h3><a href="#">Copyright Statement</a></h3>
<p><div class="content_para"><p>This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.</p></div></p>
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<p><p>The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.</p>
<p>All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.</p>
<p>Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the <a href="/web/20180712205110/https://www.guideline.gov/help-and-about/summaries/inclusion-criteria">NGC Inclusion Criteria</a>.</p>
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