Acute Gastrointestinal Bleeding
Authors: Joseph D. Feuerstein, Daniel A. Leffler
Journal: Annals of Internal Medicine (2013)

Letters3 December 2013Acute Gastrointestinal BleedingJoseph D. Feuerstein, MD and Daniel A. Leffler, MD, MSJoseph D. Feuerstein, MDFrom Beth Israel Deaconess Medical Center, Boston, Massachusetts.Search for more papers by this author and Daniel A. Leffler, MD, MSFrom Beth Israel Deaconess Medical Center, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-11-201312030-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We compliment Kerlin and Tokar (1) for a good, thorough review of acute gastrointestinal bleeding. However, we would like to point out a few areas of discrepancy in the literature. We disagree with their recommendation that colonoscopy be done within 12 to 24 hours of presentation for lower gastrointestinal bleeding. The only study indicating that colonoscopy altered outcomes in diverticular bleeding episodes was by Jensen and colleagues (2). Follow-up studies by Green and associates (3) and Laine and coworkers (4) did not show any reduction in need for colectomy, change in clinical outcome, or reduction in cost. ...References1. Prasad Kerlin M and Tokar JL. Acute gastrointestinal bleeding. Ann Intern Med. 2013;159:ITC2-15 LinkGoogle Scholar2. Jensen DM, Machicado GA, Jutabha R, and Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342:78-82. [PMID: 10631275] CrossrefMedlineGoogle Scholar3. Green BT, Rockey DC, Portwood G, Tarnasky PR, Guarisco S, Branch MS, et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol. 2005;100:2395-402. [PMID: 16279891] CrossrefMedlineGoogle Scholar4. Laine L and Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol. 2010;105:2636-41. [PMID: 20648004] CrossrefMedlineGoogle Scholar5. Martí M, Artigas JM, Garzón G, Alvarez-Sala R, and Soto JA. Acute lower intestinal bleeding: feasibility and diagnostic performance of CT angiography. Radiology. 2012;262:109-16. [PMID: 22084211] CrossrefMedlineGoogle Scholar6. Loffroy R. Multidetector CT angiography for the detection of colonic diverticular bleeding: when, how, and why? [Editorial]. Dig Dis Sci. 2013;58:1822-4. [PMID: 23695874] CrossrefMedlineGoogle Scholar7. Garcia-Tsao G, Sanyal AJ, Grace ND, and Carey W; Practice Guidelines Committee of the American Association for the Study of Liver Diseases. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46:922-38. [PMID: 17879356] CrossrefMedlineGoogle Scholar8. Feneyrou B, Hanana J, Daures JP, and Prioton JB. Initial control of bleeding from esophageal varices with the Sengstaken-Blakemore tube. Experience in 82 patients. Am J Surg. 1988;155:509-11. [PMID: 3257849] CrossrefMedlineGoogle Scholar9. Vlavianos P, Gimson AE, Westaby D, and Williams R. Balloon tamponade in variceal bleeding: use and misuse. BMJ. 1989;298:1158. [PMID: 2500170] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Joseph D. Feuerstein, MD; Daniel A. Leffler, MD, MSAffiliations: From Beth Israel Deaconess Medical Center, Boston, Massachusetts.Disclosures: Dr. Leffler: Consultancy and grants/grants pending: Prometheus Diagnostics, Alba Pharmaceuticals, Alvine Therapeutics, Shire Therapeutics. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAcute Gastrointestinal Bleeding Meeta Prasad Kerlin , Jeffrey L. Tokar Acute Gastrointestinal Bleeding Meeta Prasad Kerlin and Jeffrey L. Tokar Metrics 3 December 2013Volume 159, Issue 11Page: 793KeywordsAngiographyChronic liver diseaseCirrhosisColectomyColonoscopyComputed axial tomographyEndoscopyEsophagusHemorrhageLesionsLiver diseasesNecrosisProphylaxis ePublished: 3 December 2013 Issue Published: 3 December 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...