ABSTRACT
Background and Aim
Despite medical advances, the incidence of acute lower gastrointestinal bleeding (ALGIB) is gradually increasing in Asia and Vietnam, with many cases being severe. However, recent data on clinical features, interventions, and outcomes in Vietnam remain limited. This study aims to characterize the presentation, treatment, and outcomes of ALGIB in Vietnamese patients.
Method
A retrospective and prospective cohort study was conducted on 222 patients aged 18 years and older with ALGIB at the Department of Gastroenterology, University Medical Center Ho Chi Minh City. Clinical characteristics, interventions, and adverse outcomes were recorded.
Results
A total of 222 patients were included in the study, with a female‐to‐male ratio of 1.02 and a mean age of 63.7 years. Among them, 85.6% were admitted with symptoms of bright red blood per rectum, maroon‐colored stool, or stool with clots. The most common causes of acute lower gastrointestinal bleeding were hemorrhoids (20.7%) and colonic diverticulosis (20.3%). The rates of blood transfusion, endoscopic intervention, radiologic intervention, and surgery were 38.7%, 19.4%, 2.7%, and 2.7%, respectively. Severe lower gastrointestinal bleeding was observed in 59 patients (26.6%). There were two in‐hospital deaths (0.9%), one related to underlying comorbidities and one due to persistent, uncontrollable bleeding.
Conclusion
Hemorrhoids were the most common cause of acute lower gastrointestinal bleeding. The rates of blood transfusion, endoscopic intervention, radiologic intervention, and surgery were 38.7%, 19.4%, 2.7%, and 2.7%, respectively. Overall, 26.6% of cases progressed to severe lower gastrointestinal bleeding.
Keywords: colonoscopy, lower gastrointestinal bleeding, severe bleeding
Abbreviations
- ACG
American College of Gastroenterology
- ALGIB
acute lower gastrointestinal bleeding
- APC
argon plasma coagulation
- CT
computed tomography
- CTA
computed tomography angiography
- DRE
digital rectal examination
- EGD
esophagogastroduodenoscopy
- IBD
inflammatory bowel disease
- INR
international normalized ratio IQR, interquartile range
- NOAC
non‐vitamin K oral anticoagulant
- NSAID
nonsteroidal anti‐inflammatory drug
- SD
standard deviation
1. Introduction
Acute lower gastrointestinal bleeding (ALGIB) is defined as the loss of blood from the gastrointestinal tract distal to the ligament of Treitz to the anus. Although ALGIB is often self‐limiting, approximately 20%–30% of patients develop severe bleeding [1, 2]. The overall mortality rate is relatively low, ranging from 2% to 4%, but it increases significantly in elderly patients with hemodynamic instability [3, 4]. Etiologies of ALGIB differ markedly across geographic regions. In Europe, common causes include colonic diverticulosis, ischemic colitis, and inflammatory bowel disease (IBD) [5, 6]. In contrast, in Asia—particularly in developing countries—hemorrhoids are reported as one of the leading causes [2, 7].
A thorough understanding of the clinical features, etiologies, and progression of ALGIB is essential for early diagnosis and appropriate treatment strategies. However, research on ALGIB in Asian countries remains limited, particularly in Vietnam, where data on clinical presentation, causes, and treatment outcomes are still lacking. Furthermore, no official guidelines for the diagnosis and management of ALGIB have been established in this region. Given the financial and resource constraints in the healthcare systems of developing countries, establishing a reliable clinical database for ALGIB is crucial to improve patient care and treatment outcomes. Therefore, this study was conducted to describe the clinical characteristics, interventions, and adverse outcomes of ALGIB in Vietnamese patients.
2. Method
2.1. Study Design and Setting
A combined retrospective and prospective cohort study was conducted on patients diagnosed with ALGIB admitted to the Department of Gastroenterology, University Medical Center Ho Chi Minh City, from January 2022 to May 2025. The retrospective cohort included patients hospitalized between January 2022 and July 10, 2024. The prospective arm enrolled patients consecutively from July 11, 2024, onward, following the approval of the study protocol by the institutional Ethics Committee.
The inclusion criteria were hospitalized patients aged ≥ 18 years, the performance of lower gastrointestinal endoscopy, and presenting with symptoms suggestive of ALGIB, such as bright blood per rectum, maroon‐colored stool, stool with clots, or melena without hematemesis. Exclusion criteria comprised in‐hospital bleeding, upper gastrointestinal bleeding lesions on esophagogastroduodenoscopy (EGD), patients who had been resuscitated or received prior interventions for ALGIB at another facility, and/or those not agreeing to participate in the study. The study protocol, eligibility criteria, data collection instruments, and analysis methods were standardized throughout the study to ensure reproducibility.
2.2. Data Collection
Data at admission were recorded in every patient, which included demographic characteristics, symptoms, prior history of ALGIB, comorbidities, vital signs, findings of digital rectal examination (DRE), laboratory results, blood transfusion, endoscopy and radiology reports, and operation protocol.
2.3. Treatment
This is an observational study. If patients presented with melena alone or hematochezia and concomitant hemodynamic instability, EGD was performed to exclude upper gastrointestinal bleeding. Based on the suspected location of the lesion, comorbidities, and the progression of ALGIB, one of the following was performed as the initial diagnostic modality: colonoscopy, sigmoidoscopy, or proctoscopy. In this study, the percentages reported for each procedure reflect the first performed endoscopic modality per patient. Repeat procedures, if any, were rare and were not included in the descriptive statistics. In cases of failure to investigate the bleeding origin by lower gastrointestinal endoscopy, computed tomography angiography (CTA) was performed to detect contrast medium extravasation.
Endoscopic treatment, the first‐line hemostatic intervention, was defined as the endoscopic procedures that intervened in the definite site of bleeding [8]. When failure or inability of therapeutic endoscopy occurred, angiographic embolization, and/or surgery were chosen according to the image on CTA and the consensus of multidisciplinary team meetings. All the above methods of management were classified as therapeutic interventions.
2.4. Outcomes
The adverse outcomes of ALGIB in this study consisted of severe bleeding and in‐hospital death. Severe ALGIB was defined as persistent bleeding within the first 24 h and/or recurrent bleeding after 24 h of stability accompanied by a reduction in hematocrit of ≥ 20%, and/or a requirement of ≥ 2 units of packed red blood cells [9]. In‐hospital mortality was defined as deaths due to uncontrollable bleeding or comorbidities during hospitalization.
2.5. Ethics Statement
The study protocol adhered to the ethical principles outlined in the Declaration of Helsinki. The study was approved by the Ethics Committee for Biomedical Research of the University of Medicine and Pharmacy at Ho Chi Minh City (Approval No. 1593/DHYD‐HDDD, signed on July 11, 2024). The prospective phase of the study commenced immediately following this approval. In accordance with national legislation and institutional requirements, written informed consent was not required.
2.6. Statistical Analysis
Categorical data were reported as numerators and percentages. Quantitative data were tested for normality using the Kolmogorov–Smirnov test. Variables with a normal distribution were presented as mean ± standard deviation, while those not normally distributed were reported as median and interquartile range (IQR). All statistical analyses were performed using MedCalc version 22.1.0 (MedCalc Software Ltd., Ostend, Belgium). Variables with more than 5% missing data were excluded from the analysis. For all included variables, the proportion of missing data was less than 5%. We explored associations between baseline clinical variables and adverse outcomes such as severe bleeding and in‐hospital mortality. Known potential confounders, including age, comorbidities, medication use, and coagulation status, were considered in the descriptive and subgroup analyses. Due to the limited number of events, multivariable regression was not performed.
3. Results
A total of 222 patients with ALGIB were included, comprising 73 prospective and 149 retrospective cases. The baseline characteristics are summarized in Table 1. ALGIB appeared to affect all ages, with the oldest patient aged 98 years; the most affected age group was 65–75 years. Notably, 78.8% (175/222) had at least two comorbidities. Additionally, 48.2% were using at least one medication associated with increased bleeding risk, and 14.9% (33 patients) had a history of using two or more such drugs prior to admission.
TABLE 1.
Baseline characteristics of recruiting patients.
| Characteristics | |
|---|---|
| Age, mean (SD) | 63.7 (17.1) |
| Sex | |
| Male, n (%) | 110 (49.5) |
| Previous admission with ALGIB, n (%) | 96 (43.2) |
| Comorbidities | |
| Hypertension, n (%) | 147 (66.2) |
| Chronic coronary disease, n (%) | 65 (29.3) |
| Diabetes, n (%) | 54 (24.3) |
| Hyperlipidemia, n (%) | 53 (23.9) |
| Chronic liver disease, n (%) | 32 (14.4) |
| Chronic kidney disease, n (%) | 27 (12.2) |
| Cancer, n (%) | 25 (11.3) |
| Adrenal insufficiency, n (%) | 23 (10.4) |
| Stroke or transient ischemic attack, n (%) | 20 (9) |
| Congestive heart failure, n (%) | 13 (5.9) |
| Chronic obstructive pulmonary disease, n (%) | 4 (1.8) |
| Preadmission medications, n (%) | 107 (48.2) |
| Aspirin, n (%) | 22 (9.9) |
| Clopidogrel, n (%) | 39 (17.6) |
| Ticagrelor, n (%) | 4 (1.8) |
| Dual antiplatelet, n (%) | 8 (3.6) |
| Warfarin, n (%) | 3 (1.4) |
| NOAC, n (%) | 8 (3.6) |
| Corticosteroid, n (%) | 35 (15.8) |
| NSAIDs, n (%) | 28 (12.6) |
| Vital signs at admission | |
| Heart rate (beat per minute), mean (SD) | 89 (16.1) |
| Hear rate ≥ 100/min, n (%) | 59 (26.6) |
| Systolic blood pressure (mmHg), mean (SD) | 130 (21.9) |
| Systolic blood pressure < 100 mmHg, n (%) | 13 (5.9) |
| Presenting symptoms | |
| Melena, n (%) | 32 (14.4) |
| Bright blood per rectum, n (%) | 104 (46.9) |
| Maroon colored stool, n (%) | 78 (35.1) |
| Stool with clots, n (%) | 8 (3.6) |
| Abdominal pain, n (%) | 95 (42.8) |
| Syncope, n (%) | 3 (1.4) |
| Diarrhea, n (%) | 31 (14) |
| Fever, n (%) | 6 (2.7) |
| Blood on DRE, n (%) | 183 (82.4) |
| Laboratory data at admission | |
| Hematocrit (%), median (IQR) | 32.6 (24.9–38.2) |
| Hematocrit < 35%, n (%) | 133 (59.9) |
| Hemoglobin (g/L), median (IQR) | 106 (82–126) |
| Hemoglobin < 100 (g/L), n (%) | 100 (45) |
| Platelet (103/μL), median (IQR) | 254 (207–318) |
| Platelet < 150 × 103/μL, n (%) | 21 (9.5) |
| INR, median (IQR) | 1.07 (1.00–1.15) |
| INR ≥ 1.5, n (%) | 12 (5.4) |
| Urea (mg/dL), median (IQR) | 31.8 (23.5–47.9) |
| Creatinine (mg/dL), median (IQR) | 0.9 (0.8–1.1) |
Abbreviations: ALGIB, acute lower gastrointestinal bleeding; DRE, digital rectal examination; INR, international normalized ratio; IQR, interquartile range; NOAC, non‐vitamin K oral anticoagulant; NSAID, nonsteroidal anti inflammatory drug; SD, standard deviation.
The most common clinical presentation in patients with ALGIB was hematochezia, accounting for 46.9% of cases (Table 1). The primary source of hematochezia was the rectum and colon (92.3%), while small bowel bleeding and cases of unknown origin each constituted 3.8%. Notably, among six patients with small bowel bleeding, four (66.7%) progressed to severe ALGIB. Abdominal pain was common in patients with colonic inflammatory disorders (ischemic, hemorrhagic, or ulcerative colitis), but less frequent in those with hemorrhoids, diverticulosis, or polyps. Most patients were hemodynamically stable upon admission, with a mean systolic blood pressure of 130 mmHg and a mean heart rate of 89 beats per minute. Regarding laboratory findings, most patients with ALGIB had normal renal function and no evidence of coagulopathy. The median urea, creatinine, and INR levels were 31.8, 0.9, and 1.07, respectively (Table 1). Among 12 patients with INR ≥ 1.5, two (16.7%) required fresh frozen plasma transfusion, five (41.7%) had underlying chronic liver disease, and seven (58.3%) had a history of anticoagulant use.
Various diagnostic modalities of ALGIB are presented in Table 2. All patients in this study underwent lower gastrointestinal endoscopy. Colonoscopy was the first performed endoscopic procedure in 73.4% of cases, including 24.5% who received urgent endoscopy within 24 h of admission and 75.5% who underwent elective procedures. Flexible sigmoidoscopy or proctoscopy was the first modality in 38.7% of patients, primarily due to poor general condition or inadequate bowel preparation. Repeat endoscopy (e.g., follow‐up sigmoidoscopy after colonoscopy) was performed in a few cases when clinically indicated, but was not counted in the primary procedural statistics. Capsule endoscopy of the small bowel was conducted in 2.3% of cases to identify bleeding sources in the jejunum or ileum. Among 52 patients who underwent CTA, contrast extravasation was observed in 17.3% (9/52).
TABLE 2.
Interventions of lower gastrointestinal bleeding.
| Interventions | n (%) |
|---|---|
| Blood transfusion | 86 (38.7) |
| Packed red cell | 85 (38.3) |
| Fresh frozen plasma | 4 (1.8) |
| Cryoprecipitate | 2 (0.9) |
| Platelets | 2 (0.9) |
| Endoscopy | |
| Esophagogastroduodenoscopy | 114 (51.4) |
| Colonoscopy | 163 (73.4) |
| Sigmoidoscopy/proctoscopy | 86 (38.7) |
| Enteroscopy (capsule) | 5 (2.3) |
| Endoscopic hemostasis | 43 (19.4) |
| Hemostatic clip | 29/43 (67.5) |
| Rubber band ligation | 1/43 (2.3) |
| Argon plasma coagulation (APC) | 13/43 (30.2) |
| Computed tomography of the abdomen/pelvis | 76 (34.2) |
| Computed tomography angiography | 52 (23.4) |
| Radiologic intervention | 6 (2.7) |
| Surgery | 6 (2.7) |
The cause of ALGIB was identified in 197 patients (88.7%) (Figure 1). A definite source of bleeding was confirmed in 25.2% of cases (56/222), while suspected lesions were reported in 63.5% (141/222). The most common causes were hemorrhoids (20.7%), diverticulosis (20.3%), and ulcerative colitis (7.2%). Approximately 11.3% of cases were established as unknown diagnoses even after complicated investigations, including repeated endoscopy.
FIGURE 1.
Etiologies of acute gastrointestinal bleeding.
Methods of intervention and outcomes are presented in Table 2 and Table 3, respectively. Four patients (1.8%) required transfusion of two or more types of blood components; all experienced severe bleeding, including one in‐hospital death. Additionally, 34 patients (15.3%) required transfusion of more than two units of packed red blood cells.
TABLE 3.
Adverse outcomes of lower gastrointestinal bleeding.
| Adverse outcomes | n (%) |
|---|---|
| Severe ALGIB | 59 (26.6) |
| Ongoing gastrointestinal bleeding | 54 (24.3) |
| Recurrent gastrointestinal bleeding | 5 (2.3) |
| In‐hospital death | 2 (0.9) |
| Death due to uncontrollable ALGIB | 1 (0.45) |
| Death due to severe comorbidities | 1 (0.45) |
Abbreviation: ALGIB, acute lower gastrointestinal bleeding.
Endoscopic hemostasis was successfully achieved in 43 of 56 patients (76.8%) with confirmed bleeding sources identified on colonoscopy or proctoscopy. The most commonly used intervention was the hemostatic clip (67.5%), followed by argon plasma coagulation (APC) in 30.2%. Among nine patients with contrast extravasation on CTA, six (2.7%) required transarterial embolization. Surgery was performed in six patients (2.7%) with ALGIB.
A total of 59 patients (26.6%) experienced severe ALGIB, including 54 cases (24.3%) of ongoing bleeding within the first 24 h and five cases (2.3%) of rebleeding after initial stabilization. Patients with severe ALGIB were more likely to have multiple comorbidities, elevated INR, or a history of anticoagulant use (Table 1). Among 33 patients using two or more bleeding‐risk medications, 15 (45.5%) developed severe bleeding. There were two in‐hospital deaths (0.9%): one due to underlying hepatocellular carcinoma and one from uncontrolled severe bleeding.
4. Discussion
In our study, the mean age of patients with ALGIB was 63.7 ± 17.1 years, with the majority aged between 65 and 75. This finding is consistent with previous national and international studies [2, 10, 11, 12]. Overall, the incidence of ALGIB increases with age, particularly in patients over 80 years [13]. This trend may be attributed to the higher prevalence of diverticulosis and ischemic colitis in the elderly, as well as increased use of NSAIDs, antiplatelet agents, and anticoagulants in this population [13].
The proportion of patients with ALGIB using antiplatelet agents was notably higher than those using other drug classes, likely due to underlying cardiovascular comorbidities. Additionally, 12.6% of patients reported NSAID use prior to admission, consistent with previous domestic studies showing a high prevalence of NSAID use [2, 7]. This may be attributed to the widespread, often unregulated use of NSAIDs in Vietnam, where patients can easily access these medications without a medical prescription.
According to the literature, the most common clinical presentation of ALGIB is the passage of bright red blood, maroon‐colored blood, or blood clots, accounting for approximately 85% of cases. A smaller proportion (10%–15%) may present with melena, a symptom typically associated with upper gastrointestinal bleeding. In our study, 85.6% of patients presented with bright blood per rectum, maroon‐colored stool, or stool with clots, while 14.4% had melena, consistent with previous national and international reports [2, 7, 14]. Strate et al. [9] noted that abdominal tenderness is more frequently observed in mild LGIB associated with ischemic colitis or inflammatory bowel disease, whereas it is uncommon in severe bleeding caused by diverticulosis or angiodysplasia. Similarly, in our study, abdominal pain was more common among patients with colonic inflammatory conditions and less frequent in those with diverticular bleeding.
Quach Trong Duc et al. [12] identified heart rate ≥ 100 bpm, systolic blood pressure < 100 mmHg, hematocrit < 35%, and platelet count < 150 × 103/μL as independent risk factors significantly associated with severe ALGIB and in‐hospital mortality. These findings align with our results, in which most patients with severe LGIB presented with hemodynamic compromise and coagulopathy at admission. The risk of severe ALGIB is likely influenced by multiple confounding factors, including age, comorbidities, and pre‐existing use of NSAIDs, antiplatelets, or anticoagulants. These factors not only increase bleeding risk but may also independently affect clinical outcomes such as the need for transfusion or mortality. In our study, a substantial proportion of patients presented with multiple comorbidities and polypharmacy, complicating the interpretation of causality. Although we attempted to address this by descriptive stratification, residual confounding may still exist due to the observational nature of the study. Similarly, Aoki et al. [10] reported that hemodynamic instability (systolic blood pressure ≤ 100 mmHg and/or syncope) and the presence of multiple comorbidities were predictive of severe bleeding. These findings align with our results, in which most patients with severe LGIB presented with hemodynamic compromise and coagulopathy at admission.
Colonoscopy is considered the first‐line diagnostic modality for evaluating ALGIB and is widely adopted worldwide [8]. However, not all patients can undergo a complete colonoscopy upon admission due to poor clinical condition or inadequate bowel preparation. In our study, colonoscopy was performed in 163 patients (73.4%), with only 40 cases (24.5%) undergoing urgent colonoscopy within the first 24 h. For patients with a history of recurrent ALGIB and recent colonoscopy, flexible sigmoidoscopy or proctoscopy was prioritized, accounting for 38.7% of cases. This approach is consistent with the 2023 American College of Gastroenterology (ACG) guidelines [8].
In our study, the most common causes of ALGIB were hemorrhoids (20.7%) and diverticulosis (20.3%). This distribution differs from that reported in Western countries, where diverticular disease and ischemic colitis are the leading causes of ALGIB [5, 6, 15], but is consistent with domestic data indicating hemorrhoids as the most prevalent etiology in Vietnam [2, 7]. This discrepancy may be attributed to the epidemiology of diverticular disease, which predominantly affects older adults and is more prevalent in Western populations. Additionally, low‐fiber, high‐fat diets and higher rates of overweight and obesity in Western countries may contribute to the increased incidence of diverticular disease in these regions.
Blood transfusions were administered in 38.7% of patients, with 83.7% of these cases adhering to the 2023 ACG guideline criteria [8]. This rate is consistent with previous studies [2, 10, 14]. Endoscopic hemostasis was performed in 43 patients (19.4%) out of 56 cases with identified bleeding sites, achieving a success rate of 76.8%. Among nine patients with positive CTA findings, six (2.7%) underwent successful radiologic intervention, with a 100% success rate. Surgical intervention was required in 2.7% of all cases. These findings align with prior reports, in which radiologic and surgical intervention rates ranged from 0.2% to 3% and 1.6% to 3.9%, respectively [6, 7, 10].
The rate of severe ALGIB in our study was 26.6%, lower than the 52% reported by Tapaskar et al. [6]. This inconsistency may be attributed to differences in the definition of severe ALGIB across studies. Notably, Tapaskar's study included patients readmitted for rebleeding within 1 week of discharge, which may have contributed to the higher rate. Recent studies have reported ALGIB mortality rates ranging from 2% to 4% [4, 5], with most deaths attributed to underlying comorbidities rather than uncontrolled bleeding. In our cohort, the in‐hospital mortality rate was 0.9%, consistent with previous reports. Among the two deaths observed, one was due to severe underlying comorbidities, and the other resulted from uncontrolled hemorrhage.
5. Limitations
Our study had several limitations, including its single‐center design and potential selection bias due to the tertiary care setting. Although the majority of clinical and laboratory variables had minimal missing data (< 5%), the exclusion of patients with incomplete records might have introduced attrition bias. Further multicenter studies with larger patient populations are warranted to confirm our findings and enhance the clinical evidence base on ALGIB in Vietnam. Given the regional variation in clinical practice, healthcare resources, and patient characteristics, nationwide multicenter studies are essential to validate and generalize these findings across diverse settings in Vietnam.
6. Conclusion
This study described the clinical characteristics, interventions, and adverse outcomes of ALGIB at a tertiary hospital in Vietnam. Hemorrhoids and colonic diverticula were identified as the most common etiologies. The rates of blood transfusion, endoscopic intervention, radiologic intervention, and surgery were 38.7%, 19.4%, 2.7%, and 2.7%, respectively. Although most cases of ALGIB were self‐limited, 26.6% progressed to severe bleeding. The in‐hospital mortality rate was 0.9%, with half of the deaths associated with underlying comorbidities.
Consent
Patient consent was obtained.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgments
We sincerely thank the leadership and staff of the Department of Gastroenterology, University Medical Center Ho Chi Minh City, and the University of Medicine and Pharmacy at Ho Chi Minh City for their support.
Hoang A. Q. T. and Vo T. D., “Clinical Characteristics, Interventions and Adverse Outcomes of Acute Lower Gastrointestinal Bleeding: A Cohort Study Conducted in Vietnam,” JGH Open 9, no. 8 (2025): e70249, 10.1002/jgh3.70249.
Funding: The authors received no specific funding for this work.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
- 1. Chong V., Hill A. G., and MacCormick A. D., “Accurate Triage of Lower Gastrointestinal Bleed (LGIB) ‐ A Cohort Study,” International Journal of Surgery 25 (2016): 19–23, 10.1016/j.ijsu.2015.11.003. [DOI] [PubMed] [Google Scholar]
- 2. Vo U., To N. L., Le L. T. K., Vo U. P. P., Vo C. H. M., and Quach D. T., “Clinical Characteristics, Interventions and Outcomes of Acute Lower Gastrointestinal Bleeding: A Multicenter Study in Vietnam,” MedPharmRes 7, no. 2 (2023): 38–45, 10.32895/UMP.MPR.7.2.5. [DOI] [Google Scholar]
- 3. Ur‐Rahman A., Guan J., Khalid S., et al., “Both Full Glasgow‐Blatchford Score and Modified Glasgow‐Blatchford Score Predict the Need for Intervention and Mortality in Patients With Acute Lower Gastrointestinal Bleeding,” Digestive Diseases and Sciences 63, no. 11 (2018): 3020–3025, 10.1007/s10620-018-5203-4. [DOI] [PubMed] [Google Scholar]
- 4. Aoki T., Hirata Y., Yamada A., and Koike K., “Initial Management for Acute Lower Gastrointestinal Bleeding,” World Journal of Gastroenterology 25, no. 1 (2019): 69–84, 10.3748/wjg.v25.i1.69. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Kathryn O., Richard G., Raman U., et al., “Acute Lower GI Bleeding in the UK: Patient Characteristics, Interventions and Outcomes in the First Nationwide Audit,” Gut 67, no. 4 (2018): 654, 10.1136/gutjnl-2016-313428. [DOI] [PubMed] [Google Scholar]
- 6. Tapaskar N., Jones B., Mei S., and Sengupta N., “Comparison of Clinical Prediction Tools and Identification of Risk Factors for Adverse Outcomes in Acute Lower GI Bleeding,” Gastrointestinal Endoscopy 89, no. 5 (2019): 1005–1013.e2, 10.1016/j.gie.2018.12.011. [DOI] [PubMed] [Google Scholar]
- 7. Quach D. T., Vo U. P.‐P., Nguyen N. T.‐M., et al., “An External Validation Study of the Oakland and Glasgow‐Blatchford Scores for Predicting Adverse Outcomes of Acute Lower Gastrointestinal Bleeding in an Asian Population,” Gastroenterology Research and Practice 2021 (2021): 8674367, 10.1155/2021/8674367. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Sengupta N., Feuerstein J. D., Jairath V., et al., “Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline,” American Journal of Gastroenterology 118, no. 2 (2023): 208–231, 10.14309/ajg.0000000000002130. [DOI] [PubMed] [Google Scholar]
- 9. Strate L. L., Orav E. J., and Syngal S., “Early Predictors of Severity in Acute Lower Intestinal Tract Bleeding,” Archives of Internal Medicine 163, no. 7 (2003): 838–843, 10.1001/archinte.163.7.838. [DOI] [PubMed] [Google Scholar]
- 10. Aoki T., Yamada A., Nagata N., Niikura R., Hirata Y., and Koike K., “External Validation of the NOBLADS Score, a Risk Scoring System for Severe Acute Lower Gastrointestinal Bleeding,” PLoS One 13, no. 4 (2018): e0196514, 10.1371/journal.pone.0196514. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Hreinsson J. P., Sigurdardottir R., Lund S. H., and Bjornsson E. S., “The SHA(2)PE Score: A New Score for Lower Gastrointestinal Bleeding That Predicts Low‐Risk of Hospital‐Based Intervention,” Scandinavian Journal of Gastroenterology 53, no. 12 (2018): 1484–1489, 10.1080/00365521.2018.1532019. [DOI] [PubMed] [Google Scholar]
- 12. Quach D. T., Nguyen N. T.‐M., Vo U. P.‐P., et al., “Development and Validation of a Scoring System to Predict Severe Acute Lower Gastrointestinal Bleeding in Vietnamese,” Digestive Diseases and Sciences 66, no. 3 (2021): 823–831, 10.1007/s10620-020-06253-y. [DOI] [PubMed] [Google Scholar]
- 13. Guo C. G., Zhang F., Wu J. T., et al., “Divergent Trends of Hospitalizations for Upper and Lower Gastrointestinal Bleeding Based on Population Prescriptions of Aspirin, Proton Pump Inhibitors and Helicobacter Pylori Eradication Therapy: Trends of Upper and Lower Gastrointestinal Bleeding,” United European Gastroenterology Journal 9, no. 5 (2021): 543–551, 10.1002/ueg2.12067. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Smith C., Leggett G., Jayaprakash A., et al., “Derivation, Validation, and Comparison of a New Prognostic Scoring System for Acute Lower Gastrointestinal Bleeding,” DEN Open 4, no. 1 (2024): e323, 10.1002/deo2.323. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Gonzalez‐Gonzalez L., Iborra I., Fortuny M., et al., “External Validation of the SHA(2)PE Score and Its Comparison to the Oakland Score for the Prediction of Safe Discharge in Patients With Lower Gastrointestinal Bleeding,” Surgical Endoscopy 38, no. 8 (2024): 4468–4475, 10.1007/s00464-024-10953-1. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.