The American College of Gastroenterology has released an updated clinical guideline for managing acute lower gastrointestinal bleeding, which is one of the most common reasons for hospitalization in the US. The guideline provides 12 evidence-based recommendations, including the use of reversal agents for patients on anticoagulation and radiologic tests such as CT angiography. The guideline recommends against urgent colonoscopy for most patients and instead suggests conservative management without endoscopic procedures for certain patients with a high pre-test probability of diverticular disease. The management of patients who have stopped bleeding focuses on preventing recurrent bleeding by discontinuing nonsteroidal anti-inflammatory drugs and aspirin and potentially discontinuing clopidogrel or other nonaspirin antiplatelets. The guideline also includes a flowchart for when to consider reversal drugs for life-threatening bleeding and a referral to interventional radiology for treatment via embolization. One controversial recommendation is to consider not doing a colonoscopy in certain patients who have had a recent outpatient colonoscopy and have a high pre-test probability of diverticular disease as a cause of their bleeding.

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