Hemorragia digestiva baja en el adulto: conceptos claves en la actualización del diagnóstico y tratamiento

Abstract

Lower gastrointestinal bleeding (LGIB) is a frequent cause of emergency department consultation and hospitalization, particularly among older adults with cardiovascular comorbidities and those receiving antithrombotic therapy. Although most episodes are self-limited, a significant subgroup of patients develop persistent or recurrent bleeding requiring structured evaluation and targeted intervention. Current evidence supports the selection of candidates for outpatient management using the Oakland score. Early computed tomography angiography impacts prognosis in patients with brisk bleeding. Colonoscopy remains the main diagnostic and therapeutic tool, allowing bowel preparation to be achieved in selected cases within as little as 3 hours. Angiography with superselective embolization has demonstrated excellent outcomes with low complication rates. In anticoagulated patients, specific recommendations exist regarding anticoagulation reversal and antiplatelet management, tailored according to patient characteristics, clinical presentation, and the type of agent used. Tranexamic acid has not shown benefit in LGIB and is associated with serious adverse events. Surgical management is reserved for cases refractory to endoscopic or angiographic therapies, with an emphasis on accurate localization of the bleeding source to allow targeted resection and minimize morbidity and mortality.