Lower gastrointestinal bleeding - Management

Although acute lower gastrointestinal (GI) bleeding is much less common than upper GI bleeding, it has been studied less, and guidelines for its management are less clear. The most common cause of significant bleeding is diverticular bleeding. The most common cause of intermittent minor hematochezia is hemorrhoidal bleeding. The best diagnostic approach for patients with active bleeding is controversial, but the authors advocate urgent prepared colonoscopy, except in those patients with massive and aggressive bleeding, in whom angiography should be considered emergently. Recent data suggest that endoscopic therapy is effective and might improve outcomes. Angiography and surgery play important roles in managing certain patients who have lower GI bleeding, emphasizing that successful care of patients who have lower GI hemorrhage often requires an integrated multi-specialty approach.