Evaluation and management of gastrointestinal bleeding part 2: Lower and obscure gastrointestinal bleeding

This article, the second in a 2-part series, provides information on the diagnosis and treatment of lower and obscure gastrointestinal (GI) bleeding. The data on lower tract bleeding are not as robust as for upper tract bleeding. If lower GI bleeding is suspected, upper tract and anorectal lesions should first be excluded. Once the bleeding has stopped, colonoscopy is the first test indicated. For ongoing bleeding, red blood cell nuclear scintigraphy is indicated, while the patient is prepped for colonoscopy. If the scan is negative, colonoscopy should be performed within 6 to 12 hours. Triage and length-of-stay issues are unresolved for lower GI bleeding because of the paucity of data. Obscure GI bleeding may be overt or occult, and the most common causes are small-bowel vascular ectasias. The diagnostic yield of procedures is poor. Wireless capsule endoscopy is a new technology that offers much promise for identifying bleeding sites.