Lower Gastrointestinal Bleeding

Lower gastrointestinal bleeding is a frequent clinical challenge that appears to be increasing in incidence among older adults. Bleeding episodes are associated with a higher mortality rate, longer hospitalization, and higher resource utilization, compared to that associated with upper gastrointestinal bleeding. The increase in incidence is attributed to the high prevalence of age-related disorders such as diverticulosis, ischemic colitis, colorectal neoplasms, and angiodysplasia. Additional associated contributors include the prevalent use of aspirin, nonsteroidal anti-inflammatory drugs, anticoagulants, and antiplatelet medications. The guidelines of two major professional organizations, the American College of Gastroenterology and American Society for Gastrointestinal Endoscopy, can help inform the management of lower gastrointestinal bleeding and anticoagulant therapy in the setting of bleeding. Management principles include the proper triage of patients, timely resuscitation, and identification of the source of bleeding by endoscopic and/or imaging procedures such as angiography, which can be both diagnostic and therapeutic. Emergency surgery is seldom needed.