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This article summarizes current knowledge regarding the incidence of and risk factors associated with recurrent lower gastrointestinal hemorrhage. The literature regarding medical, endoscopic, and surgical methods to prevent rebleeding from diverticulosis, angioectasia, and chronic hemorrhagic radiation proctopathy is reviewed. In addition, the evidence for endoscopic clipping as primary prophylaxis against postpolypectomy bleeding is explored.

Background and Aims Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospitalization potentially requiring urgent intervention, which may not be readily available at weekends and off-hours. The aim of this study was to examine the association between weekend admission for LGIB and mortality, time to colonoscopy, length of stay, and hospital charges. Methods The 2016 U.S. National Inpatient Sample (NIS) dataset was queried for admissions with a primary diagnosis of LGIB. Outcomes for weekend versus weekday admissions were compared using survey-adjusted chi-squared or bivariate correlation. Multivariable regression was then used to compare primary outcomes adjusting for the Elixhauser mortality score (a validated measure of comorbidities), colonoscopy, transfusion, shock, and hospital type. Results An estimated 124,620 patients were admitted for LGIB in 2016. Comparing weekend with weekday admissions, there was no difference in unadjusted mortality (0.9% vs 1.0%, P = .636). Colonoscopy within the first day (28.6% vs 23.0%, P Conclusions Early colonoscopy (within the first day) is more common for weekday admissions, but overall outcomes are not affected by weekend admission for LGIB compared with weekday admissions.

Symptoms of lower gastrointestinal (GI) disease are common and frequently trigger consultation in primary and secondary care. Diarrhoea, abdominal pain and constipation are presentations of a wide range of different underlying pathologies, from chronic, benign, functional conditions to acutely life-threatening emergencies. Lower GI bleeding is often due to serious pathology and requires rational investigation based on a systematic clinical assessment. Extra-intestinal manifestations of lower GI disease can often give a clue to the underlying diagnosis. In this contribution, we review the aetiology, clinical features, investigations and management for a range of lower GI symptoms, namely diarrhoea, constipation, lower GI bleeding, bloating and abdominal pain.

Risk assessment is widely used in upper gastrointestinal bleeding (UGIB) however no score accurately predicts all important clinical outcomes. This review discusses the performance of the Rockall score, pre-endsocopy Rockall score, Glasgow-Blatchford score, AIMS-65 and newer scores such as Progetto Nazionale Emorragia Digestiva and CANUKA scores. The quality of external validation varies considerably for each score. There is a relative lack of risk scores available for use in lower GI bleeding (LGIB) but recent developments have focussed on the identification of low risk patients. The BLEED, NOBLADS, Strate and Sengupta scores have been developed to predict severe bleeding or death, each with varying performance. The Oakland score has been developed to identify patients at low risk of adverse outcomes who may be suitable for outpatient management. The comparative performance of the LGIB scores and Rockall, Glasgow-Blatchford and AIMS-65 in the prediction of outcomes in LGIB is also discussed.

To date, absent inferior mesenteric vein (IMV) has not been reported in the literature as a cause of or being associated with lower gastrointestinal (GI) bleeding. We describe a case of 13 year-old girl who presented with hematochezia and was subsequently found to have widespread colonic varices involving the ascending, transverse and proximal descending colon. The upper GI tract, small bowel, and rectum were not involved. Delayed venous phase of mesenteric angiography revealed an absent inferior mesenteric vein. The patient underwent laparoscopic extended right hemicolectomy with ileosigmoid anastomosis. No bleeding from recurrent varices occurred during a 1-year period of follow up. We conclude that extended right hemicolectomy is a potential curative surgical option in patients presenting with lower GI bleeding from colonic varices caused by absent IMV. Upper GI and small intestinal involvement should be excluded to prevent future bleeding from missed varices these sites.

Symptoms of lower gastrointestinal (GI) disease are common and frequently trigger consultation in primary and secondary care. Diarrhoea, abdominal pain and constipation are presentations of a wide range of different underlying pathologies, from chronic, benign, functional conditions to acutely life-threatening emergencies. Lower GI bleeding is often due to serious pathology and requires rational investigation based on a systematic clinical assessment. Extra-intestinal manifestations of lower GI disease can often give a clue to the underlying diagnosis. In this contribution, we review the aetiology, clinical features, investigations and management for a range of lower GI symptoms, namely diarrhoea, constipation, lower GI bleeding, bloating and abdominal pain.

Gastrointestinal bleeding is a problem encountered frequently in the elderly. This article reviews its diagnosis and management, focusing on issues particularly relevant in geriatric care. The article begins with an overview of acute gastrointestinal (GI) bleeding and follows with more focused descriptions of upper GI bleeding, lower GI bleeding, and the growing problem of bleeding of obscure origin. The article concludes with recommendations for the evaluation of positive fecal occult blood tests.

Gastrointestinal (GI) bleeding is an uncommon manifestation of AIDS despite the frequent involvement of the GI tract by infections, malignancies, and a variety of other disorders. GI bleeding may occur from a variety of causes, some specifically associated with AIDS and others unrelated to immunocompromise; most patients with AIDS who have lower GI bleeding have causes attributable to AIDS-specific lesions. Just as in an incompetent patient, an aggressive approach to diagnosis and treatment of GI bleeding in AIDS patients is warranted.

35:985-91. 9. Sunada K, Yamamoto H, Kita H, Yano T, Miyata T, Sekine Y, et al. Successful treatment with balloon dilatation using a double-balloon enteroscope for a stricture in the small bowel of a patient with Crohn’s disease. Dig Endosc 2004;16:237-40. 10. Yamamoto H, Sugano K. A new method of enteroscopy: the doubleballoon method. Can J Gastroenterol 2003;17:273-4. 11. Yamamoto H, Kita H, Sunada K, Hayashi Y, Sato H, Yano T, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal disease. Clin Gastroenterol Hepatol 2004;2: 1010-6. Current affiliations: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Lower gastrointestinal (GI) haemorrhage is bleeding which originates at a point distal to the duodenojejunal flexure, but proximal to the anal canal. This condition occurs with a frequency of about 25/100,000 adult population. This is about 1/4 to 1/8 the rate of upper GI bleeding in the same population. The incidence of lower GI bleeding increases exponentially with age in parallel with development of diseases causing the bleeding, and is more common in men. Bleeding from the colon (excluding piles) accounts for the vast majority of cases.

Aims Clinicians often give clinical information in the ‘notes’ field of the request form which can be helpful. We aimed to determine if these notes could be used to determine the clinical risks associated with uraemia. Method We reviewed 951 759 requests for UE 1391 with lower GI bleeding ‘LGB’ (PR bleed, colon carcinoma); 3753 with cardiac failure ‘CCF’. Of all U&Es, 22.5% had elevated urea (>8 mmol/L), of which 29.5% had acceptable renal function (eGFR ≥60 mL/min/1.73 m2). Results Elevated urea was more commonly found with clinical notes of UGB (1.9-fold risk) or CCF (2.8-fold risk), but not with LGB (0.9-fold risk). The relative likelihood was highest for a urea > 12 mmol/L for both UGB (2.8-fold risk) and CCF (3.8-fold risk). Urea >12 mmol/L with acceptable renal function had the highest association for the clinical notes of UGB (9.9-fold risk) and CCF (6.8-fold risk). Discussion Request form clinical notes are associated with urea abnormalities. This approach may provide useful information when trying to define risk levels such as those for critical result phoning.

location was classified as a lower GI bleed. CONCLUSIONS: ICD-9 code 578.1 (“blood in stool”) represents hematochezia in ~60% of cases and melena in ~30%. ICD-9 codes 578.1 and 578.9 represent an unknown location of GI bleeding in only about one-third of cases; the remainder are either upper or lower GI bleeding that has been misclassified. Detailed validation can help inform (or reassign) the use of these codes in electronic database studies. The limited specificity of such codes will persist in the ICD-10 era. Table 1. Bleeding Manifestation*

G A A b st ra ct s 1.01 (95% CI, 0.83-1.23) for women who used 0.5 to 1.5 standard tablets/week, 1.25 (95% CI, 1.02-1.53) for 2 to 5 tablets/week, 1.71 (95% CI, 1.38-2.13) for 6-14 tablets/week, and 2.11 (95% CI, 1.53-2.91) for >14 tablets/week (P 5 years; P