Abstract
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.
Keywords
This is a preview of subscription content, log in via an institution.
References
Acosta RD, Abraham NS, Chandrasekhara V, Chathadi KV, Early DS, Eloubeidi MA, Evans JA, Faulx AL, Fisher DA, Fonkalsrud L, Hwang JH, Khashab MA, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Shaukat A, Shergill AK, Wang A, Cash BD, Dewitt JM, Committee, A. S. O. P. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83:3–16.
Alvarez JA, Baldonedo RF, Bear IG, Otero J, Pire G, Alvarez P, Jorge JI. Presentation, management and outcome of acute sigmoid diverticulitis requiring hospitalization. Dig Surg. 2007;24:471–6.
Anderson MA, Ben-Menachem T, Gan SI, Appalaneni V, Banerjee S, Cash BD, Fisher L, Harrison ME, Fanelli RD, Fukami N, Ikenberry SO, Jain R, Khan K, Krinsky ML, Lichtenstein DR, Maple JT, Shen B, Strohmeyer L, Baron T, Dominitz JA, Committee, A. S. O. P. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009;70:1060–70.
Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc. 2009;69:654–64.
Baradarian R, Ramdhaney S, Chapalamadugu R, Skoczylas L, Wang K, Rivilis S, Remus K, Mayer I, Iswara K, Tenner S. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol. 2004;99:619–22.
Barkun A, Sabbah S, Enns R, Armstrong D, Gregor J, Fedorak RN, Rahme E, Toubouti Y, Martel M, Chiba N, Fallone CA, Investigators, R. The Canadian registry on nonvariceal upper gastrointestinal bleeding and endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol. 2004;99:1238–46.
Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, Sinclair P, Group, I. C. U. G. B. C. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101–13.
Barnert J, Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol. 2009;6:637–46.
Becker RC, Scheiman J, Dauerman HL, Spencer F, Rao S, Sabatine M, Johnson DA, Chan F, Abraham NS, Quigley EM, Gastroenterology, A. C. O. C. A. T. A. C. O. Management of platelet-directed pharmacotherapy in patients with atherosclerotic coronary artery disease undergoing elective endoscopic gastrointestinal procedures. Am J Gastroenterol. 2009;104:2903–17.
Bhatt DL, Scheiman J, Abraham NS, Antman EM, Chan FK, Furberg CD, Johnson DA, Mahaffey KW, Quigley EM, Harrington RA, Bates ER, Bridges CR, Eisenberg MJ, Ferrari VA, Hlatky MA, Kaul S, Lindner JR, Moliterno DJ, Mukherjee D, Schofield RS, Rosenson RS, Stein JH, Weitz HH, Wesley DJ, Foundation, A. C. O. C, Gastroenterology, A. C. O, Association, A. H. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Am J Gastroenterol. 2008;103:2890–907.
Bjarnason I, Macpherson AJ. Intestinal toxicity of non-steroidal anti-inflammatory drugs. Pharmacol Ther. 1994;62:145–57.
Bjarnason I, Hayllar J, Macpherson AJ, Russell AS. Side effects of nonsteroidal anti- inflammatory drugs on the small and large intestine in humans. Gastroenterology. 1993;104:1832–47.
Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet. 2000;356:1318–21.
Bokhari M, Vernava AM, Ure T, Longo WE. Diverticular hemorrhage in the elderly–is it well tolerated? Dis Colon Rectum. 1996;39:191–5.
Boley SJ, Sprayregen S, Sammartano RJ, Adams A, Kleinhaus S. The pathophysiologic basis for the angiographic signs of vascular ectasias of the colon. Radiology. 1977;125:615–21.
Boley SJ, Dibiase A, Brandt LJ, Sammartano RJ. Lower intestinal bleeding in the elderly. Am J Surg. 1979;137:57–64.
Bramley PN, Masson JW, McKnight G, Herd K, Fraser A, Park K, Brunt PW, Mckinlay A, Sinclair TS, Mowat NA. The role of an open-access bleeding unit in the management of colonic haemorrhage. A 2-year prospective study. Scand J Gastroenterol. 1996;31: 764–9.
Brandt LJ, Boley SJ, Mitsudo S. Clinical characteristics and natural history of colitis in the elderly. Am J Gastroenterol. 1982;77:382–6.
Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg. 1986;204:530–6.
Carl DE, Sica DA. Acute phosphate nephropathy following colonoscopy preparation. Am J Med Sci. 2007;334: 151–4.
Cea Soriano L, Lanas A, Soriano-Gabarró M, García Rodríguez LA. Incidence of upper and lower gastrointestinal bleeding in new users of low-dose aspirin. Clin Gastroenterol Hepatol. 2019;17(5):887–95.
Chan FK, Leung Ki EL, Wong GL, Ching JY, Tse YK, Au KW, Wu JC, Ng SC. Risks of bleeding recurrence and cardiovascular events with continued aspirin use after lower gastrointestinal hemorrhage. Gastroenterology. 2016;151:271–7.
Comay D, Marshall JK. Resource utilization for acute lower gastrointestinal hemorrhage: the Ontario GI Bleed study. Can J Gastroenterol. 2002;16:677–82.
Cubiella Fernández J, Núñez Calvo L, González Vázquez E, García García MJ, Alves Pérez MT, Martínez Silva I, Fernández Seara J. Risk factors associated with the development of ischemic colitis. World J Gastroenterol. 2010;16:4564–9.
Darling E. Practical considerations in sedating the elderly. Crit Care Nurs Clin N Am. 1997;9:371–80.
Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc. 2011;74:885–96.
Defreyne L, Vanlangenhove P, De Vos M, Pattyn P, Van Maele G, Decruyenaere J, Troisi R, Kunnen M. Embolization as a first approach with endoscopically unmanageable acute nonvariceal gastrointestinal hemorrhage. Radiology. 2001;218:739–48.
Diggs NG, Holub JL, Lieberman DA, Eisen GM, Strate LL. Factors that contribute to blood loss in patients with colonic angiodysplasia from a population-based study. Clin Gastroenterol Hepatol. 2011;9:415–20; quiz e49.
Eisen GM, Dominitz JA, Faigel DO, Goldstein JL, Kalloo AN, Petersen BT, Raddawi HM, Ryan ME, Vargo JJ, Young HS, Fanelli RD, Hyman NH, Wheeler-Harbaugh J, Committee, A. S. F. G. E. S. O. P. An annotated algorithmic approach to acute lower gastrointestinal bleeding. Gastrointest Endosc. 2001;53:859–63.
Ell C, May A. Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give rise to a new medical term. Endoscopy. 2006;38:73–5.
Elta GH. Urgent colonoscopy for acute lower-GI bleeding. Gastrointest Endosc. 2004;59:402–8.
Farner R, Lichliter W, Kuhn J, Fisher T. Total colectomy versus limited colonic resection for acute lower gastrointestinal bleeding. Am J Surg. 1999;178:587–91.
Farrell JJ, Friedman LS. Gastrointestinal bleeding in older people. Gastroenterol Clin North Am. 2000;29:1–36, v.
Farrell JJ, Friedman LS. Review article: the management of lower gastrointestinal bleeding. Aliment Pharmacol Ther. 2005;21:1281–98.
Farrell JJ, Graeme-Cook F, Kelsey PB. Treatment of bleeding colonic diverticula by endoscopic band ligation: an in-vivo and ex-vivo pilot study. Endoscopy. 2003;35:823–9.
Feagins LA, Weideman RA. GI bleeding risk of DOACs versus warfarin: is newer better? Dig Dis Sci. 2018;63:1675–7.
Funaki B, Kostelic JK, Lorenz J, Ha TV, Yip DL, Rosenblum JD, Leef JA, Straus C, Zaleski GX. Superselective microcoil embolization of colonic hemorrhage. AJR Am J Roentgenol. 2001;177:829–36.
Garthright WE, Archer DL, Kvenberg JE. Estimates of incidence and costs of intestinal infectious diseases in the United States. Public Health Rep. 1988;103: 107–15.
Gerson LB, Fidler JL, Cave DR, Leighton JA. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol. 2015;110: 1265–87; quiz 1288.
Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, GarcIA D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L, Investigators, A. C. A. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–92.
Hookey L, Barkun A, Sultanian R, Bailey R. Successful hemostasis of active lower GI bleeding using a hemostatic powder as monotherapy, combination therapy, or rescue therapy. Gastrointest Endosc. 2019;89:865–71.
Huang ES, Karsan S, Kanwal F, Singh I, Makhani M, Spiegel BM. Impact of asogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc. 2011;74: 971–80.
Jensen DM. Management of patients with severe hematochezia–with all current evidence available. Am J Gastroenterol. 2005;100:2403–6.
Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342:78–82.
Kanwal F, Dulai G, Jensen DM, Gralnek IM, Kovacs TO, Machicado GA, Jutabha R. Major stigmata of recent hemorrhage on rectal ulcers in patients with severe hematochezia: endoscopic diagnosis, treatment, and outcomes. Gastrointest Endosc. 2003;57:462–8.
Kessel B, Olsha O, Younis A, Daskal Y, Granovsky E, Alfici R. Evaluation of nasogastric tubes to enable differentiation between upper and lower gastrointestinal bleeding in unselected patients with melena. Eur J Emerg Med. 2016;23:71–3.
Khanna A, Ognibene SJ, Koniaris LG. Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis. J Gastrointest Surg. 2005;9:343–52.
Kobayashi K, Furumoto Y, Akutsu D, Matsuoka M, Nozaka T, Asano T, Fujiki K, Gosho M, Narasaka T, Mizokami Y. Endoscopic detachable snare ligation improves the treatment for colonic diverticular hemorrhage. Digestion. 2019;6:1–9.
Kosowicz RL, Strate LL. Predicting outcomes in lower gastrointestinal bleeding: more work ahead. Gastrointest Endosc. 2019;89(5):1014–6.
Kuo WT, Lee DE, Saad WE, Patel N, Sahler LG, Waldman DL. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol. 2003;14:1503–9.
Laine L, Connors LG, Reicin A, Hawkey CJ, Burgos-Vargas R, Schnitzer TJ, Yu Q, Bombardier C. Serious lower gastrointestinal clinical events with nonselective Nsaid or coxib use. Gastroenterology. 2003;124: 288–92.
Lanas A, Sekar MC, Hirschowitz BI. Objective evidence of aspirin use in both ulcer and nonulcer upper and lower gastrointestinal bleeding. Gastroenterology. 1992;103: 862–9.
Lanas A, García-Rodríguez LA, Polo-Tomás M, Ponce M, Alonso-Abreu I, Perez-Aisa MA, Perez-Gisbert J, Bujanda L, Castro M, Muñoz M, Rodrigo L, Calvet X, Del-Pino D, Garcia S. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol. 2009;104:1633–41.
Leitman IM, Paull DE, Shires GT. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg. 1989;209:175–80.
Levy R, Barto W, Gani J. Retrospective study of the utility of nuclear scintigraphic-labelled red cell scanning for lower gastrointestinal bleeding. ANZ J Surg. 2003;73: 205–9.
Lew JF, Glass RI, Gangarosa RE, Cohen IP, Bern C, Moe CL. Diarrheal deaths in the United States, 1979 through 1987. A special problem for the elderly. JAMA. 1991;265:3280–4.
Lin CK, Liang CC, Chang HT, Hung FM, Lee TH. Acute hemorrhagic rectal ulcer: an important cause of lower gastrointestinal bleeding in the critically ill patients. Dig Dis Sci. 2011;56:3631–7.
Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92:419–24.
Lukens FJ, Loeb DS, Machicao VI, Achem SR, Picco MF. Colonoscopy in octogenarians: a prospective outpatient study. Am J Gastroenterol. 2002;97: 1722–5.
Mamula P, Adler DG, Conway JD, Diehl DL, Farraye FA, Kantsevoy SV, Kaul V, Kethu SR, Kwon RS, Rodriguez SA, Tierney WM, Committee, A. T. Colonoscopy preparation. Gastrointest Endosc. 2009;69:1201–9.
Matuk R, Crawford J, Abreu MT, Targan SR, Vasiliauskas EA, Papadakis KA. The spectrum of gastrointestinal toxicity and effect on disease activity of selective cyclooxygenase-2 inhibitors in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2004;10:352–6.
McGuire HH. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg. 1994;220:653–6.
Meyers MA, Alonso DR, Gray GF, Baer JW. Pathogenesis of bleeding colonic diverticulosis. Gastroenterology. 1976;71:577–83.
Muravchick S. The elderly outpatient: current anesthetic implications. Curr Opin Anaesthesiol. 2002;15:621–5.
Neeki MM, Raj V, Archambeau B, Arabian S, Hussain F. Novel application of balloon tamponade in management of acute lower gastrointestinal hemorrhage. Clin Pract Cases Emerg Med. 2019;3:243–7.
Oakland K, Chadwick G, East JE, Guy R, Humphries A, Jairath V, Mcpherson S, Metzner M, Morris AJ, Murphy MF, Tham T, Uberoi R, Veitch AM, Wheeler J, Regan C, Hoare J. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut. 2019;68:776–89.
Painter NS, Burkitt DP. Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol. 1975;4: 3–21.
Patrono C. Aspirin as an antiplatelet drug. N Engl J Med. 1994;330:1287–94.
Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, Jensen ET, Lund JL, Pasricha S, Runge T, Schmidt M, Shaheen NJ, Sandler RS. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149: 1731–1741.e3.
Pelham RW, Nix LC, Chavira RE, Cleveland MV, Stetson P. Clinical trial: single- and multiple-dose pharmacokinetics of polyethylene glycol (Peg-3350) in healthy young and elderly subjects. Aliment Pharmacol Ther. 2008;28:256–65.
Peura DA, Lanza FL, Gostout CJ, Foutch PG. The American College of Gastroenterology bleeding registry: preliminary findings. Am J Gastroenterol. 1997;92: 924–8.
Pitchumoni CS, Dharmarajan TS, editors. Geriatric gastroenterology. New York: Springer; 2012.
Raju GS, Gerson L, Das A, Lewis B, Association, A. G. American Gastroenterological Association (Aga) Institute technical review on obscure gastrointestinal bleeding. Gastroenterology. 2007;133:1697–717.
Reinus JF, Brandt LJ. Vascular ectasias and diverticulosis. Common causes of lower intestinal bleeding. Gastroenterol Clin N Am. 1994;23:1–20.
Richter JM, Christensen MR, Kaplan LM, Nishioka NS. Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage. Gastrointest Endosc. 1995;41:93–8.
Robertson DJ, Grimm IS. Inflammatory bowel disease in the elderly. Gastroenterol Clin N Am. 2001;30:409–26.
Rockall T, Logan RF, Devlin HB, Northfield TC. Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National audit of acute upper gastrointestinal haemorrhage. Lancet. 1996;347:1138–40.
Rockey DC, Ahn C, De Melo SW. Randomized pragmatic trial of nasogastric tube placement in patients with upper gastrointestinal tract bleeding. J Investig Med. 2017;65:759–64.
Rothfuss KS, Bode JC, Stange EF, Parlesak A. Urinary excretion of polyethylene glycol 3350 during colonoscopy preparation. Z Gastroenterol. 2006;44:167–72.
Saltzman J. Hemostatic spray for the management of gastrointestinal bleeding. Gastroenterol Hepatol. 2019;15: 4.
Scheffel H, Pfammatter T, Wildi S, Bauerfeind P, Marincek B, Alkadhi H. Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row Ct. Eur Radiol. 2007;17:1555–65.
Schiller KF, Truelove SC, Williams DG. Haematemesis and melaena, with special reference to factors influencing the outcome. Br Med J. 1970;2:7–14.
Shaker R, Ren J, Bardan E, Easterling C, Dua K, Xie P, Kern M. Pharyngoglottal closure reflex: characterization in healthy young, elderly and dysphagic patients with predeglutitive aspiration. Gerontology. 2003;49: 12–20.
Slotwiner-Nie PK, Brandt LJ. Infectious diarrhea in the elderly. Gastroenterol Clin N Am. 2001;30:625–35.
Soulellis CA, Carpentier S, Chen YI, Fallone CA, Barkun AN. Lower GI hemorrhage controlled with endoscopically applied Tc-325 (with videos). Gastrointest Endosc. 2013;77:504–7.
Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111:755.
Strate LL, Naumann CR. The role of colonoscopy and radiological procedures in the management of acute lower intestinal bleeding. Clin Gastroenterol Hepatol. 2010;8:333–43; quiz e44.
Strate LL, Syngal S. Predictors of utilization of early colonoscopy vs. radiography for severe lower intestinal bleeding. Gastrointest Endosc. 2005;61:46–52.
Strate LL, Saltzman JR, Ookubo R, Mutinga ML, Syngal S. Validation of a clinical prediction rule for severe acute lower intestinal bleeding. Am J Gastroenterol. 2005;100:1821–7.
Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin Gastroenterol Hepatol. 2008;6:1004–10; quiz 955.
Tariq SH, Mekhjian G. Gastrointestinal bleeding in older adults. Clin Geriatr Med. 2007;23:769–84, vi.
Thiebaud PC, Yordanov Y, Galimard JE, Naouri D, Brigant F, Truchot J, Moustafa F, Pateron D. Suspected lower gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis. Am J Emerg Med. 2019;37(4):772–4.
Thomas S, Wong R, Das A. Economic burden of acute diverticular hemorrhage in the U.S.: a nationwide estimate [abstract W1290]. Presented at the 105th annual meeting of the American Gastroenterological Association, New Orleans, May 15–20, 2004.
Triadafilopoulos G. Management of lower gastrointestinal bleeding in older adults. Drugs Aging. 2012;29: 707–15.
Trivedi CD, Pitchumoni CS. Gastrointestinal bleeding in older adults. Pract Gastroenterol. 2006;30:15–42.
Vanneste BG, Van De Voorde L, De Ridder RJ, Van Limbergen EJ, Lambin P, Van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. Int J Color Dis. 2015;30:1293–303.
Velayos FS, Williamson A, Sousa KH, Lung E, Bostrom A, Weber EJ, Ostroff JW, Terdiman JP. Early predictors of severe lower gastrointestinal bleeding and adverse outcomes: a prospective study. Clin Gastroenterol Hepatol. 2004;2:485–90.
Vernava AM, Moore BA, Longo WE, Johnson FE. Lower gastrointestinal bleeding. Dis Colon Rectum. 1997;40:846–58.
Warren JL, Klabunde CN, Mariotto AB, Meekins A, Topor M, Brown ML, Ransohoff DF. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150:849–57, W152.
Wilcox CM, Clark WS. Causes and outcome of upper and lower gastrointestinal bleeding: the Grady Hospital experience. South Med J. 1999;92:44–50.
Wilcox CM, Alexander LN, Cotsonis GA, Clark WS. Nonsteroidal antiinflammatory drugs are associated with both upper and lower gastrointestinal bleeding. Dig Dis Sci. 1997;42:990–7.
Yi WS, Garg G, Sava JA. Localization and definitive control of lower gastrointestinal bleeding with angiography and embolization. Am Surg. 2013;79:375–80.
Zink SI, Ohki SK, Stein B, Zambuto DA, Rosenberg RJ, Choi JJ, Tubbs DS. Noninvasive evaluation of active lower gastrointestinal bleeding: comparison between contrast- enhanced Mdct and 99mTc-labeled RBC scintigraphy. AJR Am J Roentgenol. 2008;191:1107–14.
Zuccaro G. Management of the adult patient with acute lower gastrointestinal bleeding. American College of Gastroenterology. Practice Parameters Committee. Am J Gastroenterol. 1998;93:1202–8.
Zuckerman GR, Prakash C. Acute lower intestinal bleeding. Part II: etiology, therapy, and outcomes. Gastrointest Endosc. 1999;49:228–38.
Zuckier LS. Acute gastrointestinal bleeding. Semin Nucl Med. 2003;33:297–311.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
Sheen, E., Pan, J., Ho, A., Triadafilopoulos, G. (2020). Lower Gastrointestinal Bleeding. In: Pitchumoni, C., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-90761-1_48-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-90761-1_48-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-90761-1
Online ISBN: 978-3-319-90761-1
eBook Packages: Springer Reference MedicineReference Module Medicine