Diagnosis and management of lower gastrointestinal bleeding

There are few randomized, prospective trials evaluating the optimal diagnos tic and therapeutic strategies in the management of lower gastrointestinal bleeding. However, recent data suggest that urgent colonoscopy represents a safe and effective initial diagnostic approach. The role of tagged erythro cyte scintigraphy is yet to be defined, but it may be of utility as a scree ning test for visceral angiography. Colonoscopy and angiography both offer substantial therapeutic options but remain of unproved benefit from a treat ment standpoint; surgery continues to play an important role in the managem ent of lower gastrointestinal bleeding. Obscure gastrointestinal bleeding, which often presents as lower gastrointestinal bleeding, continues to be on e of the most challenging diagnostic and therapeutic problems in gastroente rology, Occult gastrointestinal bleeding, often arising from the lower gast rointestinal tract, usually mandates gastrointestinal evaluation. (C) 2000 Lippincott Williams & Wilkins, Inc.