[1] Small amounts of bleeding over a long time may cause iron-deficiency anemia resulting in feeling tired or heart-related chest pain.

[2] Causes of upper GI bleeds include: peptic ulcer disease, esophageal varices due to liver cirrhosis and cancer, among others.

[3] Causes of lower GI bleeds include: hemorrhoids, cancer, and inflammatory bowel disease among others.

[1] Bleeding may also be diagnosed and treated during minimally invasive angiography procedures such as hemorrhoidal artery embolization.

[2] Common causes of lower gastrointestinal bleeding include hemorrhoids, cancer, angiodysplasia, ulcerative colitis, Crohn's disease, and aortoenteric fistula.

[18] The presence of bright red blood in stool, known as hematochezia, typically indicates lower gastrointestinal bleeding.

Digested blood from the upper gastrointestinal tract may appear black rather than red, resulting in "coffee ground" vomit or melena.

[4] If the ratio of blood urea nitrogen to creatinine is greater than 30 the source is more likely from the upper GI tract.

[21] Nuclear scintigraphy is a sensitive test for detecting occult gastrointestinal bleeding when direct imaging with upper and lower endoscopies are negative.

[22] In patients with significant varices or cirrhosis nonselective β-blockers reduce the risk of future bleeding.

[13] With a target heart rate of 55 beats per minute B-blockers reduce the absolute risk of bleeding by 10%.

[16] Transjugular intrahepatic portosystemic shunting (TIPS) may be used to prevent bleeding in people who re-bleed despite other measures.

[4] Based on evidence from people with other health problems crystalloid and colloids are believed to be equivalent for peptic ulcer bleeding.

[4] After treatment of a high risk bleeding ulcer endoscopically giving a PPI once or a day rather than as an infusion appears to work just as well and is less expensive (the method may be either by mouth or intravenously).

[4] Medications typically include octreotide or, if not available, vasopressin and nitroglycerin to reduce portal venous pressures.

[2] If large amounts of pack red blood cells are used additional platelets and fresh frozen plasma (FFP) should be administered to prevent coagulopathies.

[4] In alcoholics FFP is suggested before confirmation of a coagulopathy due to presumed blood clotting problems.

[2] Evidence supports holding off on blood transfusions in those who have a hemoglobin greater than 7 to 8 g/dL and moderate bleeding, including in those with preexisting coronary artery disease.

[7][12] If the INR is greater than 1.5 to 1.8 correction with fresh frozen plasma or prothrombin complex may decrease mortality.

[4] Evidence of a harm or benefit of recombinant activated factor VII in those with liver diseases and gastrointestinal bleeding is not determined.

[16] The benefits versus risks of placing a nasogastric tube in those with upper GI bleeding are not determined.

[35] A number of endoscopic treatments may be used, including: epinephrine injection, band ligation, sclerotherapy, and fibrin glue depending on what is found.

[2] Prokinetic agents such as erythromycin before endoscopy can decrease the amount of blood in the stomach and thus improve the operators view.

[22] Proton pump inhibitors, if they have not been started earlier, are recommended in those in whom high risk signs for bleeding are found.

[4] The benefits versus risks of restarting blood thinners such as aspirin or warfarin and anti-inflammatories such as NSAIDs need to be carefully considered.

[4] If aspirin is needed for cardiovascular disease prevention, it is reasonable to restart it within seven days in combination with a PPI for those with nonvariceal upper GI bleeding.