Progress has been made in the evaluation and treatment of gastrointestinal bleeding. HemeSelect (SmithKline Diagnostics, San Jose, CA) seems to give the best specificity and sensitivity for occult bleeding. Iron-deficiency anemia requires an evaluation for colon carcinoma. Endoscopic ultrasound may be helpful in locating the source of obscure gastrointestinal bleeding. A conservative approach to gastrointestinal bleeding in children and infants is often successful. Nonsteroidal anti-inflammatory drugs may cause many of the same small intestine and colon problems as aspirin. Free radical scavengers, sulfhydryl-containing agents, and metronidazole may diminish gut complications arising from nonsteroidal anti-inflammatory drugs or aspirin. Variceal ligation may prove to be safer and more effective than sclerotherapy. The combination of nitroglycerin and vasopressin seems to be more effective for portal hypertensive bleeding than either alone. Somatostatin may be as effective but is more expensive. Angiography and embolization therapy for bleeding remain important parts of our armamentarium.
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