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A rational approach to the patient with hematochezia

Eckmann, Jason, D.a; Chedid, Victor, G.b; Loftus, Conor, G.b

Current Opinion in Gastroenterology: January 2018 - Volume 34 - Issue 1 - p 38–45
doi: 10.1097/MOG.0000000000000409
LARGE INTESTINE: Edited by Eamonn M.M. Quigley

Purpose of review Hematochezia is a common clinical presentation, with significant morbidity and economic burden. These patients often require costly interventions including hospitalization, blood transfusions, and radiologic or endoscopic procedures. The purpose of this review is to give a rational, concise approach to the patient with hematochezia, with special consideration of recent advances in the literature.

Recent findings Recent studies pertaining to hematochezia have evaluated risk stratification, endoscopic intervention, evaluation of small bowel bleeding, and management of anticoagulation.

Summary A step-wise approach to hematochezia helps determine the cause and provide the appropriate management of these patients. We propose five steps beginning with hemodynamic assessment and risk stratification, then focused history and physical examination, endoscopic intervention when warranted, and consideration of small bowel bleeding in selected instances.

aDepartment of Internal Medicine

bDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

Correspondence to Conor G. Loftus, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. Tel: +1 507 5381231; e-mail:

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