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rEVIEWS Diagnosis and management of lower gastrointestinal bleeding Jürgen Barnert and Helmut Messmann | Lower gastrointestinal bleeding (LGIB) can present as an acute and life‑threatening event or as chronic bleeding, whi ight manifest as iron‑deficiency anemia, fecal occult blood or intermittent scant hematochezia. Bleeding from the small bowel has been shown to be a dist t entity, and LGIB is defined as bleeding from a colonic source. Acute bleeding from the colon is usually less dramatic than upper gastrointestinal hemorrhage and is self‑limiting in most cases. Several factors might contribute to reased mortality, a severe course of bleeding and recurrent bleeding, luding advanced age, comorbidity, intestinal ischemia, bleeding as a result of a separate process, and hemodynamic instability. Diverticula, angiodys sias, neo sms, colitis, ischemia, anorectal disorders and postpolypectomy bleeding are the most common causes o IB. Volume resuscitation should take ce concurrently upon initial patient assessment. Colonoscopy is the diagnostic and therapeutic procedure of choice, for acute and chronic bleeding. Angiography is used if colonoscopy fails or cannot be performed. The use of radioisotope scans is for cases of unex ined intermittent bleeding, when other methods have failed to detect the source. Embolization or modern endoscopy techniques, such as injection therapy, thermocoagulation and mechanical devices, effectively promote hemostasis. Surgery is the final approach for severe bleeding. Barnert, J. Messmann, H. Nat. Rev. Gastroenterol. Hepatol. 6, 637–646 (2009); :10.1038/nrgastro.2009.167 Int