This guideline provides recommendations based on current evidence for best practice in the management of acute upper and lower GI bleeding, including the assessment and management of variceal, non-variceal, and colonic bleeding in adults. Hematochezia (red or maroon blood in the stool) is usually due to lower GI bleeding. However, it can occur with massive upper GI bleeding , which is typically associated with orthostatic hypotension. (See 'Physical examination' below.) ClinicalManagement of acute upper gastrointestinal bleeding: an update for the general physician K Siau1, W Chapman2, relevant guidelines. Despite this, the 2015 UK National Con? dential Enquiry AUGIB may mimic lower gastrointestinal bleeding. 9 Features that predict AUGIB in cases of In a new ACG clinical guideline on management of acute overt lower gastrointestinal (GI) bleeding, researchers developed evidence-based recommendations based on a systematic literature review. They defined lower GI bleeding as colorectal bleeding and not small-bowel bleeding, which has historically been included in the definition. Lower GI bleeding: The lower GI tract includes much of the small intestine, large intestine or bowels, rectum, and anus. Considerations The amount of GI bleeding may be so small that it can only be detected on a lab test such as the fecal occult blood test. GUIDELINE The role of endoscopy in the patient with lower GI bleeding This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. Colonoscopy should be performed first in most patients presenting with acute lower GI bleeding. Such bleeding may be treated endoscopically (first-line approach when possible), by angiographic A lower gastrointestinal bleeding (GIB) can be secondary to an upper GIB and should be considered in patients with hemodynamic instability, history of upper GIB, on antiplatelet or anticoagulation medications, or with a BUN/Cr ratio of >30. This is the first U