Evaluation of the bleeding patient.

The recent development and widespread use of flexible fiberoptic endoscopy and visceral arteriography have revolutionized the evaluation of patients presenting with gastrointestinal hemorrhage. The bleeding lesion can now be precisely identified within a few minutes to hours of a patient's arrival, allowing specific treatment to begin much earlier than was previously possible. The logical sequence of diagnostic studies is different for three different groups of patients with gastrointestinal bleeding. Those whose bleeding is active or recent require rapid evaluation, while those with chronic bleeding may be evaluated first by the more traditional and less hazardous barium radiologic studies. This revolutionary improvement in diagnostic accuracy should improve the survival of patients with gastrointestinal hemorrhage.