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[8] : 322 One often-stated rule of thumb is that melena only occurs if the source of bleeding is above the ligament of Treitz although, as noted below, exceptions occur with enough frequency to render it unreliable

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And the FDA's April 30, 2026 proposal - if finalized after the June 29 comment deadline - would prohibit large-scale outsourcing facilities from compounding these molecules from bulk entirely, regardless of any future shortage