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Gastrointestinal bleeding
| Gastrointestinal bleeding | |
|---|---|
| Other names | Gastrointestinal hemorrhage, GI bleed |
 | |
| A positive fecal occult blood test | |
| Specialty | Gastroenterology  |
| Symptoms | Vomiting red blood, vomiting black blood, bloody stool, black stool, fatigue[1] |
| Complications | Iron-deficiency anemia, heart-related chest pain[1] |
| Types | Upper gastrointestinal bleeding, lower gastrointestinal bleeding[2] |
| Causes | Upper: peptic ulcer disease, esophageal varices due to liver cirrhosis, cancer[3] Lower: hemorrhoids, cancer, inflammatory bowel disease[2] |
| Diagnostic method | Medical history and physical examination, blood tests[1] |
| Treatment | Intravenous fluids, blood transfusions, endoscopy[4][5] |
| Medication | Proton pump inhibitors, octreotide, antibiotics[5][6] |
| Prognosis | ~15% risk of death[1][7] |
| Frequency | Upper: 100 per 100,000 adults per year[8] Lower: 25 per 100,000 per year[2] |
Gastrointestinal bleeding (GI bleed), also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum.[9] When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.[1] Small amounts of bleeding over a long time may cause iron-deficiency anemia resulting in feeling tired or heart-related chest pain.[1] Other symptoms may include abdominal pain, shortness of breath, pale skin, or passing out.[1][9] Sometimes in those with small amounts of bleeding no symptoms may be present.[1]
Bleeding is typically divided into two main types: upper gastrointestinal bleeding and lower gastrointestinal bleeding.[2] Causes of upper GI bleeds include: peptic ulcer disease, esophageal varices due to liver cirrhosis and cancer, among others.[3] Causes of lower GI bleeds include: hemorrhoids, cancer, and inflammatory bowel disease among others.[2][1] Small amounts of bleeding may be detected by fecal occult blood test.[1] Endoscopy of the lower and upper gastrointestinal tract may locate the area of bleeding.[1] Medical imaging may be useful in cases that are not clear.[1] Bleeding may also be diagnosed and treated during minimally invasive angiography procedures such as hemorrhoidal artery embolization.[10][11]
Initial treatment focuses on resuscitation which may include intravenous fluids and blood transfusions.[4] Often blood transfusions are not recommended unless the hemoglobin is less than 70 or 80 g/L.[7][12] Treatment with proton pump inhibitors, octreotide, and antibiotics may be considered in certain cases.[5][6][13] If other measures are not effective, an esophageal balloon may be attempted in those with presumed esophageal varices.[2] Endoscopy of the esophagus, stomach, and duodenum or endoscopy of the large bowel are generally recommended within 24 hours and may allow treatment as well as diagnosis.[4]
An upper GI bleed is more common than lower GI bleed.[2] An upper GI bleed occurs in 50 to 150 per 100,000 adults per year.[8] A lower GI bleed is estimated to occur in 20 to 30 per 100,000 per year.[2] It results in about 300,000 hospital admissions a year in the United States.[1] Risk of death from a GI bleed is between 5% and 30%.[1][7] Risk of bleeding is more common in males and increases with age.[2]
- ^ a b c d e f g h i j k l m n Kim, BS; Li, BT; Engel, A; Samra, JS; Clarke, S; Norton, ID; Li, AE (15 November 2014). "Diagnosis of gastrointestinal bleeding: A practical guide for clinicians". World Journal of Gastrointestinal Pathophysiology. 5 (4): 467–78. doi:10.4291/wjgp.v5.i4.467. PMC 4231512. PMID 25400991.
- ^ a b c d e f g h i Westhoff, John (March 2004). "Gastrointestinal Bleeding: An Evidence-Based ED Approach To Risk Stratification". Emergency Medicine Practice. 6 (3). Archived from the original on 2013-07-22. Retrieved 2012-04-20.
- ^ a b van Leerdam, ME (2008). "Epidemiology of acute upper gastrointestinal bleeding". Best Practice & Research. Clinical Gastroenterology. 22 (2): 209–24. doi:10.1016/j.bpg.2007.10.011. PMID 18346679.
- ^ a b c Jairath, V; Barkun, AN (October 2011). "The overall approach to the management of upper gastrointestinal bleeding". Gastrointestinal Endoscopy Clinics of North America. 21 (4): 657–70. doi:10.1016/j.giec.2011.07.001. PMID 21944416.
- ^ a b c Chavez-Tapia, NC; Barrientos-Gutierrez, T; Tellez-Avila, F; Soares-Weiser, K; Mendez-Sanchez, N; Gluud, C; Uribe, M (September 2011). "Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding – an updated Cochrane review". Alimentary Pharmacology & Therapeutics. 34 (5): 509–18. doi:10.1111/j.1365-2036.2011.04746.x. PMID 21707680. S2CID 8673988.
- ^ a b Leontiadis, GI; Sreedharan, A; Dorward, S; Barton, P; Delaney, B; Howden, CW; Orhewere, M; Gisbert, J; Sharma, VK; Rostom, A; Moayyedi, P; Forman, D (December 2007). "Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding". Health Technology Assessment. 11 (51): iii–iv, 1–164. doi:10.3310/hta11510. PMID 18021578.
- ^ a b c Wang, J; Bao, YX; Bai, M; Zhang, YG; Xu, WD; Qi, XS (28 October 2013). "Restrictive vs liberal transfusion for upper gastrointestinal bleeding: a meta-analysis of randomized controlled trials". World Journal of Gastroenterology. 19 (40): 6919–27. doi:10.3748/wjg.v19.i40.6919. PMC 3812494. PMID 24187470.
- ^ a b Jairath, V; Hearnshaw, S; Brunskill, SJ; Doree, C; Hopewell, S; Hyde, C; Travis, S; Murphy, MF (2010-09-08). Jairath, Vipul (ed.). "Red cell transfusion for the management of upper gastrointestinal haemorrhage". Cochrane Database of Systematic Reviews (9): CD006613. doi:10.1002/14651858.CD006613.pub3. PMID 20824851.
- ^ a b "Bleeding in the Digestive Tract". The National Institute of Diabetes and Digestive and Kidney Diseases. September 17, 2014. Archived from the original on 21 February 2015. Retrieved 6 March 2015.
- ^ UCLA Health (2024-06-24). Hemorrhoidal Artery Embolization Minimally Invasive Treatment for Symptomatic Internal Hemorrhoids. Retrieved 2024-08-16 – via YouTube.
- ^ "Hemorrhoidal Artery Embolization (HAE)". www.uclahealth.org. Retrieved 2024-08-16.
- ^ Salpeter, SR; Buckley, JS; Chatterjee, S (February 2014). "Impact of more restrictive blood transfusion strategies on clinical outcomes: a meta-analysis and systematic review". The American Journal of Medicine. 127 (2): 124–131.e3. doi:10.1016/j.amjmed.2013.09.017. PMID 24331453.
- ^ Cat, TB; Liu-DeRyke, X (September 2010). "Medical management of variceal hemorrhage". Critical Care Nursing Clinics of North America. 22 (3): 381–93. doi:10.1016/j.ccell.2010.02.004. PMID 20691388.
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