Diagnosis and treatment of patients with gastrointestinal bleeding

Abstract

Acute gastrointestinal haemorrhage is a common problem and accounts for approximately 300 admissions per year for an average size hospital in the UK. Peptic ulcer and gastritis account for most cases of upper gastrointestinal (UGI) bleeding and diverticular disease and angiodysplasia account for the majority of serious lower gastrointestinal (LGI) bleeding. UGI bleeding is more than twice as common and the mortality rate is more than twice as high as LGI bleeding. Patients at greatest risk are those aged over 65, with serious co-morbid illness, those with severe bleeds and those who haemorrhage while an inpatient for other reasons. For GI bleeding endoscopy is the most accurate diagnostic test and almost always allows treatment for both UGI and LGI bleeding. Gastric acid suppression with proton pump inhibitors reduces the risk of rebleeding and mortality from peptic ulcers. Bleeding due to portal hypertension is usually variceal and best managed with endoscopic band ligation. Glypressin reduces the mortality of variceal haemorrhage as do prophylactic antibiotics. Transvenous intrahepatic portosystemic shunting is the treatment of choice for uncontrolled variceal bleeding and balloon tamponade can provide a bridge to this. Angiography is occasionally needed for localization and treatment, particularly where the bleeding remains obscure after endoscopy. Surgery is required where other treatment modalities have failed, but every effort should be made to localize the cause of bleeding to reduce surgical mortality.