Severe Gastrointestinal Bleeding Research Articles

Diagnostic Value of Computed Tomography in Crohn's Disease Patients Presenting with Acute Severe Lower Gastrointestinal Bleeding.

ObjectiveTo investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn's disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding.Materials and MethodsA consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis.ResultsThe diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between single-phase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09–9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21–6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-α therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07–0.95; p = 0.041).ConclusionThe diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.

Stomach carcinoid as a cause of severe gastrointestinal bleeding

Stomach carcinoid as a cause of severe gastrointestinal bleeding

Circulating Angiogenic Mediators in Patients with Moderate and Severe von Willebrand Disease: A Multicentre Cross-Sectional Study.

Inhibition of von Willebrand factor (VWF) expression in endothelial cells results in enhanced, possible dysfunctional angiogenesis, consistent with observations of severe gastrointestinal bleedings caused by vascular malformations in patients with von Willebrand disease (VWD). VWF is stored in endothelial Weibel-Palade bodies (WPB) with several other mediators of angiogenesis, like angiopoietin-2, osteoprotegerin and galectin-3. Increased release of angiopoietin-2 has been observed in medium of endothelial cells lacking VWF, but data on circulating levels of angiogenic factors in patients with VWD are lacking. The aim of this study was therefore to investigate plasma levels of angiogenic factors in patients with various types of VWD to obtain more insight into the pathogenesis of vascular malformations in these patients. We hypothesized that VWF deficiency leads to increased circulating levels of other WPB components. We therefore measured plasma levels of the WPB components angiopoietin-2, osteoprotegerin and galectin-3 as well as two other angiogenic factors (angiopoietin-1 and vascular endothelial growth factor [VEGF]) that are not stored within WPB. We observed that various angiogenic mediators are significantly different between types of VWD patients. Type 2A VWD patients had higher angiopoietin-1 levels compared with type 2B patients. Patients who have increased VWF clearance had higher angiopoietin-2 levels, whereas patients who have impaired VWF synthesis had higher galectin-3 levels. VEGF levels were negatively associated with VWF levels as type 3 VWD patients had the highest VEGF levels. However, complete VWF deficiency did not lead to increased circulating levels of other WPB components.

Quick eating caused plastic bread bag clip ingestion and severe gastrointestinal bleed in young adult: a case report.

Quick eating caused plastic bread bag clip ingestion and severe gastrointestinal bleed in young adult: a case report.

Severity of Gastrointestinal Bleeding in Patients Treated with Direct-Acting Oral Anticoagulants

BackgroundDirect-acting oral anticoagulants (DOACs), which have gained approval for stroke prevention in nonvalvular atrial fibrillation and treatment of venous thromboembolism, have become increasingly preferred over warfarin given their predictable pharmacodynamics, lack of required monitoring, and superior outcomes. Direct-acting oral anticoagulants have been shown to be associated with an increased frequency of gastrointestinal bleeding compared with warfarin, but the severity and characteristics of gastrointestinal bleeding in these patients is poorly understood. MethodsWe retrospectively evaluated electronic medical records of patients with gastrointestinal bleeding (n = 8496) from 2010-2016. We identified 61 patients with gastrointestinal bleeding episodes while treated with DOACs (rivaroxaban, dabigatran, or apixaban) and 123 patients with gastrointestinal bleeding while taking warfarin. We randomly selected a control group of 296 patients with gastrointestinal bleeding who were not receiving anticoagulation treatment from the same sample. Outcomes included the need for hospitalization, blood transfusion, endoscopic or surgical intervention, and 30-day mortality. ResultsThe DOAC and warfarin groups were similar in terms of age and underlying comorbidity (assessed using the Charlson Comorbidity Index), but the DOAC group had greater concomitant aspirin use. Gastrointestinal bleeding was classified as upper (n = 186), lower (n = 88), anorectal (n = 183), small bowel (n = 9), and indeterminate (n = 14). After adjusting for differences in baseline variables, the DOAC group had fewer hospitalizations and required fewer transfusions than the warfarin group. The DOAC and control groups were not statistically different for all outcomes. There were no significant mortality differences among groups. ConclusionAlthough prior studies have shown a higher frequency of gastrointestinal bleeding in patients treated with DOACs compared with warfarin, our data suggest that gastrointestinal bleeding in patients taking DOACs may be less severe. These differences occurred despite significantly greater concomitant aspirin use in the DOAC group compared with warfarin users.

Cholestatic liver injury as a side-effect of dabigatran and the use of coagulation tests in dabigatran intoxication and after reversal by idarucizumab in bleeding and sepsis

Idarucizumab, an antidote specific for dabigatran, became available recently. Dabigatran is not associated with increased risk of hepatotoxicity in comparison with warfarin, but it is seen as a rare side-effect. Cases of cholestatic liver injury due to dabigatran have not been reported previously. We present a case of severe gastro-intestinal bleeding with underlying dabigatran intoxication in a patient with renal failure and the effect of reversal of dabigatran using idaruzicumab on coagulation assays. International normalized ratio (INR) and activated partial thromboplastin time (APTT) results were elevated in a setting of sepsis, possibly due to liver failure. INR and APTT can be elevated if sepsis is complicated by disseminated intravascular coagulation (DIC) or liver failure, making it challenging to determine dabigatrans contribution to their prolongation. A rebound effect after administration of idarucizumab and slow elimination of dabigatran due to reduced kidney function could be detected using the Hemoclot® diluted thrombin time (dTT) in this situation, in contrast to with non-dilutional assays. Before admission, cholestatic liver injury started shortly after initiation of dabigatran etexilate therapy. As no other cause was found, this liver injury was likely to be drug-induced. Bleeding cessated promptly after administration of idarucizumab in dabigatran intoxication. In conclusion, the anticoagulant effect of dabigatran can be measured by Hemoclot® dTT in sepsis and cholestatic liver injury was seen as a possible rare side-effect of dabigatran treatment.

Role of Prophylactic Endotracheal Intubation in Severe Upper Gastrointestinal (GI) Bleeding: An Updated Systemic Review and Meta-Analysis

Introduction: Upper GI bleeding needing intensive care unit admission carries a significant risk of mortality and disease burden. Airway management to prevent aspiration during ongoing severe upper GI bleeding remains controversial and lacks evidence based guidelines. A consideration for prophylactic endotracheal intubation (PI) based on clinical judgement is recommended by most gastrointestinal societies. Evidence based guidelines at lacking in this area. A previous meta-analysis tried to address this question, however, it included only two published studies and two abstracts. New studies are available since last publication, hence the need for updated meta-analysis. Methods: On January 30,2017, we conducted a systematic search of Medline, EMBASE, Web of Science Collection databases and the Cochrane Central Register of Controlled Trials for fully published studies in English literature which involved patients with upper GI bleeding and compared complications of prophylactic intubation before endoscopy versus no intubation before the procedure. Studies which included pediatric population or lacked control arm were excluded. The primary outcome of interest was comparison of aspiration pneumonia and mortality between the two groups. Secondary outcome of interest was witnessed aspiration. Mantel-Haenszal method for fixed effect model and DerSimonian and Laird method for random effects model was used to calculate odds ratio (OR) for these outcomes. Duval and Tweedie's Trim and Fill test was used to detect any publication bias. RevMan 5.3 and CMA version 3.0 was used for statistical analyses Results: Our search identified 167 studies. Out of these 11 studies were relevant and 6 fully published studies met our inclusion criteria. Five studies reported outcomes for aspiration pneumonia. Using random effects model, our analysis for aspiration pneumonia showed significantly higher risk of aspiration pneumonia with 48 hours in patients who underwent prophylactic intubation before EGD compared to those who did not (Odds ratio OR, 4.0; 95% confidence interval CI, 1.15 - 14.2). We experienced moderate heterogeneity in our analysis (I2= 53%) which is attributed to varying baseline characteristics of included patient population. No significant publication bias was noted in this analysis. A higher mortality was noted in patients who underwent prophylactic intubation before EGD (Odds ratio, OR 1.37; 95% CI, 1.11-1.69). There was no difference in aspiration between the two groups (OR 1.45, 95% CI 0.58-3.62). Conclusion: Patients undergoing prophylactic intubation in severe upper GI bleeding has a higher odds aspiration pneumonia and mortality. A routine use of prophylactic intubation before EGD in severe upper GI bleeding should be discouraged.Figure: Forest Plot Comparing Aspiration in Prophylactic Intubation Versus No Intubation.Figure: Funnel Plot Comparing Aspiration in Prophylactic Intubation Versus No Intubation.Figure: Forest Plot Comparing Mortality in Prophylactic Intubation Versus No Intubation.

Rectal Dieulafoy’s Lesion: An Underrecognized Cause of Lower Gastrointestinal Bleeding

ABSTRACTDieulafoy’s lesion is a rare but potentially a life-threatening condition. It accounts for 1%–2% of acute gastrointestinal (GI) bleeding. The lesion is most frequently located in the stomach and may be located anywhere in the alimentary tract. It can be present as severe GI bleeding or chronic GI blood loss. The cause of lesion remains uncertain. The range of clinical presentation varies from acute ill hospitalized patients as well as in the newborn.

On Razorʼs Edge: (S)Hell of a Mussell Impaction With Upper Gastrointestinal Bleeding

Esophageal seafood shell impactions have been reported to cause erosions, tears, perforations and fistulae due to sharp broken edges. Severe upper gastrointestinal hemorrhage as an initial presentation can very rarely occur due to tears and lacerations by razor sharp edges, particularly if lodged for prolonged period due to esophageal peristalsis. They require early recognition and removal, which may be very difficult. We report a rare case of such a challenging broken mussel shell impaction with delayed presentation causing severe pain and hemorrhage and discuss the methodology employed for successful retrieval and management of such difficult shell ingestions.Figure: Impacted broken (umbo/dorsal) edge in crico-pharynx.Figure: Retrieved mussel shell with broken sharp (umbo/dorsal) edge and intact ventral beveled egde.Figure: Lacerations in the upper esophagus with bleeding.A 79 year old woman presented to ED with neck pain and spitting up blood after consumption of Italian seafood pasta 2 hours post consumption. She signed out against medical advice after initial ED presentation as she felt better and again presented to the ED 8 hours later with immense throat and neck pain and intermittent hematemesis. An urgent endoscopy revealed an impacted broken mussel shell in the upper esophagus with the broken beak/umbo/dorsal margin in the oropharyngeal sphincter (Image 1). This was grabbed with an alligator forceps and broken edge was snugged with the tip of scope to avoid lacerations and pushed down into the stomach. The shell was released in the fundus and subsequently grabbed with a Roth net. The broken sharp umbo/dorsal edge was snugged with the scope tip with ventrally beveled margins facing away to avoid trauma/laceration during withdrawal. The mesh of the net afforded some level of protection as well. Additionally, plenty of lubricant was applied on the scope externally and the scope was inserted all the way further down to pylorus to enable sufficient lubrication of esophagus prior to withdrawal of the Roth net with the broken shell. The shell was successfully withdrawn. Esophageal reintubation revealed lacerations akin to Mallory-Weiss tear in the upper esophagus (Image 3). This is a unique case presenting with hematemesis after consumption of Italian seafood pasta. Sea shell impaction should be suspected in such cases and our technique of grabbing the broken sharp (dorsal/umbo) edge and moving it down to stomach and providing enough esophageal lubrication and withdrawing in a Roth net, with the beveled ventral shell edge (Image 2) facing away from the scope, ensured a safe procedural outcome.

Endoscopic Treatment of Hyperplastic Gastric Polyp Presenting as Acute Gastrointestinal Bleed

Hyperplastic polyps are seen in approximately 1% of upper gastrointestinal endoscopies. Rarely, they have been implicated in cases of severe gastrointestinal bleeding. We present a case of acute upper gastrointestinal bleed from hyperplastic polyps in a patient taking rivaroxaban and aspirin. An 83-year-old male with a past medical history of atrial fibrillation, on rivaroxaban and aspirin, presents after several episodes of melanotic stool and hematemesis. The patient reported progressive weakness and fatigue over a two week period. The patient had no history of proton pump inhibitor use or H. pylori infection. Admission hemoglobin and platelets were 6.6 g/dL and 87,000. Antiplatelet and anticoagulation therapy was held and the patient was transfused three units of red blood cells and one set of platelets. Intravenous proton pump inhibitors were initiated. Upper endoscopy revealed bright red blood throughout the gastric cavity with active bleeding from a 1.5 cm pedunculated gastric polyp located in the greater curvature of the stomach. Heater probe coagulation with a 7-French gold probe catheter was applied to the site. The site continued to seep and two endoclips were placed at the base of the polyp with control of bleeding (Figure 1). The patient continued to require blood transfusions over the next two days. On hospital day four, a second endoscopy was performed and two additional 0.5 cm hemorrhagic polyps were found and treated with hot snare polypectomy and endoclips (Figure 2). Pathology report revealed hyperplastic polyps (Figure 3). Upon discussion and assessment of the patient's risks, benefits and preferences, the decision was made to resume rivaroxaban and aspirin. At three month follow-up, the patient reported no further episodes of bleeding. The combination of (1) advanced age, (2) presence of polyps and (3) use of oral anticoagulation and/or antiplatelet agents expectedly increases a patient's risk for gastrointestinal bleeding. Case studies involving bleeding due to hyperplastic polyps with an attributed cause linked to oral anticoagulants appear to be positively correlated with survival. In this patient's case, no reversal agent was yet available. However, cessation of medications and endoscopic intervention appeared adequate in providing symptom resolution. Ongoing studies are investigating the benefits of direct Xa inhibitor reversal. Data from these studies may further optimize the treatment of acute gastrointestinal bleeding.FigureFigureFigure

A Complete Histologic Approach to Gastrointestinal Biopsy From Hematopoietic Stem Cell Transplant Patients With Evidence of Transplant-Associated Gastrointestinal Thrombotic Microangiopathy.

- Transplant-associated thrombotic microangiopathy is a serious complication of hematopoietic stem cell transplant that may progress to multi-organ dysfunction. Transplant-associated thrombotic microangiopathy may involve the intestinal vasculature (intestinal transplant-associated thrombotic microangiopathy [iTMA]), causing patients to experience debilitating symptoms of ischemic colitis, including disproportionately severe abdominal pain and gastrointestinal bleeding, requiring heavy narcotic use and frequent transfusion support. Pathophysiology remains poorly investigated but may include endothelial damage mediated by inflammatory markers and the complement system. Endoscopy of hematopoietic stem cell transplant patients often produces biopsy samples, in which mucosal lamina propria capillaries are sufficient for an evaluation of iTMA features. - To provide a detailed review of histologic features of iTMA. - We conducted a systematic review of studies assessing histologic features of iTMA. Studies were identified by PubMed search and included a cohort study performed by our group. - The histologic hallmark of iTMA is endothelial cell injury that leads to hemorrhage and thrombosis of the capillaries. Histologic features include endothelial cell swelling, endothelial cell separation, perivascular mucosal hemorrhage, intraluminal schistocytes, intraluminal fibrin, intraluminal microthrombi, loss of glands, and total denudation of mucosa. Identification of features consistent with iTMA has immediate implications for clinical management that could potentially improve outcome and survival.

Phase I study of chimeric antigen receptor modified T cells in treating HER2-positive advanced biliary tract cancers and pancreatic cancers

This phase I clinical trial (NCT01935843) is to evaluate the safety, feasibility, and activity of chimeric antigen receptor-engineered T cell (CART) immunotherapy targeting human epidermal growth factor receptor 2 (HER2) in patients with advanced biliary tract cancers (BTCs) and pancreatic cancers (PCs). Eligible patients with HER2-positive (>50%) BTCs and PCs were enrolled in the trial. Well cultured CART-HER2 cells were infused following the conditioning treatment composed of nab-paclitaxel (100–200 mg/m2) and cyclophosphamide (15–35 mg/kg). CAR transgene copy number in the peripheral blood was serially measured to monitor the expansion and persistence of CART-HER2 cells in vivo. Eleven enrolled patients received 1 to 2-cycle CART-HER2 cell infusion (median CAR+ T cell 2.1 × 106/kg). The conditioning treatment resulted in mild-to-moderate fatigue, nausea/vomiting, myalgia/arthralgia, and lymphopenia. Except one grade-3 acute febrile syndrome and one abnormal elevation of transaminase (>9 ULN), adverse events related to the infusion of CART-HER2 cells were mild-to-moderate. Post-infusion toxicities included one case of reversible severe upper gastrointestinal hemorrhage which occurred in a patient with gastric antrum invaded by metastasis 11 days after the CART-HER2 cell infusion, and 2 cases of grade 1–2 delayed fever, accompanied by the release of C-reactive protein and interleukin-6. All patients were evaluable for assessment of clinical response, among which 1 obtained a 4.5-months partial response and 5 achieved stable disease. The median progression free survival was 4.8 months (range, 1.5–8.3 months). Finally, data from this study demonstrated the safety and feasibility of CART-HER2 immunotherapy, and showed encouraging signals of clinical activity.

Improved outcomes following implementation of an acute gastrointestinal bleeding multidisciplinary protocol

Effective multidisciplinary management of gastrointestinal bleeding (GIB) requires effective communication. We instituted a protocol to standardize communication practices with the hypothesis that outcomes would improve following protocol initiation. We performed a retrospective cohort analysis of 442 patients who required procedural management of acute GIB at our institution during a 50-month period spanning 25 months before and 25 months after implementation of a multidisciplinary communication protocol. The protocol stipulates that when a patient with severe GIB is identified, a conference call is coordinated among the gastroenterology, interventional radiology, and acute care surgery teams. A consensus plan is generated and then reassessed following procedural interventions and changes in patients' status. Patients' characteristics, management strategies, and outcomes were compared before and after protocol initiation. Patient populations before and after protocol initiation were similar in age, comorbidities, outpatient use of antiplatelet/anticoagulant medications, admission vital signs, and admission laboratory values. The median interval between admission and the first procedure was significantly shorter in the protocol group (40 vs 47 hours, p = 0.046). The proportion of patients who received packed red blood cell transfusions decreased following protocol initiation (41% vs 50%, p = 0.018). Median hospital length of stay was significantly shorter in the protocol group (5.0 vs 6.0 days, p = 0.014). Readmissions with GIB were decreased after protocol implementation (8% vs. 15%, p = 0.023). Implementation of a multidisciplinary protocol for management of acute GIB was associated with earlier intervention, fewer packed red blood cell transfusions, shorter hospital length of stay, and fewer readmissions with GIB. Future research should seek to establish causal relationships between communication practices and outcomes. Therapeutic study, level III.

Leech Infestation Presenting as Severe Rectal Bleeding

ABSTRACTLeech or Hirudinea is a major parasite in rural India. Normally, the leech attacks the skin and exposed areas. An 18‑year‑old child presented with bleeding per rectum for 1 day along with giddiness. A history revealed that while the boy was working in a field, had acrawling sensation in the perianal area. After admission, the patient was resuscitated with crystalloids and a limited colonoscopy revealed a rectal ulcer with a leech head attached to its base. The hooklets were removed using foreign body removal forceps and injection Adrenaline at 1:10,000 dilutions was injected in 1 ml aliquots into four quadrant to achieve hemostasis. There was no postprocedure complication. Leech infestation can present with exsanguinating acute severe lower gastrointestinal bleed.

Acute Severe Gastrointestinal Tract Bleeding Is Associated With an Increased Risk of Thromboembolism and Death

We performed a retrospective cohort study of patients with and without gastrointestinal bleeding (GIB) to determine whether GIB increases the risks of thromboembolism and death. We collected data from 522 patients with acute severe GIB and 1044 patients without GIB (control subjects, matched for age, sex, year of diagnosis, history of thromboembolism, and use of antithrombotic drugs) who underwent endoscopy at the National Center for Global Health and Medicine in Japan from January 2009 through December 2014. Hazard ratios of GIB for thromboembolism and mortality risk were estimated, adjusting for confounders. We also compared standardized mortality ratios between the GIB cohort and the age- and sex-matched general population in Japan. During a mean follow up of 23.7 months, thromboembolism was identified in 11.5% of patients with GIB and 2.4% of control subjects (hazard ratio, 5.3; 95% confidence interval, 3.3-8.5; P<.001). Multivariate analysis revealed GIB as a risk factor for all-thromboembolic events, cerebrovascular events, and cardiovascular events. During a mean follow-up of 24.6 months, 15.9% of patients with GIB and 8.6% of control subjects died (hazard ratio, 2.1; 95% confidence interval, 1.6-2.9; P < .001). Multivariate analysis revealed GIB as a risk factor for all-cause mortality. Compared with the general population, patients with GIB were at increased risk of death (standardized mortality ratio, 12.0). In a retrospective analysis of patients undergoing endoscopy in Japan, we identified acute GIB was a significant risk factor for late thromboembolism and death, compared with patients without GIB. GIB also increased risk of death compared with the general population.

Combined Endoscopic and Surgical Treatment of Severe Gastrointestinal Bleeding in a Patient with Heart Assist Device under Therapeutic Anticoagulation.

Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot. A combined endoscopic and surgical treatment was initiated, including gastrotomy for blood clot removal, surgical transgastric suturing, endoscopic over-the-scope clip (OTSC) placement and hemospray application. Postoperative endoscopic visualization showed effective bleeding control. The patient unfortunately died due to causes unrelated to the treatment. This case shows that a minimal invasive combination of endoscopic and surgical techniques can be an alternative treatment for severe upper GI bleeding in critically ill and anticoagulated patients.

"Watermelon stomach" can be the cause of severe gastrointestinal bleeding

Irregular vascular dilatation in the antrum or the cardia of the stomach can be the cause of severe gastrointestinal bleeding. The first term for it - in the beginning of the 50's of the previous century - was GAVE (Gastric Antral Vascular Ectasia) since at that time no similar phenomenon had been registered before. A quarter of a century later, after publishing a few cases, a witty internist described it as "watermelon stomach" because the macroscopic picture is similarly looking as the aforesaid fruit's appearing. This rare condition occured in one of our patient with many comorbid diseases.

Mo1086 Severity of Gastrointestinal Bleeding in Patients Treated With Direct-Acting Oral Anticoagulants (Doacs)

Mo1086 Severity of Gastrointestinal Bleeding in Patients Treated With Direct-Acting Oral Anticoagulants (Doacs)

Mo2028 Endoscopic Application of Highly Mucoadhesive Drug Loadable Powder for Acute Severe Gastrointestinal Bleeding in a Swine Model

Mo2028 Endoscopic Application of Highly Mucoadhesive Drug Loadable Powder for Acute Severe Gastrointestinal Bleeding in a Swine Model

Plasma copeptin levels in the patients with gastrointestinal bleeding

IntroductionGastrointestinal bleeding is a significant cause of morbidity and mortality worldwide. In addition, it constitutes an important part of health expenditures.In this study, we aimed to determine whether there is a relationship between plasma copeptin levels and the etiology, location and severity of gastrointestinal bleeding. Materials and methodsThis study was performed prospectively in 104 consecutive patients who were admitted to an emergency department with complaints of bloody vomiting or bloody or black stool. To evaluate the level of biochemical parameters such as Full Blood Count (FBC), serum biochemistry, bleeding parameters and copeptin, blood samples were obtained at admission. For the copeptin levels, 2 more blood samples were obtained at the 12th and 24th hours after admission.The values obtained were compared using statistical methods. ResultsIn terms of the etiology of bleeding, the copeptin levels in the patients with peptic ulcer were higher than the levels in patients with other gastrointestinal bleeding. However, the difference was not statistically significant.There were no significant differences among all groups' 0th, 12th and 24th hour levels of copeptin. DiscussionWe conclude that copeptin cannot be effectively used as a biochemical parameter in an emergency department to determine the etiology and location of gastrointestinal bleeding. It can, however, be used to make decisions on endoscopy and the hospitalization of patients with suspected gastrointestinal bleeding.