Phys · gastrointestinal
Gastrointestinal Bleeding
Also known as GI bleed · upper GI bleed · UGIB · haematemesis · melaena · lower GI bleed · LGIB · haematochezia · variceal bleed · peptic ulcer bleed · obscure GI bleed · acute gastrointestinal haemorrhage
Consultant-physician-depth guide to acute upper and lower gastrointestinal bleeding — risk stratification (Glasgow-Blatchford, Rockall), resuscitation, restrictive transfusion, endoscopic therapy, variceal management and obscure GI bleed — structured for FRACP DWE and DCE preparation.
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Target exams
Red flags
- Haemodynamic instability — shock, postural drop, tachycardia (massive ongoing haemorrhage)
- Known or suspected varices (cirrhosis, portal hypertension) — higher mortality, different drug pathway
- Aortoenteric fistula — prior aortic graft surgery with sentinel bleed: do not delay surgery
- Persistent bleeding or rebleeding within 72 hours after endoscopic therapy
- Anticoagulation or bleeding disorder compounding haemorrhage
- Altered mental state, syncope or chest pain — coexisting ischaemia from hypovolaemia
Gastrointestinal Bleeding
Meet the patient
A 72-year-old man on apixaban for atrial fibrillation and aspirin after a coronary stent arrives with melaena, a heart rate of 110, and a blood pressure of 95 over 60. He is pale, cool, and peripherally shut down — this is the GI-bleed long case in a single body.[1]
Resuscitate him before you reach for the endoscope. The two questions that anchor the whole topic: is he haemodynamically stable? and is this variceal or non-variceal? — because the answer to the second one changes the drugs you give in the first 30 minutes.[1]
References8ShowHide
- [1]Blatchford O, Murray WR, Blatchford M A risk score to predict need for treatment for upper-gastrointestinal haemorrhage Lancet, 2000.PMID 11073021
- [2]Rockall TA, Logan RF, Devlin HB, Northfield TC Risk assessment after acute upper gastrointestinal haemorrhage Gut, 1996.PMID 8675081
- [3]Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding N Engl J Med, 2013.PMID 23281973
- [4]Lau JY, Sung JJ, Lee KK, et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers N Engl J Med, 2000.PMID 10922420
- [5]Bernard B, Grangé JD, Khac EN, et al. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis Hepatology, 1999.PMID 10347104
- [6]Ioannou GN, Doust J, Rockey DC Terlipressin for acute esophageal variceal hemorrhage Cochrane Database Syst Rev, 2003.PMID 12535432
- [7]Stiegmann GV, Goff JS, Michaletz-Onody PA, et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices N Engl J Med, 1992.PMID 1579136
- [8]Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding Am J Gastroenterol, 2005.PMID 16279893