Gastrointestinal Bleeding

Description

• Bleeding from GI tract:
  • Upper GI tract: Proximal to ligament of Treitz
  • Lower GI tract: Distal to ligament of Treitz to anus
• Mortality rate:
  • 10% overall; from <5% in children up to 25% for adults age >70
  • Upper GI bleed (UGIB) 6–8%
    • Variceal 30–50%
  • Lower GI bleed (LGIB) 2–4%

Etiology

• Ulcerative disease of upper GI tract:
  • Peptic ulcer disease (40%):
    • Helicobacter pylori infection
    • Drug-induced (NSAIDs, aspirin, glucocorticoids, K⁺ supplements, Fe supplements)
  • Gastric or esophageal erosions (25%):
    • Reflux esophagitis
    • Infectious esophagitis (Candida, HSV, CMV)
    • Pill-induced esophagitis
    • Esophageal foreign body
  • Gastritis and stress ulcerations:
    • Toxic agents (NSAIDs, alcohol, bile)
    • Mucosal hypoxia (trauma, burns, sepsis)
    • Cushing ulcers from severe CNS damage
    • Chemotherapy
• Portal HTN:
  • Esophageal or gastric varices (10%)
  • Portal hypertensive gastropathy
• Arteriovenous malformations:
  • Aortoenteric fistula (s/p aortoiliac surgery)
  • Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu syndrome)
  • Dieulafoy vascular malformations
  • Gastric antral vascular ectasia (GAVE or watermelon stomach)
  • Idiopathic angiomas
• Mallory–Weiss tear (5%)
• Gastric and esophageal tumors
• Pancreatic hemorrhage
• Hemobilia
• Strongyloides stercoralis infection

• Diverticulosis (33%)
• Cancer or polyps (19%)
• Colitis (18%):
  • Ischemic, inflammatory, infectious, or radiation
• Vascular (8%):
  • Angiodysplasia
  • Radiation telangiectasia
  • Aortocolonic fistula
• Inflammatory bowel disease:
  • Crohn disease and ulcerative colitis
• Postpolypectomy
• Anorectal (4%):
  • Hemorrhoids (internal and external)
  • Anal fissures
  • Anorectal varices
  • Rectal ulcer
  • Foreign body