Gastrointestinal Bleeding

Basics

Description

  • Bleeding from gastrointestinal (GI) tract:
  • Upper GI bleed (UGIB): Bleeding proximal to ligament of Treitz
  • Lower GI bleed (LGIB): Bleeding distal to the ligament of Treitz
  • Approximately 47 per 100,000 adults annually
  • Declining incidence:
    • Eradication of Helicobacter pylori
    • Widespread use of proton pump inhibitors (PPI)
  • More common in men
  • Mean age of presentation: 63 yr
  • 10% Mortality rate

Etiology

Upper Gi Bleed (Ugib)

  • Esophageal disorders:
    • Esophageal varices (10%)
    • Mallory–Weiss tears (5%)
    • Reflux esophagitis
    • Infectious esophagitis (Candida, HSV, CMV)
    • Esophageal cancer
  • Ulcerative disease of upper GI tract:
    • Peptic ulcer disease (40%):
      • H. pylori infection
      • Drug induced (NSAIDs, aspirin, glucocorticoids, K+ supplements, Fe supplements)
      • Pill-induced esophagitis
      • Esophageal foreign body
    • Gastritis and stress ulcerations:
      • Toxic agents (NSAIDs, alcohol, bile)
      • Mucosal hypoxia (trauma, burns, sepsis)
      • Cushing ulcers (severe CNS damage)
      • Chemotherapy
    • Portal hypertensive gastropathy
    • Gastric antral vascular ectasia
    • Arteriovenous malformations
    • Aortoenteric fistula (s/p aortoiliac surgery)
    • Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu syndrome)
    • Dieulafoy vascular malformations
  • Gastric and esophageal tumors
  • Pancreatic hemorrhage
  • Hemobilia:
    • Traumatic
    • Hepatobiliary surgical procedures
    • Hepatic artery aneurysm
  • Strongyloidiasis hyperinfection syndrome
  • Schistosomiasis:
    • Varices from periportal fibrosis
    • Ulceration from egg deposits in the intestinal mucosa

Lower Gi Bleed (Lgib)

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

Pediatric Considerations

Meckel diverticulum and intussusception are causes of LGIB in children

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