Gastrointestinal Hemorrhage

  • Michael A. SamotowkaEmail author


There are over half a million patients hospitalized annually for gastrointestinal hemorrhage (GIH) in the USA [1]. The overall inpatient mortality rate in the USA is approximately 3 %. The majority of bleeds (~75 %) arise from the upper gastrointestinal tract, defined as proximal to the ligament of Treitz. GIH is most common in the elderly, and this population is prone to having a higher incidence of associated medical comorbidities. In the GIH patient population, 80 % of the mortality is attributable to their associated comorbidities rather than as a direct consequence of their GI hemorrhage. As the elderly population of America continues to expand, it can be expected that the incidence of GI hemorrhage patients will also increase in a proportionate fashion.


Upper gastrointestinal hemorrhage Peptic ulcer disease Esophagitis Stress-related mucosal disease Zollinger-Ellison syndrome Mallory-Weiss tear Variceal hemorrhage Capsule endoscopy Push enteroscopy Double-balloon enteroscopy Angiodysplasia Diverticular disease Lower gastrointestinal hemorrhage Small bowel hemorrhage Acute mesenteric ischemia Proctitis 


  1. 1.
    Longstreth G. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90:206–10.PubMedGoogle Scholar
  2. 2.
    Fllah M, Prakash C, Edmundowicz S. Acute gastrointestinal bleeding. Med Clin North Am. 2000;84:1183–208.CrossRefGoogle Scholar
  3. 3.
    Delvaux M, Fassler I, Gray G. Clinical usefulness of the endoscopic video-capsule as the initial intestinal investigation in patients with obscure digestive bleeding validation of a diagnostic strategy based on the patient outcome after 12 months. Endoscopy. 2004;36:1067–73.CrossRefGoogle Scholar
  4. 4.
    Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Phys. 2007;76(7):1005–12.Google Scholar
  5. 5.
    Warren JR, Marshall B. Unidentified curved bacilli on gastric epithelium in active gastritis. Lancet. 1983;1:1273.PubMedGoogle Scholar
  6. 6.
    Mercer DW, Robinson EK. Chapter 47. Peptic ulcer disease. In: Townsend CM et al., editors. Sabiston textbook of surgery. 18th ed. Philadelphia: Elsevier Saunders; 2008.Google Scholar
  7. 7.
    Harbison S, Dempsey D. Pepteic ulcer disease. Curr Prob Surg. 2005;42:346–454.CrossRefGoogle Scholar
  8. 8.
    Svanes C. Trends in perforated peptic ulcer: incidence, etiology, treatment and prognosis. World J Surg. 2000;24(3):277–83.CrossRefGoogle Scholar
  9. 9.
    Schuster KM, Fever WJ, Barquist ES. Outcomes of cocaine-induced gastric perforations repaired with an omental patch. J Gastrointest Surg. 2007;11(11):1560–3.CrossRefGoogle Scholar
  10. 10.
    Vakil N, Van Zanten SV, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20.CrossRefGoogle Scholar
  11. 11.
    Zimmerman J, Shohat V, Tsvang E, et al. Esophagitis is a major cause of upper gastrointestinal hemorrhage in the elderly. Scand J Gastroenterol. 1997;32:906–9.CrossRefGoogle Scholar
  12. 12.
    Lin PC, Change CH, Hsu PL, et al. The efficacy and safety of proton pump inhibitors vs. histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients: a meta-analysis. Crit Care Med. 2010;38:1197–205.CrossRefGoogle Scholar
  13. 13.
    Stollman N, Metz DC. Pathophysiology and prophylaxis of stress ulcer in intensive care unit patients. J Crit Care. 2005;20:35–45.CrossRefGoogle Scholar
  14. 14.
    Cook DJ, Fuller HD, Fuyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med. 1994;330:377–81.CrossRefGoogle Scholar
  15. 15.
    Cook DJ, et al. Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. Crit Care Med. 1999;27:2812–7.CrossRefGoogle Scholar
  16. 16.
    Reilly J, Fennerty MB. Stress ulcer prophylaxis: the prevention of gastrointestinal bleeding and the development of nosocomial infections in critically ill patients. J Pharm Pract. 1998;11:418–32.CrossRefGoogle Scholar
  17. 17.
    Laine L, Takevchi K, Tamawaski A. Gastric mucosal defence and cytoprotection: bench to bedside. Gastroenterology. 2008;135:41–60.CrossRefGoogle Scholar
  18. 18.
    Alhazzani W, Alanezi F, Jaeschke RZ, et al. Proton pump inhibitor versus Histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2013;41(3):693–705.CrossRefGoogle Scholar
  19. 19.
    Fennerty MB. Pathophysiology of the upper gastrointestinal tract in the critically ill patient: rationale for the therapeutic benefits of acid suppression. Crit Care Med. 2002;30(6 Suppl):S351–5.CrossRefGoogle Scholar
  20. 20.
    DelValle J. Zollinger-Ellison syndrome and other neuroendocrine tumors. In: Wolfe MM, editor. Therapy of digestive disorders. New York: Elsevier; 2006. p. 469–84.Google Scholar
  21. 21.
    Dolan JP, Norton JA. Chapter 58. Zollinger-Ellison syndrome. In: Yeo CL, editor. Schakelford’s surgery of the alimentary tract. 6th ed. Philadelphia: Elsevier Saunders; 2007.Google Scholar
  22. 22.
    Hui AJ, Sung JJ. Endoscopic treatment of upper gastrointestinal bleeding. Curr Treat Options Gastroenterol. 2005;8:153–62.CrossRefGoogle Scholar
  23. 23.
    Bharucha AE, Gostout CJ, et al. Clinical and endoscopic risk factors in the Mallory-Weiss syndrome. Am J Gastroenterol. 1997;92:805–8.PubMedGoogle Scholar
  24. 24.
    Cappell MS, Dass K, Manickam P. Characterization of the syndrome of UGI bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography. Dig Dis Sci. 2014;59:2381–9.CrossRefGoogle Scholar
  25. 25.
    Burks JA, Faries PL, et al. Endovascular repair of bleeding aortoenteric fistulas: a 5 year experience. J Vasc Surg. 2001;34:1055–9.CrossRefGoogle Scholar
  26. 26.
    Samotowka M. Bariatric surgery complications for the acute care surgeon. Bariatric Surg. 2016; In Press.Google Scholar
  27. 27.
    Keyur P, Ali MA, Wong RCK. Unusual causes of upper gastrointestinal bleeding. Gastroenterol Endoscop Clin N Am. 2015;25(3):583–605.CrossRefGoogle Scholar
  28. 28.
    Barkun A, Bardou M, Marshall JK, Nonvariceal Upper GI Bleeding Consensus Conference Group, et al. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003;139:843–57.CrossRefGoogle Scholar
  29. 29.
    Barkun AN, Bardov M, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101–13.CrossRefGoogle Scholar
  30. 30.
    Reverter E, et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding. Gastroenterol. 2014;146:412–9.CrossRefGoogle Scholar
  31. 31.
    Garcia–Pagán JC, Patch D. Trials and tribulations: the prevention of variceal rebleeding. Gastroenterology. 2015;149(3):528–31.CrossRefGoogle Scholar
  32. 32.
    Young PP, Cotton BA, Goodnough LT. Massive transfusion protocol for patients with substantial hemorrhage. Transfus Med Rev. 2011;25(4):293–303.CrossRefGoogle Scholar
  33. 33.
    Bernard B, Grange JD, et al. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999;29:165–1661.CrossRefGoogle Scholar
  34. 34.
    Chavez-Tapia N, et al. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010; 9:CD002907.Google Scholar
  35. 35.
    Burrough A, McCormick P, et al. Randomized, double-blind, placebo-controlled trial of somatostatic for variceal bleeding: emergency control and prevention of early variceal re-bleeding. Gastroenterol. 1990;99:1388–95.CrossRefGoogle Scholar
  36. 36.
    Carbonell N, Pauwels A, et al. Improved survival after variceal bleeding patients with cirrhosis over the past two decades. Hepatology. 2004;40:652–9.CrossRefGoogle Scholar
  37. 37.
    Garcia-Tsao G, Bosch J. Management of varicies and variceal hemorrhage in cirrhosis. N Engl J Med. 2010;362:823–32.CrossRefGoogle Scholar
  38. 38.
    Garcia-Pagan J, Pascoli M, et al. Use of early TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study. J Hepatol. 2013;58:45–50.CrossRefGoogle Scholar
  39. 39.
    Franchis R, on behalf of the Baveno VI faculty. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743–52.CrossRefGoogle Scholar
  40. 40.
    Gralnek IM. Obscure-overt gastrointestinal bleeding. Gastroenterol. 2005;128:1424–30.CrossRefGoogle Scholar
  41. 41.
    Chen X, Zhi-Hua R, et al. A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases. World J Gastroenterol. 2007;13(32):4372–8.CrossRefGoogle Scholar
  42. 42.
    Triester SL, Leighton JA, 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;100:2407–18.CrossRefGoogle Scholar
  43. 43.
    Manner H. Argon plasma coagulation therapy. Curr Opin Gastroenterol. 2008;24(5):612–6.CrossRefGoogle Scholar
  44. 44.
    Farrell JJ, Friedman LS. Gastrointestinal bleeding in the elderly. Gastroenterol Clin North Am. 2001;30:377–407.CrossRefGoogle Scholar
  45. 45.
    Zuckerman GR, Prakash C. Acute lower intestinal bleeding: part 1: clinical presentation and diagnosis. Gastrointest Endosc. 1998;48(6):606–17.CrossRefGoogle Scholar
  46. 46.
    Jacovides CL, Nadolski G, et al. Arteriography for lower gastrointestinal hemorrhage role of preceding abdominal computed tomographic angiogram in diagnosis and localization. JAMA Surg. 2015;150(7):650–6.CrossRefGoogle Scholar
  47. 47.
    Nguyen NQ, Rayner CK, et al. Push enteroscopy alters management in a majority of patients with obscure gastrointestinal bleeding. J Gastroenterol Hepatol. 2005;20(5):716–21.CrossRefGoogle Scholar
  48. 48.
    Farrell JJ, Friedman LS. Review article: the management of lower gastrointestinal bleeding. Aliment Pharmacol Ther. 2005;21:1281–98.CrossRefGoogle Scholar
  49. 49.
    Tan KK, Nallathamby V, Wong D, Sim R. Can superselective embolization be definitive for colonic diverticular hemorrhage? An institutions experience over 9 years. J Gastrointest Surg. 2010;14(1):112–8.CrossRefGoogle Scholar
  50. 50.
    Oldenburg WA, Lau LL, et al. Acute mesenteric ischemia: a clinical review. Arch Intern Med. 2004;164(10):1054–62.CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Trauma/Surgical Critical CareCleveland ClinicClevelandUSA

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