Gastrointestinal hemorrhage

Abstract

Gastrointestinal (GI) hemorrhage is a centuries-old problem that continues to be significant today. The incidence of GI hemorrhage remains constant at 100 per 100,000 hospitalizations per year from upper sources and 20.5 per 100,000 from lower sources (1,2). A more elderly population with multiple comorbidities is thought to be a major contributing factor. With the advent of evidence-based medicine, there has been increased awareness and demand for proven approaches in medicine. GI bleeding is no exception, and there has been a relative increase in the number of studies analyzing treatment approaches. A recent review of the literature reveals efforts to standardize the care of these patients to obtain better outcomes and to more efficiently utilize resources. There have been several developments in recent years with regard to diagnosing and managing GI hemorrhage. Endoscopy is a proven modality for the evaluation of upper GI bleeding. A recent study of cost and length of hospital stay in patients with GI hemorrhage found that early endoscopy and protocol-driven decision-making in patient care decreases length of stay and cost (3). Advances in diagnostic and therapeutic interventional radiology techniques have also increased the effectiveness of evaluating and treating GI hemorrhage with fewer complications. Establishing evaluative measures to determine early on which patients require aggressive care and which can be managed as outpatients has also been studied. Capsule endoscopy in which the entire length of the intestine is imaged by swallowing a microcamera that transmits images has become a reality. Knowledge of this development and others is an important step toward obtaining better patient outcomes.