Updates in Diagnosis and Management of Acute Gastrointestinal Hemorrhage

Abstract

Acute upper gastrointestinal bleeding (UGIB) is a common cause of hospitalization, with incidences ranging from 48 to 160 cases per 100, 000 adults per year. Adequate resuscitation and risk stratification before endoscopy are important in optimizing the care of patients with UGIB. The management of acute non-variceal UGIB includes the performance of an early endoscopy within 24 h and the treatment of high-risk lesions using various endoscopic mono- or combination therapies (all favored over epinephrine injection alone). The management of the acute variceal bleeding is a multidisciplinary process that includes the initial assessment of the patient, effective resuscitation, timely diagnosis, control of bleeding, and prevention of rebleeding. Antibiotic prophylaxis, vasoactive drugs, and endoscopic treatments are the first-line measures; TIPS should be proposed early to high-risk patients or as a rescue therapy for first-line treatment failure. Colonoscopy is the diagnostic procedure of choice in most patients with LGIB, and its role in the treatment of lower GI bleeding has been shown to be an efficacious and safe method even if a therapeutic endoscopy occurred in about 30% of patients. The optimal timing of colonoscopy in LGIB remains to be determined. Superselective mesenteric angiography remains the cornerstone of management of patients with acute LGIB, but it is an invasive and time-consuming procedure. Emergent surgery should be considered only as a last resort and is rarely needed to prevent death from exsanguination. This article reviews the causes, clinical presentation, diagnostic methods, and endoscopic treatment of UGIB and LGIB and management of specific lesions.