Approach to gastrointestinal bleeding

Gastrointestinal bleeding can occur from an upper (UGIB) source or lower (LGIB) source depending on the location proximal or distal to the ligament of Treitz. Gastrointestinal bleeding may also be classified as obscure, defined as bleeding that persists or recurs without an obvious etiology after esophagogastroduodenoscopy (EGD), colonoscopy, and radiologic evaluation of the small bowel. Prevention therapy is based on a patient’s risk. Risks include history of non-steroidal anti-inflammatory drug (NSAID) use, history of previous ulcer disease, and hospitalization with acute illness associated with physiologic stress and chronic liver disease. Acute presentation of gastrointestinal bleeding includes the passage of melena or red blood per rectum and/or hematemesis. Upper endoscopy will provide a diagnosis and a prognosis in almost all instances of UGIB. Variceal bleeding can be treated with band ligation. Medical therapy can decrease the risk of bleeding in patients with high risk lesions.