GI bleed

Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. GI bleeding can be broadly divided into two clinical scenarios: Upper gastrointestinal bleeding (UGIB) and Lower gastrointestinal bleeding (LGIB). UGIB is defined as bleeding derived from a source proximal to the Ligament of Treitz, which is located at the duodenojejunal flexure, while LGIB refers to bleeding that originates distal to this point.

Causes

The causes of GI bleeding are varied and can range from relatively benign conditions to life-threatening emergencies. Common causes of UGIB include peptic ulcer disease, gastritis, and esophageal varices, often related to cirrhosis. LGIB is frequently caused by diverticulosis, colorectal cancer, hemorrhoids, and inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis.

Symptoms

Symptoms of GI bleeding can vary depending on the location and severity of the bleed. Common symptoms include hematemesis (vomiting blood), melena (black, tarry stools), hematochezia (passage of fresh blood per rectum), and anemia. Less visible symptoms may include weakness, shortness of breath, and dizziness due to the anemia caused by blood loss.

Diagnosis

Diagnosis of GI bleeding often involves a combination of medical history, physical examination, and diagnostic tests. Endoscopy is the primary diagnostic tool for both UGIB and LGIB, with esophagogastroduodenoscopy (EGD) being used for upper GI bleeding and colonoscopy for lower GI bleeding. Other diagnostic tools may include laboratory tests, imaging studies such as CT scan or angiography, and capsule endoscopy.

Treatment

Treatment for GI bleeding depends on the cause, location, and severity of the bleeding. Initial management often focuses on stabilizing the patient, which may include intravenous fluids, blood transfusions, and medications to stabilize blood pressure and promote clotting. Specific treatments may involve endoscopic interventions, such as endoscopic hemostasis, surgery, or angiographic embolization for more severe or refractory cases.

Prevention

Prevention of GI bleeding involves managing the underlying conditions that contribute to the risk of bleeding. This may include the use of medications such as proton pump inhibitors (PPIs) for peptic ulcer disease, careful management of anticoagulants, and screening for conditions like colorectal cancer that may present with GI bleeding as a symptom.