Gastrointestinal haemorrhage

Gastrointestinal haemorrhage (GI bleed), also known as gastrointestinal bleeding, is a significant condition that can present as either an acute or chronic loss of blood from the gastrointestinal tract. The bleeding can originate from any location along the gastrointestinal tract, from the mouth to the anus. It is classified into two main categories: upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB), depending on the source of the bleeding being above or below the duodenum.

Causes

The causes of gastrointestinal haemorrhage vary depending on whether the bleeding is in the upper or lower gastrointestinal tract.

Upper Gastrointestinal Bleeding

Common causes of UGIB include peptic ulcers, gastritis, esophageal varices related to cirrhosis, and Mallory-Weiss tears. Peptic ulcers are the most frequent cause, often due to Helicobacter pylori infection or nonsteroidal anti-inflammatory drug (NSAID) use.

Lower Gastrointestinal Bleeding

In the case of LGIB, common sources include diverticulosis, colorectal cancer, inflammatory bowel disease (such as Crohn's disease and ulcerative colitis), and hemorrhoids. Angiodysplasia, a condition characterized by fragile blood vessels in the gastrointestinal tract, can also cause LGIB.

Symptoms

Symptoms of gastrointestinal haemorrhage can vary widely and may include hematemesis (vomiting blood), melena (black, tarry stools), hematochezia (passage of fresh blood per anus), and anemia symptoms such as fatigue, pallor, and shortness of breath. The severity of symptoms often depends on the rate and volume of bleeding.

Diagnosis

Diagnosis of gastrointestinal haemorrhage involves a combination of medical history, physical examination, and diagnostic tests. Endoscopy is the primary diagnostic tool for both UGIB and LGIB, allowing direct visualization of the bleeding site. Other diagnostic methods may include laboratory tests, imaging studies such as CT scans, and angiography.

Treatment

Treatment for gastrointestinal haemorrhage depends on the cause, location, and severity of the bleeding. Initial management focuses on stabilizing the patient, which may include intravenous fluids, blood transfusions, and medications to reduce stomach acid and promote clotting. Endoscopic treatments, such as endoscopic band ligation or endoscopic sclerotherapy, are commonly used for conditions like esophageal varices and peptic ulcers. Surgery may be necessary if the bleeding is severe or if it cannot be controlled by endoscopic methods.

Prevention

Preventive measures for gastrointestinal haemorrhage include the management of risk factors, such as avoiding excessive use of NSAIDs, controlling Helicobacter pylori infection, and managing chronic liver disease to prevent the development of esophageal varices.

Prognosis

The prognosis of gastrointestinal haemorrhage varies depending on the underlying cause, the patient's overall health, and how quickly treatment is initiated. While many cases can be managed successfully, gastrointestinal haemorrhage remains a significant cause of morbidity and mortality, especially in severe cases or in patients with multiple comorbidities.