Gastrointestinal Hemorrhage

Document Type : Review Article

Authors

1 Professor of General Surgery and Gastrointestinal, Liver Disease Research Center, Iran University of Medical Sciences and Health Services, Tehran, Iran

2 Assistant Professor, Department of Gastroenterology, Iran University of Medical Sciences, Firouzgar Hospital

3 General Surgeon, Laleh Hospital

4 Associate Professor, Department of Internal Medicine and Gastroenterology, Iran University of Medical Sciences, Shahid Rajaee Hospital

5 Assistant Professor, Department of General Surgery, Islamic Azad University of Medical Sciences, Bu Ali Hospital

6 Assistant Professor, Department of General Surgery, Islamic Azad University of Medical Sciences, Amirul Mominin Hospital

Abstract
Gastrointestinal bleeding is a common problem and yet sometimes difficult to manage. It could be occult or overt, and may start in any part of the gut. The source of bleeding could be in upper (UGIB) or lower (LGIB) or less likely the small bowel (MGIB); which can become obscure and difficult to find the source. In the past few decades, many drugs has become available for acid suppression and thus prevention of bleeding and at the same time patient especially the elders use ulcerogenic drugs such as analgesics, NSAIDs, SSRIs and different anticoagulants for their accompanying illness which makes the treatment decisions precarious. Most bleeders stop spontaneously and only 15% need urgent resuscitation and intensive treatment of these only 5% need surgical intervention; which are usually the aged with severe comorbidties.

Keywords


1. Abougergi MS, Travis AC, Saltzman JR “The
in-hospital mortality rate for UGIB has decreased over 2 decades in U.S: A nationwide analysis. Gastrointest, Endos, 2015. 81: 882-888.
2. JasonS, Mizell and Richard H, et al. “Acute Gastrointestinal Hemorrhage” Chap 65, in Greenfield Surgery, 6th ed edited by Mulholland MW, Lillemoe K, Doherty GM et al, 2017. pp 1063-1079. Wolters Kluwer.
3. Stanley A. J, Dalton H. R, Blatchford O, et al, “Multicenter comparison of the Glasgow Blatchford and Rockall scores in the prediction of clinical endpoints after upper gastrointestinal hemorrhage. Aliment Pharmacol Therap 2011; 34: 470-475.
4. NICE (clinical guideline). “Acute gastrointestinal bleeding: Management” updated August 2016, UK.
5. Masclee G. M, Volkhof V. E, Coloma P. M, et al “Risk of upper gastrointestinal bleeding from different drug combinations, Gastroenterology 2014; 147: 784-792 eq.
6. Lain L, Yang H, Chang SC, et al. Trends for incidence of hospitalization and death due to GIB complications in the United States from 2001 to 2009. Am J Gastroenterol 2012; 107: 1190-1195.
7. Nagata N, Nikura R, AoKiT et al, Lower GI bleeding risk of nonsteroidal antiinflammatory drugs and antiplatelet drug use alone and the effect of combined therapy” Gastrointest Endosc 2014; 80; 1124.
8. Nagata N, Nikura R, AoKi T. et al “Impact of discontinuing nonsteroidal antiinflammatory drugs on long term recurrence in colonic diverticular bleeding. W J Gastroenterol 2015; 21: 1292.
9. Jalali S. A, Agah Sh, “GI bleeding” in Disease of the Gut, home edition in Farsi, Chap 15, pp 239-248. 1914. Farshid press Tehran.
10.       Jalali S. A, Samadi K. A. In Principles of Surgery edited by same Chap 5 “Hypovolemic Shock” pp 208-15. IUMSHS press 2006.
11.       Jalali S. A, “Review of clinical picture, new diagnostic modalities and role of surgical treatment in CA of stomach” IJS vol21, No2, 2013.
12.       Tavakkoli A, Ashley W. A “Acute Gastrointestinal Hemorrhage” Chap 46, in Sabiston Textbook of Surgery. Edited by Townsend, Beauchamp, Evers, Mattox, andInternational edition pp 1139-57, Elsevier 2017.
13.       Stratel L, Lamount TJ, Graver S, “Etiology of lower gastrointestinal bleeding”. UpTo Date, 2018.
14.       Jalali S. A. R, Jalali S. A, “Ischemich Colitis “I J S, vol23, N3: 2015 pp 1-10.
15.       Jalali S. A, “Frequency of Diverticulosis in Iran” IJS, vol 15-16. 1998.
16.       Suzuki K, Uchiyama S, Imajyo K, et al. “Risk factors for colonic diverticular hemorrhage: Japanese multicenter study “Digestion 2012; 85: 261.
17.       Strate L. L, Liu Y. L, Huang E. S, “Use of aspirin or nonsteroidal antiinflammatory drugs increases risk of diverticulitis and diverticular bleeding” Gastroenterol 2011; 140: 1427.
18.       YH, GL, Leung L. K, Tirnauer J. S “Anticoagulation in older adults” UpTo Date, Aug 2017. Wolters Kluwer.
19.       Strate L, Lamont J. L, Grover S, “Etiology of lower gastrointestinal bleeding in adults, UpTo Date 2018.
20.       Lhewa D. Y, Strate L. L. “Pros and cons of colonoscopy in management of Acute lower gastrointestinal bleeding” W J Gastroenterol 2012; 18: 1185-90.
21.       Niikura R, Nagata N, Yamada A, et al, “Recurrence of colonic diverticular bleeding and associated risk factors. “Colorectal Dis 2012; 14: 302-305.
22.       Leung W. K, HoSS, Suen B. Y, et al. “Capsule endoscopy or angiography in patients with Acute overt obscure bleeding: a prospective randomized study with long term follow up. “Am J Gastroenterol 2012; 107: 1370- 1376.
23.       Artifone L. A, Marson F. P, Khan M. A, “Endoscopic ultrasonography - Guided hemostasis technique. “Gastrointest Clin N Amer 2017, 27(4): 741-747.
24.       Smith S. R, Murray D, Pockney P. G, et al “Lower GI Bleeding” Dis Colon Rectum 2018, 61 (1): 99- 106.
25.       Speir E. J, Ermentrout R. M, Martin J. G, “Management of lower GI bleedingTech Vascular Inter Radiol. 2017, 20(4): 258-262.
26.       Chan F. K. L, Goh K. L, Fujimoto K, et al. “Management of patients on antithrombotic agents undergoing emergency and elective endoscopy”. Gut 2018; 67(3): 405- 417.
27.       Schrimer B. D, “Bleeding Duodenal Ulcer”. Chap 88, in Mastery of Surgery. edited by Fischer, sixth edition 2012 Wolters/Kluwer. Lippincot, Williams & Wilkins. Philadelphia- London.
28.       Jalali S. A, “Surgeon’s responsibilities in perioperative assessment of surgical patients”. I J S, vol15, N2; 2007.
29.       Neumayer L, Ghalyaie N, “Principles of preoperative and operative surgery Chap 10, in Sabiston Textbook of Surgery edited by Townsend, Beauchamp, Evers Mattox. International edition, 2017. Pp203-40; Elsevier.
30.       Jalali S. A, “A short review of clinical picture, new diagnostic modalities and role of surgical treatment in Colorectel CA of stomach”. IJS, vol 22, N2: 2014.
31.       Schroder V. T, Papas T. N, Vaslef S. N, et al. “Vagotomy/ drainage is superior to local oversew in patients who require emergency surgery for bleeding

peptic ulcer.  Ann Surg 2014; 259: 1111-1118.
32.       Dempsey D. T, “Pyloroplasty and Gastrojejunostomy”. Chap90 in Mastery of Surgery edited by Fischer. 6th edition 2012; Wolters/Kluwer Philadelphia- London Lippincot Williams & Wilkins.