Assessment and management of gastrointestinal (GI) haemorrhage

Acute gastrointestinal (GI) bleeding is both a common reason for hospital attendance and a common occurrence in hospitalized patients. Acute upper gastrointestinal haemorrhage (AUGH) is much more likely to be responsible for profuse or life-threatening bleeding than is lower GI haemorrhage. Despite advances in endoscopic and pharmacological treatments, AUGH still carries an overall mortality of around 10%. Prompt assessment and resuscitation are critical and should be guided by a clinical assessment of the patient’s degree of shock. Careful attention should be paid to risk factors and co-morbidities. Risk stratification is mandatory and helps to guide the timing of definitive intervention. Patients with major AUGH should be nursed in appropriate units (such as high dependency or intensive therapy units), and in higher risk bleeds, specialist assistance should be sought early and appropriate pharmacological measures instituted. Flexible video-endoscopy is the initial investigation of choice as it provides not only diagnostic information but also therapeutic options. Other treatment options include radiological and surgical measures, although these are reserved for refractory bleeding or where endoscopy is inappropriate.