GI Bleeding

  • Paul Ellis Marik


• The urgency with which GI bleeding is managed is dictated by the rate of bleeding:

– The patient with trace heme-positive stools and without severe anemia can be managed as an outpatient.

– Visible blood requires hospitalization and inpatient evaluation.

– Persistent bleeding or rebleed with hemodynamic instability necessitates ICU admission.


Transjugular Intrahepatic Portosystemic Shunt Variceal Bleeding Endoscopic Therapy Gastric Varix Proton Pump Inhibitor Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Blair SD, Janvrin SB, McCollum CN, et al. Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg. 1986;73:783–785.PubMedCrossRefGoogle Scholar
  2. 2.
    Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am. 2008;92:491–509.PubMedCrossRefGoogle Scholar
  3. 3.
    Kurata JH, Nogawa AN. Meta-analysis of risk factors for peptic ulcer. Nonsteroidal antiinflammatory drugs, Helicobacter pylori, and smoking. J Clin Gastroenterol. 1997;24:2–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Barkun A, Sabbah S, Enns R, et al. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol. 2004;99:1238–1246.PubMedCrossRefGoogle Scholar
  5. 5.
    Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med. 2008;359:928–937.PubMedCrossRefGoogle Scholar
  6. 6.
    Bardou M, Toubouti Y, Benhaberou-Brun D, et al. Meta-analysis: proton-pump inhibition in high-risk patients with acute peptic ulcer bleeding. Aliment Pharmacol Ther. 2005;21:677–686.PubMedCrossRefGoogle Scholar
  7. 7.
    Morgan D. Intravenous proton pump inhibitors in the critical care setting. Crit Care Med. 2002;30:S369–S372.PubMedCrossRefGoogle Scholar
  8. 8.
    Lau JY, Sung JJ, Lam YH, et al. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med. 1999;340:751–756.PubMedCrossRefGoogle Scholar
  9. 9.
    Soares-Weiser K, Brezis M, Tur-Kaspa R, et al. Antibiotic prophylaxis of bacterial infections in cirrhotic inpatients: a meta-analysis of randomized controlled trials. Scand J Gastroenterol. 2003;38:193–200.PubMedCrossRefGoogle Scholar
  10. 10.
    Kravetz D, Romero G, Argonz J, et al. Total volume paracentesis decreases variceal pressure, size, and variceal wall tension in cirrhotic patients. Hepatology. 1997;25:59–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Gonzalez R, Zamora J, Gomez-Camarero J, et al. Meta-analysis: combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis. Ann Intern Med. 2008;149:109–122.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineEastern Virginia Medical SchoolNorfolkUSA

Personalised recommendations