ABSTRACT
Upper gastrointestinal bleeding (UGIB) is defined as intra-luminal hemorrhage from a bleeding diathesis proximal to the ligament of Treitz, whereas lower gastrointestinal bleeding (LGIB) is bleeding distal to the ligament. The majority of UGIB are due to non-variceal causes, with ulcer disease accounting for the majority of non-variceal bleeds. In general, LGIB will present with hematochezia, but about 10% of UGIB will present in a similar fashion. Advances in pharmacologic, endoscopic, and radiographic therapies have helped UGIB mortality rates to decrease, most significantly in patients >65 years of age. The advent of “super selective” angioembolization for UGIB seems to show a fairly high immediate success rate, but re-bleed rates are high. Most studies indicate that embolization should be used in patients with massive ongoing hemorrhage who cannot tolerate surgery due to medical co-morbidities. LGIB is initially evaluated with both upper and lower GI endoscopy.
