ABSTRACT
Gastrointestinal hemorrhage remains a common and serious clinical problem,
accounting for more than 300,000 hospitalizations per year in the U.S.A. (1),
and is a frequent indication for admission to the intensive care unit (ICU).
Upper gastrointestinal (UGI) bleeding, defined as a bleeding source proximal
to the ligament of Treitz, is more common than lower gastrointestinal (LGI)
bleeding, with an estimated annual hospitalization rate in the U.S. of 100-150
per 100,000 adults (2,3) versus 20 per 100,000 adults (4), respectively. Although
diagnostic and treatment modalities have markedly improved over the past
several decades, the mortality for acute UGI bleeding has remained relatively
constant at 5-10% (1,2). This static mortality rate is likely due to the successful
improvement in overall life expectancy, resulting in an increased average age,
and comorbid medical conditions for patients presenting with acute UGI bleeding
(1,3). Mortality for LGI bleeding is currently less than 5%, having benefiting
from improved diagnostic/therapeutic techniques and intensive care management (4). It should be emphasized that the majority of patients presenting with
acute GI blood loss will resolve the initial bleed spontaneously. Therefore, the
primary benefit and clinical success are derived from noninterventional therapies
delivered within the ICU setting. The cornerstones of effective management for
patients presenting with acute, significant GI blood loss continues to be rapid
assessment combined with early and effective resuscitation and recognition of
potential complicating factors that can impact the hospital course. Successful
outcome is a product of team effort, with admission to an ICU for all patients pre-
senting with significant bleeding and timely consultation of gastroenterologists,
radiologists, and surgeons.
