ABSTRACT
Gastrointestinal (GI) bleeding is one of the commonest medical emergencies, usually causing haemorrhagic shock. Many intensive care unit patients have coagulopathies, so may bleed from the highly vascular lower GI tract. Although most upper GI bleeds are from peptic ulcers, these seldom necessitate intensive care unit admission. Most gastric ulcers in people not taking non-steroidal anti-inflammatory drugs are caused by the bacterium Helicobacter pylori, one of the most common chronic bacterial infections in humans. Once a major complication of critical illness incidence of stress ulceration has declined, possibly owing to increased use of enteral nutrition. Endoscopy is the first-line treatment for upper GI bleeds. While balloon tamponade usually stops bleeding, half of patients rebleed on balloon deflation. Balloon tamponade quickly stops bleeding from oesophageal varices, but is only a temporary measure, and removal often restarts bleeding. Balloon tamponade should be limited to a maximum of 24 hours.
