Today, I review, link to and embed Appendix S2 Overview of GI Bleeding from The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Radiology. 2024 Mar;310(3):e232298. doi: 10.1148/radiol.232298.
All that follows is from the above resource.
Appendix S2 Overview of GI Bleeding
GI bleeding is the most common GI diagnosis leading to hospitalization within the United States(1). Data compiled from the 2014 National Inpatient Sample showed that a principal discharge diagnosis associated with GI bleeding was associated with over 500,000 hospitalizations, 2.2 million hospital days and $5 billion in direct costs (1). Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high health care utilization and
costs.GI bleeding can be characterized by the presumed location of origin. Upper GI bleeding (UGIB) is defined as bleeding that originates from the esophagus, stomach, or duodenum. This
accounts for approximately 80% of bleeding events (2). Lower GI bleeding (LGIB) has previously been defined as bleeding that originates distal to the ligament of Treitz but more
recently is defined as bleeding distal to the ileocecal valve and throughout the colon. LGIB, depending on its anatomic landmarks, accounts for approximately 15%–30% of all GI bleeding events (3,4). Finally, small bowel, or midgut GI bleeding is defined as bleeding that occurs between the ligament of Treitz to the ileocecal valve and accounts for approximately 5%–10% of GI bleeding events (3,5). Bleeding from the small bowel is often considered the most difficult to diagnose and treat due to its length and accessibility. Small bowel bleeding often occurs in areas that are out of reach from standard endoscopy and colonoscopy, and only potentially accessible
by capsule endoscopy and deep enteroscopy (6).Understanding whether bleeding is overt or occult can help to triage the urgency of diagnostic and potentially therapeutic evaluation. The most common manifestations of overt bleeding are hematemesis, melena, and hematochezia. Hematemesis and melena typically indicate an upper GI source of bleeding whereas hematochezia most often represents a lower GI
source. Occult GI bleeding tends to present more slowly over time and often with symptoms of iron deficiency anemia without visualized blood loss in stool. As a result, occult GI bleeding
often requires a comprehensive, bidirectional luminal evaluation.The most common etiology of overt UGIB is peptic ulcer disease (2). LGIB is most often caused by diverticular bleeding, which can be challenging to capture in the acute setting at the
time of colonoscopy (4). Small bowel bleeding, both overt and occult, is often caused by angioectasias in older patients but may be related to inflammatory bowel disease in younger
patients (3,5). In all cases of overt and occult GI bleeding it is important to exclude a GI malignancy. A recent publication provides a more in-depth review of the imaging findings for
many of the GI bleeding etiologies, which is beyond the scope of this document (7)*.
*(7) See Linking To And Excerpting From “Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms”
Posted on November 29, 2024 by Tom Wade MD
The treatment of GI bleeding includes close monitoring of hemodynamics, resuscitation with intravenous fluids and blood products as needed, and endoscopic therapy tailored to the presumed etiology of bleeding. Endoscopy is the most effective diagnostic and therapeutic modality for GI bleeding including capsule endoscopy for suspected small bowel bleeding. However, radiologic techniques are frequently used, including CT angiography (CTA), catheter angiography (CA), CT enterography (CTE), magnetic resonance enterography (MRE), nuclear medicine red blood cell scan, and technetium-99 m pertechnetate scintigraphy (Meckel scan) (3,5,6). The decision to perform one test over another depends on the history, physical
examination, hemodynamics, clinical manifestation of bleeding and available local expertise.
