Gastrointestinal Bleeding: Symptoms, Causes, Treatment

Gastrointestinal hemorrhage (GIB) – colloquially known as gastrointestinal bleeding – (synonyms: Gastrointestinal hemorrhage; GI hemorrhage; anorectal hemorrhage; hemorrhage from the gastrointestinal tract; intestinal hemorrhage; intestinal hemorrhage; colonic hemorrhage; small intestinal hemorrhage; duodenal hemorrhage; Duodenal hemorrhage; Enterorrhage; Gastroenteric hemorrhage; Gastroenteric hemorrhage; Gastrointestinal hemorrhage; Gastrostaxis; Duodenal hemorrhage; Intestinal hemorrhage; Intestinal hemorrhage; Colonic hemorrhage; Colonic hemorrhage; Gastric effusion hemorrhage; Gastrointestinal hemorrhage; Gastric hemorrhage; Upper gastrointestinal hemorrhage; Occult intestinal hemorrhage; Occult intestinal hemorrhage; Lower gastrointestinal hemorrhage; Cecal hemorrhage; Cecal hemorrhage; ICD-10-GM K92. 2: Gastrointestinal hemorrhage, unspecified) is bleeding from the gastrointestinal tract (digestive tract). Upper gastrointestinal bleeding (GIB) can be distinguished from lower GIB:

  • Upper gastrointestinal bleeding (OGIB): the source of bleeding is above the duodenum (duodenum)/jejunum (jejunum) junction [= flexura duodenojejunalis] or proximal to Treitz` ligament (Treitz discovered the suspensorius duodeni muscle in 1853, which was later called Treitz` ligament or Treitz` ligament (ligamentum suspensorium duodeni). The structure fixes the junction of the duodenum and jejunum to the posterior wall of the abdomen). Possible source of bleeding is thus esophagus (esophagus), stomach or duodenum (duodenum).
  • Lower gastrointestinal bleeding (UGIB): the source of bleeding is below the flexura duodenojejunalis, thus in the small intestine, colon (large intestine) or rectum (rectum).

In 75-90% of cases, upper gastrointestinal bleeding (OGIB) is present. The most common cause of bleeding in the non-variceal bleeding group is duodenal ulcer (ulcer of the duodenum) and ventriculi ulcer (ulcer of the stomach), which are responsible for about 50% of all cases.In lower gastrointestinal bleeding (UGIB), depending on age, the main cause is an anorectal source of bleeding. Chronic gastrointestinal bleeding is defined as persistent bleeding with a drop in serum hemoglobin levels that does not lead to circulatory instability and is associated with iron deficiency. Gastrointestinal bleeding can be a symptom of many diseases (see under “Differential Diagnoses”). The incidence (frequency of new cases) for upper gastrointestinal hemorrhage is 50-100 cases per 100,000 inhabitants per year and for lower gastrointestinal hemorrhage (without hemorrhoidal hemorrhage) about 20 cases per 100,000 inhabitants per year (in Germany). Course and prognosis: The clinical spectrum of gastrointestinal hemorrhage ranges from anemia (anemia), which can only be detected by laboratory chemistry, to fulminant hemorrhage with shock (medical emergency). If hemodynamic instability is present, emergency hospitalization is required. Unfavorable prognostic factors include older age (> 65 years), concomitant diseases such as heart failure (cardiac insufficiency) or pulmonary disease, massive blood loss (initial Hk value (hemocrit value) < 30%), and complications (e.g., acute renal failure). Gastrointestinal bleeding may be recurrent (recurring). After hemostasis, 30% recur within three days. While bleeding in the upper gastrointestinal tract (gastrointestinal tract) can be very dramatic, bleeding in the lower gastrointestinal tract tends to be less dramatic. This is also reflected in a relatively low mortality rate of 2%. Note: Follow-up of bleeding in the gastrointestinal tract under anticoagulants (anticoagulants) or antiplatelet agents (2.5 mg rivaroxaban plus ASA, 5 mg rivaroxaban alone, or 100 mg ASA alone) showed that of 14 bleeding cases, one leads to carcinoma; in severe bleeding complications, ten cases are associated with a cancer diagnosis. The average lethality (mortality relative to the total number of people with the disease) of all gastrointestinal bleeding is 5-10%.