Gastrointestinal Haemorrhage

3.5.1 - Gastrointestinal Haemorrhage

from Section 3.5 - Acute Gastrointestinal Failure

Published online by Cambridge University Press: 27 July 2023

Megan Fahy and

Edited by

Debashish Dutta and

Ned Gilbert-Kawai: Affiliation:
The Royal Liverpool Hospital
Debashish Dutta: Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann: Affiliation:
Royal Berkshire Hospital, Reading

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Summary

Key Learning Points

1. In suspected variceal bleeding, terlipressin and prophylactic antibiotics should be administered at presentation.
2. In upper gastrointestinal bleeding, a restrictive approach to blood transfusion reduces rebleeding rates and mortality.
3. Following a non-variceal upper gastrointestinal bleed in those taking aspirin for secondary prevention of vascular events, aspirin should be restarted when haemostasis is achieved.
4. Haematochezia is caused by an upper gastrointestinal bleed in approximately 10 per cent of presentations.
5. Early initiation of enteral feeding is effective in preventing bleeding from stress ulcer in critically unwell adults.

Keywords

terlipressin transfusion variceal bleeding haematochezia haemostasis

Type: Chapter
Information: Intensive Care Medicine
The Essential Guide
, pp. 205 - 207

DOI: https://doi.org/10.1017/9781108989060 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2021

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References

References and Further Reading

Gralnek, I, Dumonceau, JM, Kuipers, E, et al. Diagnosis and management of nonvariceal upper gastrointestinal haemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guidelines. Endoscopy 2015;47:1–46.Google Scholar

National Institute for Health and Care Excellence. 2012. Acute upper gastrointestinal bleeding in over 16s: management. Clinical guideline [CG141]. www.nice.org.uk/guidance/cg141 Google Scholar

Osman, D, Djibre, M, Da, Silva D, Goulenok, C. Management by the intensivist of gastrointestinal bleeding in adults and children. Ann Intensive Care 2012;2:46.CrossRef Google Scholar PubMed

PEPTIC Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group, Alberta Health Services Critical Care Strategic Clinical Network, the Irish Critical Care Trials Group; Young, PJ, Bagshaw, SM, Forbes, AB, et al. Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital mortality among ICU patients receiving invasive mechanical ventilation: the PEPTIC randomized clinical trial. JAMA 2020;323:616–26.Google Scholar PubMed

Siau, K, Chapman, W, Sharma, N, et al. Management of acute upper gastrointestinal bleeding: an update for the general physician. J R Coll Physicians Edinb 2017;47:218–30.CrossRef Google Scholar PubMed

Tripathi, D, Stanley, AJ, Hayes, PC, et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut 2015;64:1680–704.CrossRef Google Scholar PubMed

Wang, Y, Ye, Z, Ge, L, et al. Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis. BMJ 2019;367:l16744.Google Scholar