Gastrointestinal tract hemorrhage. The value of a nasogastric aspirate

Lower gastrointestinal bleeding (LGIB) continues to be a problem for physicians. Acute LGIB is defined as bleeding that emanates from a source distal to the ligament of Treitz. Although 80% of all LGIB will stop spontaneously, the identification of the bleeding source remains challenging and rebleeding can occur in 25% of cases. Some patients with severe hematochezia require urgent attention to minimize further bleeding and complications. This article reviews the causes, diagnostic methods, and endoscopic treatment of LGIB.

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“…A clear NG-tube aspirate does not rule out an upper-GI source, whereas the presence of bile makes an upper source unlikely [16].…”

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confidence: 99%

Lower gastrointestinal bleeding: a review

Edelman

Sugawa

2007

Surg Endosc

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“…Fecal occult blood was determined by digital rectal examination using a guaiac-impregnated slide (Hemoccult; SmithKline Diagnostics, Sunnyvale, CA). Testing of a clear NG aspirate for occult blood was not analyzed, as this test is of no clinical value (18). The following study exclusion criteria were prospectively established: (1) NG intubation for indications other than GI bleeding, such as assisted enteral feeding; (2) NG intubation in a patient <21 years old; (3) intubation through the os (orogastric) rather than the nose (NG); (4) intubation performed in a nonmonitored setting (not an intensive care unit, cardiac care unit, or emergency room) because of insufficient patient monitoring to assess intubation complications; and (5) NG intubation solely for fecal occult blood (i.e., without acute hematocrit decline, hypotension, or profound anemia).…”

Section: Methodsmentioning

confidence: 99%

Safety and Efficacy of Nasogastric Intubation for Gastrointestinal Bleeding After Myocardial Infarction: An Analysis of 125 Patients at Two Tertiary Cardiac Referral Hospitals

Cappell

2005

Dig Dis Sci

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Our purpose was to analyze risks versus benefits of nasogastric (NG) intubation for gastrointestinal (GI) bleeding performed soon after myocardial infarction (MI). While NG intubation and aspiration is relatively safe, clinically beneficial, and routinely performed in the general population for recent GI bleeding, its safety after MI is unstudied and unknown. In addition to the usual complications of NG tubes, patients status post-MI may be particularly susceptible to myocardial ischemia or cardiac arrhythmias from anxiety or discomfort during intubation. We studied NG intubation within 30 days of MI in 125 patients at two hospitals from 1986 through 2001. Indications for NG intubation included melena in 55 patients; fecal occult blood with an acute hematocrit decline, severe anemia, or sudden hypotension in 37; hematemesis in 18; bright red blood per rectum in 8; and dark red blood per rectum in 7. The intubation was performed on average 5.3 +/- 7.2 (SD) days after MI. NG aspiration revealed bright red blood in 38 patients, "coffee grounds"-appearing blood in 45, and clear (or bilious) fluid in 42. Among 114 of the patients undergoing esophagogastroduodenoscopy (EGD), EGD revealed the cause of bleeding in 79 (95%) of 83 patients with a grossly bloody NG aspirate versus 12 (39%) of 31 patients with a clear aspirate (P < 0.0001, OR = 31.3, OR CI = 9.4-103.1). Among 85 patients undergoing EGD within 16 hr of NG intubation, stigmata of recent hemorrhage were present in 28 (42%) of 66 with a bloody NG aspirate versus 3 (16%) of 19 with a clear aspirate (P = 0.06, OR = 3.93). Among 35 patients undergoing lower GI endoscopy, lower endoscopy revealed the cause of bleeding in 14 (56%) of 25 patients with a clear NG aspirate versus 1 (10%) of 10 patients with a grossly bloody aspirate (P < 0.04, OR = 11.46, OR CI = 1.55-78.3). The two NG tube complications (epistaxis during intubation and gastric erosions from NG suctioning) were neither cardiac nor major (requiring blood transfusions). This study suggests that short-term NG intubation is relatively safe and may be beneficial and indicated for acute GI bleeding after recent MI. Aside from improving visualization at EGD, the potential benefits include providing a rational basis for the timing of endoscopy (urgent versus semielective), for prioritizing the order of endoscopy (EGD versus colonoscopy), and for avoiding or deferring endoscopy in low-yield situations (e.g., colonoscopy when the NG aspirate is bloody). These benefits may be particularly relevant in patients after recent MI due to their increased endoscopic risks.

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“…NG tube aspiration with or without lavage, in this group of patients, is a useful and easy bedside test. Aspiration of clear bile makes an upper GI source unlikely with the caveat that this can still be falsely negative in up to 10% especially if only clear fluid was aspirated (Cuellar 1990). Aspiration of blood or coffee grounds warrants urgent upper GI endoscopy.…”

Section: Nasogastric Tubementioning

confidence: 99%

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

2017

International Journal of Research Studies in Medical and Health

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ABSTRACT:Acute lower Gastro intestinal bleeding is a relatively common problem in the emergency department. Etiology is diverse as is the degree of bleeding and natural history. Hence there are a number of subtle aspects of clinical assessment, investigations and management which require attention and application fr optimal outcomes. The goal of this review is to highlight the practical issues in managing the condition from the perspective of a medical officer or a junior resident in surgery who is on-call in the emergency department. A working algorithm incorporating the key management issues is also presented.

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Gastrointestinal tract hemorrhage. The value of a nasogastric aspirate

Cited by 67 publications

References 10 publications

Lower gastrointestinal bleeding: a review

Lower gastrointestinal bleeding: a review

Safety and Efficacy of Nasogastric Intubation for Gastrointestinal Bleeding After Myocardial Infarction: An Analysis of 125 Patients at Two Tertiary Cardiac Referral Hospitals

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

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