New Trends and Advances in Non-Variceal Gastrointestinal Bleeding—Series II

Abstract

The gastrointestinal tract is a long tubular structure wherein any point in the mucosa along its entire length could be the source of a hemorrhage. Upper (esophagel and gastroduodenal) and lower (jejunum, ileum, and colon) gastrointestinal bleeding are common. Gastroduodenal and colonic bleeding are more frequent than bleeding from the small bowel, but nowadays the entire gastrointestinal tract can be explored endoscopically and bleeding lesions can be locally treated successfully to stop or prevent further bleeding. The extensive use of antiplatelet and anticoagulants drugs in cardiovascular patients is, at least in part, the cause of the increasing number of patients suffering from gastrointestinal bleeding. Patients with these conditions are usually older and more fragile because of their comorbidities. The correct management of antithrombotic drugs in cases of gastrointestinal bleeding is essential for a successful outcome for patients. The influence of the microbiome in the pathogenesis of small bowel bleeding is an example of the new data that are emerging as potential therapeutic target for bleeding prevention. This text summarizes the latest research and advances in all forms of acute gastrointestinal bleeding (i.e., upper, small bowel and lower). Diagnosis is approached, and medical, endoscopic or antithrombotic management are discussed in the text in an accessible and comprehensible way.

Predictive Role of Admission Venous Lactate Level in Patients with Upper Gastrointestinal Bleeding: A Prospective Observational Study

“…All patients in the analyzed group were diagnosed and treated according to the present guidelines [1,8,9]. On admission, clinical examination with measurement of arterial blood pressure, pulse rate, and oxygen saturation was performed.…”

A review on increasing risk for gastrointestinal bleeding associated with dabigatran

“…The advantages of this delayed approach are the increased effectiveness of endoscopic interventions as the effect of the drug diminishes, improved safety in nonemergency situations, and improved endoscopic visualization due to reduced/stopped bleeding and better colonic cleansing. In contrast, in patients with severe GIB or unstable hemodynamics, emergency endoscopy should be carried out as soon as possible following resuscitation [64]. When repeated endoscopic treatments are unsuccessful, the next course of action could be radiological or surgical intervention.…”

Lower Gastrointestinal Bleeding

“…If colonoscopy interventions are failed, angiographic embolization or surgery should be considered. 25,26 Postpolypectomy Bleeding…”