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Evaluation of the patient with gastrointestinal bleeding: an evidence based approach
1Northeastern Ohio University College of Medicine, USA.
Insights
Gastrointestinal bleeding, a serious condition, affects many people annually. Evidence-based evaluation in the emergency department (ED) is crucial for managing upper and lower gastrointestinal bleeding.
Area of Science:
- Gastroenterology
- Emergency Medicine
- Internal Medicine
Background:
- Gastrointestinal bleeding is a frequent and severe medical issue.
- Upper gastrointestinal bleeding (UGIB) affects 40-150 individuals per 100,000 population yearly, with 6-10% mortality.
- Lower gastrointestinal bleeding hospitalizations occur in 20-27 per 100,000 population, increasing with age, and carry a 4-10%+ mortality rate.
Purpose of the Study:
- To review the evidence-based medicine approach for evaluating overt or acute gastrointestinal bleeding in the emergency department (ED).
Main Methods:
- This review synthesizes current evidence regarding the diagnostic and management strategies for gastrointestinal bleeding presented in the ED.
Main Results:
- Mortality rates for UGIB have remained stagnant at 6-10% over decades.
- Lower gastrointestinal bleeding incidence rises significantly with age.
- Evidence-based evaluation protocols are essential for effective ED management.
Conclusions:
- Prompt and accurate evaluation of gastrointestinal bleeding in the ED is critical for patient outcomes.
- Standardized, evidence-based approaches can improve the management of both upper and lower gastrointestinal bleeding.
- Further research may focus on reducing the unchanged mortality rates associated with UGIB.
Abstract:
Gastrointestinal bleeding is a common and potentially life-threatening problem. The incidence of upper gastrointestinal bleeding (UGIB) is 40 to 150 episodes per 100,000 population per year. Mortality in large series is 6% to 10% for UGIB and has remained unchanged over the past 30 to 60 years. The incidence of hospitalization for acute lower gastrointestinal bleeding is about 20 to 27 episodes per 100,000 population per year, with a 200-fold increase with advancing age from the third to ninth decades. The mortality rate is 4% to 10% or higher. The evaluation of overt or acute gastrointestinal bleeding in the ED is reviewed here from the perspective of evidence-based medicine.