Evaluation of primary and secondary gastrointestinal bleeders

To determine whether the diagnostic evaluation of patients admitted for nongastrointestinal disease, who subsequently bleed while in hospital (secondary bleeders), should differ from that of patients hospitalized with a primary diagnosis of GI bleeding, patients consecutively referred to a consultant service were prospectively evaluated. Ninety-four primary and 43 secondary bleeders underwent a detailed historical survey and endoscopic or radiologic diagnostic evaluation of the upper and lower gastrointestinal tract. Primary bleeders hemorrhaged with greater severity and potential or definitive bleeding sites were found in them more often than in secondary bleeders. Primary bleeders usually had upper gastrointestinal lesions, whereas secondary bleeders frequently had colonic bleeding. Prior historical events other than the use of nonsteroidal anti-inflammatory agents did not affect the source or severity of bleeding. The clinical spectra of primary and secondary bleeders differ so that evaluation of secondary bleeders of modest severity should be modified and often can be deferred until the underlying disease has been controlled.