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Uncontrolled bleeding of the gastrointestinal tract
Alain D'Hondt1, Lionel Haentjens, Nicolas Brassart
1aDepartment of Intensive Care bDepartment of Radiology cDepartment of Gastroenterology, CHU Ambroise Paré, Mons dDepartment of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium.
Current Opinion in Critical Care
|September 28, 2017
Summary
New strategies improve acute gastrointestinal bleeding management. Advances in diagnostics and treatments, including massive transfusion protocols and endoscopic interventions, offer better outcomes for patients with severe bleeding.
Area of Science:
- Gastroenterology
- Emergency Medicine
- Hematology
Background:
- Acute gastrointestinal bleeding is a common emergency.
- Its incidence is increasing due to direct anticoagulant use and aging populations.
- Improved diagnostic and therapeutic tools are emerging.
Purpose of the Study:
- To review updated guidelines and advancements in managing massive gastrointestinal bleeding.
- To highlight improvements in diagnostic and therapeutic interventions.
- To discuss the future outlook for managing this critical condition.
Main Methods:
- Review of recent literature on diagnostic and therapeutic tools for gastrointestinal bleeding.
- Analysis of validated severity assessment scores.
- Examination of protocols for massive blood transfusions and management of patients on anticoagulants.
Main Results:
- Validated scores improve severity assessment upon admission.
- Massive transfusion protocols and specific anticoagulant reversal agents are available.
- Endoscopic hemostatic powders and self-expanding metal stents aid management.
- New diagnostic tools include video-capsule endoscopy and advanced imaging (CT angiography/enterography).
Conclusions:
- Multidisciplinary algorithms are crucial for managing massive bleeding.
- Close collaboration between emergency physicians, intensivists, endoscopists, radiologists, and surgeons is essential.
- A sequential, collaborative strategy optimizes the management of acute and massive gastrointestinal bleeding.
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