[APPROACH TO PATIENTS WITH GASTROINTESTINAL BLEEDING].

Area of Science:

• Gastroenterology
• Internal Medicine

Background:

• Despite advances in endoscopic techniques and knowledge, hospitalizations and mortality from gastrointestinal bleeding (GIB) have not decreased as anticipated in developed nations.
• Key contributing factors include an aging population, rising prevalence of alcoholic liver cirrhosis, gastroesophageal reflux disease, obesity, antibiotic resistance in Helicobacter pylori, and increased use of anti-aggregation therapies, anticoagulants, and NSAIDs.

Purpose of the Study:

• To present the incidence, signs, and symptoms of GIB.
• To outline initial clinical evaluation, diagnostic methods, common causes, and endoscopic hemostatic treatments for upper and lower GIB.

Main Methods:

• Systematic review of meta-analyses and systematic reviews published in English from 2005-2015, sourced from MEDLINE and Ovid databases.
• Inclusion of randomized, double-blind studies on adults with GIB, guidelines from the European and American Societies of Gastroenterological Endoscopy, and recent expert literature.

Main Results:

• The review covers the current state of GIB management, including new classifications, controversies in nasogastric tube use, prokinetic agents, and proton pump inhibitors for upper GIB.
• It addresses restrictive transfusion strategies, clinical stratification of bleeding severity, hospitalization criteria, use of clinical bleeding scores, gastroprotection for high-risk patients, and the role of initial endoscopy.
• Management of variceal bleeding (assessment, prophylaxis) and novel endoscopic, radiological, and surgical treatments are also discussed.

Conclusions:

• This comprehensive review provides an up-to-date overview of gastrointestinal bleeding management.
• The educational content can inform the development of national guidelines for GIB management.