Evaluation and medical therapy of acute gastrointestinal bleeding

Gastrointestinal bleeding is a major reason for hospitalization and an important cause of morbidity and mortality. Diagnosis and treatment of this common clinical problem has changed markedly over the past 40 years. The initial approach to patients with gastrointestinal bleeding should be both therapeutic and diagnostic, with close attention to cardiovascular status and clotting parameters. Once the patient is stabilized, clinical history, physical examination, gastric aspirate, and laboratory data should be assessed to determine if the bleeding site is in the upper or lower gastrointestinal tract. Once that is determined, a more specific diagnosis should be made if possible, as therapy often will depend upon a precise diagnosis. Therapy includes angiographic and pharmacologic techniques, as well as tamponade in the case of esophageal varices. The use of antacids in acute upper gastrointestinal bleeding is well established, while the role of cimetidine is less clear. Newer modalities of treatment, such as the use of laser coagulation, are currently being evaluated.