Gastrointestinal bleeding in patients with acute spinal injuries

Twenty out of 365 patients (5.5 per cent) with acute spinal cord injuries referred to a spinal ward over a 91/2-year period bled from the gastrointestinal tract. A cause of the haemorrhage was found in 15 patients. Six patients were endoscoped. Most patients had gastroduodenal ulceration but we could not be certain whether this was due to stress or peptic ulceration. We did not confirm that cervical cord lesions were associated with a higher incidence of gastrointestinal bleeding. The 4 patients who died probably represent an "inevitable' mortality in severely ill patients. The role of endoscopy is outlined, the pathogenesis of gastrointestinal ulceration discussed and future management of these patients is suggested.