Gastrointestinal bleeding

Gastrointestinal bleeding (GIB) remains a leading cause of mortality. Upper GIB accounts for 80% of all GIB. Peptic ulcer and variceal bleeding account for two third of upper GIB. Hematemesis or/and melena and sometimes rectal bleeding may reveal upper GIB. Early risk assessment of upper GIB should be performed using clinical scores such as GlasgowBlatchford or Rockall scores. Pre-endoscopic proton-pump inhibitor should be initiated when peptic ulcer bleeding is suspected. Early treatment with vasopressors lowering portal hypertension should be initiated as soon as possible when variceal bleeding is suspected. Diagnostic endoscopy should be performed within 24 hours for peptic ulcer bleeding suspicion and within 12 hours when variceal bleeding is suspected. Abundant rectal bleeding should be explored with a GI endoscopy first. Endoscopic haemostatis is the other cornerstone of treatment of upper GI bleeding. Arterial embolization should be considered in case of failure of endoscopic treatment. For lower GIB, abdominopelvic CT-scan with intravenous contrast agent may help to localize bleeding site and guide angiographic intervention.