Acute gastrointestinal bleeding

Acute gastrointestinal bleeding is a life-threatening disease with a mortality rate of 5-10%. Upper gastrointestinal bleeding occurs more frequently (85%) and has a more severe course compared to lower gastrointestinal bleeding. By the introduction of new diagnostic avenues to examine the small bowel (capsule and balloon enteroscopy) the source of mid-gastrointestinal bleeding can be diagnosed more often, but bleeding of the small bowel is still a rare disease. The medical history may be helpful in the diagnosis of the bleeding source. Prognosis and mortality depend on bleeding intensity, presence of comorbidity, and age of the patient. Furthermore, rebleeding is associated with increased mortality. Therefore, one major goal in the treatment of gastrointestinal bleeding is to avoid rebleeding. Endoscopy is the gold standard in the diagnosis of acute gastrointestinal bleedings and allows endoscopic treatment if possible. Scintigraphy is more sensitive compared to angiography in the detection of the bleeding source; however, the localization of bleeding is more difficult. Furthermore, angiography offers the possibility of treating acute bleeding lesions. With the transjugular stent shunt it is possible to treat acute esophageal variceal bleeding if endoscopic or conservative treatment with drugs or tubes fails. Due to its high mortality rate, surgery is the last resort only if all other methods fail to treat acute bleedings.