The management and treatment of gastrointestinal bleeding depends on several factors which include:
- Severity of bleeding
- Cause of bleeding
- Site of bleeding (upper or lower gastrointestinal bleeding)
- Age and general condition of the patient
Treatment is initially focused on fluid resuscitation in order to replenish the bodily fluids lost through bleeding and prevent hypovolemia or shock. Fluid resuscitation is one of the most vital aspects in the management of patients who have become critically ill through blood loss.
Depending on the cause and site of the bleeding, various different treatment approaches are used. Some of the treatment approaches to gastrointestinal bleeding are described below:
Peptic ulcer is one of the most common causes of upper gastrointestinal bleeding. Acid production in the stomach needs to be suppressed to allow ulcers to heal, which can be achieved using proton pump inhibitors. Examples of these agents include pantoprazole, omeprazole and rabeprazole.
Variceal bleeding is a life threatening condition caused by portal hypertension or high blood pressure in the portal vein, which carries blood to the liver from the gastrointestinal tract and spleen. Portal hypertension can cause engorgement of the blood vessels at the base of the esophagus (esophageal varices) or in the rectum (rectal varices). Rupture of the esophageal varices leads to bleeding in the upper gastrointestinal tract and lower gastrointestinal bleeding occurs when the rectal varices burst. To reduce the portal hypertension, drugs such as vasopressin analogues and octreotide may be administered. Sometimes, a Sengstaken-Blakemore tube is used to mechanically press upon the varices and stop the bleeding.
Esophagogastroduodenoscopy (EGD/OGD) or upper gastrointestinal endoscopy is a procedure that can be use to both identify and treat the source of bleeding in the upper gastrointestinal tract. The endoscope is passed into the esophagus into the stomach and duodenum to view the lining of these structures and take a biopsy sample. Some of the procedures that may then be performed include sclerotherapy injection, thermal cautery and band ligation.