Acute gastrointestinal bleeding (acute GIB) is a major cause of mortality and morbidity in patients despite various advances in diagnosis and treatment. In the United States, around 390,000 patients are admitted with acute GIB annually, and mortality rates range from 3 to 8.8%.[1] The presentation of these patients can vary from minor, self-limited bleeding that can be managed in outpatient settings to life-threatening bleeding that requires aggressive resuscitation and emergent intervention.[1] Early and accurate diagnosis followed by prompt and appropriate treatment is imperative in the management of acute GIB. In this review, we will discuss the epidemiology, presentation, diagnosis, and management of acute GIB, with particular focus on diagnostic imaging and endovascular management.

GIB is usually categorized on the basis of the location and severity of the bleeding. Upper GIB (UGIB) originates between the esophagus and the ligament of Treitz, whereas lower GIB (LGIB) occurs in the small bowel distal to the ligament of Treitz, the colon, or the rectum.[1]

In 75 to 85% of GIB cases, the source of hemorrhage is in the upper gastrointestinal tract.[2] The annual incidence of UGIB is around 50 to 100 per 100,000 population, and the median age of patients is 60 to 70 years.[3] The mortality rate in these patients is between 3 and 14%, and this increases to 43 to 64% in patients who need intensive care.[4] The most common causes of UGIB are peptic ulcer disease, esophagogastric varices, and erosive esophagitis; other less common causes are bleeding from esophageal or gastric tumors, Mallory–Weiss syndrome, reflux esophagitis, angiodysplasia, and iatrogenic or posttraumatic changes.[5] This review does not focus on the management of variceal bleeding, even though it is a common and important cause of GIB, as the diagnostic and interventional approach differs between variceal and nonvariceal bleeding.

Around 33 to 87 per 100,000 population are hospitalized because of LGIB annually, with mortality rates ranging from 2.5 to 3.9% and rebleeding occurring within a year in 13 to 19% of these individuals . Compared to UGIB, there are fewer effective methods for preventing the recurrence of LGIB.[3] [6] [7] [8] [9] [10] [11] In patients with LGIB, determining the source of the bleeding and its severity is crucial in managing patients. The causes of LGIB can be anatomic, vascular, inflammatory, or neoplastic. Diverticulosis has been found to be the most common cause, accounting for 15 to 55% of LGIB cases; however, angiodysplasia is the most common cause of LGIB in individuals over the age of 65 years.[12] [13]

Article published online:
02 November 2023

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