Iʼm Dr. Ryan Stanton and itʼs time to find out Whatʼs Going Around. This week I have seen several episodes of GI bleeding. I see cases year round, but a recent flurry of cases reminded me that we should talk about it. GI bleeding is a blanket description of any bleeding within the GI tract, including the esophagus, stomach, small, and large bowel.
These cases can be anything from just a little bit of blood to life-threatening hemorrhage. The most common causes are stomach ulcers, diverticulosis, masses, and hemorrhoids. In younger folks, other than hemorrhoids, peptic ulcer disease is one of the more likely culprits. This can be caused by a bacteria called Helicobacter Pylori as well as medications.
In fact, one of the most common I see in the ED is from the chronic or frequent use of NSAIDs for pain, such as ibuprofen, naproxen, and others. These are best managed by a cessation of the medication and other treatments that can be guided by a GI or primary care physician. In older adults, the lower GI tract takes center stage in most cases with diverticulosis, cancer, and hemorrhoids. With the growing elderly population, we are also seeing large number of people on anticoagulant medications used to help treat and prevent cardiovascular diseases.
This increases the risk of GI bleeding and also hinders their resolution. This bleeding can be characterized with dark tarry stools called melena, all the way up to major bleeding with clots. When you notice blood for the first time, itʼs important to get checked out. If itʼs minor, this can be done with your PCP, but it significant bleeding, more urgent evaluation is indicated. In the emergency department, we check for blood in the stool, blood levels, and a good history and physical to try and identify the source.
Most cases get to go home with medications and referral to a gastroenterologist. On occasion, admission and interventions in the hospital may be necessary. You can join the conversation on Facebook at our Whatʼs Going Around as well as the Stanton MD page. Also, follow @everydaymed on Twitter. I'm Dr. Ryan Stanton and that's what's going around.
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