Gastrointestinal Bleeding

Lower GI bleeding (LGIB) afflicts 20 to 27 of every 100,000 persons annually in the United States. The rate of LGIB increases more than 200-fold from the third to the ninth decade of life, with 25% to 35% of all cases occurring in elderly patients. It is one of the common medical emergencies that can become life-threatening in elderly patients. Risk stratification for LGIB by Strate et al. has identified seven predictors of severe bleeding: heart rate higher than 100 beats/ min, systolic blood pressure lower than 115 mm Hg, syncope, nontender abdominal examination, gross rectal bleeding, aspirin use, and more than two comorbid conditions. Patients with more than three risk factors have an 84% risk for severe bleeding, defined as transfusion of more than 2 units of red blood cells. Pediatric GI bleeding is fairly common worldwide; however, the incidence of severe GI bleeding in U.S. children is very low. LGIB is a more common complaint in the practice of general pediatrics, and it accounts for 10% to 15% of referrals to a pediatric gastroenterologist. In most children, bleeding is not life-threatening and ceases spontaneously, with only supportive care being required. The age of the child guides the clinician toward specific diagnoses.