Acute Gastrointestinal Bleeding and Its Rehabilitation

Introduction

The gastrointestinal tract's vital function is to supply nutrients, water, and electrolytes to the body. Acute gastrointestinal bleeding is a common cause of hospitalization, increasing morbidity and mortality. Appropriate management and treatment depend on the rate of active bleeding, bleeding source, and hemodynamic stability. Fluid administration, red blood cell replacement, and nasogastric aspiration are used to treat patients with acute gastrointestinal bleeding.

What Is Acute Gastrointestinal Bleeding?

Acute gastrointestinal bleeding is sudden and severe bleeding that occurs in any part of the gastrointestinal tract, which includes the esophagus, stomach, small intestine, large intestine (colon), rectum, and anus. This condition is a medical emergency, which itself is not a disease, but only a symptom of underlying diseases or conditions.

Acute gastrointestinal bleeding is potentially life-threatening, but most cases are safely managed on an outpatient basis. Acute bleeding from the gastrointestinal tract occurs in the following three forms.

1. Hematemesis - Vomiting of red blood or coffee ground substances.

2. Melena - Black, tarry, and foul-smelling stools.

3. Hematochezia - Passage of bright red or maroon-colored blood from the rectum.

It occurs in both the upper and lower gastrointestinal tract.

1. Upper gastrointestinal tract bleeding - Bleeding occurs from the duodenum, stomach, and duodenum. It is four times more common than lower tract bleeding.

2. Lower gastrointestinal tract bleeding - Bleeding from the colon, rectum, and anus.

What Are the Causes of Acute Gastrointestinal Bleeding?

The following are the causes of gastrointestinal bleeding.

Causes of Upper Gastrointestinal Bleeding:

• Crohn's disease.

• Peptic ulcer.

• Esophageal varices.

• Esophageal cancer.

• Gastritis.

• Liver cancer.

• Pancreatic cancer.

• Stomach cancer.

• Gastroesophageal reflux disease (GERD).

• Gastrointestinal stromal tumors(GIST).

Causes of Lower Gastrointestinal Bleeding:

• Anal cancer.

• Colorectal cancer.

• Diverticulitis or diverticulosis.

• Ulcerative colitis.

• Rectal ulcers.

• Hemorrhoids.

• Anal fissures.

• Colon polyps.

What Are the Symptoms of Acute Gastrointestinal Bleeding?

Acute gastrointestinal bleeding symptoms are sudden and severe, which include the following.

• Vomiting of red blood.

• Blood in the stools.

• Black and tarry stools.

Symptoms associated with blood loss include the following.

• Syncope (dizziness or faintness).

• Difficulty in urination.

• Anxiety due to rapid pulse.

• Shock due to insufficient blood flow to the organs.

• Fatigue.

• Weakness.

• Pale skin.

• Shortness of breath.

• Reduced blood pressure.

• Unconsciousness.

• Abdominal cramps and pain.

How to Diagnose Acute Gastrointestinal Bleeding?

Healthcare providers perform the following diagnostic tests to detect acute gastrointestinal

bleeding.

1. Fecal occult blood test (FOBT) - Detects signs of blood in the poop sample.

2. Upper Endoscopy - An endoscope (a long tube with a light and a camera at the tip) detects bleeding in the upper gastrointestinal tract.

3. Colonoscopy or Sigmoidoscopy - Endoscopes are passed through the anus to detect bleeding in the lower gastrointestinal tract.

4. Computed Tomography (CT) Scan - Provide enhanced and three-dimensional views of the intestine to examine for GI bleeding.

5. Gastrointestinal X-Rays - Barium contrast solution is used to view the digestive tract and detect bleeding signs.

6. Angiography - Dye is used to visualize the gastrointestinal blood vessels.

7. Capsule Endoscopy - A pill-sized camera is swallowed that takes pictures of the gastrointestinal tract and is excreted through a bowel movement.

8. Radionuclide Scan - A radioactive imaging study that highlights red blood cells.

What Are the Management and Rehabilitation Therapies for Acute Gastrointestinal Bleeding?

There is no home care for acute and heavy bleeding. Therefore, emergency surgery with laparoscopy is necessary for cases of acute and severe bleeds to detect the source of bleeding and provide prompt treatment. The followings are the management and rehabilitative therapies for acute GI bleeding.

Pre-endoscopic management:

• Hemodynamic resuscitation is indicated for patients with hemodynamic instability.

• Blood transfusions compensate for the blood loss.

• Colloids and crystalloid fluids restore reduced blood pressure.

Endoscopic Management:

• Patients with active bleeding are admitted to the intensive care unit for management.

• Endoscopy is the method of choice for controlling active bleeding.

• It is used in association with other medical procedures.

• The endoscopic interventions include the application of clips, argon plasma coagulation, heater probe coagulation, injection of epinephrine or sclerosants, band ligation, bipolar electrocoagulation, and laser therapy.

Pharmacological management:

The following drugs treat gastrointestinal bleeding.

• Vitamin K prevents bleeding and reverses hypoprothrombinemia.

• Nitroglycerin.

• Vasopressin (a potent vasoconstrictor).

• Proton pump inhibitors (PPI) such as Pantoprazole and Omeprazole suppress gastric acid secretion.

• Octreotide inhibits gastric acid secretion and vasoconstriction effects.

Non-pharmacological management:

• Angiographic interventions include catheterization and angiogram in which vasopressin is infused to reduce recurrent bleeding.

• Transcatheter embolization therapy is effective for patients with bleeding due to peptic ulcers. It reduces blood supply to the source of bleeding and promotes clot formation.

• Balloon tamponade, in which a large gastric balloon is inserted into the esophagus and inflated to reduce esophageal bleeding.

Gastrointestinal Rehabilitation:

• Nutrition management and counseling are important to this rehabilitation program.

• It includes specialized dieticians, doctors, nurses, and gastroenterologists.

• The therapy includes enteral nutrition, diet modification, and electrolyte and fluid management.

• Tube feeding (enteral nutrition) is performed with a home gastrostomy tube and nasogastric tube feeding.

Recommended Diet:

• The primary goal during the active bleeding phase is to allow the gastrointestinal tract to rest and heal.

• Nutrition is given through the intravenous route.

• Foods rich in fiber, such as vegetables, fruits, whole grains, high-fiber cereals, and prune juice, are recommended.

• Protein and iron help to restore the iron lost during bleeding episodes. Therefore, protein-rich foods like fish, poultry, and meat and iron-rich foods like beans, legumes, spinach, vegetables, cereals, and whole grains are recommended.

• Intake of alcohol, caffeine, mints, spicy foods, garlic, onions, tobacco, and non-steroidal anti-inflammatory drugs (NSAIDs) is restricted.

Home-Based Rehabilitation Modalities After GI Bleeding:

• Healthcare providers advise the patients to take drugs such as proton pump inhibitors daily on an empty stomach 30 minutes before eating.

• Iron supplements, along with vitamin C tablets or orange juice, improve iron absorption.

• It is vital to follow-up visits with a gastroenterologist to detect signs of re-bleeding.

• Eating food in an upright position is recommended.

• Exercise under the supervision of doctors and caretakers.

• Relaxation techniques and deep breathing exercises to reduce stress.

• Maintaining a balanced diet and active and healthy lifestyle.

Conclusion

Most people with acute gastrointestinal bleeding make a full recovery. But the intestines take a few months to heal completely, and the bleeds can come back even after treating successfully. So the patients need to follow the medications, care instructions, and rehabilitative therapies.