Diagnosis and Management of Gastrointestinal Bleeding

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Abstract
An aggressive diagnostic approach is advocated for the patient with gastrointestinal bleeding in order to provide a rational basis for therapy. Since routine barium studies may be negative in many of these patients, endoscopy and angiography are important adjunctive procedures. The indications, limitations, and value of these diagnostic aids are presented. Some of the rarer causes of bleeding are reviewed, with particular emphasis on acquired vascular lesions and patients in whom mucocutaneous disorders may be associated with bleeding into the gastrointestinal tract. One of the most difficult problems in management is presented by the patient with acute erosive gastritis. Current concepts in the pathophysiology of this process are discussed in relation to therapy. When surgical intervention is required in this condition, a vagotomy and pyloroplasty are favored over ablative procedures.

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