Gastrointestinal bleed refers to any form of bleeding observed in the digestive tract including the esophagus, stomach, duodenum, small and large intestines. It is associated with an increased failure to control bleeding in the upper or lower gastrointestinal tract. While it is not an infection in itself, the bleeding is a symptom of several conditions, and 80 percent of the cases stop spontaneously. The symptoms of this condition are seen with blood in stool, abdominal pain, fatigue, shortness of breath as well as pale skin.
GI bleed continues to be a problem for physicians caused by difficulties in identifying the source of bleeding and complications. It is one of the most common medical emergencies that require urgent medical assessment ( Van Leerdam, 2008) . However, the treatment for GI bleeding is still a significant problem due to difficulties in understanding the causes and risk factors associated with the condition. As such, the ongoing research on the risk factors and causes of gastrointestinal bleeding is crucial in developing better treatments and diagnostic procedures. This paper analyzes the literature on gastrointestinal bleed and applies the findings on evidence-based nursing.
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Epidemiology and etiology
Gastrointestinal bleed is a significant cause of hospital admissions with a mortality rate of between 6 to 10 percent in the United States. Despite the introduction of endoscopic therapy that reduces the rate of bleeding, the rate of mortality from the condition is still high. The disease may be categorized based upon the pathophysiologic and anatomic factors such as portal hypertension, tumors iatrogenic and ulcerative ( Van Leerdam, 2008) . Some of its causes include peptic ulcers, an inflammation in the GI lining, cancer, esophageal varices, gastritis, hemorrhoid, and angiodysplasia. Accurate evaluation of GI bleeding and early management of the condition is critical in decreasing the morbidity and mortality rates. Management practices should focus on resuscitative measures of infusing fluids or blood transfusion in reversing the direct consequences of bleeding while preventing any damage that may be caused by immediate bleeding.
Risk factors
Age is a risk factor for GI with the elderly having much worse symptoms than any other patient with symptoms of GI. Thus, the risk of mortality is high in elderly patients since they have a higher prevalence of colonic diverticulosis or colonic angiodysplasia. The risk is also higher in individuals with severe coexistent comorbidities who are hospitalized, which explains why there is increased mortality for hospitalized patients who develop the condition ( Nithiwathanapong, Reungrongrat & Ukarapol, 2005). The availability of comorbidity increases the risk of gastrointestinal bleed in patients.
Another risk factor is liver disease or cirrhosis that is associated with doubling the risk of GI bleeding and mortality risk. This condition causes a burst in the veins within the body, releasing blood to the GI tract and leading to the gastrointestinal bleeding. Additionally, the influence of factors such as smoking, mental stress, alcohol and development of liver cirrhosis has been associated with an early appearance of GI bleeding ( Nithiwathanapong, Reungrongrat & Ukarapol, 2005) .
Literature review
Several studies have been conducted on GI bleed to understand its risk factors and prevalence. Among the studies have been a focus on the risk factor of aspirin in causing GI bleeding. Aspirin is widely used in preventing cardiovascular events among patients with multiple risk factors due to its potent anti-inflammatory and analgesic actions. However, it is also widely considered to cause GI bleed based on its usage rather than the dosage. A study by Sørensen et al. (2000) examined the risk of hospitalization for GI bleeding with use of low-dose aspirin with findings showing that regular users have a significantly higher risk of developing GI bleeding compared to non-regular users. In the study, there is an increase in acute gastrointestinal bleeding in people using low-dose aspirin. Additionally, users of NSAIDs with a history of ulcer complications have a higher increased risk of developing the condition than those without a history of ulcers.
Secondly, a history of peptic ulcers diseases increases the risk of GI bleed inpatient with half of all upper GI bleeding cases in a patient are related to open sores developing in the lining of the stomach or duodenum caused by an infection of H. pylori bacteria. A survey by Tirgar et al., (2005) to evaluate the role of several risk factors in GI bleeding arising from peptic ulcers showed that the condition is strongly linked to peptic ulcers. The study indicated an increased risk of GI bleeding for patients with peptic ulcers that occur primarily in the stomach or duodenum. The study also identified erosions in the esophagus, stomach or duodenum as leading to GI bleeding (Tirgar et al., (2005).
Thirdly, GI bleeding is most prevalent in elderly patients put under corticosteroid use. The study by Jiang et al. (2015) sought to analyze the causes of GI bleeding among inpatients. The study showed that corticosteroids increases the risk of gastrointestinal bleeding among elderly patients on the long-term use of NSAIDs who are often afflicted with several underlying diseases. This shows that patients with variceal GI bleeding are at high risk of mortality due to the decomposition of their underlying conditions (Jiang et al., 2015). In this regard, the drugs should be used with caution especially in the elderly to reduce the risk of GI bleeding.
Clinical implications
The study has clinical and policy implications that can help in understanding the increased risk of gastrointestinal bleeding in patients. Nurses, care managers and guideline makers may benefit from this information, applying the information in making evidence-based decisions about diagnosis and patients who are eligible for therapy. Results from the study have indicated the effect of gastrointestinal bleed in prolonging hospital stay of patients while creating a higher risk of mortality ( Van Leerdam, M. E. (2008) . This calls for a need to prevent the condition as one way of improving outcomes in the patients. The prevention initiatives include measures such as reducing use of NSAIDs in patients who are at high risk of developing the condition as well as recognizing early signs of bleeding. Additionally, the findings from this study increase the possibility of preventing gastrointestinal bleeding by understanding risk factors and causes. As such, physicians should be aware of the risk factors associated with gastrointestinal infection to be able to reduce its impact on a patient effectively.
Strengths, Limitations and Future considerations
One of the strength of these studies was lack of bias due to its focus on incident cases as well as conducting several sensitivity analyses to evaluate the robustness of the results and its validity. The observational nature of the previous reviews and the differences in findings is another advantage of the study. On the other hand, limitations may include underestimating the incidence of gastrointestinal bleeding since it was a retrospective analysis. This means the methods of hemostasis and types of therapeutic doses cannot be controlled. Secondly, the results may not reflect the entire population as it focuses on a specific section of people.
Findings from this study raise questions and future opportunities. For example, future studies should consider additional outcomes such as overall bleeding and its effects. Future studies should also consider focusing on getting adequate samples of older people given evidence suggesting variations in the risk of GI bleeding with age.
References
Jiang, Y., Li, Y., Xu, H., Shi, Y., Song, Y., & Li, Y. (2016). Risk factors for upper gastrointestinal bleeding requiring hospitalization. Int J Clin Exp Med, 9(2), 4539-4544.
Nithiwathanapong, C., Reungrongrat, S., & Ukarapol, N. (2005). Prevalence and risk factors of stress-induced gastrointestinal bleeding in critically ill children. World journal of gastroenterology , 11 (43), 6839.
Sørensen, H. T., Mellemkjær, L., Blot, W. J., Nielsen, G. L., Steffensen, F. H., McLaughlin, J. K., & Olsen, J. H. (2000). Risk of upper gastrointestinal bleeding associated with the use of low-dose aspirin. The American journal of Gastroenterology, 95(9), 2218-2224.
Tirgar Fakheri, H., Sotoudehmanesh, R., Âli Âsgari, A., & Nouraie, M. (2005). Risk factors for upper gastrointestinal bleeding in patients with peptic ulcer disease: A case-control study. Journal of Mazandaran University of Medical Sciences, 15(46), 69-76.
Van Leerdam, M. E. (2008). Epidemiology of acute upper gastrointestinal bleeding. Best practice & research Clinical gastroenterology , 22 (2), 209-224.
