Significant advances have been made in understanding the pathophysiology and management of gastrointestinal bleeding occurring in the intensive care unit (ICU) setting, including improvements in endoscopic and radiographic techniques, advances in resuscitative measures, and development of more potent pharmacologic agents. Despite these advances, the mortality rate associated with gastrointestinal bleeding has remained unchanged at 8% to 10% over the last half-century, and hemorrhage still constitutes a major cause of morbidity and mortality in the ICU. The apparent failure of better clinical management to improve mortality rates associated with gastrointestinal bleeding may be partly due to selection bias. Patients who die of gastrointestinal hemorrhage generally have multiple chronic comorbidities and are elderly,<sup>101 Laine L. Acute and chronic gastrointestinal bleeding Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management Philadelphia: WB Saunders (1998).  198-219

Cliccare qui per andare alla sezione Riferimenti</sup> and these factors probably largely account for the unchanged mortality rate.<sup>141 Peura D.A., Johnson L.F. Cimetidine for prevention and treatment of gastroduodenal mucosal lesions in patients in an intensive care unit Ann Intern Med 1985 ;  103 : 173-177

Cliccare qui per andare alla sezione Riferimenti, 169 Schuster D.P., Rowley H., Feinstein S. , e al. Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit Am J Med 1984 ;  76 : 623-630  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 174 Shuman R.B., Schuster D.P., Zuckerman G.R. Prophylactic therapy for stress ulcer bleeding: A reappraisal Ann Intern Med 1987 ;  106 : 562-567

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Gastrointestinal bleeding may be divided into upper and lower sources, with the ligament of Treitz constituting the anatomic dividing line. Gastrointestinal bleeding in the ICU is usually detected as coffee grounds in the nasogastric aspirate; fecal occult blood; or as hematemesis, melena, or hematochezia in more acute circumstances. It may be accompanied by a decrease in hemoglobin and hematocrit or might present purely with symptoms from blood loss and hypovolemia. The clinical approach to individuals with gastrointestinal hemorrhage depends not only on the severity, nature, and location of the bleed, but also on patient characteristics and comorbidities and the available medical skills and resources.<sup>101 Laine L. Acute and chronic gastrointestinal bleeding Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management Philadelphia: WB Saunders (1998).  198-219

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This article focuses on stress-related erosive syndrome (SRES), the commonest cause of upper gastrointestinal bleeding in the ICU and lower gastrointestinal bleeding from intestinal vasculopathy. Many other causes of gastrointestinal bleeding that may be encountered in the ICU, most notably acid-peptic disorders and the sequelae of portal hypertension (esophageal varices), are discussed elsewhere in this issue.