Review
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Mar 9, 2025; 14(1): 101639
Published online Mar 9, 2025. doi: 10.5492/wjccm.v14.i1.101639
Management of gastrointestinal bleed in the intensive care setting, an updated literature review
Vignesh K Nagesh, Sai Priyanka Pulipaka, Ruchi Bhuju, Emelyn Martinez, Shruthi Badam, Gomathy Aarthy Nageswaran, Hadrian Hoang-Vu Tran, Daniel Elias, Charlene Mansour, Jaber Musalli, Sanket Bhattarai, Lokeash Subramani Shobana, Tannishtha Sethi, Ritvik Sethi, Namrata Nikum, Chinmay Trivedi, Amer Jarri, Colin Westman, Nazir Ahmed, Shawn Philip, Simcha Weissman, Jonathan Weinberger, Ayrton I Bangolo
Vignesh K Nagesh, Sai Priyanka Pulipaka, Ruchi Bhuju, Emelyn Martinez, Shruthi Badam, Daniel Elias, Charlene Mansour, Jaber Musalli, Sanket Bhattarai, Namrata Nikum, Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
Gomathy Aarthy Nageswaran, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Hadrian Hoang-Vu Tran, Lokeash Subramani Shobana, Tannishtha Sethi, Ritvik Sethi, Simcha Weissman, Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
Chinmay Trivedi, Colin Westman, Nazir Ahmed, Shawn Philip, Jonathan Weinberger, Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
Amer Jarri, Department of Pulmonology and Critical Care, HCA Florida Bayonet Point Hospital, Hudson, FL 34667, United States
Ayrton I Bangolo, Department of Hematology & Oncology, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ 07601, United States
Author contributions: Nagesh VK, Pulipaka SP, Bhuju R, Martinez E, Badam S, Nageswaran GA, Tran HHV, Elias D, Mansour C, Musalli J, Bhattarai S, Shobana LS, Sethi T, Sethi R, Nikum N, Trivedi C, Jarri A, Westman C, Ahmed N and Philip S searched the literature, wrote and revised the manuscript. Weissman S, Weinberger J and Bangolo AI supervised the project.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vignesh K Nagesh, MD, Doctor, Department of Internal Medicine, Palisades Medical Center, 7600 River Road, North Bergen, NJ 07047, United States.vgneshkrishnan@gmail.com
Received: September 21, 2024
Revised: November 8, 2024
Accepted: December 2, 2024
Published online: March 9, 2025
Processing time: 80 Days and 17.9 Hours
Abstract

Gastrointestinal (GI) bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit (ICU). This literature review consolidates current insights on the epidemiology, etiology, management, and outcomes of GI bleeding in critically ill patients. GI bleeding remains a significant concern, especially among patients with underlying risk factors such as coagulopathy, mechanical ventilation, and renal failure. Managing GI bleeding in the ICU requires a multidisciplinary approach, including resuscitation, endoscopic intervention, pharmacologic therapy, and sometimes surgical procedures. Even with enhanced management strategies, GI bleeding in the ICU is associated with considerable morbidity and mortality, particularly when complicated by multi-organ failure. This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients, aiming to enhance survival rates and improve the quality of care within the ICU setting.

Keywords: Gastrointestinal bleed; Varices; Variceal bleeding; Diverticular bleed; Angiodysplasia; Ulcer; Hemorrhoids; Endoscopy; Enteroscopy; Embolization

Core Tip: Gastrointestinal (GI) bleeding in the intensive care unit is a serious, life-threatening condition, requiring a multidisciplinary approach. Despite advances in prophylactic strategies and critical care protocols reducing its incidence, GI bleeding remains a major concern, particularly in patients with risk factors such as coagulopathy and renal failure. Enhanced management strategies are crucial, yet the condition is still associated with significant morbidity and mortality, especially in cases complicated by multi-organ failure. The purpose of this compilation of the most recent literature is to review the most up-to-date recommendations and protocols to be followed for the management of a patient with GI bleeding in an intensive care unit.