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Lower Gastrointestinal Bleeding Medication

  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
 
Updated: Mar 29, 2016
 

Medication Summary

Vasoconstrictive agents reduce the blood flow and facilitate hemostatic plug formation in the bleeding vessel. However, the results are less than satisfactory in patients with severe atherosclerosis and coagulopathy.

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Posterior Pituitary Hormones

Class Summary

Agents with vasopressor and antidiuretic hormone (ADH) activity may reduce lower gastrointestinal bleeding (LGIB).

Vasopressin (Pitressin Injection)

 

Vasopressin is a pituitary hormone that causes severe vasoconstriction in the splanchnic bed. This agent has vasopressor and ADH activity: Vasopressin increases water resorption at the distal renal tubular epithelium (ADH effect) and promotes smooth muscle contraction throughout the vascular bed of the renal tubular epithelium (vasopressor effects). However, vasoconstriction also increases in the splanchnic, portal, coronary, cerebral, peripheral, pulmonary, and intrahepatic vessels.

Vasopressin decreases the portal pressure in portal hypertension. A notable undesirable effect is coronary artery constriction that may dispose patients with coronary artery disease to cardiac ischemia. This can be prevented with concurrent use of nitrates.

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Adrenergic Agonists

Class Summary

Epinephrine can be used in lower gastrointestinal bleeding, causing vasoconstriction and physical compression of the vessel. Epinephrine may be used in cases of diverticular bleeding or postpolypectomy hemorrhage.

Epinephrine

 

Epinephrine has alpha-agonist effects that include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta2-agonist effects include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects. Epinephrine solution (1/10,000 ) can be injected into bleeding site at the time of the endoscopic evaluation.

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Contributor Information and Disclosures
Author

Burt Cagir, MD, FACS Clinical Professor of Surgery, The Commonwealth Medical College; Attending Surgeon, Assistant Program Director, Robert Packer Hospital; Attending Surgeon, Corning Hospital

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth Cirincione, MD Director of Colon and Rectal Surgery, Department of Surgery, Nassau University Medical Center

Elizabeth Cirincione, MD is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons

Disclosure: Nothing to disclose.

Gavin F Chico, MD Consulting Staff, CHRISTUS Coushatta Rural Health Clinic

Disclosure: Nothing to disclose.

Kenneth J Manas, MD Assistant Professor, Department of Medicine, Section of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center

Kenneth J Manas, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marc D Basson, MD, PhD, MBA, FACS Associate Dean for Medicine, Professor of Surgery and Basic Science, University of North Dakota School of Medicine and Health Sciences

Marc D Basson, MD, PhD, MBA, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

David Greenwald, MD Professor of Clinical Medicine, Fellowship Program Director, Department of Medicine, Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine

David Greenwald, MD is a member of the following medical societies: Alpha Omega Alpha, New York Society for Gastrointestinal Endoscopy, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Michael A Grosso, MD Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital

Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons

Disclosure: Nothing to disclose.

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Types of lower gastrointestinal bleeding (LGIB).
Methods used to treat lower gastrointestinal bleeding (LGIB).
Types of lower gastrointestinal (GI) bleeding. HR = heart rate; SBP = systolic blood pressure.
Algorithm for massive lower gastrointestinal (GI) bleeding, surgical perspective. EGD = esophagogastroduodenoscopy; NG = nasogastric; 99mTc RBC = technetium-99m pertechnetate–labeled autologous RBC.
Table 1. Common Causes of Lower Gastrointestinal Bleeding in Adults
Lower Gastrointestinal Bleeding in Adults Percentage of Patients
Diverticular disease
  • Diverticulosis/diverticulitis of small intestine
  • Diverticulosis/diverticulitis of colon
60%
Inflammatory bowel disease
  • Crohn disease of small bowel, colon, or both
  • Ulcerative colitis
  • Noninfectious gastroenteritis and colitis
13%
Benign anorectal diseases
  • Hemorrhoids
  • Anal fissure
  • Fistula-in-ano
11%
Neoplasia
  • Malignant neoplasia of small intestine
  • Malignant neoplasia of colon, rectum, and anus
9%
Coagulopathy 4%
Arteriovenous malformations (AVMs) 3%
TOTAL 100%
Source: Vernava AM, Longo WE, Virgo KS. A nationwide study of the incidence and etiology of lower gastrointestinal bleeding. Surg Res Commun. 1996;18:113-20.[9]
Table 2. Common Causes of Lower Gastrointestinal Bleeding in Children and Adolescents
Lower Gastrointestinal Bleeding in Children and Adolescents
Intussusception
Polyps and polyposis syndromes
  • Juvenile polyps and polyposis
  • Peutz-Jeghers syndrome
  • Familial adenomatous polyposis (FAP)
Inflammatory
  • Crohn disease
  • Ulcerative colitis
  • Indeterminate colitis
Meckel diverticulum
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