[Gastrointestinal bleeding].

Gastrointestinal bleeding (GIB) accounts for more than 1 million hospitalizations annually in the United States, with significant morbidity, mortality, and economic burden. GIB is traditionally classified by the bleeding source—upper GIB (UGIB) is proximal and lower GIB (LGIB) is distal to the ligament of Treitz in the terminal duodenum. UGIB accounts for more than 500,000 U.S. hospital admissions annually, with approximately 165 incidents per 100,000 patients. Mortality rates have remained consistent at 13 to 14% over the past two decades despite advances in medical therapy, intensive care unit (ICU) management, endoscopy, and surgery. An increasing proportion of elderly patients, who may die owing to comorbid conditions, and increases in the number of cirrhotic and variceal patients may contribute to the lack of change in mortality rates. In the United States, hospitalized patients with and without complications of nonvariceal UGIB had a mean length of stay of 4.4 and 2.7 days and hospitalization costs of $5632 and $3402 (2004 U.S. dollars), respectively. The incidence of LGIB in the United States is approximately 20.5 per 100,000 patients, with a mortality rate of 4%. Age greater than 70 years, intestinal ischemia, comorbid illness, coagulation defects, transfusion of packed red blood cells (RBCs), and male gender are the predictors of increased LGIB mortality.