EMERGENCIES IN CRITICAL CARE: Edited by Christopher W. SeymourUncontrolled bleeding of the gastrointestinal tractD’Hondt, Alaina; Haentjens, Lionela; Brassart, Nicolasb; Flamme, Frédéricc; Preiser, Jean-Charlesd Author Information aDepartment of Intensive Care bDepartment of Radiology cDepartment of Gastroenterology, CHU Ambroise Paré, Mons dDepartment of Intensive Care, Erasme University Hospital – Université Libre de Bruxelles, Brussels, Belgium Correspondence to Jean-Charles Preiser, MD, PhD, Department of Intensive Care, Erasme University Hospital – Université Libre de Bruxelles, 808 route de Lennik, 1070 Brussels, Belgium. Tel: +32 25554756; fax: +32 25554698; e-mail: [email protected] Current Opinion in Critical Care 23(6):p 549-555, December 2017. | DOI: 10.1097/MCC.0000000000000452 Buy Metrics Abstract Purpose of review Acute gastrointestinal bleeding is a frequent emergency situation, whose incidence will likely rise as a result of the increasing use of direct anticoagulants and of the medical progresses resulting in longer life expectancy with underlying comorbidities. Updated guidelines and improvements in the diagnostic and therapeutic tools are now available and will likely improve the management of massive gastrointestinal bleeding in the near future. Recent findings The assessment of severity has been improved by validated scores useable upon admission. Massive blood transfusion protocols and specific care in case of bleeding of patients treated with direct anticoagulants, including concentrates of coagulation factors and monoclonal antibodies are now available. The endoscopic management has been facilitated by the use of hemostatic powders and by the use of self-expanding metal stents in case of variceal hemorrhage. New diagnostic tools include emergency video-capsule endoscopy, multiphasic computed tomography angiography and enterography. Summary The implementation of multidisciplinary diagnostic and therapeutic algorithms for the management of massive bleeding requires a close collaboration between emergency physicians, intensivists, endoscopists, radiologists and surgeons. A sequential strategy involving each of these specialists is desirable for a successful management of acute and massive gastrointestinal bleeding. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.