title: Incidence of occult upper gastrointestinal bleeding in patients presenting to the ED with hematochezia.
abstract: OBJECTIVE
  The aim of the study was to determine the incidence of nasogastric (NG) aspiration revealing a clinically unsuspected upper gastrointestinal (GI) bleeding in patients presenting to the emergency department (ED) with hematochezia. A secondary aim was to identify factors associated with an upper GI source.
  
  
  METHODS
  Data were prospectively collected from patients 18 years or older with either bright red blood per rectum or maroon stools. Patients were excluded if their history revealed hematemesis or their examination revealed melena, bleeding from an external hemorrhoid, or anal fissure. An NG tube was placed, and initial and postlavage aspirates were inspected and tested with Gastrocult (Beckman Coulter, Inc, Palo Alto, CA) for the presence of blood. Additional data included demographics, history, vital signs, and laboratory results.
  
  
  RESULTS
  Of 114 patients, 11 (9.6%; 95% confidence interval, 4.9%-16.6%) had a positive NG aspirate. There were no statistically significant differences in age, sex, or race between the 2 groups. Factors associated with a positive aspirate were history of upper GI bleeding (P = .04), heart rate (P = .055), and hemoglobin (P = .03).
  
  
  CONCLUSIONS
  Patients presenting to the ED with hematochezia require NG tube placement and aspiration to exclude an upper GI source of bleeding. History of an upper GI bleeding and anemia were associated with a positive NG aspirate.
authors.affiliation: Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA. byerss@einstein.edu
authors.forename: Stacie E
authors.initials: SE
authors.lastname: Byers
authors.forename: Carl R
authors.initials: CR
authors.lastname: Chudnofsky
authors.forename: Barbara
authors.initials: B
authors.lastname: Sorondo
authors.forename: Paul
authors.initials: P
authors.lastname: Dominici
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Parrillo
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012007:Rectum