Management of gastrointestinal bleeding in palliative care

Management of gastrointestinal bleeding in patients with palliative care needs depends on the cause and severity of the bleed. Consider the potential benefits and harms of each intervention, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.

The principles of planning for and managing gastrointestinal bleeding in patients with palliative care needs are the same as for bleeding from any source; see Bleeding in palliative care. Identify and address reversible causes of bleeding, if appropriate.

Radiotherapy or endoscopic interventions (eg laser therapy, stenting) may be considered for localised bleeding.

A mild haematemesis or melaena may not require intervention, but can occasionally herald a larger bleed. For moderate haematemesis or melaena, consider managing pain with an opioid, and distress with a benzodiazepine. Be alert for more severe bleeding, and reassess the patient’s advance care plan.

For major bleeds, immediately address pain and distress. If death appears imminent, see Catastrophic terminal events in palliative care for management. If death does not appear imminent, consider the patient’s suitability for active intervention; management in a critical care setting (eg emergency department, critical care unit) is required if clinically appropriate.