Categorization of Gastrointestinal Bleeding Terms

What do the terms upper GI bleeding (UGIB), lower GI bleeding (LGIB), and middle GI bleeding (MGIB) mean? 

Although this categorization is appealingly simplistic, sometimes clinically suspected MGIB, based on one negative EGD and one negative colonoscopy, turns out to be UGIB that was missed on an initial EGD or LGIB that was missed on an initial colonoscopy. This initial misdiagnosis can occur in up to 20% of cases of suspected MGIB.

Categorization of Gastrointestinal Bleeding Terms

LocationDefinitionMethod of Evaluation
UGIBEsophagus, stomach, duodenum to the ligament of TreitzEGD
LGIBColon from the ileocecal valve to the anusColonoscopy (usually)
Nuclear medicine studies or arteriography (special situations)
MGIBSmall bowel from ligament of Treitz to the ileocecal valveCapsule endoscopy, enteroscopy (push-type, single balloon, or double balloon)
Radiologic (contrast enterography)

EGD, Esophagogastroduodenoscopy; LGIB, lower gastrointestinal bleeding; MGIB, middle gastrointestinal bleeding; UGIB, upper gastrointestinal bleeding.

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