Introduction

A range of different gastrointestinal (GI) complications can occur following cardiac surgery. Gastrointestinal haemorrhage is the most common, but mesenteric ischaemia has the highest mortality. Gastrointestinal complications occur in between 0.5% and 5.5% of patients and are associated with a significant excess mortality. Off-pump coronary artery bypass surgery does not appear to protect against such complications.

Gastrointestinal haemorrhage

Upper gastrointestinal haemorrhage

Clinically significant upper GI haemorrhage occurs in up to 4% of patients after cardiac surgery and has a high mortality.

Patients commonly present with haematemesis, melaena or drop in haemoglobin, but unexplained hypotension may occur before blood loss becomes apparent. Some of these patients are on antiplatelet drugs or anticoagulants and approximately 20% to 30% of cases require surgical treatment. Stress ulcer prophylaxis is controversial and under investigation currently. Endoscopy of the upper GI tract is mandatory once resuscitation has been performed. It aids diagnosis, allows endoscopic therapy and appears to be safe. However, the high rate ofsurgical intervention suggests that therapeutic endoscopy is less effective or bleeding more severe than in other patient groups.

Patients with liver disease tend to have a worse prognosis which is directly related to the degree of liver dysfunction or failure. Evidence of Helicobacter pylori infection should be sought, but it is important to remember that acid suppression reduces the sensitivity of biopsy-based tests and breath tests.