An update on the management of non-variceal upper gastrointestinal bleeding

Abstract

Upper gastrointestinal bleeding (UGIB) continues to be a common gastrointestinal emergency that carries significant morbidity and mortality. The epidemiology of UGIB has been changing over the last few decades with an overall decrease in peptic ulcer disease and increase in the prevalence of other etiologies including vascular lesions and malignancy. Appropriate risk assessment and patient stratification are crucial to ensuring that optimal care is delivered to patients and some risk assessment tools have shown excellent ability to define a low-risk group who can be managed as outpatients safely. Regardless of the etiology of UGIB, resuscitative interventions by primary care providers remain the most important initial measures to improve the outcome for patients including hemodynamic stabilization, an appropriate blood transfusion strategy, with or without acid-lowering agents, while also providing subsequent urgent endoscopic assessment and intervention. In addition, with increasing use of antithrombotic agents in clinical practice and its associated risk of bleeding, the management of such agents in the acute setting has become a real challenge to all physicians. In this article, we provide an up-to-date, evidence-based, practical review of recent changes and advances in UGIB with a focus on non-variceal etiologies.

Advancements in endoscopic hemostasis for non-variceal upper gastrointestinal bleeding

“…Non-variceal upper gastrointestinal (GI) bleeding is a leading cause of hospitalization, with an incidence ranging from 61-78 cases per 100000 and an estimated mortality between 2%-10%[ 1 ]. Bleeding can originate from sites within the esophagus, stomach, and duodenum, commonly manifesting as hematemesis and melena, and in cases of brisk bleeding, hematochezia[ 1 , 2 ]. The primary culprits are gastric and duodenal ulcers, Mallory-Weiss tears, esophagitis, and gastritis, and less frequently angiodysplasias, gastric antral vascular ectasias, Dieulafoy’s lesions, polyps, and malignancy[ 1 , 2 ].…”

“…Currently, the mainstay of care for those hemodynamically stable involves endoscopic evaluation through esophagogastroduodenoscopy[ 2 ]. Over the past 30 years, numerous endoscopic devices have been developed with demonstrated effectiveness at controlling upper GI bleeding.…”

Risk Factors for Mortality Among Upper Gastrointestinal Bleeding Patients : Literature Review

“…Other symptoms that may arise in UGIB patients due to blood loss include hemodynamic instability, syncope, fatigue, and shortness of blood loss [1,2]. UGIB can occur due to several causes, and these causes are grouped into two categories: variceal and non-variceal etiologies [3]. The non-variceal group occurs due to mucosal structure damage that extends into blood vessels [4], which can be caused by various factors such as Helicobacter pylori (H Pylori) [3].…”

“…UGIB can occur due to several causes, and these causes are grouped into two categories: variceal and non-variceal etiologies [3]. The non-variceal group occurs due to mucosal structure damage that extends into blood vessels [4], which can be caused by various factors such as Helicobacter pylori (H Pylori) [3]. Meanwhile, the variceal group can occur as a complication of portal hypertension [5].…”