Initial Assessment and Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding

Abstract

Upper gastrointestinal bleeding (UGIB) is a substantial clinical and economic burden, with an estimated mortality rate between 3% and 15%. The initial management starts with hemodynamic assessment and resuscitation. Blood transfusions may be needed in patients with low hemoglobin levels or massive bleeding, and patients who are anticoagulated may require administration of fresh frozen plasma. Patients with significant bleeding should be started on a proton-pump inhibitor infusion, and if there is concern for variceal bleeding, an octreotide infusion. Patients with UGIB should be stratified into low-risk and high-risk categories using validated risk scores. The use of these risk scores can aid in separating low-risk patients who are suitable for outpatient management or early discharge following endoscopy from patients who are at increased risk for needing endoscopic intervention, rebleeding, and death. Upper endoscopy after adequate resuscitation is required for most patients and should be performed within 24 hours of presentation. Key to improving outcomes is appropriate initial management of patients presenting with UGIB.

Pre-Endoscopic Scores Predicting Low-Risk Patients with Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

“…Yet in over 80% of cases of UGIB, interventions such as endoscopic therapy, blood transfusion or surgery are not needed to stop the bleeding [ 55 ]. Although co-morbid conditions may also play a role in the need for hospitalization and other outcomes, not all patients with GIB require admission, hence the critical importance of stratifying patients into being at low or high risk for developing adverse events using validated prognostic scores [ 56 ]. A risk assessment tool that correctly identifies very low-risk patients, soon after presentation, who do not need hospital admission or intervention and can be safely discharged to obtain an elective out-patient endoscopy has the potential of reducing health resource utilization in acute UGIB [ 57 ].…”

New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding

“…Even though an initial analysis had suggested that tranexamic acid could possibly reduce mortality, a subsequent subgroup evaluation could not confirm this effect (40). No impact on mortality, rebleeding rate and transfusion requirements was noticed as well, and thus a formal recommendation for its use in patients with UGIB cannot be done (7).…”