Management of acute nonvariceal upper gastrointestinal bleeding: Current policies and future perspectives

Abstract

Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB, and is recommended within 24 h of presentation. Proton pump inhibitor (PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy, but has no effect on rebleeding, mortality and need for surgery. Endoscopic therapy should be undertaken for ulcers with high-risk stigmata, to reduce the risk of rebleeding. This can be done with a variety of modalities. High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality, particularly in patients with high-risk stigmata.

Outcome Following a Negative CT Angiogram for Gastrointestinal Hemorrhage

“…This is comparable to the results from a large systematic review by Straube et al [9] and a study by Holster and Kuipers [10]; the mortality rates for patients with upper GI bleed were estimated at 12 and 6-13 % respectively. A study by Anthony et al [11] documented a 30-day mortality rate of 18 % in patients with acute lower GI bleed.…”

The use of somatostatin and octreotide in the treatment of gastrointestinal bleeding

“…Акутна крварења из горњих делова гастроинтестиналног тракта (делови од усне дупље до Treitz-oвог лигамента) најчешћа су ургентна стања у гастроентерологији, сa морталитетом од 6-14%. Стопа инциденце показује широку географску варијацију у опсегу од 48 до 160 случајева на 100.000 становника, са већом инциденцом међу особама мушког пола и старијим особама (1).…”

“…Узроци ових крварења су пептички улкуси (31%-67%), ерозије, езофагитиси, тумори, малигнитети, Маllоry-Weiss синдром и нешто ређе (2-8%) ретка стања као што су ангиодисплазије, хемобилија, вазоентеричне фистуле, гастричне антралне васкуларне лезије, Dieulafoy лезије (1 крварења тј. крварења из проширених вена једњака, а знатно ређе желуца.…”

Transcatheter arterial embolisation in upper gastrointestinal bleeding in a sample of 29 patients in a gastrointestinal referral center in Germany

“…During EGD, endoscopic injection treatment of the bleeding source with suprarenin and/or fibrin glue, topical argon-plasma coagulation (APC), or placement of one or more endoclips may be performed [4]. If endoscopic hemostasis is not achieved, many cases require a surgical intervention, which is associated with an increased risk of morbidity and mortality especially in multimorbid high-risk patients [4].…”

“…As a general rule, the primary diagnostic and therapeutic procedure is an esophago-gastro-duodenoscopy (EGD), which should be performed immediately upon diagnosis of suspected acute upper GI bleeding [2,3]. During EGD, endoscopic injection treatment of the bleeding source with suprarenin and/or fibrin glue, topical argon-plasma coagulation (APC), or placement of one or more endoclips may be performed [4]. If endoscopic hemostasis is not achieved, many cases require a surgical intervention, which is associated with an increased risk of morbidity and mortality especially in multimorbid high-risk patients [4].…”