Management of acute upper gastrointestinal bleeding

Abstract

Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.

Endoscopic findings and outcomes of upper gastrointestinal bleeding patients in northern Iran population referred to the emergency department

“…The peptic ulcer disease which has been indicated to be the commonest source of UGIB mainly in the west [5][6][7][8][9] was the main cause in our study, too.…”

What constitutes urgent endoscopy? A social media snapshot of gastroenterologists’ views during the COVID-19 pandemic

“…In some clinical scenarios, the decision to perform or delay a procedure is evident. For example, there is clear consensus that procedures for indications such as suspected variceal bleeding, non-variceal upper gastrointestinal bleeding, acute cholangitis, foreign body removal, and cancer-related care (i. e. tissue acquisition for diagnosis, loco-regional staging, and palliative procedures) are urgent and should continue to be performed [7][8][9]. Similarly, endoscopic evaluations of chronic symptoms such as diarrhea and gastroesophageal reflux disease (GERD), or screening for colorectal cancer in average-risk individuals, are considered non-urgent and should be deferred.…”

Gastritis, Esophagitis and Peptic Ulcer Disease

“…Though a nasogastric tube can be placed to evaluate gastric aspirate for resolution of intragastric bleeding and clearance of clots and particulate, the routine placing of a nasogastric tube for diagnosis or therapeutic effect is not required [18,19].…”