Management of acute upper gastrointestinal bleeding

Abstract

summarizing evidence for risk assessment, resuscitation, blood transfusion, medical and endoscopic therapy, and early post-endoscopic management. We will not review interventions for long term secondary prevention of bleeding, such as testing for and treating Helicobacter pylori infection, use of non-steroidal anti-inflammatory drugs (NSAIDs), or maintenance antisecretory therapy. Upper gastrointestinal bleeding is managed by many clinicians across many specialties, including emergency room physicians, hospitalists, internists, gastroenterologists, surgeons, interventional radiologists, and hematologists. A variety of topics-including risk assessment, the threshold for blood transfusion, the timing of endoscopy, and medical and endoscopic therapies-have continued to evolve in recent years. In addition, it has become increasingly important and complex to determine the appropriate management of patients who need antithrombotic agents, with gastroenterological, cardiovascular, and hematological aspects needing to be considered. This article provides a comprehensive and evidence based summary of the assessment and management of patients with acute upper gastrointestinal bleeding, which is relevant to clinician specialists, academics, and clinical researchers. A summary of management is provided in the box.