Management of Upper Gastrointestinal Bleeding by an Internist

Abstract

Nonvariceal upper gastrointestinal bleeding (UGIB) carries high morbidity and mortality, which can be lowered by timely evaluation and management. This article presents a comprehensive literature review and current guidelines for the management of nonvariceal UGIB by an internist. Pre-endoscopic management includes optimal resuscitation, and making a decision about holding the anticoagulation and antiplatelet therapy versus continuation due to risk of thrombosis. Proton pump inhibitors (PPIs) are beneficial for both ulcer and nonulcer diseases as they reduce the risk of re-bleeding by clot stabilization. Endoscopy should only be performed after hemodynamic stability has been achieved and should not be delayed by more than 24 hours. Resumption of anticoagulation and antiplatelet therapy is based on endoscopic findings and thromboembolic risk. The patient should be discharged on PPIs and should be followed up by a primary care physician.

Findings of Esophagogastroduodenoscopy in Patients Suspected of Upper Gastrointestinal Bleeding Referred to the Main Endoscopy Unit at King Fahad Specialist Hospital

“…It is a life-threatening event commonly encountered in the emergency and hospital setting [ 1 ]. Mortality varies (6-14%), and it depends on the degree of initial blood loss, the rate of rebleeding after endoscopy, the underlying disease and the patient's age [ 2 ].…”

Dieulafoy's lesion: A challenging diagnosis

“…Proton pump inhibitors are also used to decrease gastric acidity. 9 Causative and definite treatment includes endoscopic techniques, such as argon plasma electrocoagulation, photocoagulation or current that result in blood clotting, or the placement of bands (banding) or clips (clipping) to close off the abnormal vessel. 10 Angiography may also be used as a second-line treatment when endoscopy is unsuccessful and can stop the bleeding through embolization.…”

An Early Description of Hematemesis in Persian Medicine

“…The upper gastrointestinal bleeding (UGIB) is one of the most important and common types of urgent GI manifestations, with high morbidity and mortality rates during hospitalization, which also imposes significant costs to the health system ( 2 ). Of course, this complication can be reduced significantly with timely diagnosis and appropriate treatment, although mortality rate still remains high, despite clinical progress ( 2 ).…”

“…The upper gastrointestinal bleeding (UGIB) is one of the most important and common types of urgent GI manifestations, with high morbidity and mortality rates during hospitalization, which also imposes significant costs to the health system ( 2 ). Of course, this complication can be reduced significantly with timely diagnosis and appropriate treatment, although mortality rate still remains high, despite clinical progress ( 2 ). UGIB is described as an acute or chronic bleeding anywhere from the beginning of the esophagus to the end of the narrow intestine at the proximity of ligament of Treitz, which includes the esophagus, stomach, and duodenum ( 2 , 3 ).…”