Non-variceal upper gastrointestinal bleeding

Abstract

Non-variceal upper gastrointestinal bleeding (NVUGIB) is bleeding that develops in the oesophagus, stomach or proximal duodenum. Peptic ulcers, caused by Helicobacter pylori infection or use of NSAIDs and low-dose aspirin (LDA), are the most common cause. Although the incidence and mortality associated with NVUGIB have been decreasing owing to considerable advances in the prevention and management of NVUGIB over the past 20 years, it remains a common clinical problem with an annual incidence of ∼67 per 100,000 individuals in the United States in 2012. NVUGIB is a medical emergency, and mortality is in the range ∼1-5%. After resuscitation and initial assessment, early (within 24 hours) diagnostic and therapeutic endoscopy together with intragastric pH control with proton pump inhibitors (PPIs) form the basis of treatment. With a growing ageing population treated with antiplatelet and/or anticoagulant medications, the clinical management of NVUGIB is complex as the risk between gastrointestinal bleeding events and adverse cardiovascular events needs to be balanced. The best clinical approach includes identification of risk factors and prevention of bleeding; available strategies include continuous treatment with PPIs or H. pylori eradication in those at increased risk of developing NVUGIB. Treatment with PPIs and/or use of cyclooxygenase-2-selective NSAIDs should be implemented in those patients at risk of NVUGIB who need NSAIDs and/or LDA.

Risk of rebleeding, vascular events and death after gastrointestinal bleeding in anticoagulant and/or antiplatelet users

“…The management of patients who develop a GI bleeding event during AP or AC therapy represents one of the most frequent problems in clinical practice. Today, hospitalisation due to either upper or lower GI bleeding in patients taking these compounds is very common due to increased indications and a growing elderly population worldwide . The dilemma in the medical management of these patients is whether to interrupt AP or AC treatment to better control the bleeding event or maintain treatment to reduce the risk of thrombotic complications.…”

“…The dilemma in the medical management of these patients is whether to interrupt AP or AC treatment to better control the bleeding event or maintain treatment to reduce the risk of thrombotic complications. Furthermore, a bleeding event increases the risk of thrombotic events due to compensatory mechanisms . Based on a risk‐benefit evaluation with data from the UK databases, interruption of aspirin for any reason is associated with a negative outcome since the number of GI bleeding events avoided was far less than the number of thromboembolic events induced .…”

“…Today, hospitalisation due to either upper or lower GI bleeding in patients taking these compounds is very common due to increased indications and a growing elderly population worldwide. 21,22 The dilemma in the medical management of these patients is whether to interrupt AP or AC treatment to better control the bleeding event or maintain treatment to reduce the risk of thrombotic complications. Furthermore, a bleeding event increases the risk of thrombotic events due to compensatory mechanisms.…”

“…Furthermore, a bleeding event increases the risk of thrombotic events due to compensatory mechanisms. 21,23 Based on a risk-benefit evaluation with data from the UK databases, interruption of aspirin for any reason is associated with a negative outcome since the number of GI bleeding events avoided was far less than the number of thromboembolic events induced. 24 In addition, preventing thromboembolic events in CV and cerebrovascular diseases are considered clinically more important than the increased risk of GI bleeding, since GI bleeding is associated with less mortality, morbidity or physical impairment and can be controlled endoscopically or radiologically in most cases.…”

Correlation between the Glasgow-Blatchford score, shock index, and Forrest classification in patients with peptic ulcer bleeding

“…The application value of the GBS in assessing the condition of a patient, need for intervention, and evaluation of the prognosis for patients with upper gastrointestinal bleeding has been confirmed by numerous studies [14][15][16]. The European Society of Gastrointestinal Endoscopy has recommended assessment using the GBS before endoscopy, with low-risk (GBS 0-1) patients not requiring early endoscopy or hospitalization [17].…”