Evaluation of upper GI bleed

Diseases

Summary

Upper gastrointestinal bleeding (UGIB) refers to gastrointestinal blood loss whose origin is proximal to the ligament of Treitz at the duodenojejunal junction. Acute UGIB can manifest in a variety of ways, with or without hemodynamic compromise, including hematemesis, coffee-ground emesis, the return of bright red blood through a nasogastric tube, melena, and, rarely, hematochezia (bright red blood per rectum). Hematochezia is typically only seen with an extremely brisk UGIB; significant hemodynamic compromise is common in these patients.[1] [2]

Causes are multiple, but in developed countries bleeding is usually secondary to peptic ulcer disease (PUD), erosions, esophagitis, or varices.

UGIB results in more than 250,000 hospital admissions annually in the US, with a mortality of up to 11%.[3] [4] Ordinarily, mortality is secondary to hypovolemic shock. Rapid evaluation, hemodynamic resuscitation, and appropriate pharmacologic and endoscopic interventions are the cornerstones of therapy.

Library

Moderate to severe esophagitis with multiple linear, clean-based esophageal ulcers
Large gastric ulcer along the lesser curvature with a visible vessel in the ulcer bed (arrow)
Large gastric ulcer with large, protuberant visible vessel
Grade II esophageal varices in a patient with portal hypertension
Ulcer in the mid-esophagus with a visible vessel
Large gastric ulcer after the endoscopic placement of two mechanical clips to provide hemostasis and prevent rebleeding

Citations

Key Articles

Hwang JH, Fisher DA, Ben-Menachem T, et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc. 2012 Jun;75(6):1132-8.[Abstract][Full Text]
Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805-22.[Abstract][Full Text]
Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2021. Endoscopy. 2021 Mar;53(3):300-32.[Abstract][Full Text]
Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria®: nonvariceal upper gastrointestinal bleeding. 2024 [internet publication].[Full Text]

Other Online Resources

BMJ: management of gastrointestinal bleeding

Referenced Articles

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