Rare causes of acute non-variceal upper gastrointestinal bleeding: A comprehensive review

Abstract

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastroenterological emergency associated with significant morbidity and mortality. Gastroenterologists and other involved clinicians are generally assisted by international guidelines in its management. However, NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines, with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and treatment. Conversely, the management of rare and extraordinary rare causes of NVUGIB is not covered by current guidelines. Given they are frequently life-threatening conditions, all the involved clinicians, that is emergency physicians, diagnostic and interventional radiologists, surgeons, in addition obviously to gastroenterologists, should be aware of and familiar with their management. Indeed, they typically require a prompt diagnosis and treatment, engaging a dedicated, patient-tailored, multidisciplinary team approach. The aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.

Keywords: Gastrointestinal bleeding; Upper gastrointestinal bleeding; Non-variceal upper gastrointestinal bleeding; Rare causes; Vascular causes; Upper endoscopy

Core Tip: Rare and extraordinary rare causes of non-variceal upper gastrointestinal bleeding (NVUGIB) are commonly life-threatening conditions. Thus, a prompt diagnosis and a subsequent equally early treatment are required, typically involving a patient-tailored, multidisciplinary team approach. However, given the rare occurrence, their management is not covered by NVUGIB current guidelines. Our study aimed to review the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.