Trends in upper gastrointestinal bleeding management

Abstract

Upper gastrointestinal bleeding (UGIB) can be attributed to either non-variceal or variceal causes. The latter is more aggressive with hemodynamic instability secondary to decompensated cirrhosis and portal hypertension. Non-variceal UGIB (NVUGIB) occurs due to impaired gastroprotective mechanisms attributed to several drugs such as anticoagulants and nonsteroidal anti-inflammatory drugs. Helicobacter pylori infection contributes to the development of peptic ulcer bleeding as well. NVUGIB presentation can be either hemodynamically stable or unstable. During the initial assessment a scoring system including patient-related factors (current cardiac, renal, and liver diseases and hemodynamic and laboratory parameters) is used to determine the patient’s prognosis. The Glasgow Blatchford score has been shown to be the most useful and precise. Those with high-risk NVUGIB require urgent assessment and upper endoscopy to achieve better short-term and long-term outcomes such as less hospitalization, blood transfusion, and surgery.

Keywords: Gastric; Peptic; Non-steroidal anti-inflammatory drugs; Anticoagulants; Melena

Core Tip: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a medical emergency that requires assessment of patient factors, hemodynamic parameters, and laboratory work to determine the patient’s prognosis and treatment. Patients with low-risk NVUGIB are typically discharged quickly, while patients with high-risk NVUGIB may require administration of volume replacement, blood transfusion, and high-dose intravenous proton pump inhibitors. These high-risk patients also require urgent upper endoscopy. Evaluation of the need for anticoagulant and analgesics after discharge is also needed.