Modern management of acute non-variceal upper gastrointestinal bleeding.
An acute upper gastrointestinal bleed (AUGIB) often represents a life-threatening event and is recognised universally as a common cause of emergency hospitalisation. Large observational studies have improved our understanding of the disease characteristics and its impact on mortality but despite significant advancement in endoscopic management, mortality remains high, particularly in elderly patients and those with multiple comorbidities. Skilled assessment, risk stratification and prompt resuscitation are essential parts of patient care, with endoscopy playing a key role in the definitive management. A successful outcome partly relies on the clinician's familiarity with current guidelines and recommendations, including the National Institute for Clinical Excellence guidelines published in 2012. Validated risk stratification scores, such as the Blatchford and Rockall score, facilitate early discharge of low-risk patients as well as help in identifying those needing early endoscopic intervention. Major advances in therapeutic endoscopy, including more recently, the development of non-toxic proprietary powders (Hemospray and EndoClot), have resulted in the development of effective treatments of bleeding lesions, reduction in rebleeding rates and the need for emergency surgery. The role of proton-pump inhibitor therapy prior to endoscopy and the level of optimum red cell transfusion in the setting of AUGIB remain fields that require further research.
Department of Gastroenterology, Calderdale Royal Hospital, , Halifax, UK.
Vinod S
VS
Hegade
Ruchit
R
Sood
Noor
N
Mohammed
Sulleman
S
Moreea
D000208:Acute Disease; D019468:Disease Management; D004359:Drug Therapy, Combination; D004724:Endoscopy / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery* / Q000628:therapy*; D016480:Helicobacter pylori; D006801:Humans; D009026:Mortality; D010438:Peptic Ulcer Hemorrhage; D054328:Proton Pump Inhibitors; D018570:Risk Assessment / Q000379:methods
D054328:Proton Pump Inhibitors