title: Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.
abstract: Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy.
authors.affiliation: Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; The Endoscopy Unit of the Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Iyad
authors.initials: I
authors.lastname: Khamaysi
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gralnek
mesh_terms: D000208:Acute Disease; D019468:Disease Management; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D009017:Morbidity; D010437:Peptic Ulcer / Q000150:complications / Q000175:diagnosis; D041742:Upper Gastrointestinal Tract / Q000473:pathology
keywords: Acute upper GI bleeding; Non-variceal upper gastrointestinal bleeding/haemorrhage; Oesophagogastric variceal bleeding; Peptic ulcer bleeding; Risk stratification; Timing of endoscopy in acute upper GI bleeding