title: Initial assessment and management of patients with nonvariceal upper gastrointestinal bleeding.
abstract: Upper gastrointestinal bleeding (UGIB) is a substantial clinical and economic burden, with an estimated mortality rate between 3% and 15%. The initial management starts with hemodynamic assessment and resuscitation. Blood transfusions may be needed in patients with low hemoglobin levels or massive bleeding, and patients who are anticoagulated may require administration of fresh frozen plasma. Patients with significant bleeding should be started on a proton-pump inhibitor infusion, and if there is concern for variceal bleeding, an octreotide infusion. Patients with UGIB should be stratified into low-risk and high-risk categories using validated risk scores. The use of these risk scores can aid in separating low-risk patients who are suitable for outpatient management or early discharge following endoscopy from patients who are at increased risk for needing endoscopic intervention, rebleeding, and death. Upper endoscopy after adequate resuscitation is required for most patients and should be performed within 24 hours of presentation. Key to improving outcomes is appropriate initial management of patients presenting with UGIB.
authors.affiliation: *Department of Internal Medicine †Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital ‡Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Emily D
authors.initials: ED
authors.lastname: Bethea
authors.forename: Anne C
authors.initials: AC
authors.lastname: Travis
authors.forename: John R
authors.initials: JR
authors.lastname: Saltzman
mesh_terms: D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D003661:Decision Support Techniques; D016099:Endoscopy, Gastrointestinal; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006454:Hemoglobins / Q000378:metabolism; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015282:Octreotide / Q000008:administration & dosage; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012008:Recurrence; D012151:Resuscitation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005765:Gastrointestinal Agents; D006454:Hemoglobins; D054328:Proton Pump Inhibitors; D015282:Octreotide