Upper gi bleeding accounts for 7580% of all acute gi bleeding cases 9more common in men and elderly 9incidence. Management of upper gastrointestinal bleeding by an internist. Upper gi bleeding ugib is defined as bleeding derived from a source proximal to the ligament of treitz. Approach to upper gastrointestinal bleeding thomson. The need for prognostic scales to define the course of action regarding the optimal use of. While non variceal bleeding associated with peptic ulcer disease or other causes of ugib. Guideline recommendations from the international consensus group free. Management of acute upper gastrointestinal bleeding. This update of the 2010 international consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding ugib refines previous important statements and presents new clinically relevant recommendations. The role of endoscopy in the management of acute nonvariceal upper gi bleeding this is one of a series of statements discussing the use of gi endoscopy in common clinical situations. Upper gastrointestinal bleeding ugib is a common medical emergency, with a reported mortality of 210%. The role of endoscopy in the management of acute nonvariceal. There has been tremendous advancement in pharmacological and endoscopic.
Evaluate the most recent guidelines for management and prevention of upper gi bleeding. Upper gi barium studies are contraindicated in the setting of acute upper gi bleeding because they will interfere with subsequent endoscopy, angiography, or surgery. Evidencebased recommendations on acute upper gastrointestinal gi bleeding for people over 16. Upper gi bleeding occurs when irritation and ulcers of the lining of the esophagus, stomach, or duodenum result in bleeding. When you experience upper gi bleeding, it means that the bleeding could be happening anywhere from your esophagus to your stomach to the first part of your small intestine, which is called the duodenum. Management of acute upper gastrointestinal bleeding the bmj. Ugib is broadly categorized into variceal and non variceal bleeding. Signs of bleeding in the digestive tract depend where it is and how much bleeding there is. During an upper gi endoscopy, a lower gi endoscopy, a colonoscopy, a flexible sigmoidoscopy, or a laparotomy, a doctor can stop the bleeding in your gi tract. Gastrointestinal gi bleeding refers to any bleeding that starts in the gastrointestinal tract. High concentrations of acid increase the probability of rebleeding due to decreased clot stability and therefore ppis can be used to reduce this risk. Upper gastrointestinal bleeding occurs above the ligament of treitz as a result of duodenal or gastric ulcers, gastric or esophageal varices caused by cirrhosis of the liver, or malloryweiss syndrome.
Management of upper gastrointestinal bleeding annals of. Key pointsacute upper gastrointestinal bleeding has a high mortality rate. Apply an understanding of the pathophysiology and risk factors for upper gastrointestinal gi bleeding to patient care. The upper gi tract includes the esophagus the tube from the mouth to the stomach, stomach, and. The term encompasses mesenchyme tumors of the gi tract, mesentery and. Blood may be observed in vomit or in altered form as black stool. An oesophogastroduodenoscopy found no cause for the bleeding. Timing of endoscopy for acute upper gi bleeding patients with acute upper gastrointestinal bleeding were assigned to receive endoscopy within 6 hours or between 6 and 24 hours after gastroenterolog. Uncommon causes of upper gi bleeding are polyps and abnormal blood vessels. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 7080 gl are recommended. The nonvariceal upper gastrointestinal bleeding is a major cause of morbidity and mortality worldwide. Design plans for the prevention of upper gi bleeding caused by commonly associated risk factors. Acute upper gastrointestinal gi bleeding remains one of the most common encounters in emergency medicine.
The image below depicts an ulcer with active bleeding. Management and prevention of upper gi bleeding accp. Can be categorized as either variceal or nonvariceal. Upper gastrointestinal bleeding acute management geeky. This lecture was recorded at emergency medicine grand rounds at broward health medical center on may 16, 2016. Marshall, md, msc, for the nonvariceal upper gi bleeding consensus conference group background. Upper gi bleeding tasos manokas, md assistant professor of gastroenterology introduction gi bleeding results in over 300,000 hospitalizations annually in u. The treatment for upper gi bleeding depends on its cause, your symptoms, your overall health, and any complications you may have.
In 5 to 10 percent of patients with severe ugib, it may present as hematochezia. Design plans for the prevention of upper gi bleed ing caused by commonly associated risk factors. Aisha subhani, an attending physician at bhmc for over ten years. Upper gi bleeding the incidence of gastrointestinal hemorrhage ranges from 50 to 150 per 100 000 population each year. Diagnosis and management of upper gastrointestinal bleeding. Upper gastrointestinal bleeding ugib is a common medical condition that results in substantial morbidity, mortality, and medical care cost. Bleeding from the upper gi tract is four times as common as from the lower gi tract and is a major cause. Approach to upper gastrointestinal bleeding upper gi bleeding is the most common complication of peptic ulceration and portal hypertension. American college of gastroenterology guideline on the management of helicobacter pylori eradication.
Elderly patients and people with chronic medical diseases withstand acute upper gastrointestinal bleeding less well than younger, fitter patients, and have a higher risk of death. Documents acute upper gastrointestinal bleeding in over. Consensus recommendations for managing patients with. If the bleeding is mild occasional or small amount. Variceal is a complication of end stage liver disease. Upper gi bleeding d p hurlstone a j lobo d p hurlstone is a consultant endoscopist at the royal hallamshire hospital, sheffield, uk. Conditional, moderatequality evidence patients with upper gi bleeding should generally undergo endoscopy within 24 hours of admission, following resuscitative efforts to optimize hemodynamic parameters and other medical problems.
Introduction upper gastrointestinal bleeding ugib is a poten. Management of upper gastrointestinal bleeding annals of internal. If there has been a hematemesis the patient must have gastroduodenoscopy as soon as it can be arranged. Timing of endoscopy for acute upper gastrointestinal bleeding. When this occurs, the child will vomit bright red blood, or dark looking flecks or clots that look like coffee grounds. Upper endoscopy is the best way to determine the cause of the upper gi bleeding and will be recommended if the bleeding has been serious.
Bleeding that requires more than three units of blood in 24 hours usually demands operative. European society of gastrointestinal endoscopy esge guideline authors ian m. Upper gi bleeding emergency surgery course graz, march 14 2017 problem above angle of treitz common emergency 12 pts 10% rebleeed 1% angioembolization 20% over 60 y main cause, peptic ulcer. The goals are to stop the bleeding and to find and treat the cause of the bleeding.
The role of endoscopy in the management of acute non. This article covers the acute management of patients with overt upper gastrointestinal bleeding, abstract. The standards of practice committee of the american society for gastrointestinal endoscopy asge prepared this text. Upper gi bleeding is a major complication of peptic ulcer disease. Upper gastrointestinal bleeding ugib is one of the most common gi medical emergencies, which all gi units deal with everyday. Upper gi bleeding with dr peter lim, gastroenterologist at royal prince alfred hospital case you are a jmo on the ward seeing a 73 year old male admitted with a neck of femur fracture who is now 2 days postrepair. Case 1 65 yo female with known cad, hld, on asa and statin admitted for syncope, has orthostatic hypotension, hemoglobin of 6 and a report of black tarry stools. Upper gastrointestinal bleeding ugib is a common medical emergency, with a reported. Approach to acute upper gastrointestinal bleeding in. Devise a plan to effectively manage acute gi bleeding and optimize treatment responses in the individual patient. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding alan barkun, md, msc. Also remember that patients who take long term aspirin not only have increased risk of ulcer, but that they have a reduced platelet count, so if their ulcer bleeds, they are likely to lose more. Management of upper gastrointestinal bleeding emergencies.
A department of medicine grand rounds presented by loren laine, md, professor of medicine gastroenterology, yale university. The increased use of nonsteroid antiinflammatory drugs by the general population and the increased prescription of antiplatelet agents and anticoagulants after cardiovascular interventions and for prevention of cerebral vascular accidents may have aggravated the situation. Upper gastrointestinal bleeding ugib is defined as bleeding derived from a source proximal to the ligament of treitz. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. Gastrointestinal bleeding upper gi bleeding bleeding above the ampulla of vater mid gi bleeding bleeding from the ampulla of vater to the terminal ileum lower gi bleeding colonic bleeding raju gs, et al. Management of nonvariceal upper gastrointestinal bleeding. This distinction becomes crucial as the management strategies are different for variceal and nonvariceal bleeding. If endoscopy will be delayed or cannot be performed, an iv ppi is recommended to reduce further bleeding.
In this test, a flexible tube with a tiny video camera. In 1983, mazul and clark introduced gastrointestinal stromal tumors gist. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage. Materials and methods out of a total of 1790 patients who presented to the hospital from may 2015 to august 2017 with upper gi bleed, and underwent upper gi endoscopy, data of 1270 patients, aged. An upper gastrointestinal bleed was diagnosed and the patient was managed conservatively with aggressive resuscitation and close monitoring. Almost all people who develop acute upper gastrointestinal bleeding are treated in hospital and the. Your digestive or gastrointestinal gi tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Upper gi bleeding gi bleeding digestive health sharecare. There is also interest in using wireless capsule endoscopy for patients who have presented to the. Upper or lower differential diagnosis next steps and interventions. Management of bleeding duodenal gist michael arvind, narasimman sathiamurthy, tan wee jin department of surgery, hospital pulau pinang, jln residensi, 10990, penang, malaysia. Upper gastrointestinal bleeding ugib is a common medical condition with. Management of acute upper gi bleeding bja education oxford.
Please use one of the following formats to cite this article in your essay, paper or report. Pdf management of acute upper gastrointestinal bleeding. Acute gastrointestinal gi bleeding is a potentially lifethreatening abdominal emergency that remains a common cause of hospitalization. Reported mortality rates range from 11% to 33% for patients admitted primarily due to gi hemorrhage or who developed it as a complication of their hospital stay respectively.
It commonly presents with hematemesis vomiting of blood or coffee groundlike material andor melena black, tarry stools. This entity has an annual incidence of 48 to 160 cases per 100,000 adults, with a mortality. The amount of bleeding can be so small that only a lab test can find it. An 80 year old man presented to the accident and emergency department complaining of black stools, increasing shortness of breath, chest tightness and epigastric pain. Endoscopy done within 424hrs if pt could not be stabilized, an emergency. His research interests include highresolution chromoendoscopy for the detection of early colorectal cancer, in addition to novel endoluminal resection techniques. Assessing upper gastrointestinal bleeding in adults. Causes of bleeding in the upper and lower gastrointestinal. The management of patients with acute nonvariceal upper gastrointestinal bleeding has evolved.
Sanders6, matthew kurien6, gianluca rotondano7, tomas hucl8, mario dinisribeiro9, riccardo marmo10, istvan racz11, alberto arezzo12. Upper gastrointestinal gi bleeding doesnt just happen by itself. Bleeding may come from any site along the gi tract, but is often divided into. The bsg guidelines on the management of variceal bleeding. Treatment of gastrointestinal gi bleeding depends on the cause and location of your bleeding. Nice advises not offering acidsuppression drugs proton pump inhibitors or h 2receptor antagonists before endoscopy to patients with suspected nonvariceal upper gastrointestinal bleeding. Acute upper gastrointestinal gi bleeding, defined as hemorrhage in the gi tract proximal to the ligament of treitz, is a potentially lifethreatening condition requiring accurate, prompt, and appropriate patient evaluation and management. Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Diagnosis and management of nonvariceal upper gastrointestinal.
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