Pdf management of acute upper gastrointestinal bleeding. The rates of ugib are higher in men and the elderly. Upper gastrointestinal bleeding ugib is defined as bleeding derived from a source proximal to the ligament of treitz. Approach to upper gastrointestinal bleeding upper gi bleeding is the most common complication of peptic ulceration and portal hypertension. 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. Upper gastrointestinal bleeding causes significant morbidity and mortality in the united states, and has been associated with increasing nonsteroidal antiinflammatory drug use and the high prevalence of helicobacter pylori infection in patients with peptic ulcer bleeding. Upper gastrointestinal bleeding in oncological patients. Oct 16, 2017 upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum.
Acute upper gastrointestinal bleeding the upper gastrointestinal tract is made up of the gullet oesophagus, stomach and the first part of the small intestine known as the duodenum. The majority of patients with upper gastrointestinal haemorrhage require hospital management. Upper gastrointestinal bleeding nursing management rnpedia. Most upper gi bleeds are a direct result of peptic ulcer erosion, stress related mucosal disease, that may evidence as superficial erosive gastric lesion to frank ulcerations, erosive gastritis secondary to use or abuse of. Management of acute bleeding in the upper gastrointestinal tract. The incidence of upper gastrointestinal bleeding is approximately 50 per 100 000 persons per year. Lower gastrointestinal bleeding lgib is the loss of blood through the gastrointestinal tract whose origin is below the treitz angle 1. The annual incidence is estimated to be between 20 and 27 cases per 100,000 popula. Gastrointestinal bleeding d millar md facs university of cincinnati trauma and emergency surgery. The role of endoscopy in the management of acute nonvariceal.
Acute upper gastrointestinal bleeding overview nice pathways acute upper gastrointestinal bleeding. Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. Bleeding that requires more than three units of blood in 24 hours usually demands operative measures. Feb 01, 2008 deep, bleeding tears of the mucosa at the gastroesophageal junction are found in 5% to 10% of all patients with upper gastrointestinal bleeding. The surgical management of acute upper gastrointestinal. Sources of gi bleeding upper gitract proximal to the ligament oftreitz 80% of acute gi bleeds lower gitract distal to the ligament oftreitz 20% of acute gi bleeds 3. Gastroesophageal variceal hemorrhage is a major complication of portal hypertension from cirrhosis and accounts for 5% to 15% of all cases of bleeding from the upper gi tract. It has an incidence of 103170 per 100,000 population each year,1, 2 with a reported mortality of 711% in patients admitted to hospital and 2633% in those developing bleeding whilst an inpatient for other reasons.
Few centers combine the use of detachable microcoils with an injection of. The symptoms of upper gastrointestinal bleeding include vomiting blood. Nov 29, 2017 upper gi bleeding the incidence of gastrointestinal hemorrhage ranges from 50 to 150 per 100 000 population each year. Benefitsharms of implementing the guideline recommendations. Approach to management of upper gastrointestinal gi bleeding. Endoscopic advances in the management of nonvariceal. Depending on the amount of the blood loss, symptoms may include shock upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions.
Key clinical pointsacute lower gastrointestinal bleeding colonoscopy should be the initial procedure for most patients presenting with acute lower gastrointestinal bleeding. General practitioners have an important role in assessing and resuscitating patients and then managing them following discharge to reduce the risk of recurrent bleeding. Outcome and treatment are dependent upon the presence or absence of liver disease. In this lesson, we will learn about management and treatment for upper gastrointestinal bleeds. We do not believe there is enough data to provide definitive guidelines to. American college of cardiology american heart association task force on practice guidelines. Almost all people who develop acute upper gastrointestinal bleeding are treated in hospital and the. Upper gi bleeding the incidence of gastrointestinal hemorrhage ranges from 50 to 150 per 100 000 population each year.
Nonvariceal upper gastrointestinal bleeding remains a common clinical. Approach to upper gastrointestinal bleeding thomson. Acute upper gastrointestinal bleeding augib is one of the commonest emergency admissions to gastroenterologists. Sanders6, matthew kurien6, gianluca rotondano7, tomas hucl8, mario dinisribeiro9, riccardo marmo10, istvan racz11, alberto arezzo12. Approach to acute upper gastrointestinal bleeding in adults. Common causes of upper gastrointestinal bleeding include malloryweiss tears, bleeding peptic ulcers, oesophageal varices and oesophagitisacute gastritis.
This entity represents approximately 20% of all cases of gastrointestinal gi bleeds 2. Its clinical presentations are hematemesis, melena stool, or even fresh bleeding per rectum. Alberti lr, santos rs, castro afd, fonseca apdfp, key e, et al 2016 upper gastrointestinal bleeding in oncological patients. Aug 12, 2019 acute gastrointestinal bleeding is a potentially lifethreatening abdominal emergency that remains a common cause of hospitalization. The source of upper gi bleeding can be anywhere proximal to the ligament of treitz. Upper gastrointestinal endoscopy should be performed if the results of nasogastric aspiration shows evidence of upper gastrointestinal bleeding, or is negative for blood and bile. It commonly presents with hematemesis vomiting of blood or coffee groundlike material andor melena black, tarry stools. The main sources of bleeding are peptic ulcers, esophagitis, druginduced mucosal damage, sequelae of portal hypertension esophageal varices, varices of the gastric fundus, portal hypertensive gastropathy. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage. Nonvariceal upper gastrointestinal bleeding ugib carries high morbidity and mortality, which can be lowered by timely evaluation and management. Upper gastrointestinal bleeding is a potentially fatal condition at times due to loss of large volumes of blood. An upper gastrointestinal bleed is a serious condition and can be life threatening.
However, current guidelines recommend the use of risk stratification. Upper gastrointestinal bleeding cause and management. Depending on the amount of the blood loss, symptoms may include shock. Cureus management of upper gastrointestinal bleeding by an. Management of acute bleeding in the upper gastrointestinal. The most important causes are peptic ulcer and oesophagogastric varices. 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. Upper gastrointestinal gi bleeding is defined as bleeding proximal to ligament of treitz.
Where possible, metaanalyses were conducted to combine the results of. Management of nonvariceal upper gastrointestinal bleeding wee e. Upper gastrointestinal bleeding ugib is a common medical condition that results in substantial morbidity, mortality, and medical care cost. The most important nonvariceal cause is peptic ulcer. Appropriate management of acute upper gastrointestinal bleeding and reduced. 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 secondary to ulcer disease is common and results in substantial patient morbidity and medical expense.
All patients with significant upper gastrointestinal bleeding should be started on intravenous proton pump inhibitor therapy until the cause of bleeding has been confirmed with endoscopy. Schistosomiasis is a parasitic illness originating from africa and is uncommon in the united kingdom uk. Upper gastrointestinal ugi bleeding is a common, potentially life threatening condition, resulting in 300,000 hospital admissions and 30,000 deaths annually in the united states. Management of acute upper gastrointestinal bleeding. Hence, it is recommended to combine epinephrine injection therapy. Nonvariceal upper gastrointestinal bleeding is unique from variceal. June 2012 nice clinical guideline 141 guidanceukcg141 nhs evidence has accredited the process used by the centre for clinical practice at nice to produce guidelines. Alcoholic persons are predisposed to malloryweiss tears. Almost all people who develop acute upper gastrointestinal bleeding are treated in hospital and the guideline therefore focuses on hospital care. Patients with hematochezia most frequently bleed from a colonic source. Endoscopic advances in the management of nonvariceal upper. Introduction upper gastrointestinal bleeding ugib is a poten. Patients bleeding from upper gastrointestinal gi varices due to schistosomiasis were excluded since the cause of bleeding compared to those patients bleeding due to cirrhosis of the liver.
Practice guidelines management of the adult patient with. 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. Patients with acute upper gastrointestinal gi bleeding commonly present. Nonvariceal upper gastrointestinal bleeding remains a common clinical problem. The standards of practice committee of the american society for gastrointestinal endoscopy asge prepared this text.
The annual incidence of upper gastrointestinal bleeding ugib is 48 to 160 events per 100,000 adults in the united states, where it is the cause of approximately 300,000 hospital admissions per year. For the endoscopic treatment of nonvariceal upper gastrointestinal bleeding, use one of the following. Blood may be observed in vomit hematemesis or in altered form in the stool melena. Endoscopic management is classified as injection, thermal, and mechanical methods. European society of gastrointestinal endoscopy esge guideline. Diagnosis and management of upper gastrointestinal bleeding. Upper gastrointestinal gi haemorrhage is a common cause for admission to hospital and is associated with a mortality of around 10%. Recent advances in endovascular techniques for management of. Prompt assessment and resuscitation are vital, as are risk stratification of the severity of bleeding, early involvement of the multidisciplinary team and timely access to endoscopy, preferably within 24 h. The mortality of this condition is between 5% and 11%. Pdf upper gastrointestinal bleeding ugib is a common medical emergency, with a reported mortality of 210%. Case 1 65 yo female with known cad, hld, on asa and statin admitted for syncope, has orthostatic hypotension, hemoglobin of.
Common sources of upper gastrointestinal bleeding in children include mucosal lesions and variceal hemorrhage most commonly extra hepatic portal venous obstruction and, in intensive care settings infections and drugs are other etiological factors associated with bleeding. The symptoms of upper gastrointestinal bleeding include vomiting blood or passing dark, sticky stools that contain blood. 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. I calculate both of these scores as part of my initial assessment and combine the results. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the united kingdom. The majority of bleeds are due to peptic ulcers for. Acute gastrointestinal bleeding is an important medical emergency. Almost all people who develop acute upper gastrointestinal bleeding are treated in hospital and this interactive flowchart therefore focuses on hospital care. This entity has an annual incidence of 48 to 160 cases per 100,000 adults 24, with a mortality rate of 10% to 14% 5. Accreditation is valid for 5 years from september 2009 and applies to guidelines. Upper gastrointestinal bleeding an overview sciencedirect.
European society of gastrointestinal endoscopy esge guideline authors ian m. Clinicalmanagement of acute upper gastrointestinal bleeding. Management of upper gastrointestinal bleeding springerlink. Preendoscopic management includes optimal resuscitation, and making a decision about holding the anticoagulation. Society for gastrointestinal endoscopy, a 2012 guideline issued by the. Upper gastrointestinal bleeding is characterized by the sudden onset of bleeding from the gi tract at a site or sites proximal to the ligament of treitz.
The care of patients with upper gi bleeding has recently changed. Blood may be observed in vomit or in altered form as black stool. Prognosis is dependent upon the severity of bleeding, endoscopic findings and the presence of medical comorbidity. In 5 to 10 percent of patients with severe ugib, it may present as hematochezia. Upper gastrointestinal bleeding ugib is the loss of blood through the gastrointestinal tract whose origin proximal to the treitz angle 1. Mar 01, 2012 upper gastrointestinal bleeding causes significant morbidity and mortality in the united states, and has been associated with increasing nonsteroidal antiinflammatory drug use and the high. The causes of upper gi bleeding, the endoscopic management of acute. Usually, tearing of this type is precipitated by vomiting or coughing fits.
After initial resuscitation to stabilize the patient, carefully performed endoscopy provides an accurate diagnosis and identifies highrisk ulcer patients who are likely to rebleed with medical therapy alone and will benefit most from endoscopic hemostasis. Management of gastrointestinal bleeding clinical gate. The role of endoscopy in the management of acute non. Cureus management of upper gastrointestinal bleeding by. Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Endoscopy is undertaken only after resuscitation is optimized and is done to. Design plans for the prevention of upper gi bleed ing caused by commonly associated risk factors. Superficial veins in this anatomic region lack support from surrounding tissues figure 231. Steering committee and members of the national audit of acute upper gastrointestinal haemorrhage. Note that bleeding from the nose, oropharynx, mouth, or lungs can present with symptoms suggestive of upper gi bleeding e. Upper gastrointestinal bleeding ugib is defined as originating in the distal esophagus.
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