Upper Gastrointestinal Bleeding in Adults: Evaluation and Management.

Area of Science:

• Gastroenterology
• Internal Medicine
• Emergency Medicine

Background:

• Upper gastrointestinal (GI) bleeding is a significant medical emergency.
• Risk factors include prior bleeding, anticoagulants, NSAIDs, and advanced age.
• Common causes are peptic ulcers, gastritis, and varices.

Purpose of the Study:

• To outline the definition, risk factors, and causes of upper GI bleeding.
• To describe diagnostic approaches and initial management strategies.
• To discuss therapeutic interventions including endoscopy and pharmacotherapy.

Main Methods:

• Clinical assessment of hemodynamic stability and symptoms.
• Laboratory investigations including CBC, metabolic panel, and coagulation studies.
• Risk stratification using clinical prediction guides like the Glasgow-Blatchford score.

Main Results:

• Urgent endoscopy within 24 hours is recommended for unstable patients.
• Fluid resuscitation and blood transfusion are critical for hypovolemia.
• High-dose proton pump inhibitors are recommended for 72 hours post-endoscopy.

Conclusions:

• Effective management involves prompt diagnosis, risk stratification, and timely intervention.
• Endoscopic hemostasis, embolization, or surgery are treatment options.
• Restarting antithrombotic therapy requires careful consideration due to insufficient evidence.