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Non-variceal Upper Gastrointestinal Bleeding and Its Endoscopic Management.
Reid D Wasserman1, William Abel1, Klaus Monkemuller2
1Department of Internal Medicine, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States.
Summary
Urgent resuscitation and endoscopic intervention within 24 hours are crucial for upper gastrointestinal bleeding (UGIB). Prompt treatment with IV PPIs and endoscopic therapies like injection, thermal, or mechanical methods improve outcomes for non-variceal bleeding.
Area of Science:
- Gastroenterology
- Internal Medicine
- Emergency Medicine
Background:
- Upper gastrointestinal bleeding (UGIB) is a significant cause of patient morbidity and mortality.
- Symptoms include hematemesis, melena, and hematochezia, with signs ranging from tachycardia to shock.
- The ligament of Treitz anatomically distinguishes upper from lower GI bleeds.
Purpose of the Study:
- To review the triage and initial resuscitation steps for UGIB.
- To discuss the causes and management strategies for UGIB.
- To evaluate endoscopic techniques and their effectiveness, focusing on non-variceal bleeding.
Main Methods:
- Review of current literature on UGIB management.
- Discussion of resuscitation protocols including fluids and blood products.
- Analysis of endoscopic interventions: injection, thermal, and mechanical therapies.
Main Results:
- Initial management involves resuscitation and consideration of urgent endoscopy (ideally within 24 hours).
- Intravenous proton pump inhibitors (PPIs) are key for non-variceal UGIB to reduce high-risk stigmata.
- Pro-kinetic agents may aid diagnosis; endoscopic techniques can be combined for hemostasis.
Conclusions:
- Timely resuscitation and endoscopic intervention are critical for managing UGIB.
- Effective endoscopic management strategies, particularly for non-variceal bleeding, are essential.
- This review provides a focused overview of UGIB triage, resuscitation, and endoscopic treatment options.
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