Non-variceal upper gastrointestinal bleeding: advances and future directions in management
Waku Hatta1, Yohei Ogata1, Takashi Chiba2
1Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Clinical Endoscopy
|December 18, 2025
Summary
This review highlights current best practices for non-variceal upper gastrointestinal bleeding (NVUGIB) management, emphasizing personalized care. Key strategies include risk assessment, restrictive transfusion, endoscopic treatment, and selective use of transcatheter arterial embolization (TAE) for refractory cases.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Management
Background:
- Numerous clinical guidelines exist for non-variceal upper gastrointestinal bleeding (NVUGIB), but recommendations vary significantly.
- Effective management of NVUGIB requires a structured approach across multiple stages of care.
Purpose of the Study:
- To review and synthesize the latest evidence for managing NVUGIB.
- To provide a comprehensive overview of NVUGIB treatment strategies, from initial assessment to refractory bleeding management.
Main Methods:
- Systematic review of recent evidence on NVUGIB management.
- Structured summary across pre-endoscopic, endoscopic, post-endoscopic, and refractory bleeding phases.
Main Results:
- Pre-endoscopic: Risk scores aid mortality prediction; restrictive transfusion (7-8 g/dL) and IV erythromycin are recommended.
- Endoscopic: Various hemostasis techniques are available; transcatheter arterial embolization (TAE) is preferred over surgery for failed endoscopy.
- Post-endoscopic: High-dose acid suppression is crucial; repeat endoscopy is first-line for rebleeding, though optimal TAE timing is debated.
Conclusions:
- NVUGIB management should be individualized due to diverse clinical presentations.
- Further research is necessary to develop evidence-based, personalized treatment strategies for NVUGIB.
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