PMID- 21654147
OWN - NLM
STAT- MEDLINE
DCOM- 20120105
LR  - 20151221
IS  - 0972-2823 (Electronic)
IS  - 0022-3859 (Linking)
VI  - 57
IP  - 2
DP  - 2011 Apr-Jun
TI  - Management of nonvariceal upper gastrointestinal bleeding.
PG  - 161-7
LID - 10.4103/0022-3859.81868 [doi]
AB  - Nonvariceal upper gastrointestinal bleeding is unique from variceal bleeding in 
      terms of patient characteristics, management, rebleeding rates, and prognosis, 
      and should be managed differently. The majority of nonvariceal upper 
      gastrointestinal bleeds will not rebleed once treated successfully. The incidence 
      is 80 to 90% of all upper gastrointestinal bleeds and the mortality is between 5 
      to 10%. The causes include nonacid-related ulceration from tumors, infections, 
      inflammatory disease, Mallory-Weiss tears, erosions, esophagitis, dieulafoy 
      lesions, angiodysplasias, gastric antral vascular ectasia, and portal 
      hypertensive gastropathy. Rarer causes include hemobilia, hemosuccus 
      pancreaticus, and aortoenteric fistulas. Hematemesis and melena are the key 
      features of bleeding from the upper gastrointestinal tract, but fresh per rectal 
      bleeding may be present in a rapidly bleeding lesion. Resuscitation and 
      stabilization before endoscopy leads to improved outcomes. Fluid resuscitation is 
      essential to avoid hypotension. Though widely practiced, there is currently 
      insufficient evidence to show that routine red cell transfusion is beneficial. 
      Coagulopathy requires correction, but the optimal international normalized ratio 
      has not been determined yet. Risk stratification scores such as the Rockall and 
      Glasgow-Blatchford scores are useful to predict rebleeding, mortality, and to 
      determine the urgency of endoscopy. Evidence suggests that high-dose proton pump 
      inhibitors (PPI) should be given as an infusion before endoscopy. If patients are 
      intolerant of PPIs, histamine-2 receptor antagonists can be given, although their 
      acid suppression is inferior. Endoscopic therapy includes thermal methods such as 
      coaptive coagulation, argon plasma coagulation, and hemostatic clips. Four 
      quadrant epinephrine injections combined with either thermal therapy or clipping 
      reduces mortality. In hypoxic patients, endoscopy masks allow high-flow oxygen 
      during upper gastrointestinal endoscopy. The risk of rebleeding reduces after 72 
      hours. In rebleeding, repeat endoscopy is useful and persistent failure of 
      endoscopic therapy mandates either embolization or surgery. In this review, we 
      analyze the management of nonvariceal upper gastrointestinal bleeding with 
      evidence from the currently published clinical trials.
FAU - Wee, E
AU  - Wee E
AD  - Gastroenterology, Department of General Medicine, Khoo Teck Puat Hospital, 
      Singapore. wee.eric.wl@alexandrahealth.com.sg
LA  - eng
PT  - Journal Article
PT  - Review
PL  - India
TA  - J Postgrad Med
JT  - Journal of postgraduate medicine
JID - 2985196R
SB  - IM
MH  - Esophageal Diseases/diagnosis/*therapy
MH  - Gastrointestinal Hemorrhage/diagnosis/etiology/*therapy
MH  - Humans
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Stomach Diseases/diagnosis/*therapy
EDAT- 2011/06/10 06:00
MHDA- 2012/01/06 06:00
CRDT- 2011/06/10 06:00
PHST- 2011/06/10 06:00 [entrez]
PHST- 2011/06/10 06:00 [pubmed]
PHST- 2012/01/06 06:00 [medline]
AID - jpgm_2011_57_2_161_81868 [pii]
AID - 10.4103/0022-3859.81868 [doi]
PST - ppublish
SO  - J Postgrad Med. 2011 Apr-Jun;57(2):161-7. doi: 10.4103/0022-3859.81868.