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    Diagnosis and management of upper gastrointestinal bleeding.

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    Authors
    Wilkins, Thad
    Khan, Naiman
    Nabh, Akash
    Schade, Robert R.
    Issue Date
    2012-03-01
    URI
    http://hdl.handle.net/10675.2/316423
    
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    Abstract
    Upper gastrointestinal bleeding causes significant morbidity and mortality in the United States, and has been associated with increasing nonsteroidal anti-inflammatory drug use and the high prevalence of Helicobacter pylori infection in patients with peptic ulcer bleeding. Rapid assessment and resuscitation should precede the diagnostic evaluation in unstable patients with severe bleeding. Risk stratification is based on clinical assessment and endoscopic findings. Early upper endoscopy (within 24 hours of presentation) is recommended in most patients because it confirms the diagnosis and allows for targeted endoscopic treatment, including epinephrine injection, thermocoagulation, application of clips, and banding. Endoscopic therapy results in reduced morbidity, hospital stays, risk of recurrent bleeding, and need for surgery. Although administration of proton pump inhibitors does not decrease mortality, risk of rebleeding, or need for surgery, it reduces stigmata of recent hemorrhage and the need for endoscopic therapy. Despite successful endoscopic therapy, rebleeding can occur in 10 to 20 percent of patients; a second attempt at endoscopic therapy is recommended in these patients. Arteriography with embolization or surgery may be needed if there is persistent and severe bleeding.
    Citation
    Diagnosis and management of upper gastrointestinal bleeding. 2012, 85 (5):469-76 Am Fam Physician
    Affiliation
    Department of Family Medicine
    Department of Medicine
    Collections
    Department of Family Medicine: Faculty Research and Presentations
    Department of Medicine Faculty: Research and Presentations
    Department of Medicine Faculty: Research and Presentations

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