Clin Endosc.  2012 Sep;45(3):220-223.

Management of Non-Variceal Upper Gastrointestinal Bleeding

• Kim SY
• Hyun JJ
• Jung SW
• Lee SW

Abstract

Upper gastrointestinal bleeding (UGIB) is a critical condition that demands a quick and effective medical management. Non-variceal UGIB, especially peptic ulcer bleeding is the most significant cause. Appropriate assessment and treatment have a major influence on the prognosis of patients with UGIB. Initial fluids resuscitation and/or transfusion of red blood cells are necessary in patients with clinical evidence of intravascular volume depletion. Endoscopy is essential for diagnosis and treatment of UGIB, and should be provided within 24 hours after presentation of UGIB. Pre-endoscopic use of intravenous proton pump inhibitor (PPI) can downstage endoscopic signs of hemorrhage. Post-endoscopic use of high-dose intravenous PPI can reduce the risk of rebleeding and further interventions such as repeated endoscopy and surgery. Eradication of Helicobacter pylori and withdrawal of non-steroidal anti-inflammatory drugs are recommended to prevent recurrent bleeding.

Keyword

Gastrointestinal hemorrhage; Peptic ulcer hemorrhage; Gastrointestinal endoscopy; Disease management

MeSH Terms

Disease Management
Endoscopy
Endoscopy, Gastrointestinal
Erythrocytes
Gastrointestinal Hemorrhage
Helicobacter pylori
Hemorrhage
Humans
Peptic Ulcer
Peptic Ulcer Hemorrhage
Prognosis
Proton Pumps
Resuscitation
Proton Pumps

Figure

• 

  Fig. 1 Forrest classification can be summarized as grade: (Aa) Arterial hemorrhage ("spurting"). (Ab) Diffuse hemorrhage ("oozing"). (Ba) Non-bleeding visible vessel. (Bb) Adherent clot. (Bc) Flat pigmented spot. (C) Ulcer without recent stigmata of bleeding ("clean base").

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