Recent advances in the management of acute upper gastrointestinal bleeding

2020 ◽  
Vol 18 (6) ◽  
pp. 16-23
Author(s):  
Mikaeil Mirzaali ◽  
Ana Carmona Carrasco ◽  
Pradeep Mundre ◽  
Ruchit Sood
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Emergency ◽  
Red Blood Cell Transfusion ◽  
Endoscopic Management ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Suboptimal Care ◽  
Treatment Considerations ◽  
Rockall Score ◽  
Upper Gastrointestinal

Upper gastrointestinal bleeding is a common medical emergency with associated significant morbidity and mortality. There are multiple published national and international guidelines on the management of acute upper gastrointestinal bleeding (AUGIB). However, the 2015 National Confidential Enquiry into Patient Outcome and Death group (NCEPOD) report identified several areas of concern regarding suboptimal care. This article discusses the latest evidence and guidance on the pre-endoscopic, endoscopic and post-endoscopic management of patients presenting with AUGIB. AUGIB should be assessed for risk stratification using a validated score, such as the Glasgow-Blatchford Score, Rockall Score or AIMS65. Treatment considerations include the optimum threshold for red blood cell transfusion, as well as the reintroduction of antithrombotic agents. Novel endoscopic therapies include haemostatic powder spray, over-the-scope clips, ultrasound doppler probes and self-expandable oesophageal stents.

scholarly journals A Study of Clinical and Endoscopic Profile of Acute Upper Gastrointestinal Bleeding

2015 ◽  
Vol 12 (1) ◽  
pp. 21-25 ◽  
Author(s):  
KR Dewan ◽  
BS Patowary ◽  
S Bhattarai
Keyword(s):  
Gastrointestinal Bleeding ◽  
Scoring System ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Emergency ◽  
Ulcer Disease ◽  
Gastrointestinal Bleed ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleed ◽  
Rockall Score ◽  
Upper Gastrointestinal

Backgroud Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. Higher mortality rate is associated with rebleeding. Rockall scoring system identifies patients at higher risk of rebleed and mortality.Objective To study the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome.Method This is a prospective, descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to January 2013. It included 120 patients at random presenting with manifestations of upper gastrointestinal bleed. Their clinical and endoscopic profiles were studied. Rockall scoring system was used to assess their prognosis.Result Males were predominant (75%). Age ranged from 14 to 88 years, mean being 48.76+17.19. At presentation 86 patients (71.7%) had both hematemesis and malena, 24 patients (20%) had only malena and 10 patients (8.3%) had only hematemesis. Shock was detected in 21.7%, severe anemia and high blood urea were found in 34.2% and 38.3% respectively. Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices (47.5%), peptic ulcer disease (33.3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%). Median hospital stay was 7.28+3.18 days. Comorbidities were present in 43.3%. Eighty six patients (71.7%) had Rockall score < 5 and 34 (28.3%) had >6. Five patients (4.2%) expired. Risk factors for death being massive rebleeeding, comorbidities and Rockall score >6.Conclusion Acute Upper Gastrointestinal bleeding is a medical emergency. Mortality is associated with massive bleeding, comorbidities and Rockall score >6. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.Kathmandu University Medical Journal Vol.12(1) 2014: 21-25

scholarly journals No Benefit of Hemostatic Drugs on Acute Upper Gastrointestinal Bleeding in Cirrhosis

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Yang An ◽  
Zhaohui Bai ◽  
Xiangbo Xu ◽  
Xiaozhong Guo ◽  
Fernando Gomes Romeiro ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Hospital Mortality ◽  
Upper Gastrointestinal Bleeding ◽  
Meld Score ◽  
Drug Group ◽  
Red Blood Cell Transfusion ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Rebleeding Rate ◽  
Cirrhotic Patients ◽  
Upper Gastrointestinal

Background and Aims. Acute upper gastrointestinal bleeding (AUGIB) is one of the most life-threatening emergency conditions. Hemostatic drugs are often prescribed to control AUGIB in clinical practice but have not been recommended by major guidelines and consensus. The aim of this study was to investigate the therapeutic effect of hemostatic drugs on AUGIB in cirrhosis. Methods. All cirrhotic patients with AUGIB who were admitted to our hospital from January 2010 to June 2014 were retrospectively included. Patients were divided into hemostatic drugs and no hemostatic drug groups. A 1 : 1 propensity score matching (PSM) analysis was performed by adjusting age, gender, etiology of liver disease, Child-Pugh score, MELD score, hematemesis, red blood cell transfusion, vasoactive drugs, antibiotics, proton pump inhibitors, and endoscopic variceal therapy. Primary outcomes included 5-day rebleeding and in-hospital mortality. Results. Overall, 982 cirrhotic patients with AUGIB were included (870 in hemostatic drugs group and 112 in no hemostatic drug group). In overall analyses, hemostatic drugs group had a significantly higher 5-day rebleeding rate (18.10% versus 5.40%, P=0.001) than no hemostatic drug group; in-hospital mortality was not significantly different between them (7.10% versus 4.50%, P=0.293). In PSM analyses, 172 patients were included (86 patients in each group). Hemostatic drugs group still had a significantly higher 5-day rebleeding rate (15.10% versus 5.80%, P=0.046); in-hospital mortality remained not significantly different (7.00% versus 3.50%, P=0.304) between them. Statistical results remained in PSM analyses according to the type of hemostatic drugs. Conclusions. The use of hemostatic drugs did not improve the in-hospital outcomes of cirrhotic patients with AUGIB.

Upper Gastrointestinal Bleeding

2017 ◽  
Author(s):  
Chasen A Croft ◽  
Frederick Moore
Keyword(s):  
Intensive Care ◽  
Gastrointestinal Bleeding ◽  
Surgical Intervention ◽  
Upper Gastrointestinal Bleeding ◽  
Hemodynamic Instability ◽  
Therapeutic Modality ◽  
Endoscopic Management ◽  
Angiographic Embolization ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

Acute upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening emergency. Despite significant advances in intensive care resuscitation, medical treatment of gastric acid hypersecretion, and progress in endoscopic and surgical management, mortality from upper gastrointestinal hemorrhage has remained steady over the past four decades. One of the major challenges of managing UGIB involves identifying patients who are at high risk for rebleeding and death and who require admission to the intensive care unit. Regardless of the cause, initial evaluation of patients with UGIB is based on the degree of hemodynamic instability and the presumed rate of bleeding. Those patients with evidence of active bleeding and hemodynamic instability require aggressive resuscitation and hospitalization. Although diagnostic imaging may be useful in identifying the source of bleeding, endoscopy remains the “gold standard” diagnostic and therapeutic modality. Recent advances in transcatheter angiographic embolization have made this modality an attractive alternative to surgical intervention in patients who fail endoscopic management. However, in the hemodynamically unstable patient, surgical intervention is often necessary. In this review, we describe the most common causes of acute UGIB and detail the initial workup and management of each cause.  This review contains 6 figures, 3 tables, and 71 references. Key words: acute upper gastrointestinal bleeding, angiographic embolization, Billroth, Dieulafoy, esophagogastroduodenoscopy, peptic ulcer disease, scintigraphy, varices

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