Following results of this audit, both sign scottish intercollegiate network guidelines and nice national institute for health and clinical excellence have published guidance on the management of this common and. Assessment and resuscitation all patients with augib should be promptly assessed and triaged for early fluidblood product resuscitation and endoscopy. In this lesson, we will learn about management and treatment for upper gastrointestinal bleeds. Endoscopy is the modality of choice for determining diagnosis, prognosis, and therapy for upper gi bleeding. Severe esophagitis, variceal bleeding, malloryweiss lesion, and bleeding from mucosal lesions of the stomach or duodenum are the causes. Most upper gi bleeds are a direct result of peptic ulcer erosion, stress related mucosal disease, that may evidence as superficial erosive gastric lesion to frank ulcerations, erosive. Common causes of upper gastrointestinal bleeding include malloryweiss tears, bleeding peptic ulcers, oesophageal varices and oesophagitisacute gastritis. The guidelines development group consisted of representatives from the bsg endoscopy committee, the association of coloproctology of great. Diagnosis and management of acute lower gastrointestinal. The role of endoscopy in the management of acute nonvariceal upper gi bleeding this is one of a series of statements discussing the use of gi endoscopy in common clinical situations.
Upper gastrointestinal bleeding causes significant morbidity and mortality in the united states, and has been associated with increasing nonsteroidal antiinflammatory drug use and the high. Upper gi bleeding is a medical emergence with high mortality which can be lowered by proper assessment and management. Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. The best way to diagnose these is with upper gastrointestinal endoscopy. Acute upper gastrointestinal bleeding is a major life threatening medical emergency. Management of upper gastrointestinal bleeding by an. Definition upper gi ugi bleeding is generally defined as bleeding that. Gastrointestinal gi bleeding can be occult or overt. Finally, upper gastrointestinal bleeding ugib is usually observed as black or tarry stools manes 9.
For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 7080 gl are recommended. Acute upper gastrointestinal gi bleeding is common. In an analysis of the 5 studies combining thermal methods with injection 23. Management and prevention of upper gi bleeding accp. Acute gastrointestinal bleeding is a potentially lifethreatening abdominal emergency that remains a common cause of hospitalization. The standards of practice committee of the american society for gastrointestinal endoscopy asge prepared this text. Management of acute bleeding in the upper gastrointestinal. Combining epinephrine injections with human thrombin 600 iu.
For the endoscopic treatment of nonvariceal upper gastrointestinal bleeding, use one of. Management of upper gi bleeding, in particular, underwent a major transition with the advent of proton pump inhibitor therapy. Search terms included upper gi bleeding, nonvariceal, guidelines. Diagnosis and management of upper gastrointestinal bleeding in. Managing acute upper gi bleeding, preventing recurrences. Guidelines for endoscopic management of nonvariceal. This entity has an annual incidence of 48 to 160 cases per 100,000 adults, with a mortality. In 2007, a ukwide gi bleed audit showed an overall mortality of 10% in patients admitted with augib. Upper gastrointestinal bleeding ugib is a common medical condition that results in substantial morbidity, mortality, and medical care cost. The majority of patients with upper gastrointestinal haemorrhage require hospital management. Most available epidemiological data and data on the management of ugb comes from specialized departments intensive care units or gastroenterology departments, but little is known from the ed perspective. Upper gastrointestinal bleeding ugib is a common medical emergency, with a reported. Elderly patients and people with chronic medical diseases withstand acute upper gastrointestinal bleeding less well than younger, fitter patients, and have a higher risk of death.
Introduction patients with acute upper gastrointestinal gi bleeding commonly present with hematemesis vomiting of blood or coffeegroundlike material andor melena black, tarry stools. General practitioners have an important role in assessing and resuscitating patients and then managing them following discharge to reduce the risk of recurrent bleeding. Management of acute upper gastrointestinal bleeding. Upper gastrointestinal bleeding ugib is defined as bleeding derived.
The present chapter will focus on the initial management of patients with acute variceal bleeding, including general management. European society of gastrointestinal endoscopy esge guideline authors ian m. Nonvariceal upper gastrointestinal bleeding remains a common clinical problem globally. Upper gastrointestinal bleeding ugib is defined as a recent and sudden onset of haemorrhage originating from the oropharynx to the ligament of treitz. Management of upper gastrointestinal bleeding request pdf. An upper gastrointestinal bleed is a serious condition and can be life threatening. Diagnosis and management of upper gastrointestinal bleeding. Blood may be observed in vomit or in altered form as black stool. The reported incidence of acute upper gastrointestinal bleeding ugib in the united kingdom varies over the range 84172100 000 year.
Introduction upper gastrointestinal bleeding ugib is a poten. A validated scoring system can help the internist decide about the level of care, timing of endoscopy, and discharge planning. Management of upper gastrointestinal bleeding by an internist. Sanders6, matthew kurien6, gianluca rotondano7, tomas hucl8, mario dinisribeiro9, riccardo marmo10, istvan racz11, alberto arezzo12. Upper gastrointestinal bleeding ugib is defined as bleeding derived from a source proximal to the ligament of treitz. Key clinical pointsacute lower gastrointestinal bleeding colonoscopy should be the initial procedure for most patients presenting with acute lower gastrointestinal bleeding. High concentrations of acid increase the probability of rebleeding due to decreased clot stability and therefore ppis can be used to reduce this risk. The role of endoscopy in the management of acute non. Endoscopy should be performed after the patient has been adequately resuscitated and has achieved a degree of hemodynamic stability, but within 24 hours of presentation. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage. Where possible, metaanalyses were conducted to combine the results of studies. This update of the 2010 international consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding ugib refines previous important statements and presents new clinically relevant recommendations. A recent uk wide audit showed that crude mortality has not significantly changed since the 1950s. The rates of ugib are higher in men and the elderly.
Appropriate management of acute upper gastrointestinal bleeding and reduced risk of death acute upper gastrointestinal bleeding is a major life threatening medical emergency. This guideline covers how upper gastrointestinal bleeding can be effectively managed in adults and young people aged 16 years and older. Management of acute upper gastrointestinal bleeding the bmj. Before starting any longterm antiplatelet therapy, patients with a history of ulcers should be tested and treated for h pylori table 4. Acute upper gastrointestinal bleeding the upper gastrointestinal tract is made up of the gullet oesophagus, stomach and the first part of the small intestine known as the duodenum. In 5 to 10 percent of patients with severe ugib, it may present as hematochezia. Further management of upper gastrointestinal bleeding. It is also important during the anamnesis process to attend to the age of the patient, presence of coagulopathy, disease or cardiovascular risk factors, use of nonsteroidal antiinflamma.
However, modern management based upon endoscopic diagnosis and therapy has the potential to stop active bleeding, prevent further bleeding and save lives. Sign guideline on the management of acute upper and lower gi bleeding. Almost all people who develop acute upper gastrointestinal bleeding are treated in hospital and the. The management of patients with acute nonvariceal upper gastrointestinal. Endoscopic advances in the management of nonvariceal upper. Overview acute upper gastrointestinal bleeding in over.
Upper gastrointestinal bleeding acute management geeky. Management of upper gastrointestinal bleeding annals of. American college of gastroenterology guideline on the management of. Upper gastrointestinal hemorrhagediagnosis and management. The basic management is similar for all patients with upper gastrointestinal ugi bleeding regardless of the cause or whether chronic liver disease is present or absent. Upper gastrointestinal bleeding nursing management rnpedia. Reference sign national clinical guideline on management of acute upper and lower gastrointestinal bleeding sign 2008 sep. An international multidisciplinary group of experts developed the recommendations. The current management of a patient with upper gastrointestinal hemorrhage involves three steps. Design plans for the prevention of upper gi bleed ing caused by commonly associated risk factors. This entity has an annual incidence of 48 to 160 cases per 100,000 adults 24, with a mortality rate of 10% to 14% 5. Management of gastrointestinal bleeding clinical gate. Acute upper gastrointestinal bleeding augib is a major medical emergency. Nice advises not offering acidsuppression drugs proton pump inhibitors or h 2receptor antagonists before endoscopy to patients with suspected nonvariceal upper gastrointestinal bleeding.
The management of acute upper gastrointestinal bleeding. Some suggest that for patients with a history of bleeding ulcer who need aspirin, eradication of h pylori substantially reduces the risk of recurrent. Management of acute upper gi bleeding bja education. Upper gastrointestinal bleeding ugib is a common medical emergency, with a reported mortality of 210%. This article covers the acute management of patients with overt upper gastrointestinal bleeding, abstract. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. It aims to identify which diagnostic and therapeutic steps are useful so hospitals can develop a structure in which clinical teams can deliver an optimum service for people who develop this condition. Upper gastrointestinal bleeding is characterized by the sudden onset of bleeding from the gi tract at a site or sites proximal to the ligament of treitz. Pdf management of acute upper gastrointestinal bleeding. Upper gastrointestinal bleeding ugb is common in emergency departments eds and can be caused by many esogastroduodenal lesions.
Gastrointestinal bleeding is a common medical problem that is managed by clinicians in a variety of medical specialties. Upper gastrointestinal bleeding ugib is the loss of blood through the gastrointestinal tract whose origin proximal to the treitz angle 1. Consensus recommendations for managing patients with. Can be categorized as either variceal or nonvariceal. Management of upper gastrointestinal bleeding in emergency. Initial clinical assessment is directed towards the. Diagnosis and management of nonvariceal upper gastrointestinal. In clinical practice, identification of lower versus ugib can be difficult. The management of acute upper gastrointestinal bleeding 29 june, 2004 gastrointestinal haemorrhage may be associated with an underlying disease state or trauma, or it may arise as a rare complication of investigative procedures such as diagnostic endoscopy. This is the first uk national guideline to concentrate on acute lower gastrointestinal bleeding lgib and has been commissioned by the clinical services and standards committee of the british society of gastroenterology bsg. It commonly presents with hematemesis vomiting of blood or coffee groundlike material andor melena black, tarry stools. The symptoms of upper gastrointestinal bleeding include vomiting blood. Upper gastrointestinal bleeding is rare in children.
Nonvariceal upper gastrointestinal bleeding ugib carries high morbidity and mortality, which can be lowered by timely evaluation and management. Devise a plan to effectively manage acute gi bleeding and optimize treatment responses in the individual patient. Upper gastrointestinal bleeding cause and management. The initial evaluation of patients with acute upper gi bleeding involves an assessment of hemodynamic stability and resuscitation if necessary. Ugib refers to bleeding from any point proximal to the duodenojejunal flexure.