Upper gastrointestinal bleeding (UGIB) refers to GI blood loss whose origin is proximal to the ligament of Treitz at the duodenojejunal junction. Acute UGIB can manifest in a variety of ways, with or without haemodynamic compromise, including haematemesis, coffee-ground emesis, the return of bright red blood through a nasogastric tube, and melaena. Haematochezia (bright red blood per rectum) may rarely occur in patients with an extremely brisk UGIB.[1]Wilcox CM, Alexander LN, Cotsonis G. A prospective characterization of upper gastrointestinal hemorrhage presenting with hematochezia. Am J Gastroenterol. 1997 Feb;92(2):231-5.
http://www.ncbi.nlm.nih.gov/pubmed/9040197?tool=bestpractice.com
[2]Hwang JH, Fisher DA, Ben-Menachem T, et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc. 2012 Jun;75(6):1132-8.
http://www.giejournal.org/article/S0016-5107(12)00198-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/22624808?tool=bestpractice.com
Causes are multiple, but in westernised countries they are usually secondary to either varices or peptic ulcer disease (PUD).
UGIB results in more than 250,000 hospital admissions annually in the US, with mortality of up to 14%.[3]Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc. 2014 Dec 5;81(4):882-8.e1.
http://www.ncbi.nlm.nih.gov/pubmed/25484324?tool=bestpractice.com
[4]Barkun AN, Bardou M, Kuipers EJ, et al; International Consensus Upper Gastrointestinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010 Jan 19;152(2):101-13.
http://www.annals.org/content/152/2/101.full.pdf
http://www.ncbi.nlm.nih.gov/pubmed/20083829?tool=bestpractice.com
In the UK, UGIB accounts for 70,000 hospital admissions annually, the majority of these being non-variceal in origin, with a mortality of 10%.[5]Jairath V, Desborough MJ. Modern-day management of upper gastrointestinal haemorrhage. Transfus Med. 2015 Dec 28;25(6):351-7.
http://www.ncbi.nlm.nih.gov/pubmed/26707695?tool=bestpractice.com
[6]Siau K, Chapman W, Sharma N, et al. Management of acute upper gastrointestinal bleeding: an update for the general physician. J R Coll Physicians Edinb. 2017 Sep;47(3):218-30.
www.doi.org/10.4997/JRCPE.2017.303
http://www.ncbi.nlm.nih.gov/pubmed/29465096?tool=bestpractice.com
Ordinarily, mortality is secondary to hypovolaemic shock. Rapid evaluation, haemodynamic resuscitation, and appropriate pharmacological and endoscopic interventions are the cornerstones of therapy.
