Upper gastrointestinal bleeding (UGIB) refers to gastrointestinal 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, melaena, and, rarely, haematochezia (bright red blood per rectum). Haematochezia is typically only seen with an extremely brisk UGIB; significant haemodynamic compromise is common in these patients.
Causes are multiple, but in developed countries bleeding is usually secondary to peptic ulcer disease (PUD), erosions, oesophagitis, or varices.
UGIB results in more than 250,000 hospital admissions annually in the US, with a mortality of up to 11%. 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%. Ordinarily, mortality is secondary to hypovolaemic shock. Rapid evaluation, haemodynamic resuscitation, and appropriate pharmacological and endoscopic interventions are the cornerstones of therapy.
Douglas G. Adler, MD, FACG, AGAF, FASGE
Professor of Medicine
Director, Gastrointestinal Fellowship Program
Director of Therapeutic Endoscopy
Division of Gastroenterology
Department of Internal Medicine
Huntsman Cancer Institute
University of Utah
Salt Lake City
DGA has consulted for Boston Scientific and Merit Medical, which make endoscopic retrograde cholangiopancreatography (ERCP) products. He is also an author of references cited in this topic.
Dr Douglas G. Adler would like to gratefully acknowledge the assistance of Dr Patrick D. Martin.
PDM declares that he has no competing interests.
Ned Snyder, MD, FACP
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
NS declares that he has no competing interests.
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
DJH declares that he has no competing interests.
Giuseppe Malizia, MD
Divisione di Gastroenterologia
Ospedale V. Cervello
GM declares that he has no competing interests.
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