Assessment of upper gastrointestinal bleeding

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 manners, including haematemesis, coffee-ground emesis, the return of bright red blood through a nasogastric tube, and melaena with or without haemodynamic compromise. 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;92:231-235. 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;75:1132-1138. 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 300,000 hospital admissions annually in the US, with a mortality of 7% to 10%.[3]Yavorski RT, Wong RK, Maydonovitch C, et al. Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol. 1995;90:568-573. http://www.ncbi.nlm.nih.gov/pubmed/7717312?tool=bestpractice.com The annual incidence in the UK is 50 to 150 per 100,000, with the highest incidence in socio-economically deprived areas.[4]National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding: costing report. Implementing NICE guidance. June 2012. https://www.nice.org.uk/guidance/cg141/ (last accessed 6 April 2017). https://www.nice.org.uk/guidance/cg141/resources/costing-report-186491773 Ordinarily, mortality is secondary to hypovolaemic shock. Rapid evaluation, haemodynamic resuscitation, and appropriate pharmacological and endoscopic interventions are the cornerstones of therapy.