Assessment of upper gastrointestinal bleeding

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.[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. https://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 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%.[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]Rosenstock SJ, Møller MH, Larsson H, et al. Improving quality of care in peptic ulcer bleeding: nationwide cohort study of 13,498 consecutive patients in the Danish Clinical Register of Emergency Surgery. Am J Gastroenterol. 2013 Sep;108(9):1449-57. http://www.ncbi.nlm.nih.gov/pubmed/23732464?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. http://www.rcpe.ac.uk/sites/default/files/jrcpe_47_3_bhala.pdf 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.