上消化道出血（Upper gastrointestinal bleeding, UGIB）是指源于十二指肠空肠连接处 Treitz 韧带（十二指肠悬韧带）近端的消化道的失血。急性 UGIB 可以表现为多种形式，伴随或不伴随血流动力学损害，包括呕血、咖啡渣样呕吐物、鼻胃管引流出鲜血以及黑便。特别急性的 UGIB 患者很少出现便血（经直肠排出鲜鲜血）。[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
引起上消化道出血的原因有很多，但在西方国家该病通常继发于静脉曲张或消化性溃疡 (peptic ulcer disease, PUD)。
在美国，UGIB 每年导致 250,000 多人入院，死亡率高达 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
在英国，UGIB 每年导致 70,000 多人入院，其中大多数为非静脉曲张性，死亡率为 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
通常，死亡继发于低血容量性休克。迅速的评估、血流动力学复苏以及适当的药物治疗和内镜干预是治疗的基础。
