Diagnostic And Therapeutic Approaches For Non-Variceal Upper Gastrointestinal Bleeding

Abstract

Upper gastrointestinal bleeding (UGIB) is a common, life-threatening medical condition. Non-variceal causes account for more than 90% of bleeding episodes. Peptic ulcer disease is the most frequent cause of non-variceal UGIB. Patients present with hematemesis and/or melena but hematochezia might be present in patients with severe bleeding. Despite advances in diagnostic and therapeutic methods, mortality remains high in the elderly and patients with comorbidities. Endoscopy is the primary procedure that should be performed to identify the etiology of UGIB and for treatment purposes following adequate resuscitation of patients. Early endoscopy (within the first 24 hours) has considerably improved the clinical outcomes. A number of scoring systems are being used in patients with UGIB to identify the risk of complications, rebleeding risk, the need for interventional procedures and the risk of death. The most commonly used scoring tools are the Rockall score, Glasgow-Blatchford score and AIMS65 score. Primary treatment modalities include adequate resuscitation, intravenous fluid support, transfusion of red blood cell suspension, acid suppression therapy and administration of prokinetic agents. In general, angiography, computed tomography, technetium-99m-labeled red blood cell scintigraphy and capsule endoscopy may be used in patients whose bleeding cannot be detected endoscopically. Interventional radiological procedures should be initially performed for hemorrhages that cannot be stopped endoscopically and surgical options should be considered when interventional radiological procedures are out of reach or unsuccessful.