Abstract
Non-variceal gastrointestinal bleeding (GIB) is a significant cause of mortality and morbidity worldwide which is encountered in the ambulatory and hospital settings. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GIB, small bowel bleeding (also formerly referred to as obscure GIB) or lower GIB. Although the etiologies of GIB are variable, a strong, consistent risk factor is use of non-steroidal anti-inflammatory drugs. Advances in the endoscopic diagnosis and treatment of GIB have led to improved outcomes. We present an updated review of the current practices regarding the diagnosis and management of non-variceal GIB, and possible future directions.
Highlights
Non-variceal gastrointestinal bleeding (GIB) is a common problem worldwide that is encountered in the ambulatory and hospital settings and is associated with significant morbidity and mortality
In a large study of 2242 patients with upper GI bleeding (UGIB), of the 575 (26%) who had peptic ulcer disease (PUD), those with H.Pylori associated ulcers had the lowest rates of rebleeding and mortality, H.Pylori-negative ulcers were associated with poorer outcomes regardless of nonsteroidal anti-inflammatory drug (NSAID) use and, those with H.Pylori negative ulcers and no NSAID use had the worst outcomes and had more severe systemic disease [52]
In patients with UGIB secondary to PUD, pre-endoscopic IV pump inhibitors (PPI) therapy reduces the proportion of high-risk lesions at index endoscopy, and the need for endoscopic therapy, it is not associated with better outcomes of mortality, need for surgery or rebleeding [71]
Summary
Non-variceal gastrointestinal bleeding (GIB) is a common problem worldwide that is encountered in the ambulatory and hospital settings and is associated with significant morbidity and mortality. The annual rate of hospitalization for any type of GIB in the United States (U.S) is estimated to be 350 hospital admissions/100,000 population, with more than 1,000,000 hospitalizations every year, and a mortality rate of 2–10% [1,2,3]. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GI bleeding (UGIB), small bowel bleeding ( formerly referred to as obscure GIB (OGIB)) or lower GIB (LGIB). Among hospitalized patients with GIB, 40% are attributed to UGIB, 25% LGIB and 35% in an undefined location [4]. We present a brief review on the etiology, manifestations and recommended guidelines on the management of GIB, with a focus on endoscopic diagnosis and management
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