Diagnosis and Treatment of Upper Gastrointestinal Bleeding for the Primary Care Physician

Abstract

Upper gastrointestinal bleeding (UGIB) is a highly prevalent medical-surgical emergency that must be treated early due to its high morbidity and mortality. It presents as bleeding from the esophagus, stomach or proximal duodenum, and is divided into non-variceal and variceal etiology. Among non-variceal ulcers, peptic ulcer stands out as the most frequent, being this produced by an imbalance between protective and aggressive factors. On the other hand, in variceal-type hemorrhages, gastroduodenal varices stand out, which are a consequence of increased portal pressure. The incidence of UGIB worldwide varies considerably between literature and mortality between 5 and 14% according to different studies. Unfortunately, there are no reliable national figures for incidence and prevalence. The physician must have a good understanding of the clinical presentation and pathophysiology in order to be assertive in the suspicion, diagnosis and management of this pathology. Regarding treatment, the confrontation is divided into emergency management and then endoscopic management, since early intensive resuscitation can reduce morbidity and mortality in patients with upper gastrointestinal bleeding.