Emergency management of upper gastrointestinal hemorrhage

Abstract

In the United States, upper gastrointestinal (UGI) hemorrhage is a common medical emergency resulting in 250,000 admissions/year or SO-150 episodes/ 100,000 population/yeari-3 at an annual cost of nearly one billion dollars.4 It accounts for approximately 15% of admissions to the Medical Intensive Care Unit at The University of New Mexico Hospital. Men are more likely to suffer UGI hemorrhage than women, and bleeding becomes more frequent among both sexes with advancing age.” Despite significant advances in pre-hospital care, patient monitoring, blood banking, endoscopic diagnosis, anesthesia, and surgery, the overall mortality rate for this condition has remained constant at approximately 10% over the past four decades.5 This may be related to the slowly rising average age of patients (currently 59 years)(i.j-9) and to an increasing percentage of patients hemorrhaging within the context of serious underlying disease. Prompt, careful evaluation and management may improve the outcome in individual patients.9 This review explores issues in the care of patients with UGI hemorrhage in the temporal order in which they are confronted by the emergency physician: initial management, clinical evaluation, empirical emergency therapy, specific diagnostic tests, prognosis, prevention of UGI bleeding, and, finally, future trends. Like many other emergent conditions, decisions made early in the clinical course of UGI hemorrhage are the most important in reducing avoidable morbidity and mortality.