Abstract

Nonvariceal upper gastrointestinal bleeding (UGIB) carries high morbidity and mortality, which can be lowered by timely evaluation and management. This article presents a comprehensive literature review and current guidelines for the management of nonvariceal UGIB by an internist. Pre-endoscopic management includes optimal resuscitation, and making a decision about holding the anticoagulation and antiplatelet therapy versus continuation due to risk of thrombosis. Proton pump inhibitors (PPIs) are beneficial for both ulcer and nonulcer diseases as they reduce the risk of re-bleeding by clot stabilization. Endoscopy should only be performed after hemodynamic stability has been achieved and should not be delayed by more than 24 hours. Resumption of anticoagulation and antiplatelet therapy is based on endoscopic findings and thromboembolic risk. The patient should be discharged on PPIs and should be followed up by a primary care physician.

Highlights

  • BackgroundUpper gastrointestinal bleeding (UGIB) is defined as a clinically significant bleeding from the gastrointestinal (GI) tract above the ligament of Treitz which includes the esophagus, stomach, and duodenum

  • Upper GI bleeding is a medical emergence with high mortality which can be lowered by proper assessment and management

  • A validated scoring system can help the internist decide about the level of care, timing of endoscopy, and discharge planning

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Summary

Introduction

Upper gastrointestinal bleeding (UGIB) is defined as a clinically significant bleeding (no fixed amount of blood) from the gastrointestinal (GI) tract above the ligament of Treitz (anatomical landmark between the duodenum and jejunum) which includes the esophagus, stomach, and duodenum. Patients with endoscopic findings of high-risk stigmata (Table 1) (active bleeding, visible vessel, clots) should be hospitalized for three days assuming no further episode of bleeding occurs They can be fed with clear liquids soon after endoscopy [13]. The P2Y12 platelet receptor blocker should be restarted, with or without a loading dose, as soon as it is considered safe, depending on the patient's indication for taking it and any intervention performed during the endoscopy that may increase the risk for bleeding (such as removal of a large polyp) [27]. Patients should follow up with a primary care physician after discharge to decide about PPI

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Longstreth GF

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