Upper gastrointestinal bleeding

Abstract

Abstract Upper gastrointestinal (GI) bleeding is defined as bleeding originating from the part of the GI tract proximal to the ligament of Treitz. Among the various causes of upper GI bleeding, bleeding from peptic ulcer disease is the most common and responsible for 30–40% of all cases. Other common causes of upper GI bleeding include oesophageal varices, gastritis, and oesophagitis. The management of upper GI bleeding has improved substantially with widespread utilization of endoscopy and the availability of potent acid-suppressive medications. Consequently, recent trends show a decline in the incidence of hospitalization and mortality due to non-variceal upper GI bleeding. Haemodynamic resuscitation precedes endoscopy and other therapeutic options irrespective of the aetiology of upper GI bleeding. Pre-endoscopic risk stratification allows for the selective need of hospitalization and inpatient management in cases with non-variceal upper GI bleeding. This strategy improves the utilization of healthcare resources and directs them preferentially to sicker patients. With endoscopic risk stratification, the requirement of endoscopic haemostasis can be ascertained effectively. Endoscopic haemostasis is effective in 80–90% of cases with bleeding due to variceal or non-variceal causes. Strategies to prevent re-bleeding are important to reduce future recurrences. Proton pump inhibitors and anti-Helicobacter pylori regimens are efficacious in preventing re-bleeding in cases with peptic ulcer bleeds. Non-selective beta blockers and several sessions of endoscopic variceal ligation effectively prevent bleeding from oesophageal varices. With the currently available pharmacotherapy and endoscopic haemostatic modalities, the requirement of surgery has declined in both variceal and non-variceal upper GI bleeding. The increasing utilization of interventional radiology has further reduced the need for surgery in cases with refractory upper GI bleeding.