Diagnosis and management of upper gastrointestinal bleeding

Jeff T Wilkins, Naiman Khan, Akash Nabh, Robert R. Schade

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Upper gastrointestinal bleeding causes significant morbidity and mortality in the United States, and has been associated with increasing nonsteroidal anti-inflammatory drug use and the high prevalence of Helicobacter pylori infection in patients with peptic ulcer bleeding. Rapid assessment and resuscitation should precede the diagnostic evaluation in unstable patients with severe bleeding. Risk stratification is based on clinical assessment and endoscopic findings. Early upper endoscopy (within 24 hours of presentation) is recommended in most patients because it confirms the diagnosis and allows for targeted endoscopic treatment, including epinephrine injection, thermocoagulation, application of clips, and banding. Endoscopic therapy results in reduced morbidity, hospital stays, risk of recurrent bleeding, and need for surgery. Although administration of proton pump inhibitors does not decrease mortality, risk of rebleeding, or need for surgery, it reduces stigmata of recent hemorrhage and the need for endoscopic therapy. Despite successful endoscopic therapy, rebleeding can occur in 10 to 20 percent of patients; a second attempt at endoscopic therapy is recommended in these patients. Arteriography with embolization or surgery may be needed if there is persistent and severe bleeding.

Original languageEnglish (US)
Pages (from-to)469-476
Number of pages8
JournalAmerican Family Physician
Volume85
Issue number5
StatePublished - Jan 1 2012

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Hemorrhage
Morbidity
Therapeutics
Christianity
Electrocoagulation
Mortality
Proton Pump Inhibitors
Helicobacter Infections
Peptic Ulcer
Surgical Instruments
Helicobacter pylori
Resuscitation
Epinephrine
Endoscopy
Length of Stay
Angiography
Anti-Inflammatory Agents
Injections
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Family Practice

Cite this

Wilkins, J. T., Khan, N., Nabh, A., & Schade, R. R. (2012). Diagnosis and management of upper gastrointestinal bleeding. American Family Physician, 85(5), 469-476.

Diagnosis and management of upper gastrointestinal bleeding. / Wilkins, Jeff T; Khan, Naiman; Nabh, Akash; Schade, Robert R.

In: American Family Physician, Vol. 85, No. 5, 01.01.2012, p. 469-476.

Research output: Contribution to journalArticle

Wilkins, JT, Khan, N, Nabh, A & Schade, RR 2012, 'Diagnosis and management of upper gastrointestinal bleeding', American Family Physician, vol. 85, no. 5, pp. 469-476.
Wilkins, Jeff T ; Khan, Naiman ; Nabh, Akash ; Schade, Robert R. / Diagnosis and management of upper gastrointestinal bleeding. In: American Family Physician. 2012 ; Vol. 85, No. 5. pp. 469-476.
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