Update on the management of upper gastrointestinal bleeding
Upper gastrointestinal bleeding is a common emergency presentation requiring prompt resuscitation and management. Peptic ulcers are the most common cause of the condition. Thorough initial management with a structured approach is vital with appropriate intravenous fluid resuscitation and use of a re...
| Prif Awduron: | , |
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| Fformat: | Erthygl |
| Iaith: | English |
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BMJ Publishing Group
2022-12-01
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| Cyfres: | BMJ Medicine |
| Mynediad Ar-lein: | https://bmjmedicine.bmj.com/content/1/1/e000202.full |
| _version_ | 1827061825867350016 |
|---|---|
| author | Adrian J Stanley Josh Orpen-Palmer |
| author_facet | Adrian J Stanley Josh Orpen-Palmer |
| author_sort | Adrian J Stanley |
| collection | DOAJ |
| description | Upper gastrointestinal bleeding is a common emergency presentation requiring prompt resuscitation and management. Peptic ulcers are the most common cause of the condition. Thorough initial management with a structured approach is vital with appropriate intravenous fluid resuscitation and use of a restrictive transfusion threshold of 7-8 g/dL. Pre-endoscopic scoring tools enable identification of patients at high risk and at very low risk who might benefit from specific management. Endoscopy should be carried out within 24 h of presentation for patients admitted to hospital, although optimal timing for patients at a higher risk within this period is less clear. Endoscopic treatment of high risk lesions and use of subsequent high dose proton pump inhibitors is a cornerstone of non-variceal bleeding management. Variceal haemorrhage results in higher mortality than non-variceal haemorrhage and, if suspected, antibiotics and vasopressors should be administered urgently, before endoscopy. Oesophageal variceal bleeding requires endoscopic band ligation, whereas bleeding from gastric varices requires thrombin or tissue glue injection. Recurrent bleeding is managed by repeat endoscopic treatment. If uncontrolled bleeding occurs, interventional radiological embolisation or surgery is required for non-variceal bleeding or transjugular intrahepatic portosystemic shunt placement for variceal bleeding. |
| first_indexed | 2025-02-18T19:32:48Z |
| format | Article |
| id | doaj.art-1b7cae33566f4bcb8e11a04d82954bb8 |
| institution | Directory Open Access Journal |
| issn | 2754-0413 |
| language | English |
| last_indexed | 2025-02-18T19:32:48Z |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Medicine |
| spelling | doaj.art-1b7cae33566f4bcb8e11a04d82954bb82024-10-18T15:20:11ZengBMJ Publishing GroupBMJ Medicine2754-04132022-12-011110.1136/bmjmed-2022-000202Update on the management of upper gastrointestinal bleedingAdrian J Stanley0Josh Orpen-Palmer1Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UKGlasgow Royal Infirmary, Glasgow, UKUpper gastrointestinal bleeding is a common emergency presentation requiring prompt resuscitation and management. Peptic ulcers are the most common cause of the condition. Thorough initial management with a structured approach is vital with appropriate intravenous fluid resuscitation and use of a restrictive transfusion threshold of 7-8 g/dL. Pre-endoscopic scoring tools enable identification of patients at high risk and at very low risk who might benefit from specific management. Endoscopy should be carried out within 24 h of presentation for patients admitted to hospital, although optimal timing for patients at a higher risk within this period is less clear. Endoscopic treatment of high risk lesions and use of subsequent high dose proton pump inhibitors is a cornerstone of non-variceal bleeding management. Variceal haemorrhage results in higher mortality than non-variceal haemorrhage and, if suspected, antibiotics and vasopressors should be administered urgently, before endoscopy. Oesophageal variceal bleeding requires endoscopic band ligation, whereas bleeding from gastric varices requires thrombin or tissue glue injection. Recurrent bleeding is managed by repeat endoscopic treatment. If uncontrolled bleeding occurs, interventional radiological embolisation or surgery is required for non-variceal bleeding or transjugular intrahepatic portosystemic shunt placement for variceal bleeding.https://bmjmedicine.bmj.com/content/1/1/e000202.full |
| spellingShingle | Adrian J Stanley Josh Orpen-Palmer Update on the management of upper gastrointestinal bleeding BMJ Medicine |
| title | Update on the management of upper gastrointestinal bleeding |
| title_full | Update on the management of upper gastrointestinal bleeding |
| title_fullStr | Update on the management of upper gastrointestinal bleeding |
| title_full_unstemmed | Update on the management of upper gastrointestinal bleeding |
| title_short | Update on the management of upper gastrointestinal bleeding |
| title_sort | update on the management of upper gastrointestinal bleeding |
| url | https://bmjmedicine.bmj.com/content/1/1/e000202.full |
| work_keys_str_mv | AT adrianjstanley updateonthemanagementofuppergastrointestinalbleeding AT joshorpenpalmer updateonthemanagementofuppergastrointestinalbleeding |