Japan gastroenterological endoscopy society jges has compiled a set of guidelines for endoscopic management of non. Management of acute upper gastrointestinal bleeding. In those with esophageal varices, bleeding occurs in about 515% a year and if they have bled once, there is a higher risk of further bleeding within six weeks. This article covers the acute management of patients with overt upper gastrointestinal bleeding, abstract. Pdf on jan 1, 2007, grzegorz wallner and others published management of patients with upper gastrointestinal bleeding find, read and.
Guidelines on the management of acute upper gastrointestinal bleeding have. This primeview focuses on the pathophysiology of nvugib. Pdf management of acute upper gastrointestinal bleeding. Nonvariceal upper gi bleed acute management inhospital. Only 18% of readmissions were due to recurrent nonvariceal upper gastrointestinal bleeding. Acute upper gastrointestinal haemorrhage remains the most common medical emergency managed by gastroenterologists. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 7080 gl are recommended. Clinically and endoscopically stratify patients as low or highrisk for rebleeding andor mortality to guide management. Upper gastrointestinal bleeding ugib is a common medical emergency, with a reported mortality of 210%. Introduction patients with acute upper gastrointestinal gi bleeding commonly present with hematemesis vomiting of blood or coffeegroundlike material andor melena black, tarry stools. Management of upper gastrointestinal bleeding in children. Management of acute nonvariceal upper gastrointestinal bleeding. Elderly patients and people with chronic medical diseases withstand acute upper gastrointestinal bleeding less well than younger, fitter patients, and have a higher risk of death. Pdf management of nonvariceal upper gastrointestinal.
Non variceal upper gastrointestinal bleeding, scoring system, optimal cutoff point introduction upper gastrointestinal bleeding ugib is a common disease, with an incidence of 48160 cases per 100,000 individuals and mortality rate of 5. Inpatient bed stay, endoscopy provision and blood product transfusions are the main contributors to the overall cost of ugib. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. Acute upper gastrointestinal hemorrhage ugih is a common condition worldwide that has an estimated annual incidence of 40. Hemorrhage form the gastrointestinal gi tract is categorized as upper gib.
Emergency upper gastrointestinal endoscopy is the standard procedure recommended for both diagnosis and treatment of ugib. Overview of the management of patients with variceal. The standards of practice committee of the american society for gastrointestinal endoscopy asge prepared this text. Diagnosis and management of upper gastrointestinal bleeding. The incidence of non variceal acute upper gi bleeding is approximately 85 per 100,000 per year 1. Aim the aim of this study was to audit the efficacy of endoscopic injection therapy for non variceal upper gastrointestinal gi bleeding at auckland hospital.
Upper gastrointestinal bleeding is one of the commonest emergencies encountered by general physicians. Upper gi bleeding non variceal peptic ulcer disease 50 % malloryweiss tears 15 % gastritis or duodenitis 10 % oesophagitis 10 % av malformations, tumors, miscellaneous 5 % each related to portal hypertension oesophageal varices gastric varices. Almost all people who develop acute upper gastrointestinal bleeding are treated in. Upper gastrointestinal bleeding ugib is the loss of blood through the gastrointestinal tract whose origin proximal to the treitz angle 1. Acute upper gastrointestinal bleeding augib is one of the most common medical emergencies in the uk. Acute upper gastrointestinal bleeding ugib is common, but the annual incidence has been decreasing. Guideline recommendations from the international consensus group. For upper gastrointestinal bleeding ugib, guidelines recommend pharmacological treatment before endoscopy.
The role of endoscopy in the management of acute non. Once haemodynamic stability has been achieved, therapeutic endoscopy is vital in control and arrest of bleeding. This update of the 2010 international consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding ugib refines previous important statements and presents new clinically relevant recommendations. Since the previous guideline from this international expert consensus group. Acute endoscopic intervention in nonvariceal upper.
The role of endoscopy in the management of acute non variceal upper gi bleeding this is one of a series of statements discussing the use of gi endoscopy in common clinical situations. Acute upper gastrointestinal bleeding is the commonest emergency managed by gastroenterologists. Variceal bleeding is a gastrointestinal emergency that is one of the major causes of death in patients with cirrhosis. Original article comparison of different scoring systems. Acute upper gastrointestinal bleeding is a common emergency condition associated with high morbidity and mortality. Management and prevention of upper gi bleeding accp. Despite treatment, re bleeding occurs in about 716% of those with upper gi bleeding. Nonvariceal upper gastrointestinal bleeding nature. Upper gastrointestinal bleeding is an uncommon but potentially serious, lifethreatening condition in children. Consider inserting a nasogastric tube and empiric highdose proton pump inhibitors while waiting for endoscopy.
Clinical parameters including timing of endoscopy, risk stratification, and predictors. Sanders6, matthew kurien6, gianluca rotondano7, tomas hucl8, mario dinisribeiro9, riccardo marmo10, istvan racz11, alberto arezzo12. Upper gastrointestinal bleeding ugib is a common medical emergency, with a reported. Non variceal upper gastrointestinal bleeding is a medical emergency in which bleeding develops in the oesophagus, stomach or proximal duodenum and. Pdf endoscopic injection therapy for nonvariceal upper. The majority of the non variceal upper gastrointestinal bleeding nvugib in the uk is caused by pud. Sign national clinical guideline on management of acute upper and lower gastrointestinal bleeding sign 2008 sep. Non variceal upper gastrointestinal bleeding nvugib is an often lifethreatening bleeding in the oesophagus, stomach or proximal duodenum. If you continue to use this site we will assume that you are happy with it. Updated international consensus recommendations on. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage.
Almost all people who develop acute upper gastrointestinal bleeding are treated in hospital and the guideline therefore focuses on hospital care. When patients who have cirrhosis present with gi bleeding, they should be resuscitated and receive vasoactive agents such as. An acute upper gastrointestinal bleed augib often represents a lifethreatening event and is recognised universally as a common cause of emergency hospitalisation. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. Guideline recommendations from the international consensus group article pdf available in annals of internal medicine 17111. Thirtyday readmission among patients with nonvariceal. Updated international guideline on nonvariceal upper. We use cookies to ensure that we give you the best experience on our website.
Patients with acute upper gastrointestinal gi bleeding commonly. This entity has an annual incidence of 48 to 160 cases per 100,000 adults 24, with a mortality rate of 10% to 14% 5. It has an incidence ranging from approximately 50 to 150 per 100 000 of the population each year, the incidence being highest in areas of the lowest socioeconomic status. The annual initial inhospital treatment cost for all augib cases in the. The majority of the upper gi bleeding is 8090 % are non variceal.
An audit of patients admitted to hospital in the uk published in 1995 reported 11% mortality in patients. The clinical community recognise the need for improvement in the treatment of these patients. Acute upper gastrointestinal bleeding ugib is a gastroenterological. Acute upper and lower gastrointestinal bleeding accounts for about 75,000 hospital admissions each year in the uk and causes the death of about 10% of these patients.
This guideline covers how upper gastrointestinal bleeding can be effectively managed in adults and young people aged 16 years and older. Guideline on nonvariceal upper gastrointestinal bleeding. An international multidisciplinary group of experts developed the recommendations. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. Methods the medical records of 183 patients who had undergone endoscopic injection of. Management of upper gastrointestinal bleeding annals of. Diagnosis and management of nonvariceal upper gastrointestinal. Devise a plan to effectively manage acute gi bleeding and optimize treatment responses in the individual patient. There are several causes of ugi bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. Peptic ulcer bleeding causes more than 60 percent of cases of upper gastrointestinal bleeding, whereas esophageal varices cause approxi mately 6 percent. Bleeding from gastric varices is treated by injection with cyanoacrylate. Aasldacg practice guideline on prevention and management of gastroesophageal varices and variceal. Society for gastrointestinal endoscopy, a 2012 guideline issued by the.
Transfusion strategies for acute upper gastrointestinal. We present a case of recurrent upper gastrointestinal gi bleeding in a man aged 57 years with primary biliary cholangitis who was ultimately diagnosed with an isolated duodenal variceal bleed, which was successfully treated with histoacryl glue injection. European society of gastrointestinal endoscopy esge guideline authors ian m. Estimates of costs of hospital stay for variceal and. Despite advancement in technology the management of augib remains a challenge. Pdf management of patients with upper gastrointestinal bleeding. Upper gastrointestinal ugi bleeding is generally defined as bleeding proximal to the ligament of treitz, which leads to hematemesis. International consensus guidelines recommend early endoscopy within. Overview acute upper gastrointestinal bleeding in over. Diagnosis and management of nonvariceal gastrointestinal. Nonetheless, 30day mortality remains high, at up to 11%. Design plans for the prevention of upper gi bleed ing caused by commonly associated risk factors. Uk guidelines on the management of variceal haemorrhage in.
All patients with variceal upper gastrointestinal bleeding should undergo upper endoscopy, performed after the patient is hemodynamically stable. Management of nonvariceal upper gastrointestinal bleeding ncbi. Transfuse patients with massive bleeding with blood, platelets and clotting factors in line with local protocols for managing massive bleeding level 5, grade d. Pdf nonvariceal upper gastrointestinal bleeding marc. The news of treatment of variceal upper gastrointestinal. Management of acute upper gastrointestinal bleeding the bmj. Management of nonvariceal upper gastrointestinal bleeding. Ugih upper gastrointestinal hemorrhage vce videocapsule endoscopy vka vitamin k antagonist introduction. Causes of upper gastrointestinal bleeding ugib in patients with liver cirrhosis can be grouped into two categories. The initial evaluation of patients with acute upper gi bleeding involves an assessment of hemodynamic stability and resuscitation if necessary. Introduction upper gastrointestinal bleeding ugib is a poten. This guideline is an official statement of the european society. Updated advice on ppi therapy in acute upper gi bleeding.
It aims to identify which diagnostic and therapeutic steps are useful so hospitals can develop a structure in which clinical teams can deliver an optimum service for people who develop this condition. In up to 20% of cases, augib may mimic lower gastrointestinal bleeding. The rates of ugib are higher in men and the elderly. Large observational studies have improved our understanding of the disease characteristics and its impact on mortality but despite significant advancement in endoscopic management, mortality remains high, particularly in. Apply an understanding of the pathophysiology and risk factors for upper gastrointestinal gi bleeding to patient care. The outcome for patients with variceal bleeding depends on achieving hemostasis and avoiding complications related to bleeding or underlying chronic liver disease. Nonetheless, 30day mortality remains high, at up to 11% 2. Units offering an emergency acute upper gastrointestinal bleeding service should have expertise in vbl, balloon tamponade and management of gastric variceal bleeding level 5, grade d. Diagnosis and management of upper gastrointestinal. The rate of death among patients readmitted to the hospital 4. The endoscopic treatment of choice for esophageal variceal bleeding is band ligation of varices. Approach to acute upper gastrointestinal bleeding in adults. Predictors of variceal or nonvariceal source of upper.
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