Acute upper gastrointestinal bleeding (UGIB) - Initial evaluation and management

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• 作者：Iyad Khamaysi ; Ian M. Gralnek
• 关键词：Acute upper GI bleeding ; Non-variceal upper gastrointestinal bleeding/haemorrhage ; Oesophagogastric variceal bleeding ; Peptic ulcer bleeding ; Risk stratification ; Timing of endoscopy in acute upper GI bleeding
• 刊名：Best Practice Research Clinical Gastroenterology
• 出版年：October, 2013
• 年：2013
• 卷：27
• 期：5
• 页码：633-638
• 全文大小：189 K

文摘

Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 鈥榦n-call鈥?gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 鈥榥on-variceal鈥?and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy.