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Gastrointest Endosc Clin N Am. 2018 Jul;28(3):261-275. doi: 10.1016/j.giec.2018.02.001. Epub 2018 Apr 17.

Initial Assessment, Risk Stratification, and Early Management of Acute Nonvariceal Upper Gastrointestinal Hemorrhage.

Author information

1
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
2
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: jsaltzman@bwh.harvard.edu.

Abstract

Inhospital mortality from nonvariceal upper gastrointestinal bleeding has improved with advances in medical and endoscopy therapy. Initial management includes resuscitation, hemodynamic monitoring, proton pump inhibitor therapy, and restrictive blood transfusion. Risk stratification scores help triage bleeding severity and provide prognosis. Upper endoscopy is recommended within 24 hours of presentation; select patients at lowest risk may be effectively treated as outpatients. Emergent endoscopy within 12 hours does not improve clinical outcomes, including mortality, rebleeding, or need for surgery, despite an increased use of endoscopic treatment. There may be a benefit to emergent endoscopy in patients with evidence of active bleeding.

KEYWORDS:

Clinical management; Nasogastric lavage; Nonvariceal upper gastrointestinal bleeding; Proton-pump inhibitor; Risk stratification; Timing of endoscopy; Upper endoscopy; Video capsule endoscopy

PMID:
29933774
DOI:
10.1016/j.giec.2018.02.001
[Indexed for MEDLINE]

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