%0 Journal Article
%T The Acute Management of Nonvariceal Upper Gastrointestinal Bleeding
%A Hisham AL Dhahab
%A Alan Barkun
%J Ulcers
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/361425
%X Background. The mortality from nonvariceal upper gastrointestinal bleeding is still around 5%, despite the increased use of proton-pump inhibitors and the advancement of endoscopic therapeutic modalities. Aim. To review the state-of-the-art management of acute non variceal upper gastrointestinal bleeding from the presentation to the emergency department, risk stratification, endoscopic hemostasis, and postendoscopic consolidation management to reduce the risk of recurrent bleeding from peptic ulcers. Methods. A PubMed search was performed using the following key words acute management, non variceal upper gastrointestinal bleeding, and bleeding peptic ulcers. Results. Risk stratifying patients with acute non variceal upper gastrointestinal bleeding allows the categorization into low risk versus high risk of rebleeding, subsequently safely discharging low risk patients early from the emergency department, while achieving adequate hemostasis in high-risk lesions followed by continuous proton-pump inhibitors for 72 hours. Dual endoscopic therapy still remains the recommended choice in controlling bleeding from peptic ulcers despite the emergence of new endoscopic modalities such as the hemostatic powder. Conclusion. The management of nonvariceal upper gastrointestinal bleeding involves adequate resuscitation, preendoscopic risk assessment, endoscopic hemostasis, and post endoscopic pharmacological and nonpharmacological treatment. 1. Introduction About 10% of the population in the Western world will experience peptic ulcer disease at some point during their lives. Individuals with peptic ulcer disease may present with a variety of gastrointestinal (GI) symptoms including abdominal pain, vomiting, and bleeding. Indeed, peptic ulcer disease is the most common cause of conditions such as upper GI hemorrhage and perforation, which are associated with high mortality and morbidity [1]. Acute upper gastrointestinal bleeding (AUGIB) is one of the commonest causes for hospitalization worldwide. In the United States, there are 250,000 to 300,000 hospital admissions and 15,000 to 30,000 deaths each year resulting from acute upper GI hemorrhage [2]. The mortality from bleeding peptic ulcer disease remains unchanged around 5% [3, 4], despite the use of PPI and advances in endoscopic therapy. The unchanged mortality rate might reflect the increased use of aspirin and NSAID in the elderly population with multiple underlying comorbidities that puts such patients at higher risk of both bleeding and death [5]. The incidence of AUGIB ranges from 48 to 160 cases per 100 000
%U http://www.hindawi.com/journals/ulcers/2012/361425/