Skip Navigation

British Medical Bulletin 2007 83(1):307-324; doi:10.1093/bmb/ldm023
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (3)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Palmer, K.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Palmer, K.
Related Collections
Right arrow Gastroenterology and Hepatology
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Acute upper gastrointestinal haemorrhage

Kelvin Palmer

GI Unit, Western General Hospital, Edinburgh, UK

* Correspondence to: K. Palmer, GI Unit, Western General Hospital, Edinburgh, UK. E-mail: Kelvin.Palmer{at}luht.scot.nhs.uk

Acute gastrointestinal haemorrhage is a common medical emergency that has a hospital mortality of approximately 10%. Peptic ulcer bleeding, complicating non-steroidal anti-inflammatory drugs, aspirin or Helicobacter pylori infection is the most common cause of major bleeding. Gastro-oesophageal varices are less common but managing the underlying liver disease and the severity of bleeding may be demanding. The prognosis of patients presenting with acute bleeding is dictated by the presence of medical co-morbidities and by the severity of liver disease in patients with varices. Validated prognostic scoring systems, based upon the severity of bleeding, diagnosis, endoscopic findings and extent of co-morbidities, predict mortality and have clinical utility. The treatment of non-variceal bleeding is based upon cardiovascular resuscitation followed by endoscopic therapy in patients with active bleeding or major stigmata of recent haemorrhage. Proton pump inhibitor drugs reduce the risk of re-bleeding but have little effect on mortality. Emergency surgery is undertaken for uncontrolled bleeding or re-bleeding that cannot be controlled by further endoscopic therapy. Oesophageal varices are managed by fluid resuscitation, antibiotics and endoscopic band ligation. Vasoactive drugs may stop active bleeding but have no effect upon mortality. Management of the complications of the underlying liver disease and complete variceal ablation in a banding programme are essential. Gastric varices are treated by injection with tissue adhesives or transjugular intrahepatic porto-systemic shunt (TIPSS) insertion. Surgical intervention has little role in the management of varices and patients who do not respond to endoscopic therapies are best treated by TIPSS.

Keywords: gastrointestinal bleeding • endoscopy • bleeding ulcer • varices • proton pump inhibitor drugs

Accepted for publication August 23, 2007.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 InnovAiTHome page
C. Mehta and J. Chang
Gastro-intestinal bleeding
InnovAiT, May 1, 2009; 2(5): 300 - 306.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.