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Chapter-07 Non-variceal Upper Gastrointestinal Hemorrhage: Advances in Diagnosis and Treatment

BOOK TITLE: Recent Advances in Surgery 33

Author
1. Mehta Samir P
2. Byrne James P
ISBN
9789380704227
DOI
10.5005/jp/books/11221_7
Edition
1/e
Publishing Year
2010
Pages
16
Author Affiliations
1. Southampton University Hospitals, NHS Trust, UK
2. Southampton University Hospitals NHS Trust, UK
Chapter keywords

Abstract

Acute upper gastrointestinal hemorrhage (UGIH), defined as bleeding proximal to the ligament of Treitz, remains a common hospital emergency in the UK, managed primarily by gastroenterologists with surgical input required where appropriate. This review aims to summarize the latest evidence in the management of non-variceal UGIH whilst also outlining improvements in diagnosis and management that have occurred in the last decade. Non-variceal hemorrhage remains a common and life threatening clinical condition. Over half of acute UGIH is associated with NSAID usage. High dose PPI infusion reduces the risk of rebleeding and length of hospital stay. Octreotide may reduce the risk of rebleeding and need for surgery. Tranexamic acid may have a role in the management of acute UGIH although this has not yet been proven. Endoscopy is the first line intervention and the majority of patients will not require any further treatment. Early endoscopy facilitates prompt discharge in low-risk patients and reduces the risk of rebleeding in high-risk patients. Multi-detector CT has high sensitivity in identifying the source of bleeding throughout the gastrointestinal tract. Transcatheter embolization may offer advantages, compared to surgery following failed endoscopic therapy. Transcatheter embolization is best provided in high volume centers where there are experienced interventional radiologists. A proportion of patients will always require definitive surgical management.

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