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c 


  


c 

   
 Ê  Ê  hemorrhage   upper gastrointestinal tract 


   Ê  Ê      ligament of Treitz      Ê Ê 
 duodenum   diaphragm 
Ê  splenic flexure   colon
 Ê   
Ê  Ê  medical emergencies
 Ê Ê
   hospital Ê Ê 




   

  medications
 endoscopy  Ê   ÊÊ
 
 
 Ê
   Ê Ê

a

cute gastrointestinal (GI) bleeding is a potentially life-threatening abdominal emergency that remains a
common cause of hospitalization. Upper gastrointestinal bleeding (UGIB) is defined as bleeding derived
from a source proximal to the ligament of Treitz.

The incidence of UGIB is approximately 100 cases per 100,000 population per year.[1] Bleeding from the
upper GI tract is approximately 4 times as common as bleeding from the lower GI tract and is a major
cause of morbidity and mortality. Mortality rates from UGIB are 6-10% overall.[1] (See Epidemiology,
below.)

The diagnosis of and therapy for nonvariceal upper gastrointestinal bleeding (UGIB) has evolved since
the late 20th century from passive diagnostic esophagogastroduodenoscopy with medical therapy until
surgical intervention was needed to active intervention with endoscopic techniques followed by
angiographic and surgical approaches if endoscopic therapy fails.[2] (See Workup and Treatment and
Management, below.)

Variceal hemorrhage is not discussed in this article because the underlying mechanisms of bleeding are
different and require different therapies.

The underlying mechanisms of nonvariceal bleeding involve either arterial hemorrhage, such as in ulcer
disease and mucosal deep tears, or low-pressure venous hemorrhage, as in telangiectasias and
angiectasias. In variceal hemorrhage, the underlying pathophysiology is due to elevated portal pressure
transmitted to esophageal and gastric varices and resulting in portal gastropathy.

    


ca
Peptic ulcer disease (PUD) remains the most common cause of UGIB. In a literature review involving
more than 10,000 patients with UGIB, PUD was responsible for 27-40% of all bleeding episodes.[5] High-
risk patient populations at risk for PUD include those with a history of alcohol abuse, chronic renal failure,
and/or nonsteroidal anti-inflammatory drug (NSID) use.[6]

Peptic ulcer disease is strongly associated with V  


 infection. The organism causes
disruption of the mucous barrier and has a direct inflammatory effect on gastric and duodenal mucosa.
(Rates of V
infection are reportedly lower in patients with complicated ulcer disease than in patients
with uncomplicated ulcers. Hosking et al reported a 71% incidence of V
 infection in patients with
bleeding duodenal ulcers; patients with nonbleeding ulcers had an incidence of 93%.)

Eradication of V
 been demonstrated to reduce the risk of recurrent ulcers and, thus, recurrent ulcer
hemorrhage. In fact, the proportion of UGIB cases caused by peptic ulcer disease has declined,[7] a
phenomenon that is believed to be due to the use of proton pump inhibitors (PPIs) and V
therapy.


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