Management of Upper Gastrointestinal Bleeding
Summary
Upper gastrointestinal bleeding (UGIB) constitutes a significant emergency in gastroenterology, arising from diverse aetiologies including peptic ulcers, variceal haemorrhage, erosive diseases and iatrogenic lesions. Early risk stratification utilises clinical scoring systems to guide resuscitation and prioritise endoscopic intervention. Endoscopic haemostatic techniques—such as injection therapy, thermal coagulation, mechanical clipping and topical haemostatic agents—have revolutionised acute management, achieving high rates of initial haemostasis. Pharmacological adjuncts, including proton pump inhibitors and vasoactive agents, further reduce rebleeding and improve outcomes, particularly in variceal bleeding secondary to portal hypertension. For refractory cases, transcatheter arterial embolisation provides a minimally invasive alternative to surgery, which retains its role in patients unsuitable for endoscopic or radiological therapy. Mortality and rebleeding rates have declined globally through multidisciplinary protocols encompassing prompt endoscopic evaluation, tailored pharmacotherapy and advanced interventional radiology. Furthermore, attention to comorbid conditions and optimisation of coagulation status form integral components of comprehensive care. Emerging approaches aim to refine risk prediction, enhance haemostatic efficacy and reduce resource utilisation, paving the way for personalised management pathways.
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Management of Upper Gastrointestinal Bleeding publication trend
The graph below shows the total number of articles in management of upper gastrointestinal bleeding across all publications each year (not limited to Nature Index journals).
Technical terms
Haemostasis: The process of stopping bleeding by mechanical, chemical or thermal means.
Endoscopic therapy: Treatment of gastrointestinal lesions using an endoscope to deliver haemostatic interventions directly.
Variceal bleeding: Haemorrhage from dilated submucosal veins in the oesophagus or stomach, typically due to portal hypertension.
Non-variceal bleeding: Bleeding from mucosal lesions such as ulcers, erosions or vascular malformations, excluding varices.
Transcatheter arterial embolisation: A radiological procedure that occludes bleeding vessels via endovascular delivery of embolic agents.
Machine learning: Computational techniques that analyse data to predict clinical outcomes and support decision-making.
References
- Machine learning in the assessment and management of acute gastrointestinal bleeding. BMJ Medicine (2024).
- PuraStat in gastrointestinal bleeding: results of a prospective multicentre observational pilot study. Surgical Endoscopy (2021).
- Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis. World Journal of Emergency Surgery (2019).
- Reductions in 28-Day Mortality Following Hospital Admission for Upper Gastrointestinal Hemorrhage. Gastroenterology (2011).
- Comorbidities Affect Risk of Nonvariceal Upper Gastrointestinal Bleeding. Gastroenterology (2013).
About these summaries
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