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c
Ê Ê hemorrhage upper gastrointestinal tract
Ê Ê ligament of Treitz
ÊÊ
duodenum diaphragm
Ê splenic flexure colon
Ê
Ê
Ê medical emergencies
Ê Ê
hospital ÊÊ
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.
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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