Upper gastrointestinal bleeding natural history, complications and prognosis: Difference between revisions

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Revision as of 14:49, 14 November 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

If left untreated upper gastrointestinal bleeding can become life-threatening. Massive blood loss can result in a severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death. Complications of UGIB include end-organ damage and iron-deficiency anemia. Prognosis is generally good with prompt treatment, and the 1-year mortality rate of patients with nonvariceal UGIB is approximately 10%.

Natural History, Complications, and Prognosis

Natural History

If left untreated upper gastrointestinal bleeding can become life-threatening. Massive blood loss can result in severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death. Chronic blood loss if left untreated results in anemia.

Complications

Complications of UGIB include:^[1]

End-organ damage
Iron-deficiency anemia

Prognosis

Prognosis is generally good with appropriate treatment, and the 1-year mortality rate of patients with nonvariceal UGIB is approximately 10%.^[2]^[3]^[4]^[5]
In UGIB, the prognosis doesn't depend on the severity of bleeding but depends upon patien'ts age and comorbid conditions.
The majority of patients with UGIB will stop bleeding spontaneously.
A clean ulcer base has less than a 3% chance of rebleeding; therefore, these lesions are not usually treated or scoped again.
In otherwise stable patients, patients with a clean ulcer base has less than a 3% chance of rebleeding and are good candidates for early discharge.

Risk of recurrent bleeding without endoscopic therapy versus with endoscopic therapy
Active arterial (spurting) bleeding	55% versus 20%
Nonbleeding visible vessel	43% versus 15%
Adherent clot	22% versus 15%

Despite advances in gastric acid suppression as well as improved endoscopic diagnostic and therapeutic techniques, the mortality rate from UGIB has remained stable.

References

↑ Sonnenberg A (2012). "Complications following gastrointestinal bleeding and their impact on outcome and death". Eur J Gastroenterol Hepatol. 24 (4): 388–92. doi:10.1097/MEG.0b013e328350589e. PMID 22233622.
↑ Roberts SE, Button LA, Williams JG (2012). "Prognosis following upper gastrointestinal bleeding". PLoS ONE. 7 (12): e49507. doi:10.1371/journal.pone.0049507. PMC 3520969. PMID 23251344.
↑ Katschinski B, Logan R, Davies J, Faulkner G, Pearson J, Langman M (1994). "Prognostic factors in upper gastrointestinal bleeding". Dig. Dis. Sci. 39 (4): 706–12. PMID 7908623.
↑ Kurien M, Lobo AJ (2015). "Acute upper gastrointestinal bleeding". Clin Med (Lond). 15 (5): 481–5. doi:10.7861/clinmedicine.15-5-481. PMID 26430191.
↑ Feinman M, Haut ER (2014). "Upper gastrointestinal bleeding". Surg. Clin. North Am. 94 (1): 43–53. doi:10.1016/j.suc.2013.10.004. PMID 24267496.

Template:WikiDoc Sources

[pmid22233622-1] Sonnenberg A (2012). "Complications following gastrointestinal bleeding and their impact on outcome and death". Eur J Gastroenterol Hepatol. 24 (4): 388–92. doi:10.1097/MEG.0b013e328350589e. PMID 22233622.

[pmid23251344-2] Roberts SE, Button LA, Williams JG (2012). "Prognosis following upper gastrointestinal bleeding". PLoS ONE. 7 (12): e49507. doi:10.1371/journal.pone.0049507. PMC 3520969. PMID 23251344.

[pmid7908623-3] Katschinski B, Logan R, Davies J, Faulkner G, Pearson J, Langman M (1994). "Prognostic factors in upper gastrointestinal bleeding". Dig. Dis. Sci. 39 (4): 706–12. PMID 7908623.

[pmid26430191-4] Kurien M, Lobo AJ (2015). "Acute upper gastrointestinal bleeding". Clin Med (Lond). 15 (5): 481–5. doi:10.7861/clinmedicine.15-5-481. PMID 26430191.

[pmid24267496-5] Feinman M, Haut ER (2014). "Upper gastrointestinal bleeding". Surg. Clin. North Am. 94 (1): 43–53. doi:10.1016/j.suc.2013.10.004. PMID 24267496.

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@@ Line 9: / Line 9: @@
 ===Natural History===
-If left untreated upper [[gastrointestinal]] [[bleeding]] can become life-threatening. Massive [[blood]] loss can result in severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death. Chronic blood loss if left untreated results in anemia.
+If left untreated upper [[gastrointestinal]] [[bleeding]] can become life-threatening. Massive [[blood]] loss can result in severe drop in [[blood pressure]] resulting in decreased [[blood]] supply to [[organ systems]] leading to death. [[Chronic]] [[blood]] loss if left untreated results in [[anemia]].
 ===Complications===
-Complications of UGIB include:<ref name="pmid22233622">{{cite journal |vauthors=Sonnenberg A |title=Complications following gastrointestinal bleeding and their impact on outcome and death |journal=Eur J Gastroenterol Hepatol |volume=24 |issue=4 |pages=388–92 |year=2012 |pmid=22233622 |doi=10.1097/MEG.0b013e328350589e |url=}}</ref>
+[[Complications]] of UGIB include:<ref name="pmid22233622">{{cite journal |vauthors=Sonnenberg A |title=Complications following gastrointestinal bleeding and their impact on outcome and death |journal=Eur J Gastroenterol Hepatol |volume=24 |issue=4 |pages=388–92 |year=2012 |pmid=22233622 |doi=10.1097/MEG.0b013e328350589e |url=}}</ref>
 *End-organ damage
 ** [[Myocardial Infarction|Cardiac ischemia]]
@@ Line 21: / Line 21: @@
 ===Prognosis===
-*Prognosis is generally good with appropriate treatment, and the 1-year mortality rate of patients with nonvariceal UGIB is approximately 10%.<ref name="pmid23251344">{{cite journal |vauthors=Roberts SE, Button LA, Williams JG |title=Prognosis following upper gastrointestinal bleeding |journal=PLoS ONE |volume=7 |issue=12 |pages=e49507 |year=2012 |pmid=23251344 |pmc=3520969 |doi=10.1371/journal.pone.0049507 |url=}}</ref><ref name="pmid7908623">{{cite journal |vauthors=Katschinski B, Logan R, Davies J, Faulkner G, Pearson J, Langman M |title=Prognostic factors in upper gastrointestinal bleeding |journal=Dig. Dis. Sci. |volume=39 |issue=4 |pages=706–12 |year=1994 |pmid=7908623 |doi= |url=}}</ref><ref name="pmid26430191">{{cite journal |vauthors=Kurien M, Lobo AJ |title=Acute upper gastrointestinal bleeding |journal=Clin Med (Lond) |volume=15 |issue=5 |pages=481–5 |year=2015 |pmid=26430191 |doi=10.7861/clinmedicine.15-5-481 |url=}}</ref><ref name="pmid24267496">{{cite journal |vauthors=Feinman M, Haut ER |title=Upper gastrointestinal bleeding |journal=Surg. Clin. North Am. |volume=94 |issue=1 |pages=43–53 |year=2014 |pmid=24267496 |doi=10.1016/j.suc.2013.10.004 |url=}}</ref>
+*[[Prognosis]] is generally good with appropriate treatment, and the 1-year [[mortality rate]] of patients with nonvariceal UGIB is approximately 10%.<ref name="pmid23251344">{{cite journal |vauthors=Roberts SE, Button LA, Williams JG |title=Prognosis following upper gastrointestinal bleeding |journal=PLoS ONE |volume=7 |issue=12 |pages=e49507 |year=2012 |pmid=23251344 |pmc=3520969 |doi=10.1371/journal.pone.0049507 |url=}}</ref><ref name="pmid7908623">{{cite journal |vauthors=Katschinski B, Logan R, Davies J, Faulkner G, Pearson J, Langman M |title=Prognostic factors in upper gastrointestinal bleeding |journal=Dig. Dis. Sci. |volume=39 |issue=4 |pages=706–12 |year=1994 |pmid=7908623 |doi= |url=}}</ref><ref name="pmid26430191">{{cite journal |vauthors=Kurien M, Lobo AJ |title=Acute upper gastrointestinal bleeding |journal=Clin Med (Lond) |volume=15 |issue=5 |pages=481–5 |year=2015 |pmid=26430191 |doi=10.7861/clinmedicine.15-5-481 |url=}}</ref><ref name="pmid24267496">{{cite journal |vauthors=Feinman M, Haut ER |title=Upper gastrointestinal bleeding |journal=Surg. Clin. North Am. |volume=94 |issue=1 |pages=43–53 |year=2014 |pmid=24267496 |doi=10.1016/j.suc.2013.10.004 |url=}}</ref>
-*In UGIB, the prognosis doesn't depend on the severity of bleeding but depends upon patients age and [[comorbid]] conditions.
+*In UGIB, the [[prognosis]] doesn't depend on the severity of [[bleeding]] but depends upon patien'ts age and [[comorbid]] conditions.
-*The majority of patients with UGIB will stop bleeding spontaneously.
+*The majority of patients with UGIB will stop [[bleeding]] spontaneously.
-*A clean ulcer base has less than a 3% chance of rebleeding; therefore, these lesions are not usually treated or scoped again.
+*A clean [[Ulcer|ulcer base]] has less than a 3% chance of rebleeding; therefore, these [[lesions]] are not usually treated or scoped again.
-*In otherwise stable patients, patients with a clean [[ulcer]] base has less than a 3% chance of rebleeding and are good candidates for early discharge.
+*In otherwise stable patients, patients with a clean [[ulcer]] base has less than a 3% chance of rebleeding and are good candidates for early [[discharge]].
 {| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
 ! colspan="2" style="background:#efefef;" |Risk of recurrent bleeding without endoscopic therapy versus with endoscopic therapy
@@ Line 38: / Line 38: @@
 |22% versus 15%
 |}
-*Despite advances in gastric acid suppression as well as improved endoscopic diagnostic and therapeutic techniques, the [[mortality rate]] from UGIB has remained stable.
+*Despite advances in [[gastric acid]] suppression as well as improved [[endoscopic]] [[diagnostic]] and [[therapeutic]] techniques, the [[mortality rate]] from UGIB has remained stable.
 ==References==