Upper gastrointestinal bleeding natural history, complications and prognosis
|
Upper gastrointestinal bleeding Microchapters |
|
Differentiating Upper Gastrointestinal Bleeding from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Management |
|
Surgery |
|
Case Studies |
|
Upper gastrointestinal bleeding natural history, complications and prognosis On the Web |
|
American Roentgen Ray Society Images of Upper gastrointestinal bleeding natural history, complications and prognosis |
|
FDA on Upper gastrointestinal bleeding natural history, complications and prognosis |
|
CDC on Upper gastrointestinal bleeding natural history, complications and prognosis |
|
Upper gastrointestinal bleeding natural history, complications and prognosis in the news |
|
Blogs on Upper gastrointestinal bleeding natural history, complications and prognosis |
|
Directions to Hospitals Treating Upper gastrointestinal bleeding |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
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 patients 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.
Follow up
- All patients should be monitored for continued or return of bleeding
- Rebleeding is often first detected by recurrent signs of overt hemorrhage such as melena or hematemesis, or by hemodynamic instability.
- After endoscopic treatment, patients at increased risk of bleeding are followed with serial hematocrit analyses
- In patients with evidence of rebleeding, a second attempt at endoscopic therapy generally is recommended. Should bleeding persist following the second attempt, surgical or radiologic intervention should be considered
- Second-look endoscopy refers to the practice of performing a planned follow-up endoscopy, generally within 24 hours of the initial endoscopy.
- The 2010 recommendations on the management of patients with nonvariceal UGIB from the International Consensus Upper Gastrointestinal Bleeding Conference Group, however, do not recommend the use of routine second-look endoscopy
- Length of stay in the hospital should be based on the stability of the patient as well as the endoscopic appearance of the culprit bleeding site.
- Patients with low-risk lesions can be discharged early from the hospital
- Following endoscopic variceal ligation for esophageal variceal hemorrhage, repeat EGD should be performed in 2 to 3 weeks when the banding ulcers have healed. At that time, additional banding may be performed to ensure that the varices have been obliterated
- Following gastric ulcer hemorrhage, repeat endoscopy in 6 to 8 weeks should be considered to confirm ulcer healing and to exclude the possibility of a malignant gastric ulcer.
- Routine endoscopic follow-up is not required for duodenal ulcers. Lifelong therapy with PPIs may be warranted in patients who are at a high risk for recurrence for ulcers, or who have experienced peptic ulcer hemorrhage.
- Eradication ofH pylori, if previously performed, should be confirmed. There are no guidelines regarding the optimal timing for resumption of oral diet following UGIB.
- The timing and pace of diet introduction should largely depend on the likelihood of rebleeding.\
- Patients with low-risk lesions can safely be started on clear liquids with quick advancement to solids
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.