Upper gastrointestinal bleeding natural history, complications and prognosis

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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 severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death.

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.

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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