Initial Assessment and Resuscitation in Nonvariceal Upper Gastrointestinal Bleeding

Tracey G Simon; Anne C Travis; John R Saltzman

doi:10.1016/j.giec.2015.02.006

Initial Assessment and Resuscitation in Nonvariceal Upper Gastrointestinal Bleeding

Gastrointest Endosc Clin N Am. 2015 Jul;25(3):429-42. doi: 10.1016/j.giec.2015.02.006. Epub 2015 Apr 18.

Authors

Tracey G Simon¹, Anne C Travis², John R Saltzman³

Affiliations

¹ Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02215, USA.
² Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
³ Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: jsaltzman@partners.org.

PMID: 26142029
DOI: 10.1016/j.giec.2015.02.006

Abstract

Acute nonvariceal upper gastrointestinal bleeding remains an important cause of hospital admission with an associated mortality of 2-14%. Initial patient evaluation includes rapid hemodynamic assessment, large-bore intravenous catheter insertion and volume resuscitation. A hemoglobin transfusion threshold of 7 g/dL is recommended, and packed red blood cell transfusion may be necessary to restore intravascular volume and improve tissue perfusion. Patients should be risk stratified into low- and high-risk categories, using validated prognostic scoring systems such as the Glasgow-Blatchford, AIMS65 or Rockall scores. Effective early management of acute, nonvariceal upper gastrointestinal hemorrhage is critical for improving patient outcomes.

Keywords: AIMS65; Gastrointestinal bleeding; Glasgow-Blatchford score; Nonvariceal hemorrhage; Risk stratification.

Publication types

Review

MeSH terms

Acute Disease
Blood Transfusion / methods*
Endoscopy, Gastrointestinal
Gastrointestinal Hemorrhage / epidemiology*
Gastrointestinal Hemorrhage / therapy*
Global Health
Humans
Incidence
Prognosis
Resuscitation / methods*
Risk Assessment*