Article

Upper gastrointestinal bleeding: a review

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Abstract

Despite recent diagnostic and therapeutic advances, the mortality rate for upper gastrointestinal bleeding has remained at 10% for the past three decades.1 Two factors are probably responsible for this persistently high mortality rate. First, this population is composed of a larger than average proportion of elderly patients who have marked associated medical diseases. Second, advanced techniques in intensive care allow patients who are critically ill or have had multiple traumas to be supported for long periods of time; many of these patients subsequently develop upper gastrointestinal bleeding that may be fatal.

Recent developments in the management of the patient with gastrointestinal bleeding include fiberoptic endoscopy, cimetidine therapy, gastric pH monitoring, and radiographic arterial embolization. Their clinical application is being investigated. Although bleeding episodes are controlled in most cases with medical management, approximately 15% to 20% of patients require surgery.1

Etiology

The most frequently encountered causes of upper gastrointestinal bleeding are peptic ulcer disease, acute gastric mucosal lesions, esophageal varices, and the Mallory-Weiss syndrome. Depending on the patient population considered, precise order of frequency varies (Table 1).2, 3 Peptic ulcer disease is responsible for approximately 50% of the cases of upper gastrointestinal bleeding in most series. Bleeding is directly responsible for 40% of all deaths encountered in the 20% of patients who bleed as a result of peptic ulcer disease.4 Although duodenal ulcers are encountered more frequently, gastric ulcers are more virulent because of their greater associated blood loss and greater tendency for bleeding to recur.

The term acute gastric mucosal . . .


 

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