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Article

Practitioners’ Diary

Management of Non-variceal Upper Gastro-intestinal Haemorrhage

Dr Arka Banerjee, Gopal Krishna Dhali

Department:

GASTROENTEROLOGY

Abstract:

Upper gastro-intestinal haemorrhage has an estimated annual incidence of 40-150 cases per 1,00,000 population and leads to hospitalisation, and has significant morbidity and mortality. Most common causes of upper gastro-intestinal bleed are non-variceal–peptic ulcer disease leading the list. Clinical history, examination and haemodynamic resuscitation are the initial management. Risk stratification can be done by the Glasgow- Blatchford score and the Rockall score. Consultation with the cardiologist is important in patients taking anticoagulant and antiplatelet drugs. In peptic ulcer disease, the Forrest staging guides the restarting of antithrombotic agents. Intravenous proton-pump inhibitor is recommended in those awaiting upper gastro-intestinal endoscopy. Following haemodynamic resuscitation early upper gastro-intestinal endoscopy ( < 24 hours ) is recommended. Endotherapy is recommended for Forrest Ia, Ib, IIa and II b ulcers. Many patients of non-variceal upper gastro-intestinal haemorrhage can be discharged from the emergency department while others require admission.

Keyword:

Upper gastro-intestinal haemorrhage, non-variceal, peptic ulcers, morbidity, mortality, endotherapy

Journal: Medical Glory Vol 5, Issue No 2, April-June, 2021