Triage and Subsequent Management of Patients with Acute Upper Gastrointestinal Bleeding (UGIB)

Abstract

Gastrointestinal haemorrhage is potentially life-threatening. This short review is based on major guidelines issued by leading gastrointestinal societies and aims to offer a comprehensive understanding of current best practices in UGIB management and to adapt these recommendations for effective implementation in local healthcare settings. Initial assessment, resuscitation, and appropriate triage depending on clinical diagnosis and treatment of the underlying cause are the cornerstones of management. Non-operative intervention is the most valuable approach, as most cases of upper gastrointestinal bleeding (UGIB) cease spontaneously. Definitive management of UGIB is guided by the overall risk of re-bleeding and morbidity, assessed via risk scores. Early endoscopy is appropriate for most patients with UGIB whereas emergent endoscopy is required for acute variceal haemorrhage for both risk stratification and appropriate management. Failure to respond to medical and endoscopic therapies necessitates radiological intervention or urgent surgery. Radio-embolization is an increasingly valuable adjunct in the non-operative management arsenal. Advancements in endoscopic techniques and radiological embolization have significantly reduced the role of surgery in managing acute UGIB. However, close collaboration between endoscopists and surgeons remains essential. Adequate training of healthcare professionals in the initial assessment and resuscitation, risk assessment and triage of patients presenting with acute UGIB is essential for improved outcomes.

J Enam Med Col 2023; 13(2): 68-77