Haemorrhage upper gastrointestinal

British Society of Gastroenterology Endoscopy Committee (2002) Non-variceal upper gastrointestinal haemorrhage guidelines. Cut 51 (Suppl IV) iv1-iv6. Available at http //www.bsg.org.uk/pdf word docs/nonvar3.pdf [Accessed 7 July 2008],... 

NSAIDs are well known for causing upper gastrointestinal ulceration and haemorrhage [4]. Ibuprofen (<1600 mg/day) is associated with the lowest risk [2, 34]. 

Upper gastrointestinal (GI) haemorrhages comprise any bleeding occurring between the nasopharynx and the duodenojejunal fold (Treitz s arch), i.e. proximal to the duodenojejunal flexure. Such haemorrhages are especially problematic in cases where liver disease is also present. 

Upper gastrointestinal bleeding may be either chronic or acute. It becomes manifest as severe or slight haemorrhages of arterial, venous or capillary origin, (s. tab. 19.3) Elimination of the blood is effected by vomiting or in the stool. 

Spontaneous haemostasis Some 60-80% of all upper gastrointestinal haemorrhages cease spontaneously. Early diagnosis with simultaneous stabilization of the circulation facilitates such spontaneous haemostasis without further therapeutic measures being called for. In 10-15% of cases, the bleeding persists. 

Gastrolavage using a double-lumen tube may be of both diagnostic and therapeutic value in upper gastrointestinal haemorrhage. Endobronchial intubation is strongly recommended for disturbances of consciousness. 

A possible spontaneous haemostasis, which is found without active therapy in about half the cases of upper gastrointestinal bleeding, should on no account encourage the assumption of a passive approach with the postponement of suitable therapeutic procedures. There is an enormous danger of massive renewed haemorrhage as well as of the development of complications within a few hours following spontaneous haemostasis, (s. fig. 19.12)... 

The basic treatment of bleeding oesophageal varices is carried out under intensive care conditions. It essentially corresponds to the procedures for upper gastrointestinal haemorrhage, (s. pp 350, 351) The therapy has three main objectives ... 

Rockall, T.A., Logan, R.F., Devlin, H.B., Northfield, T.C. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996 38 316-321... 

Simpson, K.J., Chalmers, N., Redhead, D.N., Finlayson, N.D.C., Bonch-ier, I.A.D., Hayes, P.C. Transjugular intrahepatic portasystemic stent shunting for control of acute and recurrent upper gastrointestinal haemorrhage related to portal hypertension. Gut 1993 34 968 -973... 

Henry DA, O Connell DL. Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage. BMJ 1989 298(6681) 1142-6. 

Etoricoxib, lumiracoxib and rofecoxib caused a slight 8% to 15% increase in the INR in response to warfarin, whereas celecoxib and parecoxib had no effect. However, raised INRs accompanied by bleeding, particularly in the elderly, have been attributed to the use of waHarin and celecoxib or rofecoxib in other reports. In addition, in a case-control study in patients taking warfarin, the use of celecoxib or rofecoxib was associated with an increased risk of hospitalisation for upper gastrointestinal haemorrhage, which was of a similar magnitude to that seen with non-selective NSAIDs. 

Moreover, in a ease-control study, patients taking warfarin and admitted to hospital with an upper gastrointestinal haemorrhage were signifi-eantly more likely to be also taking rofecoxib (odds ratio 2.4)2 Note that rofeeoxib has generally been withdrawn because of adverse cardiovascular effects. 

Rockall, T. A., Logan, R. F., Devlin, H. B., and Northfield, T. C. (1995). Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. Br. Med. J., 311 222-226. 

Blatchford O, Murray WR, Blatchford M (2000) A risk score to predict need for treatment for upper-gastrointestinal haemorrhage [In Process Citation]. Lancet 356 1318-1321... 

Cameron EA, Pratap JN, Sims TJ, et al. (2002) Three-year prospective validation of a pre-endoscopic risk stratification in patients with acute upper-gastrointestinal haemorrhage. Eur J Gastroenterol Hepatol 14 497-501... 

Rockall TA, Logan RF, Devlin HB, et al. (1996) Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National Audit of Acute Upper Gastrointestinal Haemorrhage [see comments]. Lancet 347 1138-1140... 

Phang TS, Vornik V, Stubbs R (2000) Risk assessment in upper gastrointestinal haemorrhage implications for resource utilisation. N Z Med J 113 331-333... 

Blake MA, Owens A, O Donoghue DP, et al. (1995) Embolotherapy for massive upper gastrointestinal haemorrhage secondary to metastatic renal cell carcinoma report of three cases. Gut 37 835-837... 

Cook DJ, Guyatt GH, Salena BJ, et al. Endoscopic therapy for acute non-variceal upper gastrointestinal haemorrhage a meta-analysis. Gastroenterology 1992 102 139-148. 

Rockall TA, Logan RFA, Devlin HB, et al. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Br Med J 1995 311 222-226. 

Steele C, Bohra S, Broe P, et al. Acute upper gastrointestinal haemorrhage and cohtis an unusual presentation of Wegener s granulomatosis. Eur J Gastroenterol Hepatol 2001 13(8) 993-995. 

In the situation of upper gastrointestinal haemorrhage, endoscopic sensitivity is over 90%, and in... 

Chung YFA, Wong WK, Soo KC (2000) Diagnostic failures in endoscopy for acute upper gastrointestinal haemorrhage. Br J Surg 87 614-617... 

Embolization of massively bleeding duodenal ulcers constituted 5% of endoscopically treated duodenal ulcers and as little as 0.6% of all cases with upper gastrointestinal bleeding who underwent emergency endoscopy in one large series. Contrast extravasation was demonstrated in only half of these cases. Embolization did however induce haemostasis in 90% of cases (Toyoda et al. 1995). Prophylactic embolization of the GDA is sometimes performed with success (as in this series) even when no angiographic abnormality is demonstrated despite a proven endoscopic source of haemorrhage. 

Acute haemorrhagic erosive gastritis was diagnosed by endoscopy in 74 of 400 consecutive patients admitted with upper gastrointestinal haemorrhage. A history of antecedent consumption of salicylate ingestion was obtained in 47%. In some cases there were associated gastric ulcers, sometimes multiple (92 ). 

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