Evaluation and Management of Gastrointestinal Bleeding Part 1: Nonvariceal Upper Gastrointestinal Bleeding

This article, the first of a 2-part series on gastrointestinal bleeding, addresses the diagnosis and treatment of nonvariceal upper gastrointestinal (GI) bleeding. (The second article focuses on lower gastrointestinal and obscure gastrointestinal bleeding.) In the United States there are 100 cases of upper GI bleeding per 100 000 adults annually. Effective triage is essential when a patient presents with upper GI bleeding. Endoscopy is an effective tool for predicting risk, identifying etiology, and providing therapy for rebleeding. It is also an effective tool for reducing rebleeding rates and assessing the need for surgery. Once the patient with upper GI bleeding has been evaluated endoscopically, triage for rebleeding (with high-risk, moderate-risk, low-risk, and very-low-risk classifications) should be performed. Acid suppression is recommended for upper GI bleeding. Pharmacologic agents for acid suppression include histamine type 2 receptor antagonists (H₂ blockers) and proton pump inhibitors (PPIs). H₂ blockers are ineffective but PPIs are effective for preventing rebleeding, especially when given intravenously.