Alali Ali A, Barkun Alan N
Division of Gastroenterology, Department of medicine, Faculty of Medicine, Kuwait University, Kuwait.
Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada.
Gastroenterol Rep (Oxf). 2023 Mar 20;11:goad011. doi: 10.1093/gastro/goad011. eCollection 2023.
Upper gastrointestinal bleeding (UGIB) continues to be a common gastrointestinal emergency that carries significant morbidity and mortality. The epidemiology of UGIB has been changing over the last few decades with an overall decrease in peptic ulcer disease and increase in the prevalence of other etiologies including vascular lesions and malignancy. Appropriate risk assessment and patient stratification are crucial to ensuring that optimal care is delivered to patients and some risk assessment tools have shown excellent ability to define a low-risk group who can be managed as outpatients safely. Regardless of the etiology of UGIB, resuscitative interventions by primary care providers remain the most important initial measures to improve the outcome for patients including hemodynamic stabilization, an appropriate blood transfusion strategy, with or without acid-lowering agents, while also providing subsequent urgent endoscopic assessment and intervention. In addition, with increasing use of antithrombotic agents in clinical practice and its associated risk of bleeding, the management of such agents in the acute setting has become a real challenge to all physicians. In this article, we provide an up-to-date, evidence-based, practical review of recent changes and advances in UGIB with a focus on non-variceal etiologies.
上消化道出血（UGIB）仍然是一种常见的胃肠道急症，具有较高的发病率和死亡率。在过去几十年中，UGIB的流行病学一直在变化，消化性溃疡疾病总体上有所减少，而包括血管病变和恶性肿瘤在内的其他病因的患病率有所增加。适当的风险评估和患者分层对于确保为患者提供最佳治疗至关重要，一些风险评估工具已显示出能够很好地界定可安全作为门诊患者管理的低风险组。无论UGIB的病因如何，初级保健提供者的复苏干预仍然是改善患者预后的最重要初始措施，包括血流动力学稳定、适当的输血策略（使用或不使用抑酸剂），同时还要进行后续的紧急内镜评估和干预。此外，随着抗血栓药物在临床实践中的使用增加及其相关的出血风险，在急性情况下对这类药物的管理已成为所有医生面临的一项实际挑战。在本文中，我们对UGIB的最新变化和进展进行了基于证据的实用综述，重点关注非静脉曲张病因。
