Department of Internal Medicine, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States.
Department of Gastroenterology, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States.
Turk J Gastroenterol. 2024 May 20;35(8):599-608. doi: 10.5152/tjg.2024.23507.
Upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality. Clinical symptoms that patients may present with include: hematemesis, coffee-ground emesis, melena, and hematochezia. Clinical signs can range from tachycardia to shock. The anatomical landmark that differentiates upper gastrointestinal (GI) bleeds from lower bleeds is the ligament of Treitz. The first steps of treating a patient who presents with signs of UGIB are resuscitation with appropriate fluids and blood products as necessary. The consideration of endoscopy and the urgency at which it should be performed is also vital during initial resuscitation. Endoscopic therapy should ideally be performed within 24 hours of presentation after initial stabilization with crystalloids and blood products. Intravenous proton pump inhibitors are the mainstay in the initial management of upper GI bleeding from a non-variceal etiology, and they should be administered in the acute setting to decrease the probability of high-risk stigmata seen during endoscopy. Pro-kinetic agents can be given 30 minutes to an hour before endoscopy and may aid in the diagnosis of UGIB. There are 3 broad categories of endoscopic management for UGIB: injection, thermal, and mechanical. Each endoscopic method can be used alone or in combination with others; however, the injection technique with epinephrine should always be used in conjunction with another method to increase the success of achieving hemostasis. In this review article, we will review the steps of triage and initial resuscitation in UGIB, causes of UGIB and their respective management, several endoscopic techniques and their effectiveness, and prognosis with a primary focus limited to non-variceal bleeding.
上消化道出血（UGIB）是发病率和死亡率的主要原因。患者可能出现的临床症状包括：呕血、咖啡渣样呕吐物、黑便和血便。临床体征范围从心动过速到休克。区分上消化道（GI）出血和下消化道出血的解剖标志是Treitz 韧带。治疗出现 UGIB 迹象的患者的第一步是根据需要用适当的液体和血液制品进行复苏。在初始复苏期间，还必须考虑内镜检查及其执行的紧迫性。内镜治疗理想情况下应在上消化道出血的最初稳定期后 24 小时内进行，此时应使用晶体和血液制品进行初始稳定。静脉质子泵抑制剂是治疗非静脉曲张性病因引起的上消化道出血的主要方法，应在急性情况下给予，以降低内镜检查中观察到的高危征象的概率。促动力药物可在进行内镜检查前 30 分钟至 1 小时内给予，可能有助于诊断 UGIB。上消化道出血的内镜治疗有 3 种广泛的方法：注射、热疗和机械治疗。每种内镜方法都可以单独使用或与其他方法联合使用；然而，应始终将肾上腺素注射技术与另一种方法联合使用，以提高止血成功的概率。在这篇综述文章中，我们将回顾 UGIB 的分诊和初始复苏步骤、UGIB 的原因及其各自的治疗方法、几种内镜技术及其有效性以及预后，重点主要限于非静脉曲张性出血。
