Management of acute upper gastrointestinal bleeding.

Initial management of acute upper gastrointestinal (UGI) bleeding depends on the clinical status of the patient. Symptoms of reduced blood volume or shock are clear indications for blood transfusion; oxygen therapy also may be needed. A brief history and physical examination, gastric aspiration, and gastric lavage help in ascertaining if bleeding is in the UGI tract; endoscopy, barium x-ray studies, and angiography help to identify the exact site. Bleeding from the most common causes of UGI tract hemorrhage--duodenal and gastric ulcers, esophagitis, and Mallory-Weiss tears--stops spontaneously or with gastric lavage in about 85% of patients. Patients with variceal hemorrhage have a worse prognosis and require intensive care. Vasopressin (Pitressin) infusion, either intravenous or intraarterial, is the first treatment to try. If it is not effective, balloon tamponade, sclerotherapy if available, or surgery may be necessary. Advances in medical, endoscopic, and surgical therapy may reduce morbidity and mortality in the future.