Management of acute upper gastrointestinal bleeding

The purpose of this review is to summarize the management of upper gastrointestinal bleeding (UGIB). This entity has an annual incidence of 48 to 160 cases per 100,000 adults, with a mortality rate of 10% to 14%. Classically, UGIB is divided in non-variceal hemorrhage and variceal hemorrhage, being more frequently observed the first one (80%- 90%). The initial management includes investigate about the form of presentation, color and characteristics of the hemorrhage, the age of the patient, presence of coagulopathy, disease or cardiovascular risk factors, use of nonsteroidal anti-inflammatory drugs (NSAIDs), antiaggregants or anticoagulants, previous episodes of hemorrhage, endoscopy, alcohol intake, etc. However, this process must not delay the initiation of hemodynamic resuscitation in patients with patients with ongoing bleeding. To stratify these patients, risk scores including Blatchford score and Rockall score are developed. Diagnosis is realized through endscopy, which allows definitive treatment. This treatment is improved providing pre-endoscopy as well as post-endoscopy therapy, including proton pump inhibitor (PPI) therapy. In variceal hemorrhage, if endoscopy therapy fails, balloon tamponade or transjugular intrahepatic portosystemic shunt (TIPSS) are indicated. The purpose of this review is to summarize the initial management of acute UGIB, especially in the Emergency Department.