Endoscopic Diagnosis and Treatment of Nonvariceal Upper Gastrointestinal Hemorrhage
Anne Thai
University of California Davis Medical Center, Sacramento, CA, USA
Search for more papers by this authorJoseph W. Leung
Sacramento VA Medical Center, Northern California Health Care System, Mather, CA, USA
Search for more papers by this authorAnne Thai
University of California Davis Medical Center, Sacramento, CA, USA
Search for more papers by this authorJoseph W. Leung
Sacramento VA Medical Center, Northern California Health Care System, Mather, CA, USA
Search for more papers by this authorDaniel K. Podolsky MD
President, University of Texas Southwestern Medical Center, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorMichael Camilleri MD
Executive Dean for Development, Atherton and Winifred W. Bean Professor, Professor of Medicine, Physiology and Pharmacology, Distinguished Investigator, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorJ. Gregory Fitz MD FAASLD
Executive Vice President for Academic Aff airs and Provost, University of Texas Southwestern Medical Center, Dean, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorAnthony N. Kalloo MD
Professor of Medicine, Johns Hopkins University School of Medicine, Director, Division of Gastroenterology & Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
Search for more papers by this authorFergus Shanahan MD
Professor and Chair, Department of Medicine, Director, Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland, Cork, Ireland
Search for more papers by this authorTimothy C. Wang MD
Chief, Division of Digestive and Liver Diseases, Silberberg Professor of Medicine, Department of Medicine and Irving Cancer Research Center, Columbia University Medical Center, New York, NY, USA
Search for more papers by this authorSummary
Upper gastrointestinal bleeding (UGIB) represents a significant entity for all clinicians. Despite advances in Helicobacter pylori detection and eradication, education on the effects of nonsteroidal antiinflammatory drugs (NSAID) use, and the use of proton pump inhibitors (PPIs), peptic ulcer disease (PUD) remains the most common cause of nonvariceal UGIB. The initial evaluation and risk assessment of the patient are the most important steps in the management of acute gastrointestinal bleeding. Endoscopy remains the gold standard for the diagnostic evaluation of an UGIB. Endoscopy usually offers a direct visualization of the source, immediate implementation of appropriate therapies, and assessment of further management needs. The majority of supporting evidence for the performance of a second look endoscopy is based on multiple trials carried out prior to current practice that includes avoidance of single epinephrine injection therapy for high-risk stigmata bleeds, and the use of high dose PPI therapy after endoscopic hemostasis.
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