Chapter 139

Endoscopic Diagnosis and Treatment of Nonvariceal Upper Gastrointestinal Hemorrhage

Anne Thai

Anne Thai

University of California Davis Medical Center, Sacramento, CA, USA

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Joseph W. Leung

Joseph W. Leung

Sacramento VA Medical Center, Northern California Health Care System, Mather, CA, USA

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First published: 27 November 2015

Summary

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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