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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2015; 6(4): 172-182
Published online Nov 6, 2015. doi: 10.4292/wjgpt.v6.i4.172
Diagnosis and therapy of non-variceal upper gastrointestinal bleeding
Erwin Biecker
Erwin Biecker, Department of Gastroenterology, Zollernalb Klinikum, 72336 Balingen, Germany
Author contributions: Biecker E solely performed all the work of this manuscript.
Conflict-of-interest statement: The author has no conflict-of-interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Erwin Biecker, MD, PhD, Department of Gastroenterology, Zollernalb Klinikum, Tübinger Str. 30, 72336 Balingen, Germany. erwin.biecker@zollernalb-klinikum.de
Telephone: +49-7433-90922601 Fax: +49-7433-90922605
Received: March 3, 2015
Peer-review started: March 5, 2015
First decision: April 29, 2015
Revised: May 10, 2015
Accepted: September 28, 2015
Article in press: October 9, 2015
Published online: November 6, 2015
Processing time: 250 Days and 15.3 Hours
Abstract

Non-variceal upper gastrointestinal bleeding (UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions, erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor (PPI) therapy. These drugs are highly effective but the best route of application (oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal anti-inflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased.

Keywords: Gastrointestinal bleeding; Gastric ulcer; Duodenal ulcer; Endoscopy; Endoscopic therapy

Core tip: Non-variceal upper gastrointestinal bleeding (UGIB) is still accompanied by a significant mortality rate in older patients. Causes of UGIB are ulcers, Mallory-Weiss lesions, erosions, esophagitis or angiodysplasia. Endoscopy offers the localisation of the bleeding site as well as a variety of therapeutic measures. Patients with peptic lesions are effectively treated with proton pump inhibitors. Helicobacter pylori is a risk factor for the genesis of peptic ulcers and eradication therapy should be given if it is present.