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Emergency Department Evaluation And Management Of Patients With Upper Gastrointestinal Bleeding

April 2015

Abstract

Upper gastrointestinal bleeding results from a variety of conditions that may vary in severity from merely bothersome to imminently life-threatening. While stabilization is standard for nearly all causes of bleeding, identifying whether the bleed is from variceal or nonvariceal sources is critical. Testing and treatments such as nasogastric lavage, antibiotics, somatostatin analogues, proton pump inhibitors, and emergent endoscopy may benefit some patients, depending upon the bleeding source and other clinical factors; however, some therapies that are routinely used have very little evidence demonstrating effectiveness. This issue reviews the most recent evidence regarding appropriate testing, risk stratification, and indications for gastroenterology consult in the emergency department in order to treat these patients appropriately.

Key words: gastrointestinal, upper, bleed, variceal, hemorrhage, cirrhosis, hepatitis C, peptic ulcer disease, Mallory-Weiss, transfusion, anticoagulation, hematemesis, hematochezia, melena, NSAIDs, emergency medicine CME

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