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Non-variceal upper gastrointestinal bleeding

Nature Reviews Disease Primers volume 4, Article number: 18020 (2018) | Download Citation

Abstract

Non-variceal upper gastrointestinal bleeding (NVUGIB) is bleeding that develops in the oesophagus, stomach or proximal duodenum. Peptic ulcers, caused by Helicobacter pylori infection or use of NSAIDs and low-dose aspirin (LDA), are the most common cause. Although the incidence and mortality associated with NVUGIB have been decreasing owing to considerable advances in the prevention and management of NVUGIB over the past 20 years, it remains a common clinical problem with an annual incidence of 67 per 100,000 individuals in the United States in 2012. NVUGIB is a medical emergency, and mortality is in the range 1–5%. After resuscitation and initial assessment, early (within 24 hours) diagnostic and therapeutic endoscopy together with intragastric pH control with proton pump inhibitors (PPIs) form the basis of treatment. With a growing ageing population treated with antiplatelet and/or anticoagulant medications, the clinical management of NVUGIB is complex as the risk between gastrointestinal bleeding events and adverse cardiovascular events needs to be balanced. The best clinical approach includes identification of risk factors and prevention of bleeding; available strategies include continuous treatment with PPIs or H. pylori eradication in those at increased risk of developing NVUGIB. Treatment with PPIs and/or use of cyclooxygenase-2-selective NSAIDs should be implemented in those patients at risk of NVUGIB who need NSAIDs and/or LDA.

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Acknowledgements

A.L. declares that his work on this manuscript was partially funded by a grant from the Spanish Instituto de Salud Carlos III PI/PI08/1301 and “Fondo Europeo de Desarrollo Regional (FEDER) de la Unión Europea. – Una manera de hacer Europa –”. The authors thank M. Fujishiro, The University of Tokyo Hospital, for the images used in Fig. 6.

Author information

Affiliations

  1. Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón, Zaragoza, Spain.

    • Angel Lanas
  2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.

    • Angel Lanas
    •  & Càndid Villanueva
  3. Gedyt Endoscopy Center, Buenos Aires, Argentina.

    • Jean-Marc Dumonceau
  4. Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.

    • Richard H. Hunt
  5. Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

    • Mitsuhiro Fujishiro
  6. Division of Gastroenterology, University of Virginia, Charlottesville, VA, USA.

    • James M. Scheiman
  7. Ellen and Pinchas Mamber Institute of Gastroenterology, Emek Medical Center, Afula, Israel.

    • Ian M. Gralnek
  8. National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

    • Helen E. Campbell
  9. Division of Gastroenterology, University of Ottawa, Ottawa, Ontario, Canada.

    • Alaa Rostom
  10. Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.

    • Càndid Villanueva
  11. Division of Gastroenterology, The Chinese University of Hong Kong, Hong Kong, China.

    • Joseph J. Y. Sung

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Contributions

Introduction (A.L.); Epidemiology (C.V.); Mechanisms/pathophysiology (A.L. and R.H.H.); Diagnosis, screening and prevention (R.H.H., A.L., A.R. and M.F.); Management (J.J.Y.S., I.M.G., J.M.S. and J.-M.D.); Quality of life (H.E.C.); Outlook (all authors); Overview of the Primer (A.L.).

Competing interests

A.L. is an adviser to Bayer Healthcare and Bayer AG. J.M.S. is an adviser to Aralez Pharmaceuticals. All other authors declare no competing interest.

Corresponding author

Correspondence to Angel Lanas.

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DOI

https://doi.org/10.1038/nrdp.2018.20

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