Upper Gastrointestinal Bleeding

Clin Geriatr Med. 2021 Feb;37(1):155-172. doi: 10.1016/j.cger.2020.09.001.

Abstract

Upper gastrointestinal (GI) bleeding is a common reason for hospital admission in older adult patients and carries a high morbidity and mortality if not properly managed. Risk factors include advanced age, Helicobacter pylori infection, medication use, smoking, and history of liver disease. Patients with known or suspected liver disease and suspected variceal bleeding should also receive antibiotics and somatostatin analogues. Risk stratification scores should be used to determine patients at highest risk for further decompensation. Upper endoscopy is both a diagnostic and therapeutic tool used in the management of upper GI bleeding. Endoscopy should be performed within 24 hours of presentation after appropriate resuscitation. Management of anticoagulation in upper GI bleeding largely depends on the indication for anticoagulation, the risk of continued bleeding with continuing the medication, and the risk of thrombosis with discontinuing the medication. A multidisciplinary approach to the decision of anticoagulation continuation is preferred when possible.

Keywords: Aspirin; Gastrointestinal bleeding; Hematemesis; Hematochezia; Melena; NSAIDs; Peptic Ulcer Disease; Warfarin.

Publication types

  • Review

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use
  • Esophageal and Gastric Varices / chemically induced*
  • Gastrointestinal Hemorrhage / diagnosis*
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy*
  • Hematemesis
  • Humans
  • Melena / drug therapy
  • Melena / etiology
  • Peptic Ulcer / complications*
  • Peptic Ulcer Hemorrhage / drug therapy
  • Peptic Ulcer Hemorrhage / etiology
  • Warfarin / administration & dosage
  • Warfarin / adverse effects*
  • Warfarin / therapeutic use

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Warfarin