Upper gastrointestinal bleeding natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

If left untreated upper gastrointestinal bleeding can become life-threatening. Massive blood loss can result in a severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death. Complications of UGIB include end-organ damage and iron-deficiency anemia. Prognosis is generally good with prompt treatment, and the 1-year mortality rate of patients with nonvariceal UGIB is approximately 10%.

Natural History, Complications, and Prognosis

Natural History

If left untreated upper gastrointestinal bleeding can become life-threatening. Massive blood loss can result in severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death. Chronic blood loss if left untreated results in anemia.

Complications

Complications of UGIB include:

• End-organ damage
  • Cardiac ischemia
  • Renal failure
  • Ischemic hepatitis
  • Anoxic brain injury
• Iron-deficiency anemia

Prognosis

• Prognosis is generally good with appropriate treatment, and the 1-year mortality rate of patients with nonvariceal UGIB is approximately 10%.
• In UGIB, the prognosis doesn't depend on the severity of bleeding but depends upon patien'ts age and comorbid conditions.
• The majority of patients with UGIB will stop bleeding spontaneously.
• A clean ulcer base has less than a 3% chance of rebleeding; therefore, these lesions are not usually treated or scoped again.
• In otherwise stable patients, patients with a clean ulcer base has less than a 3% chance of rebleeding and are good candidates for early discharge.

Risk of recurrent bleeding without endoscopic therapy versus with endoscopic therapy
Active arterial (spurting) bleeding	55% versus 20%
Nonbleeding visible vessel	43% versus 15%
Adherent clot	22% versus 15%

• Despite advances in gastric acid suppression as well as improved endoscopic diagnostic and therapeutic techniques, the mortality rate from UGIB has remained stable.