Advances and Improvements in the Management of Upper Gastrointestinal Bleeding

John R. Saltzman, MD, FACP, FACG, FASGE, AGAF, Editor
Upper gastrointestinal bleeding is the primary gastrointestinal emergency leading to hospitalization and urgent endoscopy in the United States. Compared with prior decades, patients with upper gastrointestinal bleeding are older, are more likely to have complex medical problems, and are more likely to be receiving anticoagulant and antithrombotic agents. However, while the patients we treat are now more complicated, there have also been many significant advancements in the medical and endoscopic therapies for upper gastrointestinal bleeding, and there are strong data showing that mortality from upper gastrointestinal bleeding is decreasing. Given this rapidly evolving field, it is crucial that physicians caring for patients with upper gastrointestinal bleeding be aware of the many recent changes in patient management. I am honored to be the guest editor of this issue of Gastrointestinal Endoscopy Clinics of North America dedicated to upper gastrointestinal bleeding at this time of rapid progression in the field. The authors of the articles in this issue are international experts who are recognized thought-leaders in upper gastrointestinal bleeding.

The last several years have seen significant changes in the initial management of patients with upper gastrointestinal bleeding, with more restrictive transfusion thresholds, increased use of risk stratification scores, and discontinuation of routine nasogastric tubes. In addition, there are new data and recommendations on the optimal timing of endoscopy. Concurrent with the evolution of endoscopic management, medical therapies have been developed with recent changes in proton pump inhibitor administration recommendations as well as the use of prokinetics to improve endoscopic visualization. Many modifications in endoscopic therapy have been developed, including the use of endoscopic ultrasound-guided angiotherapy, topical sprays (eg, hemostatic nanopowders), and over-the-scope clips. The medical and endoscopic management of esophageal and gastric variceal bleeding is also changing, including the use of injected glues. This issue discusses all of these important areas as well as management of rebleeding and of unusual causes of upper gastrointestinal bleeding. I highly recommend reading “Tips and Tricks on How to Optimally Manage Patients with Upper Gastrointestinal Bleeding,” which provides practical insights on improving management, as well as the “Zen of Endoscopy.”

To provide optimal care to our patients, it is critical that practicing gastroenterologists be familiar with the many recent advances in management of upper gastrointestinal bleeding. This issue of Gastrointestinal Endoscopy Clinics of North America provides a comprehensive overview of the management of patients with upper gastrointestinal bleeding by experts who provide state-of-the-art updates as well as practical clinical pearls. I am deeply indebted to all of the contributors and hope that you find this issue helpful in your practice.

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Sep 10, 2017 | Posted by in GASTOINESTINAL SURGERY | Comments Off on Advances and Improvements in the Management of Upper Gastrointestinal Bleeding

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