Upper Gastrointestinal Bleeding: New Management for an Evolving Emergency

Charles J. Lightdale, MD, Consulting Editor

Just about every clinical gastroenterologist must be ready to effectively manage upper gastrointestinal bleeding. During the past 5 years, it has become clear that many methods and skills used in the past no longer apply. The patients who present with hematemesis and melena tend to be older and sicker, frequently taking anticoagulants, antiplatelet agents, antidepressants, aspirin, or nonsteroidal anti-inflammatory drugs. How to assess these emergent patients, how to resuscitate and stabilize them, and when to perform upper gastrointestinal endoscopy are critical issues. Understanding the application of the newest methods to identify and stop the bleeding is central to successful management. Working in concert with emergency room and intensive care physicians, interventional radiologists, anesthesiologists, and skilled nurses also requires a collegial team approach and up-to-date knowledge. Bleeding from the upper gastrointestinal tract is the most common and one of the most demanding emergencies for gastroenterologists. It is of the utmost importance to be as prepared and ready as possible.

This issue of Gastrointestinal Endoscopy Clinics of North America is devoted exclusively to advances and improvements in the management of upper gastrointestinal bleeding. I am extremely grateful to the editor of this issue, Dr John R. Saltzman, Director of Endoscopy at Brigham and Women’s Hospital, Boston, Massachusetts. Dr Saltzman has been a leader and innovator in gastrointestinal endoscopy and his high-impact scholarship continues in this issue, which should have a significant influence on the management of gastrointestinal bleeding. He has taken a comprehensive approach here, finding an extraordinary group of author-experts to cover every key aspect. Readers of this issue should feel comfortable and confident that they are current in their knowledge and approach in dealing with this emergency. All practicing gastroenterologists—trainees to senior attending physicians—should read this issue from cover to cover. I consider it to be essential reading.

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