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Upper Gastrointestinal Tract BleedingPredisposing Factors, Diagnosis, and Therapy
Fred E. Silverstein, MD;
Andrew D. Feld, MD;
David A. Gilbert, MD
Arch Intern Med. 1981;141(3):322-327.
Abstract
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• The mortality from upper gastrointestinal (GI) tract bleeding has remained constant at 10% during the past 40 years. Many drugs may precipitate upper GI tract bleeding by disrupting the gastric mucosal barrier. Aspirin-induced injury to the gastric mucosa and GI tract bleeding have been documented in many studies; some of the mechanisms involved are known, but others are still being investigated. An approach to the bleeding patient is suggested; initial resuscitation, history taking, physical examination, determination of bleeding levels, and diagnostic procedures to determine the cause of bleeding are reviewed. Also described are available therapies for GI tract bleeding—gastric lavage, drug therapy, endoscopic control, electrocautery, thermal probe, tissue adhesive, and laser photocoagulation. The merits of the argon laser and the neodymium-yttrium aluminum garnet laser (both still in experimental stages) are described and compared. No pharmacologic or endoscopic therapies for upper GI tract bleeding have been proved effective.
(Arch Intern Med 1981;141:322-327)
Author Affiliations
From the Department of Medicine, University of Washington, Seattle.
Footnotes
Reprint requests to the Department of Medicine RG-20, University of Washington, Seattle, WA 98195 (Dr Silverstein).
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