Abstract：
BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency clinicians to be aware of the current evidence regarding the diagnosis and management of this disease.
OBJECTIVE: This paper evaluates key evidence-based updates concerning UGIB for the emergency clinician.
CONCLUSIONS: UGIB most frequently presents with hematemesis. There are numerous causes, with the most common peptic ulcer disease, though variceal bleeding in particular can be severe. Nasogastric tube lavage for diagnosis is not recommended based on the current evidence. A hemoglobin transfusion threshold of 7 g/dL is recommended (8 g/dL in those with myocardial ischemia), but patients with severe bleeding and hemodynamic instability require emergent transfusion regardless of their level. Medications that may be used in UGIB include proton pump inhibitors, prokinetic agents, and vasoactive medications. Antibiotics are recommended for those with cirrhosis and suspected variceal bleeding. Endoscopy is the diagnostic and therapeutic modality of choice and should be performed within 24 h of presentation in non-variceal bleeding after resuscitation, though patients with variceal bleeding may require endoscopy within 12 h. Transcatheter arterial embolization or surgical intervention may be necessary. Intubation should be avoided if possible. If intubation is necessary, several considerations are required, including resuscitation prior to induction, utilizing preoxygenation and appropriate suction, and administering a prokinetic agent. There are a variety of tools available for risk stratification, including the Glasgow Blatchford Score.
CONCLUSIONS: An understanding of literature updates can improve the ED care of patients with UGIB.
OBJECTIVE: This paper evaluates key evidence-based updates concerning UGIB for the emergency clinician.
CONCLUSIONS: UGIB most frequently presents with hematemesis. There are numerous causes, with the most common peptic ulcer disease, though variceal bleeding in particular can be severe. Nasogastric tube lavage for diagnosis is not recommended based on the current evidence. A hemoglobin transfusion threshold of 7 g/dL is recommended (8 g/dL in those with myocardial ischemia), but patients with severe bleeding and hemodynamic instability require emergent transfusion regardless of their level. Medications that may be used in UGIB include proton pump inhibitors, prokinetic agents, and vasoactive medications. Antibiotics are recommended for those with cirrhosis and suspected variceal bleeding. Endoscopy is the diagnostic and therapeutic modality of choice and should be performed within 24 h of presentation in non-variceal bleeding after resuscitation, though patients with variceal bleeding may require endoscopy within 12 h. Transcatheter arterial embolization or surgical intervention may be necessary. Intubation should be avoided if possible. If intubation is necessary, several considerations are required, including resuscitation prior to induction, utilizing preoxygenation and appropriate suction, and administering a prokinetic agent. There are a variety of tools available for risk stratification, including the Glasgow Blatchford Score.
CONCLUSIONS: An understanding of literature updates can improve the ED care of patients with UGIB.
摘要：
背景：上消化道出血（UGIB）是急诊科（ED）常见的疾病。因此,急诊临床医生了解目前有关本病诊断和治疗的证据非常重要.
目的：本文评估了急诊临床医生关于UGIB的关键循证更新。
结论：UGIB最常伴有呕血。有很多原因，最常见的消化性溃疡,尽管静脉曲张出血尤其严重。根据目前的证据，不建议使用鼻胃管灌洗进行诊断。建议血红蛋白输注阈值为7g/dL（心肌缺血患者为8g/dL），但是严重出血和血流动力学不稳定的患者需要紧急输血，无论其水平如何。可用于UGIB的药物包括质子泵抑制剂，促动力剂，和血管活性药物。对于患有肝硬化和疑似静脉曲张破裂出血的患者，建议使用抗生素。内镜检查是首选的诊断和治疗方式，应在复苏后非静脉曲张出血的24小时内进行。尽管静脉曲张出血患者可能需要在12小时内进行内窥镜检查。经导管动脉栓塞或手术干预可能是必要的。如果可能，应避免插管。如果需要插管,需要考虑几个因素，包括诱导前的复苏，利用预充氧和适当的抽吸，并施用促动力剂。有多种工具可用于风险分层，包括格拉斯哥布拉特福德得分。
结论：了解文献更新可以改善UGIB患者的ED护理。
目的：本文评估了急诊临床医生关于UGIB的关键循证更新。
结论：UGIB最常伴有呕血。有很多原因，最常见的消化性溃疡,尽管静脉曲张出血尤其严重。根据目前的证据，不建议使用鼻胃管灌洗进行诊断。建议血红蛋白输注阈值为7g/dL（心肌缺血患者为8g/dL），但是严重出血和血流动力学不稳定的患者需要紧急输血，无论其水平如何。可用于UGIB的药物包括质子泵抑制剂，促动力剂，和血管活性药物。对于患有肝硬化和疑似静脉曲张破裂出血的患者，建议使用抗生素。内镜检查是首选的诊断和治疗方式，应在复苏后非静脉曲张出血的24小时内进行。尽管静脉曲张出血患者可能需要在12小时内进行内窥镜检查。经导管动脉栓塞或手术干预可能是必要的。如果可能，应避免插管。如果需要插管,需要考虑几个因素，包括诱导前的复苏，利用预充氧和适当的抽吸，并施用促动力剂。有多种工具可用于风险分层，包括格拉斯哥布拉特福德得分。
结论：了解文献更新可以改善UGIB患者的ED护理。
