Upper gastrointestinal bleeding is the leading emergency leading to
hospitalization and urgent endoscopy. The field of gastrointestinal
bleeding is rapidly evolving. The epidemiology is changing with
more complex older patients on anticoagulant and antithrombotic
agents presenting with upper gastrointestinal bleeding. The initial
management has rapidly evolved with new transfusion thresholds, the
use of risk stratification scores and no more nasogastric tubes.
There is new data and recommendations on optimal timing of
endoscopy. Medical therapies have also evolved with changes in
proton pump inhibitor administration and the use of prokinetics to
improve endoscopic visualization. Many modifications in endoscopic
therapy have recently been advanced including the use of endoscopic
ultrasound guided angiotherapy, topical sprays (i.e. Hemospray) and
over-the-scope clips. In order to give optimal care to patients, it
is critical that practicing gastroenterologists are aware of the
many recent advances in management of patients with upper
gastrointestinal bleeding.
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