Upper gastrointestinal bleeding natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

If left untreated upper gastrointestinal bleeding can become life-threatening. Massive blood loss can result in a severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death. Complications of UGIB include end-organ damage and iron-deficiency anemia. Prognosis is generally good with prompt treatment, and the 1-year mortality rate of patients with nonvariceal UGIB is approximately 10%.

Natural History, Complications, and Prognosis

Natural History

If left untreated upper gastrointestinal bleeding can become life-threatening. Massive blood loss can result in severe drop in blood pressure resulting in decreased blood supply to organ systems leading to death. Chronic blood loss if left untreated results in anemia.

Complications

Complications of UGIB include:[1]

Prognosis

  • Prognosis is generally good with appropriate treatment, and the 1-year mortality rate of patients with nonvariceal UGIB is approximately 10%.[2][3][4][5]
  • In UGIB, the prognosis doesn't depend on the severity of bleeding but depends upon patien'ts age and comorbid conditions.
  • The majority of patients with UGIB will stop bleeding spontaneously.
  • A clean ulcer base has less than a 3% chance of rebleeding; therefore, these lesions are not usually treated or scoped again.
  • In otherwise stable patients, patients with a clean ulcer base has less than a 3% chance of rebleeding and are good candidates for early discharge.
Risk of recurrent bleeding without endoscopic therapy versus with endoscopic therapy
Active arterial (spurting) bleeding 55% versus 20%
Nonbleeding visible vessel 43% versus 15%
Adherent clot 22% versus 15%

References

  1. Sonnenberg A (2012). "Complications following gastrointestinal bleeding and their impact on outcome and death". Eur J Gastroenterol Hepatol. 24 (4): 388–92. doi:10.1097/MEG.0b013e328350589e. PMID 22233622.
  2. Roberts SE, Button LA, Williams JG (2012). "Prognosis following upper gastrointestinal bleeding". PLoS ONE. 7 (12): e49507. doi:10.1371/journal.pone.0049507. PMC 3520969. PMID 23251344.
  3. Katschinski B, Logan R, Davies J, Faulkner G, Pearson J, Langman M (1994). "Prognostic factors in upper gastrointestinal bleeding". Dig. Dis. Sci. 39 (4): 706–12. PMID 7908623.
  4. Kurien M, Lobo AJ (2015). "Acute upper gastrointestinal bleeding". Clin Med (Lond). 15 (5): 481–5. doi:10.7861/clinmedicine.15-5-481. PMID 26430191.
  5. Feinman M, Haut ER (2014). "Upper gastrointestinal bleeding". Surg. Clin. North Am. 94 (1): 43–53. doi:10.1016/j.suc.2013.10.004. PMID 24267496.


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