Nonvariceal upper gastrointestinal bleeding

Castrointestinal endoscopy has evolved over the past 3 decades and has a central role in the management of gastrointestinal (Cl) hemorrhage.This evolutionary process has enabled the Cl endoscopist to move from the sidelines in patients with upper gastrointestinal (UCI) nonvariceal bleeding, to quarterbacking the offense.In this article, historical and clinical parameters of prognostic significance will be presented.The instruments used by the Cl endoscopist will be reviewed as well as clinical studies evaluating their efficacy. CLINICAL ASSESSMENTThe patient who presents with Cl bleeding must undergo rapid evaluation to determine the nature of the bleed, whether it is acute or chronic, and the extent of the bleed.A careful clinical assessment categorizes patients as low risk, for continued bleeding or rebleeding, and high risk for concomitant morbidity and mortality.Simultaneously resuscitation procedures should be performed. HISTORYA history of aspirin or nonsteroidal antiinflammatory drug (NSAID) use is important.The prevalence of gastric ulcers in patients taking NSAIDs ranges from 5% to 25%, but the risk of bleeding is double that