Advertisement

European Radiology

, Volume 17, Issue 7, pp 1714–1726 | Cite as

Nonvariceal upper gastrointestinal bleeding

  • Stephen J. Burke
  • Jafar GolzarianEmail author
  • Derik Weldon
  • Shiliang Sun
Vascular-Interventional

Abstract

Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding.

Keywords

Upper gastrointestinal bleeding Ulcer Endoscopy Embolization Angiography 

References

  1. 1.
    Ettorre GC, Francioso G et al (1997) Helical CT angiography in gastrointestinal bleeding of obscure origin. AJR Am J Roentgenol 168:727–730PubMedGoogle Scholar
  2. 2.
    Rupp T, Singh S et al (2004) Gastrointestinal hemorrhage: the prehospital recognition, assessment and management of patients with a GI bleed. JEMS 29(8):80–81PubMedGoogle Scholar
  3. 3.
    Fallah MA, Prakash C et al (2000) Acute gastrointestinal bleeding. Med Clin North Am 84(5):1183–1208PubMedCrossRefGoogle Scholar
  4. 4.
    Conrad SA (2002) Acute upper gastrointestinal bleeding in critically ill patients: causes and treatment modalities. Crit Care Med 30 [6 Suppl]:S365–S368PubMedCrossRefGoogle Scholar
  5. 5.
    Blocksom JM, Tokioka S et al (2004) Current therapy for nonvariceal upper gastrointestinal bleeding. Surg Endosc 18:186–192PubMedCrossRefGoogle Scholar
  6. 6.
    Zuckerman GR, Prakash C (1999) Acute lower intestinal bleeding. II. Etiology, therapy, and outcomes. Gastrointest Endosc 49(2):228–238PubMedCrossRefGoogle Scholar
  7. 7.
    Rollhauser C, Fleischer DE (2004) Nonvariceal upper gastrointestinal bleeding. Endoscopy 36(1):52–58PubMedCrossRefGoogle Scholar
  8. 8.
    Mitchell S, Schaeffer DC, Dubagunta S (2004) A new view of occult and obscure gastrointestinal bleeding. Am Fam Phys 69:875–881Google Scholar
  9. 9.
    Foutch PG (1993) Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol 88:807–808PubMedGoogle Scholar
  10. 10.
    Aabakken L (2001) Nonvariceal upper gastrointestinal bleeding. Endoscopy 33(1):16–23PubMedCrossRefGoogle Scholar
  11. 11.
    Rollhauser C, Fleischer DE (2002) Nonvariceal upper gastrointestinal bleeding. Endoscopy 34(2):111–118PubMedCrossRefGoogle Scholar
  12. 12.
    Rossini FP, Taylor I et al (1989) Emergency colonoscopy. World J Surg 13:190–192PubMedCrossRefGoogle Scholar
  13. 13.
    Friedman CJ, Tegtmeyer CJ (1979) Crohn’s disease associated with Takayasu’s arteritis. Dig Dis Sci 24(12)954–958PubMedCrossRefGoogle Scholar
  14. 14.
    Defreyne L, Vanlangenhove P et al (2003) Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization. Eur Radiol 13:2604–2614PubMedCrossRefGoogle Scholar
  15. 15.
    Barkun A, Bardou M, Marshall JK (2003) Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 139:843–857PubMedGoogle Scholar
  16. 16.
    Dempsey DT, Burke DR et al (1990) Angiography in poor-risk patients with massive nonvariceal upper gastrointestinal bleeding. Am J Surg 159:282–286PubMedCrossRefGoogle Scholar
  17. 17.
    Walsh RM, Anain F et al (1999) Role of angiography and embolization for massive gastroduodenal hemorrhage. J Gastrointest Surg 3:61–66PubMedCrossRefGoogle Scholar
  18. 18.
    Koval G, Benner KG et al (1987) Aggressive angiographic diagnosis in acute lower gastrointestinal hemorrhage. Dig Dis Sci 32(3):248–253PubMedCrossRefGoogle Scholar
  19. 19.
    Nicholson AA, Ettles DG et al (1998) Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage. Gut 43:79–84PubMedCrossRefGoogle Scholar
  20. 20.
    Whitaker SC, Gregson RH (1993) The role of angiography in the investigation of acute or chronic gastrointestinal haemorrhage. Clin Radiol 47:382–388PubMedCrossRefGoogle Scholar
  21. 21.
    Alavi A, Dann RW, Baum S, Biery DN (1977) Scintigraphic detection of acute gastrointestinal bleeding. Radiology 124:753–756PubMedGoogle Scholar
  22. 22.
    Alavi A (1982) Detection of gastrointestinal bleeding with 99mTc-sulfur colloid. Semin Nucl Med 12(2):126–138PubMedCrossRefGoogle Scholar
  23. 23.
    Pavel DG, Zimmer M, Patterson VN (1977) In vivo labeling of red blood cells with 99mTc: a new approach to blood pool visualization. J Nucl Med 18:305–308PubMedGoogle Scholar
  24. 24.
    McKusick KA, Froelick J et al (1981) 99mTc red blood cells for detection of gastrointestinal bleeding: experience with 80 patients. AJR Am J Roentgenol 137:1113–1118PubMedGoogle Scholar
  25. 25.
    Gupta S, Luna E et al (1984) Detection of gastrointestinal bleeding by radionuclide scintigraphy. Am J Gastroenterol 79:26–31PubMedGoogle Scholar
  26. 26.
    Nicholson MI, Neoptolemos JP et al (1989) Localization of lower gastrointestinal bleeding using in vivo technetium-99m red blood cell scintigraphy. Br J Surg 76:358–361PubMedCrossRefGoogle Scholar
  27. 27.
    Hunter JM, Pezim ME (1990) Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding. Am Surg 159:504–506CrossRefGoogle Scholar
  28. 28.
    Bentley DE, Richardson JD (1991) The role of tagged red blood cell imaging in the localization of gastrointestinal bleeding. Arch Surg 126:821–824PubMedGoogle Scholar
  29. 29.
    Voeller GR, Bunch G, Britt LG (1991) Use of technetium-labeled red blood cell scintigraphy in the detection and management of gastrointestinal hemorrhage. Surgery 110:799–804PubMedGoogle Scholar
  30. 30.
    Gunderman R, Leef J, Ong K et al (1998) Scintigraphic screening prior to visceral arteriography in acute lower gastrointestinal bleeding. J Nucl Med 39:1081–1083PubMedGoogle Scholar
  31. 31.
    Jacobson AF, Cerqueira MD (1992) Prognostic significance of late imaging results in technetium-99m-labeled red blood cell gastrointestinal bleeding studies with early negative images. J Nucl Med 33:202–207PubMedGoogle Scholar
  32. 32.
    Sandhu C, Buckenham TM, Belli AM (1999) Using CO2-enhanced arteriography to investigate acute gastrointestinal hemorrhage. AJR Am J Roentgenol 173:1399–1401PubMedGoogle Scholar
  33. 33.
    Toyoda H, Nakano S et al (1995) Transcatheter arterial embolization for massive bleeding from duodenal ulcers not controlled by endoscopic hemostasis. Endoscopy 27:304–307PubMedCrossRefGoogle Scholar
  34. 34.
    Dempsey DT, Burke DR et al (1990) Angiography in poor-risk patients with massive nonvariceal upper gastrointestinal bleeding. Am J Surg 159:282–286PubMedCrossRefGoogle Scholar
  35. 35.
    Aina R, Oliva VL et al (2001) Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol 12:195–200PubMedCrossRefGoogle Scholar
  36. 36.
    Glickerman DJ, Kowdley KV, Rosch J (1988) Urokinase in gastrointestinal tract bleeding. Radiology 168:375–376PubMedGoogle Scholar
  37. 37.
    Rosch J, Keller FS et al (1982) Pharmacoangiography in the diagnosis of recurrent massive lower gastrointestinal bleeding. Radiology 145:615–619PubMedGoogle Scholar
  38. 38.
    Ryan JM, Key SM et al (2001) Nonlocalized lower gastrointestinal bleeding: provocative bleeding studies with intra-arterial tPA, heparin, and tolazoline. J Vasc Interv Radiol 12:1273–1277PubMedCrossRefGoogle Scholar
  39. 39.
    Malden ED, Hicks ME et al (1998) Recurrent gastrointestinal bleeding: use of thrombolysis with anticoagulation in diagnosis. Radiology 207:147–151PubMedGoogle Scholar
  40. 40.
    Yamaguchi K, Yoshikawa K (2003) Enhanced CT for initial localization of active lower gastrointestinal bleeding. Abdom Imaging 28:634–636PubMedCrossRefGoogle Scholar
  41. 41.
    Kuhl WG, Sheiman ER (2003) Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology 228:743–752CrossRefGoogle Scholar
  42. 42.
    Nusbaum M, Baum S et al (1965) Demonstration of intra-abdominal bleeding by selective arteriography. JAMA 191(5):117–118Google Scholar
  43. 43.
    Funaki B (2004) Microcatheter embolization of lower gastrointestinal hemorrhage: an old idea whose time has come. Cardiovasc Interv Radiol 27:591–599CrossRefGoogle Scholar
  44. 44.
    Rivkin K, Lyakhovetskiy A (2005) Treatment of nonvariceal upper gastrointestinal bleeding. Am J Health Syst Pharm 62:1159–1170PubMedCrossRefGoogle Scholar
  45. 45.
    Henry DA, O’Connell DL (1989) Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage. BMJ 298:1142–1146PubMedCrossRefGoogle Scholar
  46. 46.
    Chung SS, Lau JY et al (1997) Randomized comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. BMJ 314:1307–1311PubMedGoogle Scholar
  47. 47.
    Huang CS, Lichtenstein DR (2003) Nonvariceal upper gastrointestinal bleeding. Gastroenterol Clin N Am 32:1035–1052CrossRefGoogle Scholar
  48. 48.
    Rockall TA, Logan RF et al (1996) Risk assessment after acute upper gastrointestinal haemorrhage. Gut 38:316–321PubMedGoogle Scholar
  49. 49.
    Blatchford O, Murray WR, Blatchford M (2000) A risk score to predict need for upper-gastrointestinal haemorrhage. Lancet 356(9238):1318–1321PubMedCrossRefGoogle Scholar
  50. 50.
    Forrest JA, Finlayson ND, Shearman DJ (1974) Endoscopy in gastrointestinal bleeding. Lancet 2:394–397PubMedCrossRefGoogle Scholar
  51. 51.
    Wong RC, Chak A et al (2000) Role of Doppler US in acute peptic ulcer hemorrhage: can it predict failure of endoscopic therapy? Gastrointest Endosc 52(3):315–321PubMedCrossRefGoogle Scholar
  52. 52.
    Consensus Conference: Therapeutic Endoscopy and Bleeding Ulcers (1989) JAMA 262:1369–1372Google Scholar
  53. 53.
    Cook DJ, Guyatt GH et al (1992) Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 102:139–148PubMedGoogle Scholar
  54. 54.
    Sacks HS, Chalmers TC et al (1990) Endoscopic hemostasis: an effective therapy for bleeding peptic ulcers. JAMA 264:494–499PubMedCrossRefGoogle Scholar
  55. 55.
    Bleau BL, Gostout CJ et al (2002) Recurrent bleeding from peptic ulcer associated with adherent clot: a randomized study comparing endoscopic treatment with medical therapy. Gastrointest Endosc 56:1–6PubMedCrossRefGoogle Scholar
  56. 56.
    Jensen DM, Kovacs TO et al (2002) Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 123:407–413PubMedCrossRefGoogle Scholar
  57. 57.
    Rosen RJ, Sanchez G (1994) Angiographic diagnosis and management of gastrointestinal hemorrhage: current concepts. Radiol Clin North Am 32(5):951–967PubMedGoogle Scholar
  58. 58.
    Gomes AS, Lois JF, McCoy RD (1986) Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization. AJR Am J Roentgenol 146:1031–1037PubMedGoogle Scholar
  59. 59.
    Carreira JM, Reyes R, Pulido-Duque JM et al (1999) Diagnosis and percutaneous treatment of gastrointestinal hemorrhage: long-term experience. Rev Esp Enferm Dig 91:684–692PubMedGoogle Scholar
  60. 60.
    Newton TH, Adams JE (1968) Angiographic demonstration and non-surgical embolisation of spinal cord angioma. Radiology 91:873–876PubMedGoogle Scholar
  61. 61.
    Goldberger LE, Bookstein JJ (1977) Transcatheter embolisation for treatment of diverticular haemorrhage. Radiology 122:613–617PubMedGoogle Scholar
  62. 62.
    Rosenkrantz H, Bookstein JJ et al (1982) Postembolic colonic infarction. Radiology 142:47–51PubMedGoogle Scholar
  63. 63.
    Funaki B (2004) Superselective embolization of lower gastrointestinal hemorrhage: a new paradigm. Abdom Imaging 29:434–438PubMedCrossRefGoogle Scholar
  64. 64.
    Lang EK (1992) Transcatheter embolization in management of hemorrhage from duodenal ulcer: long-term results and complications. Radiology 182:703–707PubMedGoogle Scholar
  65. 65.
    Schenker MP, Duszak R et al (2001) Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Interv Radiol 12:1263–1271PubMedCrossRefGoogle Scholar
  66. 66.
    Zettinig G, Staudenherz A, Leitha T (2002) The importance of delayed images in gastrointestinal bleeding scintigraphy. Nucl Med Comm 23:803–808CrossRefGoogle Scholar
  67. 67.
    Howarth DM, Tang K, Lees W (2002) The clinical utility of nuclear medicine imaging for the detection of occult gastrointestinal haemorrhage. Nucl Med Comm 23:591–594CrossRefGoogle Scholar
  68. 68.
    Morris DC, Nichols DM et al (1986) Embolization of the left gastric artery in the absence of angiographic extravasation. Cardiovasc Intervent Radiol 9:195–198PubMedCrossRefGoogle Scholar
  69. 69.
    Funaki B (2002) Endovascular intervention for the treatment of acute arterial gastrointestinal hemorrhage. Gastroenterol Clin North Am 31(3):701–713PubMedCrossRefGoogle Scholar
  70. 70.
    Lang EV, Picus D et al (1992) Massive upper gastrointestinal hemorrhage with normal findings on arteriography: value of prophylactic embolization of the left gastric artery. AJR Am J Roentgenol 158(3):547–549PubMedGoogle Scholar
  71. 71.
    Encarnacion CE, Kadir S et al (1992) Gastrointestinal bleeding: treatment with gastrointestinal arterial embolization. Radiology 183:505–508PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Stephen J. Burke
    • 1
  • Jafar Golzarian
    • 1
    • 2
    Email author
  • Derik Weldon
    • 1
  • Shiliang Sun
    • 1
  1. 1.Department of RadiologyUniversity of IowaIowaUSA
  2. 2.Department of Radiology, Carver College of MedicineUniversity of IowaIowaUSA

Personalised recommendations