Non-variceal upper gastrointestinal bleeding continues to be an important cause of morbidity and mortality. The most common causes include peptic ulcer disease, Mallory–Weiss syndrome, erosive gastritis, duodenitis, esophagitis, malignancy, angiodysplasias and Dieulafoy’s lesion. Initial assessment and early aggressive resuscitation significantly improves outcomes. Upper gastrointestinal endoscopy continues to be the gold standard for diagnosis and treatment. We present a comprehensive review of literature for the evaluation and management of non-variceal upper gastrointestinal bleeding.

Introduction

Upper gastrointestinal bleeding is defined as bleeding proximal to the ligament of Treitz without evidence of esophageal, gastric, and duodenal varices.1 Gastrointestinal bleeding (GIB) is a significant public health issue costing nearly five billion dollars annually to the health system.2 Although, the incidence rates vary widely based on geographic location, prior studies have consistently shown higher incidence among males and the elderly population.3 In 2012, approximately 1,80,767 patients were hospitalized with UGIB.2 Recent studies have shown a decrease in mortality which is likely due to the advent of proton pump inhibitors (PPI), improved detection and treatment of Helicobacter pylori (H. pylori), and advances in endoscopic and interventional radiologic techniques.3,4 The most common cause continues to be peptic ulcers, although the incidence has declined.5 Despite endoscopy being the definitive diagnostic and therapeutic modality, a fundamental knowledge of the different etiologies and appropriate management is needed for emergency medicine physicians, intensivists, surgeons, interventional radiologists, internists, and gastroenterologists.