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Review
. 2020 Feb 2;9(2):402.
doi: 10.3390/jcm9020402.

Diagnosis and Management of Non-Variceal Gastrointestinal Hemorrhage: A Review of Current Guidelines and Future Perspectives

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Free PMC article
Review

Diagnosis and Management of Non-Variceal Gastrointestinal Hemorrhage: A Review of Current Guidelines and Future Perspectives

Sobia Mujtaba et al. J Clin Med. .
Free PMC article

Abstract

Non-variceal gastrointestinal bleeding (GIB) is a significant cause of mortality and morbidity worldwide which is encountered in the ambulatory and hospital settings. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GIB, small bowel bleeding (also formerly referred to as obscure GIB) or lower GIB. Although the etiologies of GIB are variable, a strong, consistent risk factor is use of non-steroidal anti-inflammatory drugs. Advances in the endoscopic diagnosis and treatment of GIB have led to improved outcomes. We present an updated review of the current practices regarding the diagnosis and management of non-variceal GIB, and possible future directions.

Keywords: endoscopy; gastrointestinal bleeding; guidelines; hemostasis; non-steroidal anti-inflammatory drugs; risk factors.

Conflict of interest statement

None of the authors has a conflict of interest to disclose.

Figures

Figure 1
Figure 1
Gastric ulcer with a non-bleeding visible vessel (Forrest IIa ulcer) seen along the lesser curvature. A large, fresh clot is seen along the greater curvature extending into the antrum.
Figure 2
Figure 2
Gastric ulcer with an adherent clot (Forrest IIb ulcer) with active oozing seen in the gastric body.
Figure 3
Figure 3
Actively bleeding Dieulafoy lesion seen in gastric fundus (indicated by arrow) upon retroflexion (position of gastroscope indicated by circle).
Figure 4
Figure 4
Suggested management approach to overt and occult small-bowel bleeding. PE, push enteroscopy; VCE, video capsule endoscopy; DAE, device-assisted enteroscopy; CTE, CT enterography; MRE, magnetic resonance enterography; RBC, red blood cell. Copyright © 2017 by the American Society for Gastrointestinal Endoscopy 0016-5107. Reprinted with permission from Gurudu et. al., The role of endoscopy in management of suspected small-bowel bleeding, GIE, 2017, Volume 85, Issue 1, Pages 22–31.
Figure 5
Figure 5
Management of severe hematochezia. Copyright © 2014 by the American Society for Gastrointestinal Endoscopy 0016-5107. Reprinted with permission from Pasha et. al., The role of endoscopy in the patient with lower GI bleeding, GIE, 2014, Volume 79, Issue 6, Pages 875-885.
Figure 6
Figure 6
Adherent clot with oozing blood seen within a diverticulum in the ascending colon.
Figure 7
Figure 7
Two large arteriovenous malformations (AVMs) seen in the ascending colon (indicated by arrow) which were treated with argon plasma coagulation (APC).

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