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Acute upper gastrointestinal haemorrhage accounts for approximately 25 000 hospital admissions each year in the United Kingdom. Only a small minority had sustained variceal haemorrhage, and it is unlikely that the scoring system can be applied to that group of patients. Bleeding tends to be more severe in patients who have haematemesis and melaena than in those who have melaena only. The most common cause of significant upper gastrointestinal haemorrhage remains peptic ulcer. Oesophageal varices account for a small proportion of cases, but have a disproportionate impact upon medical resources. Bleeding from gastric erosions and vascular malformations usually stops spontaneously and is rarely life-threatening. Endoscopy is necessary to define the cause of bleeding, to provide prognostic information, and to apply haemostatic therapy. Intravenous somatostatin and its synthetic analogue, octreotide, reduce splanchnic blood flow and suppress acid secretion. Injection therapy for peptic ulcer bleeding is widely used as first-line treatment. |
