Management of Upper GI bleeding

Upper gastrointestinal bleeding remains a major problem associated with high morbidity and mortality. Many decades ago, the mortality of upper GI bleed was extremely high .However, with better understanding of physiology of resuscitation and blood transfusion, mortality in upper G I bleed did drop substantially. Advent of diagnostic oesophago-gastro-duodenoscopy did raise expectation of reducing the mortality but it failed to do so. However, it did help in the diagnosis. When therapeutic endoscopy came to the fore in its management, mortality did reduce little further but it has not become still zero and is hovering around 2-15%. The management of UGI bleed can be divided into pre-endoscopic management which comprises of resuscitation and assessment, empirical medical therapy, endoscopy both for diagnosis and therapy ,interventional radiology, surgery and follow-up. The UGI bleed can broadly be divided into variceal and Non-variceal bleed and both conditions have different management strategies after initial similar treatment of resuscitation and assessment. There are scoring systems for severity stratification of upper G I bleed. Many new methods are now available for endo haemostasis.