UPPER GASTROINTESTINAL HEMORRHAGE

This review highlights points of interest in the year's literature on upper gastrointestinal hemorrhage. Clinical studies of upper gastrointestinal hemorrhage in patients with acquired immunodeficiency virus, or recovering from cardiac surgery, or who are taking corticosteroids are reported. There has been little progress in diagnostic aspects: clinical features cannot reliably predict high-risk endoscopic findings and red cell scanning is unhelpful in localizing the site of upper gastrointestinal bleeding. The diagnostic and therapeutic contributions of angiography are reviewed. General management measures include recognizing the safety of early refeeding in patients who have no high-risk features. Likewise, early discharge from the hospital may be possible; hospital admission may even be avoided altogether if appropriate criteria are met. Drug therapy continues to have no major role in the management of bleeding ulcers. This year, therapeutic endoscopy is again the major area of interest. Studies have continued to show benefit from the simple maneuver of injecting 1:10,000 adrenaline around the ulcer; more sophisticated measures probably do not produce better results. The place of surgery is being reevaluated in the light of therapeutic endoscopy, but when surgery is required, a conventional operation (vagotomy and pyloroplasty, partial gastrectomy) may be better than minimal surgery (underrunning or excising the ulcer).