Managing Upper Gastrointestinal Bleeding: Principles and Treatment Approaches

When treating upper gastrointestinal (GI) bleeding, it is crucial to take immediate and comprehensive actions to stabilize the patient. The primary objectives include restoring blood volume, correcting fluid and electrolyte imbalances, preventing and managing hemorrhagic shock, and implementing effective hemostatic measures. Prompt intervention can significantly improve outcomes and reduce the risk of complications.

Initial Stabilization and Fluid Resuscitation

One of the first steps in managing upper GI bleeding is to initiate fluid resuscitation. Intravenous fluids such as normal saline or balanced salt solutions are commonly used to maintain blood pressure and organ perfusion. In some cases, colloids like dextran may be administered to help expand intravascular volume more effectively.

Blood Transfusion and Circulatory Support

When to Consider Blood Transfusion

Early blood transfusion is often necessary to restore circulating blood volume and oxygen-carrying capacity. The decision to transfuse should be based on clinical assessment, including hemodynamic stability and hemoglobin levels. Maintaining a hemoglobin level above 7–8 g/dL is generally recommended for most patients unless contraindicated.

Control of Bleeding and Hemostasis

In addition to fluid management, active bleeding must be controlled. Endoscopic therapy is often the first-line approach for achieving hemostasis. Techniques such as endoscopic band ligation, injection of epinephrine, or thermal coagulation can be highly effective in stopping the bleed and preventing rebleeding.

Monitoring and Surgical Intervention

If bleeding persists beyond 24 to 48 hours despite medical and endoscopic interventions, surgical evaluation becomes essential. Delaying surgery can lead to worsening hemodynamic instability and increased mortality risk. Early consultation with a surgeon is advised in cases of continued bleeding or recurrent hemorrhage.

Diagnostic Evaluation and Targeted Therapy

While stabilizing the patient, it is equally important to identify the underlying cause of the bleeding. Diagnostic tools such as upper endoscopy allow for precise localization and characterization of the bleeding source. Once diagnosed, targeted treatment—whether medical, endoscopic, or surgical—should be initiated promptly to prevent recurrence and improve long-term prognosis.