Treatment Options for Upper Gastrointestinal Bleeding

Upper gastrointestinal (GI) bleeding is a serious medical condition that requires prompt diagnosis and treatment. One of the first steps in managing this condition is to assess the severity of the bleeding. Since upper GI bleeding often presents with hematemesis (vomiting blood) and, less commonly, melena (black, tarry stools), evaluating the volume of blood loss is crucial. In cases where the amount of vomited blood is difficult to determine, a nasogastric tube may be inserted. This allows for gastric decompression and helps estimate the extent of bleeding. Additionally, monitoring vital signs such as blood pressure, pulse, and heart rate provides important clues about the patient's hemodynamic stability.

Identifying the Source of Bleeding

Accurately locating the source of the bleed is essential for effective treatment. The bleeding may originate from the stomach, duodenum, or even the proximal jejunum. Endoscopy, particularly upper gastrointestinal endoscopy, is a highly effective diagnostic tool that enables direct visualization of the upper GI tract. This procedure not only helps identify the exact location of the bleed but also allows for therapeutic interventions to be performed during the same session.

Medical and Endoscopic Interventions

If endoscopy fails to detect a clear bleeding site but significant blood loss continues, interventional radiology techniques such as angiography may be employed. These procedures can pinpoint the source of bleeding and allow for targeted embolization or medication delivery to stop the hemorrhage. In some cases, endoscopic therapies like injection sclerotherapy, thermal coagulation, or clipping can be applied directly to the bleeding site to achieve hemostasis.

When Surgery Becomes Necessary

In life-threatening situations where bleeding cannot be controlled through endoscopic or radiologic means, surgical intervention becomes necessary. This is especially true if the patient develops signs of hypovolemic shock due to excessive blood loss. Surgery may involve resection of the affected area or other procedures aimed at stopping the hemorrhage and stabilizing the patient's condition. Prompt action during this critical phase can significantly improve outcomes and reduce mortality risk.