Surgical Approach to Acute Upper Gastrointestinal Bleeding

Abstract

Acute upper gastrointestinal (GI) hemorrhage remains a common and significant problem throughout the world. The mortality rate for all patients approaches 10% and health care systems incur significant costs for the diagnosis and treatment of the disorders that cause this problem. Acute upper GI bleeding is defined as the loss of blood from any point in the GI tract proximal to the ligament of Treitz (esophagus, stomach, and duodenum) and accounts for approximately 80% of the cases of hemorrhage from the entire GI tract. Traditionally, surgery provided the only means to control ongoing GI bleeding. However, with the development of therapeutic endoscopy in the 1980s, less invasive management options are increasingly available. Despite the changes in the management of upper GI bleeding, the goals of treatment remain rapid and effective resuscitation of the patient, definitive control of ongoing hemorrhage, treatment of the underlying pathology, and prevention of recurrent bleeding. Today, effective management of this clinical problem requires an in-depth knowledge of a variety of common and uncommon disease processes that may be complicated by upper GI bleeding and the multidisciplinary treatment options currently at our disposal.