The Case for Early Intensive Resuscitation for UGIB

Despite advances in the treatment and understanding of upper gastrointestinal bleeding (UGIB), as well as advancements in diagnostic and therapeutic endoscopy the mortality rate of UGIB still remains consistently high. One thought has been that early resuscitation can be the answer to what remains a persistent killer. To prove this point a team of doctors from Maimonides Medical Center tried to figure out what methods work in the intensive resuscitation process and what remains an inefficient tactic.

Thirty-six males and thirty-six females aged 21-94 were enrolled in the study, with each person suffering from either peptic ulcers, melena, hematemesis, or massive hematochezia with a positive nasogastric aspiate for blood. The patients were split into two groups, one that offered intensive resuscitation methods, and one that offered mere observation. Over the next 4 months they were monitored accordingly.

The observation group was only treated by a physician when the doctors felt that their immediate health was being jeopardized or the care was simply inadequate. Essentially this group was monitored to determine if re-bleeding was occurring or if a surgical procedure would be needed either now or down the road. The process was a more hands off one, but one that didn’t lack sensible care.

The more hands on group – the one who incorporated early intensive resuscitation – went through the same four month observation process as the first group, but once that was complete and data was gathered then physicians were assigned to each patient with the goal of shortening the time from discovery to correction. These patients were provided with intravenous hydration and were tasked with delivering blood/blood products. The data was gathered in the end and the two groups were stacked up against one another.

After all was said and done it was determined that most of the problems that the patients were suffering from stemmed from peptic ulcers or esophageal varices, and there proved to be no differences in the two groups in terms of etiology. In an odd statistic the observation group spent more time in the hospital, but fewer days in ICU compared to the intensive resuscitation group. In the end four patients from the observation group died, compared to only one from the intensive unit. What they found was that dedicated, specialized individual care has definite merits and an obvious impact, but the disparity between intensive resuscitation and the standard practice to deal with UGIB was not all that large. Despite the hard data being close early intensive resuscitation has obvious benefits over the more observational approach and limits mortality to a degree.

UGIB is still a serious condition and a startling steady killer. Get a check-up if you feel you might be suffering from any ailment causing UGIB. Keeping abreast with your physician about your UGIB problems can only be beneficial. Stay in good health.

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