Monday, June 8, 2020

UGIB and history

Case: 52 year old male is admitted to ICU with an episode of upper gastrointestinal bleed (GIB). Patient mentioned having a similar episode 2 years ago and esophagogastroduodenoscopy (EGD) was performed. Why it would be important to look for the previous EGD report prior to a new EGD?

Answer: Although the data is old, it is still robust from a 23 years long study comprising of 14,000 patients. 60 percent of patients with a history of an upper GIB tend to bleed from the same lesion. As it may be easy to miss a small lesion in such situations, knowing the previous location not only shortens the procedure time but also helps to establish the progress, extension, and recurrence of the underlying disease which may have become life-threatening now. This includes varices or portal hypertensive gastropathy, angiodysplasia, peptic ulcer disease (PUD), and malignancy.



Palmer ED. The vigorous diagnostic approach to upper-gastrointestinal tract hemorrhage. A 23-year prospective study of 1,4000 patients. JAMA 1969; 207:1477.

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