Acute Upper Gastrointestinal Bleeding
The mortality associated with acute bleeding from a peptic ulcer remains high (5 to 10%), and the condition accounts for more than 400,000 hospital admissions per year in the United States. In most settings, the vast majority of acute episodes of upper gastrointestinal bleeding (80 to 90%) have nonvariceal causes, with gastroduodenal peptic ulcer accounting for the majority of lesions.
The insertion of a nasogastric tube may be helpful in the initial assessment of the patient (specifically, triage), although the incremental information such a procedure provides remains controversial. It has been suggested that the presence of blood in the nasogastric aspirate is an adverse prognostic sign that may be useful in identifying patients who require urgent endoscopic evaluation. However, the absence of bloody or coffee-ground material does not definitively rule out ongoing or recurrent bleeding, since approximately 15% of patients without bloody or coffee-ground material in nasogastric aspirates are found to have high-risk lesions on endoscopy. The use of a large-bore orogastric tube with gastric lavage (with the use of tap water at room temperature) appears to improve only the visualization of the gastric fundus on endoscopy and has not been documented to improve outcome.
New England Journal of Medicine - Vol. 359, No. 9, August 28, 2008