Early mortality risk assessment is crucial for acute upper gastrointestinal bleeding (UGIB). This study sought to develop and internally validate a prediction model using age, pulse, urea, and albumin (APUA) components, and to assess the added value of admission lactate levels. This retrospective, single-center study included 700 adults presenting to the emergency department with suspected acute UGIB between 2018 and 2025, excluding confirmed variceal hemorrhage. We developed multivariable logistic regression models, both with and without lactate, using continuous APUA components to predict 30-day all-cause mortality. Complete-case analyses evaluated discrimination, calibration, and net benefit, with internal validation performed using 2,000 bootstrap resamples. Fifty-two patients (7.4%) died within 30 days. Lactate was independently associated with mortality (adjusted odds ratio per 1-mmol/L increase, 1.455; 95% confidence interval, 1.270-1.667). Adding lactate significantly increased the apparent area under the receiver operating characteristic curve (AUC) from 0.693 to 0.777 (AUC difference, 0.084; p = 0.003) and improved the optimism-corrected concordance statistic from 0.670 to 0.756. Calibration and overall predictive accuracy also improved, and decision curve analysis showed a higher net benefit across most evaluated thresholds. Furthermore, lactate enhanced the apparent discrimination of three established comparator scores. While the APUA-component model demonstrated modest discrimination, incorporating lactate significantly improved its predictive performance. Independent external validation is necessary before clinical implementation.

Peptic ulcer disease management has evolved from predominantly elective surgical intervention to effective medical therapy with acid suppression and Helicobacter pylori eradication. Surgery is now reserved for the emergency treatment of severe refractory disease and acute complications. Upper endoscopy serves as the diagnostic gold standard and allows for therapeutic intervention. Operative management is guided by hemodynamic stability and ulcer characteristics, ranging from damage-control strategies and drainage to Graham patch repair, wedge resection, or partial gastrectomy with reconstruction. Postoperative management is individualized and largely determined by the patient's risk of complications and overall physiologic status.

Umbilical cord ulceration (UCU) is an uncommon but devastating cause of acute fetal hemorrhage, often associated with fetal upper gastrointestinal obstruction. We report a woman aged 30-35 years (gravida 4, para 1) referred at 23 weeks of gestation for suspected fetal gastrointestinal abnormality. Prenatal ultrasonography showed an enlarged fetal stomach with a double-bubble sign, and subsequent examinations demonstrated progressive polyhydramnios with increasing bowel dilatation. At 32 weeks and 4 days of gestation, after previously reassuring fetal assessment, the fetal heart rate suddenly fell and remained at 90-97 beats per minute, prompting emergency caesarean delivery. A large volume of blood stained amniotic fluid was noted and a longitudinal vessel rupture at the fetal end of the umbilical cord was identified with active bleeding. The neonate had profound anemia and died after withdrawal of care. Histopathology confirmed umbilical cord ulceration with vessel rupture and erythrocyte extravasation. This case highlights the abrupt onset of UCU and supports heightened surveillance when fetal upper gastrointestinal obstruction is suspected.

Glossopharyngeal nerve block (GPNB) can provide effective anesthesia for procedures involving the oropharynx and upper airway. Ultrasound-guided GPNB (UGPNB) may be particularly useful when conventional sedation or topical anesthesia is undesirable because of the risk of respiratory or cardiovascular complications. In this article, we report the use of UGPNB as an alternative anesthetic technique for gastroduodenal endoscopy in a 57-year-old male patient with AMI and gastrointestinal bleeding. In this patient requiring emergency endoscopy, UGPNB was performed via the peristyloid approach to provide oropharyngeal anesthesia while minimizing the need for sedation. The block effectively suppressed the gag reflex and provided adequate procedural conditions while maintaining hemodynamic stability. No procedure-related complications or adverse effects were observed, and the patient reported no discomfort following the procedure. In conclusion, UGPNB may be a useful alternative to sedation for endoscopy in high-risk cardiac patients.

Acute gastric ischemia is rare and may lead to diffuse mucosal bleeding, often refractory to conventional endoscopic therapy. We describe the case of a 42-year-old critically ill burn patient who developed persistent upper gastrointestinal hemorrhage unresponsive to medical treatment, in whom the novel use of endoscopic vacuum therapy (EVT) was undertaken. Serial endoscopies demonstrated progressive mucosal healing, reduced necrosis, and effective bleeding control. EVT promoted granulation tissue and ulcer healing, avoiding surgical intervention. No EVT-related adverse events occurred. Despite successful hemostasis, the patient later died from a sepsis-related adverse event. In conclusion, this case illustrates EVT as a viable and effective approach for managing refractory diffuse gastric bleeding secondary to ischemia. EVT may offer a minimally invasive alternative to surgery in critically ill patients where standard therapies fail.

Gastric varices secondary to sinistral portal hypertension (SPH) are a rare cause of upper gastrointestinal (GI) hemorrhage. Endoscopic histoacryl injection is widely used for endoscopic hemostasis in portal hypertension (PH) and is considered a rescue treatment for massive acute GI bleeding. However, it is associated with a high rate of recurrence. Herein, we report a case of repeated pancreatitis-induced SPH that led to refractory gastric variceal (GV) bleeding, ultimately treated by splenectomy. From a hemodynamic perspective, this case explored treatment strategies for GV bleeding caused by SPH and provided insights for the clinical diagnosis and treatment of affected patients.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving therapy for refractory shock; however, gastrointestinal (GI) complications have been reported in up to 50% of these patients and contribute substantially to morbidity and mortality. While early enteral nutrition (EN) improves outcomes in critical illness, enteral feeding intolerance (EFI) is common during VA-ECMO, and concerns regarding bowel ischemia frequently delay nutritional support. VA-ECMO introduces unique pathophysiological mechanisms - including non-pulsatile flow, retrograde aortic perfusion, and systemic inflammation - that alter gut perfusion and promote intestinal injury. This may create a complex interaction in which impaired intestinal barrier integrity facilitates bacterial translocation and potentially amplifies multiorgan dysfunction. Upper GI bleeding has been reported in approximately 10% of patients, driven by acquired coagulopathies and mandatory anticoagulation. Acute bowel ischemia affects 5%-9%, with mortality exceeding 75%, while EFI affects 33%-53%. Despite the clinical importance of these complications, current evidence remains fragmented, and the mechanisms underlying GI dysfunction during VA-ECMO have not been comprehensively synthesized. This narrative review summarizes the current evidence on the pathophysiological mechanisms, clinical manifestations, prognostic implications, and nutritional management of GI dysfunction in adult patients receiving VA-ECMO, highlighting current knowledge gaps and priorities for future research.