David Fernando Ortiz-Pérez*, Juan José Olaya-Martelo, Luisa María Petro-Noriega, Robin Luis Petro-Noriega, Alexander Manuel Yepes-De La Torre, Julián De Jesús Ayola-Gutiérr, Jhon Alexander Pérez-Sanmiguel, Julio César Villamizar-Espitia, Karen Karolina Mendoza-Hernández and Luis Miguel Orozco-Pabón
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a frequent emergency whose prognosis has improved thanks to risk stratification, goal-directed resuscitation, proton pump inhibitors (PPIs), and early endoscopy. We report the case of a 78-year-old woman with severe chronic anemia and orthostatic syncope, in whom a duodenal ulcer classified as Forrest III was identified. We provide a detailed account of the initial evaluation, prognostic scoring systems, pre-endoscopic medical management, endoscopic strategy, and considerations for antithrombotic therapy. Drawing on the 2021 ACG and ESGE guidelines, we discuss current evidence, controversies around PPI dosing, optimal timing for endoscopy, and strategies for restarting antiplatelet or anticoagulant agents. This structured approach corrected her anemia (Hb 5.2 → 10.2 g/dL) without rebleeding and facilitated a safe discharge with outpatient follow-up. The case highlights the importance of integrating evidence-based medicine with individualized assessment of risk factors and comorbidities in NVUGIB.
Published Date: 2025-06-30;
