Diagnostic and therapeutic options in the management of nonvariceal upper gastrointestinal bleeding.
Upper gastrointestinal bleeding from peptic ulcers is common. Advances in prognostication, therapeutic endoscopy, and medical management have evolved rapidly. Patients most likely to rebleed after therapy can now be identified and monitored more closely, and patients with ulcers of low risk for rebleeding can be managed on an outpatient basis. High-risk patients include those with ulcers containing a visible vessel or who are actively bleeding. Endoscopic therapy is mandatory in high-risk patients and involves at least two hemostatic techniques. Second-look endoscopy and repeated hemostasis should be performed promptly in patients who rebleed. Adjunctive treatment includes intravenous proton pump inhibitor administered in high doses for the first 72 hours after endoscopic therapy. Further studies are needed to determine the optimal combination of hemostatic techniques to better target patients who are at risk for ulcer rebleeding.
Division of Gastroenterology and Endoscopy, Keck School of Medicine, University of Southern California, Building 1, Room 12-137, 1200 North State Street, Los Angeles, CA 90033, USA. ryangmdphd@cs.com
Shireen Andrade
SA
Pais
Russell
R
Yang
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D003972:Diathermy; D016099:Endoscopy, Gastrointestinal; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D009853:Omeprazole / Q000627:therapeutic use; D000077402:Pantoprazole; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D018570:Risk Assessment; D013454:Sulfoxides / Q000627:therapeutic use
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D015718:Fibrin Tissue Adhesive; D013454:Sulfoxides; D000077402:Pantoprazole; D009853:Omeprazole