The short-term medical management of non-variceal upper gastrointestinal bleeding.
Upper gastrointestinal (UGI) bleeding occurs frequently and results in substantial patient morbidity, mortality and medical expense. After initial resuscitation to stabilize the patient, carefully performed endoscopy provides an accurate diagnosis and can identify high-risk subgroups in ulcer patients who are likely to rebleed with medical therapy alone and would benefit most from endoscopic haemostasis. Several different pharmacological therapies have been used for patients with bleeding ulcers, including intravenous histamine H(2)-receptor antagonists, proton pump inhibitors, somatostatin and octreotide, and tranexamic acid. The results of several studies and meta-analyses favour high-dose, intravenous proton pump inhibitors, such as omeprazole or pantoprazole, after successful endoscopic haemostasis.For patients with ulcer bleeding and low-risk endoscopic stigmata, high-dose oral proton pump inhibitor therapy is suggested. Medical management with proton pump inhibitors is not a substitute for appropriate endoscopic therapy for patients with UGI bleeding and high-risk ulcer stigmata.
CURE Digestive Disease Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, California 90073-1003, USA. tkovacs@mednet.ucla.edu
Thomas O G
TO
Kovacs
Dennis M
DM
Jensen
D000818:Animals; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy / Q000473:pathology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013004:Somatostatin / Q000627:therapeutic use; D014148:Tranexamic Acid / Q000627:therapeutic use
D006635:Histamine H2 Antagonists; D006727:Hormone Antagonists; D054328:Proton Pump Inhibitors; D013004:Somatostatin; D014148:Tranexamic Acid; D015282:Octreotide