title: Management of acute nonvariceal upper gastrointestinal bleeding: current policies and future perspectives.
abstract: Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB, and is recommended within 24 h of presentation. Proton pump inhibitor (PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy, but has no effect on rebleeding, mortality and need for surgery. Endoscopic therapy should be undertaken for ulcers with high-risk stigmata, to reduce the risk of rebleeding. This can be done with a variety of modalities. High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality, particularly in patients with high-risk stigmata.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. i.holster@erasmusmc.nl
authors.forename: Ingrid Lisanne
authors.initials: IL
authors.lastname: Holster
authors.forename: Ernst Johan
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D019468:Disease Management; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D016481:Helicobacter Infections / Q000150:complications; D016558:Hemostasis, Endoscopic; D006801:Humans; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal