title: Pharmacological Treatment in Upper Gastrointestinal Bleeding.
abstract: Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency. Bleeding peptic ulcers account for the majority of causes in patients presenting with AUGIB, whereas variceal bleeding in cirrhotic patients represents a more severe form of bleeding. Endoscopic therapy is the mainstay of treatment in patients with active bleeding, as it achieves hemostasis and improves patient outcomes. Pharmacotherapy is an important adjunct to endoscopic hemostasis. In the management of patients with bleeding peptic ulcers, acid suppression after endoscopic hemostasis reduces rates of further bleeding and interventions. In patients with stable hemodynamics awaiting endoscopy, acid suppression starts ulcer healing and downstages stigmata of bleeding, thereby reducing the need for endoscopic therapy. In managing patients with variceal bleeding, early administration of vasoactive drugs lowers splanchnic blood flow, promotes hemostasis, and makes subsequent endoscopic treatment easier. The use of vasoactive agents and antibiotics have both been shown to reduce mortality. In this review article, strategies of acid suppression therapy for peptic ulcer bleeds, vasoactive agents, and antibiotics for variceal bleeding, together with recent evidence on the use of tranexamic acid in gastrointestinal bleeding, are discussed.
authors: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, 9th floor, Clinical Science Building, 30-32 Ngan Shing Street, Shatin, Hong Kong.
authors: Kelvin L Y
authors: KL
authors: Lam
authors: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, 9th floor, Clinical Science Building, 30-32 Ngan Shing Street, Shatin, Hong Kong.
authors: John C T
authors: JC
authors: Wong
authors: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 4th floor, Clinical Science Building, 30-32 Ngan Shing Street, Shatin, Hong Kong. laujyw@surgery.cuhk.edu.hk.
authors: James Y W
authors: JY
authors: Lau
keywords: Antibiotics; Gastrointestinal hemorrhage; Peptic ulcer bleeding; Proton pump inhibitors; Tranexamic acid; Variceal bleeding; Vasoactive agents