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 patien...

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Bibliographic Details
Published in:Drugs (New York, N.Y.) N.Y.), 2008-01, Vol.68 (15), p.2105-2111
Main Authors: Kovacs, Thomas O. G., Jensen, Dennis M.
Format: Article
Language:English
Subjects:
Acids
Adenosine triphosphatase
Animals
Biological and medical sciences
Blood and lymphatic vessels
Blood. Blood coagulation. Reticuloendothelial system
Cardiology. Vascular system
Clinical trials
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Endoscopic surgery
Endoscopy
Gastrointestinal Hemorrhage - drug therapy
Health aspects
Hemorrhage
Histamine
Histamine H2 Antagonists - therapeutic use
Hormone Antagonists - therapeutic use
Hospitalization
Humans
Internal Medicine
Medical sciences
Medicine
Medicine & Public Health
Morbidity
Mortality
Octreotide - therapeutic use
Omeprazole
Patients
Peptic Ulcer Hemorrhage - drug therapy
Peptic Ulcer Hemorrhage - pathology
Pharmacology. Drug treatments
Pharmacology/Toxicology
Pharmacotherapy
Proton Pump Inhibitors - therapeutic use
Protons
Somatostatin - therapeutic use
Surgery
Therapy In Practice
Tranexamic Acid - therapeutic use
Ulcers
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Summary: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.
ISSN:0012-6667
1179-1950
DOI:10.2165/00003495-200868150-00003