Pharmacological therapy of non-variceal upper gastrointestinal bleeding

Klinika Gastroenterologii i Chorób Wewnętrznych UMB. Kierownik Kliniki: prof. dr hab. n. med. Andrzej Dąbrowski
Adres do korespondencji: Dr n. med. Krzysztof Kurek, Klinika Gastroenterologii i Chorób Wewnętrznych UMB,
ul. Marii Skłodowskiej-Curie 24 A, 15-276 Białystok, tel.: 85 746 82 34, faks: 85 746 85 06, e-mail: krzysztof.kurek@umb.edu.pl
Praca finansowana ze środków własnych

Pediatr Med rodz Vol 9 Numer 1, p. 15–24
ABSTRACT

Upper gastrointestinal bleeding is a common gastroenterological emergency requiring proper management and urgent treatment. The vast majority of these haemorrhages are due to peptic ulcers, erosive gastritis and esophagitis as well as oesophageal and gastric varices. Diagnostic and/or therapeutic endoscopy is recommended within 24 h of presentation in all patients with symptoms of upper gastrointestinal bleeding. Initial pharmacological treatment includes volume resuscitation, hemodynamic stabilization and proton pump inhibitor (PPI) (bolus 80 mg) administration prior to endoscopy to downstage the bleeding lesion. In patients on anticoagulants correction of coagulopathy is recommended prior to endoscopy. High-doses of PPI (8 mg/h for at least 3 days) administration after endoscopic haemostasis promote clot stability by sustaining intragastric pH above 6. H. pylori is the key factor in peptic ulcer development and eradication is recommended immediately after feeding is restarted. Presented management reduces rebleeding rate. Despite this upper gastrointestinal bleeding still carries considerable rates of complications and mortality. To aim of this work was to review the currently available guidelines and recommendations in pharmacological managing in patients with non-variceal upper gastrointestinal bleeding.

Keywords: upper gastrointestinal bleeding, proton pump inhibitors, Helicobacter pylori, peptic ulcer, prokinetic agents