Upper gastrointestinal bleeding primary prevention
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Overview
Effective measures for the primary prevention of upper GI bleeding include administration of PPI in patients with an increased risk due to critical illness or use of NSAIDs or aspirin. In patients with cirrhosis and suspected portal hypertension, who found to have esophageal varices patients are given prophylactic treatment with a nonselective β-blocker or undergo endoscopic variceal ligation (EVL) with surveillance endoscopy.
Primary Prevention
Primary Prevention
Effective measures for the primary prevention of upper GI bleeding include administration of PPI in patients with an increased risk due to critical illness or use of NSAIDs or aspirin. In patients with cirrhosis and suspected portal hypertension, who found to have esophageal varices patients are given prophylactic treatment with a nonselective β-blocker or undergo endoscopic variceal ligation (EVL) with surveillance endoscopy.
Patients with stress ulcers
- The American Society of Health-System Pharmacists developed clinical practice guidelines that recommend prophylaxis with a PPI or with a histamine-2 receptor antagonist (H2RA) for ICU patients at high risk for UGIB.[1][2][3]
Patients on NSAID, aspirin, or antiplatelet therapy
- Joint gastroenterology and cardiology society practice guidelines recommend gastroprotective therapy with a PPI for patients considered to be at increased risk of bleeding from chronic NSAID and aspirin therapy.
Patients with cirrhosis and varices
- EGD is used to screen for the presence of varices in patients with cirrhosis complicated by portal hypertension.
- In patients with cirrhosis who do not have varices, no prophylaxis is indicated.
- In patients with cirrhosis and varices that have not bled, prophylactic treatment with nonselective β-blockers, such as nadolol or propranolol, may decrease portal blood flow and thus decrease the risk of variceal bleed.
- In patients with cirrhosis who have medium or large varices that have not bled, EVL is an alternative prophylactic treatment.
- EVL is repeated every several weeks until obliteration of varices is seen.
- Surveillance EGD should then be performed 1 to 3 months after obliteration and then every 6 to 12 months to check for variceal recurrence.
References
References
- ↑ Brooks J, Warburton R, Beales IL (2013). “Prevention of upper gastrointestinal haemorrhage: current controversies and clinical guidance”. Ther Adv Chronic Dis. 4 (5): 206–22. doi:10.1177/2040622313492188. PMC 3752180. PMID 23997925.
- ↑ Yasuda H, Matsuo Y, Sato Y, Ozawa S, Ishigooka S, Yamashita M, Yamamoto H, Itoh F (2015). “Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy”. World J Crit Care Med. 4 (1): 40–6. doi:10.5492/wjccm.v4.i1.40. PMC 4326762. PMID 25685721.
- ↑ Biecker E, Heller J, Schmitz V, Lammert F, Sauerbruch T (2008). “Diagnosis and management of upper gastrointestinal bleeding”. Dtsch Arztebl Int. 105 (5): 85–94. doi:10.3238/arztebl.2008.0085. PMC 2701242. PMID 19633792.
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