Role of Medical Therapy for Nonvariceal Upper Gastrointestinal Bleeding

Abstract

Nonvariceal upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality worldwide. Mortality from UGIB has remained 5-10% over the past decade. This article presents current evidence-based recommendations for the medical management of UGIB. Preendoscopic management includes initial resuscitation, risk stratification, appropriate use of blood products, and consideration of nasogastric tube insertion, erythromycin, and proton pump inhibitor therapy. The use of postendoscopic intravenous proton pump inhibitors is strongly recommended for certain patient populations. Postendoscopic management also includes the diagnosis and treatment of Helicobacter pylori, appropriate use of proton pump inhibitors and iron replacement therapy.

Keywords: Erythromycin; Iron replacement therapy; Nasogastric lavage; Nonvariceal upper gastrointestinal bleeding; Proton pump inhibitors; Red blood cell transfusions; Tranexamic acid.