Upper gastrointestinal bleeding secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Effective measures for the secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB.
Secondary prevention
Effective measures for the secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB.[1]
UGIB from peptic ulcer disease
- Avoid NSAIDs.
- For patients who are at high risk for rebleeding (elderly patients; those taking anticoagulant and antiplatelet medications), indefinite use of a PPI may be recommended.[2]
- H pylori status should be determined, and patients should be treated if positive.
- Eradication is confirmed with stool sample or repeat endoscopy with biopsy.
UGIB from varices
- A combination of nonselective β-blockers plus EVL is the best option for secondary prophylaxis of UGIB from varices.
- The nonselective β-blocker should be titrated up as tolerated.
- Variceal banding should be repeated every 2 to 3 weeks until the varices are obliterated.
- EGD must be performed 1 to 3 months after initial obliteration then every 6 to 12 months to check for variceal recurrence.
References
- ↑ Chan FK (2012). "Anti-platelet therapy and managing ulcer risk". J. Gastroenterol. Hepatol. 27 (2): 195–9. doi:10.1111/j.1440-1746.2011.07029.x. PMID 22142030.
- ↑ Garcia-Tsao, Guadalupe; Sanyal, Arun J.; Grace, Norman D.; Carey, William D. (2007). "Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis". The American Journal of Gastroenterology. 102 (9): 2086–2102. doi:10.1111/j.1572-0241.2007.01481.x. ISSN 0002-9270.