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World J Gastroenterol. Mar 21, 2012; 18(11): 1202-1207
Published online Mar 21, 2012. doi: 10.3748/wjg.v18.i11.1202
Management of acute nonvariceal upper gastrointestinal bleeding: Current policies and future perspectives
Ingrid Lisanne Holster, Ernst Johan Kuipers
Ingrid Lisanne Holster, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
Ernst Johan Kuipers, Departments of Gastroenterology and Hepatology, and Internal Medicine, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
Author contributions: Holster IL and Kuipers EJ were responsible for the literature review; Holster IL wrote the initial draft; Kuipers EJ prepared the final version of the paper.
Correspondence to: Ingrid Lisanne Holster, MD, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. i.holster@erasmusmc.nl
Telephone: +31-10-7034513 Fax: +31-10-7034682
Received: April 29, 2011
Revised: May 30, 2011
Accepted: June 6, 2011
Published online: March 21, 2012
Abstract

Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB, and is recommended within 24 h of presentation. Proton pump inhibitor (PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy, but has no effect on rebleeding, mortality and need for surgery. Endoscopic therapy should be undertaken for ulcers with high-risk stigmata, to reduce the risk of rebleeding. This can be done with a variety of modalities. High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality, particularly in patients with high-risk stigmata.

Keywords: Disease management; Upper gastrointestinal bleeding; Nonvariceal bleeding; Peptic ulcer bleeding; Gastrointestinal endoscopy; Pharmacotherapy; Endoscopic therapy