From the Guidelines
Treatment for Gastrointestinal (GI) Bleeding
The treatment for GI bleeding often involves medications to reduce acid production and protect the stomach lining, such as proton pump inhibitors (PPIs) like omeprazole 40 mg or pantoprazole 40 mg, administered intravenously as a bolus dose, followed by a continuous infusion of 8 mg/hour for 72 hours 1.
- Key Medications:
- PPIs: omeprazole or pantoprazole
- Octreotide: for variceal bleeding, 50 mcg IV bolus, followed by a continuous infusion of 50 mcg/hour for 3-5 days
- Endoscopy: often performed within 24 hours to diagnose and potentially treat the cause of the bleed 1
- Coagulopathy Correction: vitamin K and blood transfusions as needed to correct any coagulopathy 1
- Hospitalization: high-risk patients should be hospitalized for at least 72 hours after endoscopic hemostasis 1
Important Considerations
- Risk Stratification: early risk stratification using validated prognostic scales is crucial 1
- Endoscopic Hemostasis: indicated for high-risk lesions, with clips or thermocoagulation being effective methods 1
- Preendoscopy PPI Therapy: may downstage the lesion, and intravenous high-dose PPI therapy after successful endoscopic hemostasis decreases rebleeding and mortality in patients with high-risk stigmata 1
From the Research
Treatment Overview
The treatment for gastrointestinal (GI) bleeding typically involves a combination of medical and endoscopic interventions.
- Endoscopic therapy is the mainstay of treatment in patients with active bleeding, as it achieves hemostasis and improves patient outcomes 2.
- Pharmacotherapy, including acid suppression and vasoactive agents, is an important adjunct to endoscopic hemostasis 2, 3.
Medical Management
- Patients with upper GI bleeding should receive proton pump inhibitors (PPIs) upon presentation, with high-dose PPI treatment recommended for the first 72 hours post-endoscopy 4, 3.
- Antibiotics and vasoactive drugs are recommended in patients with cirrhosis and variceal bleeding 2, 3.
- Intravenous fluids and red cell transfusion may be necessary for resuscitation, with a hemoglobin threshold of 70-80 g/L recommended for transfusion 3.
Endoscopic Management
- Endoscopy should be undertaken within 24 hours of presentation, with earlier endoscopy considered in patients at high risk, such as those with hemodynamic instability 5, 4, 3.
- Endoscopic treatment options include ligation, thermal probes, and clips for lesions with active bleeding or non-bleeding visible vessel 5, 3.
- Patients who require endoscopic therapy for ulcer bleeding should receive high-dose proton pump inhibitors after endoscopy 3.