What medications are used to treat Gastrointestinal (GI) bleeding?

From the Guidelines

For a gastrointestinal (GI) bleed, the most effective medication management includes proton pump inhibitors (PPIs) such as pantoprazole 40mg IV bolus followed by 8mg/hr infusion or 40mg oral twice daily for upper GI bleeds, as they have been shown to reduce the rates of rebleeding, surgery, and death compared to H2-receptor antagonists or placebo 1. The choice of medication depends on the cause and severity of the bleed.

• For variceal bleeding, octreotide is recommended at 50mcg IV bolus followed by 50mcg/hr infusion for 3-5 days.
• Tranexamic acid may be used at 1g IV every 8 hours in severe bleeding.
• If Helicobacter pylori is identified, triple therapy with amoxicillin 1g twice daily, clarithromycin 500mg twice daily, and a PPI for 14 days is indicated.
• For patients on anticoagulants or antiplatelets, these medications should be temporarily discontinued and reversal agents considered if appropriate, with vitamin K (10mg IV) given for warfarin reversal, and prothrombin complex concentrate for immediate reversal in severe cases 1. Key considerations in managing GI bleed include:
• Prompt endoscopic evaluation for definitive diagnosis and potential therapeutic intervention.
• Blood transfusions for hemoglobin levels below 7g/dL. These medications work by reducing gastric acid production, promoting clot formation, constricting blood vessels, or treating underlying infections that contribute to bleeding. Recent guidelines suggest that PPIs are more effective than H2-receptor antagonists in preventing persistent or recurrent bleeding and surgery in selected patients 1. Given the proven benefit of PPIs and the inconsistent benefits of H2-receptor antagonists, the latter are not recommended for the management of patients with acute upper GI bleeding 1.

From the Research

Medications for GI Bleed

• Proton pump inhibitors (PPIs) are commonly used in the management of upper gastrointestinal bleeding, with studies suggesting their effectiveness in reducing rebleeding risk 2, 3, 4, 5.
• High-dose intravenous PPIs, such as omeprazole or pantoprazole, are recommended after successful endoscopic haemostasis for patients with ulcer bleeding and high-risk endoscopic stigmata 3, 4.
• For patients with ulcer bleeding and low-risk endoscopic stigmata, high-dose oral PPI therapy is suggested 3.
• The use of PPIs in gastroesophageal varices is more controversial, with evidence suggesting that short-course PPI use post-endoscopic variceal ligation may be beneficial, but high-dose infusion and prolonged use are not recommended 6.
• Other medications, such as histamine H(2)-receptor antagonists, somatostatin, and octreotide, may also be used in the management of upper gastrointestinal bleeding, but their effectiveness is less well established 3.

Dosage and Administration

• The optimal dosage and administration of PPIs in the management of upper gastrointestinal bleeding is not well established, with studies suggesting that both high-dose and low-dose regimens may be effective 2.
• Guidelines recommend high-dose PPI treatment for the first 72 hours post-endoscopy, as this is when rebleeding risk is highest 4.
• The use of bolus doses and continuous infusions of PPIs may also be effective in managing upper gastrointestinal bleeding, but the optimal regimen is not well established 2, 3.