Upper gastrointestinal bleeding primary prevention: Difference between revisions
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{{Upper gastrointestinal bleeding}} | {{Upper gastrointestinal bleeding}} | ||
{{CMG}}; {{AE}} {{ADG}} | |||
==Overview== | |||
Effective measures for the primary prevention of upper GI bleeding include administration of [[PPI]] in patients with an increased risk due to critical illness or use of [[NSAIDs]] or [[aspirin]]. In patients with [[cirrhosis]] and suspected [[portal hypertension]], who found to have [[esophageal varices]] patients are given [[prophylactic]] treatment with a nonselective [[Β-blockers|β-blocker]] or undergo [[Ligation|endoscopic variceal ligation]] (EVL) with surveillance [[endoscopy]]. | |||
==Primary Prevention== | |||
Effective measures for the primary prevention of upper GI bleeding include administration of [[PPI]] in patients with an increased risk due to critical illness or use of [[NSAIDs]] or [[aspirin]]. In patients with [[cirrhosis]] and suspected [[portal hypertension]], who found to have [[esophageal varices]] patients are given [[prophylactic]] treatment with a nonselective [[Β-blockers|β-blocker]] or undergo [[Ligation|endoscopic variceal ligation]] (EVL) with surveillance [[endoscopy]]. | |||
===Patients with stress ulcers=== | |||
*The American Society of Health-System Pharmacists developed clinical practice guidelines that recommend prophylaxis with a [[PPI]] or with a [[Anti-histamine|histamine-2 receptor antagonist]] (H2RA) for ICU patients at high risk for UGIB.<ref name="pmid23997925">{{cite journal |vauthors=Brooks J, Warburton R, Beales IL |title=Prevention of upper gastrointestinal haemorrhage: current controversies and clinical guidance |journal=Ther Adv Chronic Dis |volume=4 |issue=5 |pages=206–22 |year=2013 |pmid=23997925 |pmc=3752180 |doi=10.1177/2040622313492188 |url=}}</ref><ref name="pmid25685721">{{cite journal |vauthors=Yasuda H, Matsuo Y, Sato Y, Ozawa S, Ishigooka S, Yamashita M, Yamamoto H, Itoh F |title=Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy |journal=World J Crit Care Med |volume=4 |issue=1 |pages=40–6 |year=2015 |pmid=25685721 |pmc=4326762 |doi=10.5492/wjccm.v4.i1.40 |url=}}</ref><ref name="pmid19633792">{{cite journal |vauthors=Biecker E, Heller J, Schmitz V, Lammert F, Sauerbruch T |title=Diagnosis and management of upper gastrointestinal bleeding |journal=Dtsch Arztebl Int |volume=105 |issue=5 |pages=85–94 |year=2008 |pmid=19633792 |pmc=2701242 |doi=10.3238/arztebl.2008.0085 |url=}}</ref> | |||
===Patients on NSAID, aspirin, or antiplatelet therapy=== | |||
*Joint [[gastroenterology]] and [[cardiology]] society practice guidelines recommend gastroprotective therapy with a [[PPI]] for patients considered to be at increased risk of bleeding from chronic [[NSAIDs|NSAID]] and [[aspirin]] therapy. | |||
===Patients with cirrhosis and varices=== | |||
*[[Esophagogastroduodenoscopy|EGD]] is used to screen for the presence of [[varices]] in patients with [[cirrhosis]] complicated by [[portal hypertension]]. | |||
*In patients with [[cirrhosis]] who do not have [[varices]], no [[prophylaxis]] is indicated. | |||
*In patients with [[cirrhosis]] and [[varices]] that have not bled, prophylactic treatment with [[Β-blockers|nonselective β-blockers]], such as [[nadolol]] or [[propranolol]], may decrease portal blood flow and thus decrease the risk of variceal bleed. | |||
*In patients with [[cirrhosis]] who have medium or large [[varices]] that have not bled, [[EVL]] is an alternative prophylactic treatment. | |||
*[[EVL]] is repeated every several weeks until obliteration of [[varices]] is seen. | |||
*Surveillance [[EGD]] should then be performed 1 to 3 months after obliteration and then every 6 to 12 months to check for variceal recurrence. | |||
==References== | ==References== | ||
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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 primary prevention of upper GI bleeding include administration of PPI in patients with an increased risk due to critical illness or use of NSAIDs or aspirin. In patients with cirrhosis and suspected portal hypertension, who found to have esophageal varices patients are given prophylactic treatment with a nonselective β-blocker or undergo endoscopic variceal ligation (EVL) with surveillance endoscopy.
Primary Prevention
Effective measures for the primary prevention of upper GI bleeding include administration of PPI in patients with an increased risk due to critical illness or use of NSAIDs or aspirin. In patients with cirrhosis and suspected portal hypertension, who found to have esophageal varices patients are given prophylactic treatment with a nonselective β-blocker or undergo endoscopic variceal ligation (EVL) with surveillance endoscopy.
Patients with stress ulcers
- The American Society of Health-System Pharmacists developed clinical practice guidelines that recommend prophylaxis with a PPI or with a histamine-2 receptor antagonist (H2RA) for ICU patients at high risk for UGIB.[1][2][3]
Patients on NSAID, aspirin, or antiplatelet therapy
- Joint gastroenterology and cardiology society practice guidelines recommend gastroprotective therapy with a PPI for patients considered to be at increased risk of bleeding from chronic NSAID and aspirin therapy.
Patients with cirrhosis and varices
- EGD is used to screen for the presence of varices in patients with cirrhosis complicated by portal hypertension.
- In patients with cirrhosis who do not have varices, no prophylaxis is indicated.
- In patients with cirrhosis and varices that have not bled, prophylactic treatment with nonselective β-blockers, such as nadolol or propranolol, may decrease portal blood flow and thus decrease the risk of variceal bleed.
- In patients with cirrhosis who have medium or large varices that have not bled, EVL is an alternative prophylactic treatment.
- EVL is repeated every several weeks until obliteration of varices is seen.
- Surveillance EGD should then be performed 1 to 3 months after obliteration and then every 6 to 12 months to check for variceal recurrence.
References
- ↑ Brooks J, Warburton R, Beales IL (2013). "Prevention of upper gastrointestinal haemorrhage: current controversies and clinical guidance". Ther Adv Chronic Dis. 4 (5): 206–22. doi:10.1177/2040622313492188. PMC 3752180. PMID 23997925.
- ↑ Yasuda H, Matsuo Y, Sato Y, Ozawa S, Ishigooka S, Yamashita M, Yamamoto H, Itoh F (2015). "Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy". World J Crit Care Med. 4 (1): 40–6. doi:10.5492/wjccm.v4.i1.40. PMC 4326762. PMID 25685721.
- ↑ Biecker E, Heller J, Schmitz V, Lammert F, Sauerbruch T (2008). "Diagnosis and management of upper gastrointestinal bleeding". Dtsch Arztebl Int. 105 (5): 85–94. doi:10.3238/arztebl.2008.0085. PMC 2701242. PMID 19633792.