Upper gastrointestinal bleeding secondary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Upper gastrointestinal bleeding}} | {{Upper gastrointestinal bleeding}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
==Secondary prevention== | |||
Effective measures for the secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB. | |||
*NSAID use in all patients with a history of UGIB should be discouraged.<ref name="pmid22142030">{{cite journal |vauthors=Chan FK |title=Anti-platelet therapy and managing ulcer risk |journal=J. Gastroenterol. Hepatol. |volume=27 |issue=2 |pages=195–9 |year=2012 |pmid=22142030 |doi=10.1111/j.1440-1746.2011.07029.x |url=}}</ref> | |||
===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.<ref name="Garcia-TsaoSanyal2007">{{cite journal|last1=Garcia-Tsao|first1=Guadalupe|last2=Sanyal|first2=Arun J.|last3=Grace|first3=Norman D.|last4=Carey|first4=William D.|title=Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis|journal=The American Journal of Gastroenterology|volume=102|issue=9|year=2007|pages=2086–2102|issn=0002-9270|doi=10.1111/j.1572-0241.2007.01481.x}}</ref> | |||
*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== | ==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
Secondary prevention
Effective measures for the secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB.
- NSAID use in all patients with a history of UGIB should be discouraged.[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.