Hematemesis primary prevention

Please help WikiDoc by adding content here. It's easy! Click here to learn about editing.

Hematemesis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hematemesis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Hematemesis primary prevention On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hematemesis primary prevention All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hematemesis primary prevention
CDC on Hematemesis primary prevention
Hematemesis primary prevention in the news
Blogs on Hematemesis primary prevention
Directions to Hospitals Treating Hematemesis
Risk calculators and risk factors for Hematemesis primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: John Fani Srour, M.D.

Primary Prevention

Treatment of underlying disease is the best way to prevent hematemsis.

Prophylaxis Against Bleed From Variceal Hemorrhage and Ulceration

• Primary prophylaxis against variceal hemorrhage is indicated because of high rate of bleeding from esophageal varices and the high mortality associated with bleeding. Prophylactic propranolol or nadolol therapy is the only cost-effective therapy in this setting.
• Prophylaxis against stress ulceration maybe also indicated for ICU patients with any of the following characteristics:

1. Coagulopathy
2. Mechanical ventilation for more than 2 days
3. History of GI ulceration or bleeding with the past year
4. Two or more of the following risk factors — sepsis, ICU admission lasting >1 week, occult GI bleeding lasting ≥6 days, and glucocorticoid therapy.

• Effective identification and antibiotic treatment of H.Pylori infections is also crutial in preventing complications including upper GI bleeding.
• In regards to the prevention of NSAID-related peptic ulcer disease and complicating upper GI bleed: patients are at the highest risk for NSAID-induced GI toxicity when they have any of these risk factors:

1. A history of an ulcer or GI hemorrhage
2. Age >60
3. High dosage of a NSAID
4. Concurrent use of glucocorticoids
5. Concurrent use of anticoagulants

In these patients, the use of COX-2 selective inhibitor or a nonselective NSAID in combination with a PPI or misoprostol is indicated. In addition, patients with a history of uncomplicated or complicated peptic ulcers should be tested for H. pylori prior to beginning a NSAID or low dose aspirin. If present, H. pylori should be treated with appropriate therapy, even if it is believed that the prior ulcer was due to NSAIDs.