Upper gastrointestinal bleeding secondary prevention: Difference between revisions
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{{CMG}}; {{AE}} {{ADG}} | {{CMG}}; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Effective measures for the secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB. For patients who are at high risk for rebleeding (elderly patients; those taking | Effective measures for the secondary prevention of UGIB include discouraging the use of [[NSAIDS]] in all patients with a history of UGIB. For patients who are at high risk for rebleeding (elderly patients; those taking [[Anticoagulants|anticoagulan]]<nowiki/>t and [[Antiplatelet agents|antiplatelet medications]]), indefinite use of a [[PPI]] may be recommended. A combination of nonselective [[β-blockers]] plus [[EVL]] is the best option for secondary prophylaxis of UGIB from [[varices]]. | ||
==Secondary prevention== | ==Secondary prevention== | ||
Effective measures for the secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB.<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> | Effective measures for the secondary prevention of UGIB include discouraging the use of [[NSAIDS]] in all patients with a history of UGIB.<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=== | ===UGIB from peptic ulcer disease=== | ||
*Avoid NSAIDs. | *Avoid using [[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> | *For patients who are at high risk for rebleeding (elderly patients; those taking [[Anticoagulants|anticoagulant]] and [[Antiplatelet agents|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. | *[[Helicobacter pylori|H pylori]] status should be determined, and patients should be treated if positive. | ||
*Eradication is confirmed with stool sample or repeat endoscopy with biopsy. | *Eradication is confirmed with [[Stool examination|stool sample]] or repeat [[endoscopy]] with [[biopsy]]. | ||
===UGIB from varices=== | ===UGIB from varices=== | ||
*A combination of nonselective β-blockers plus EVL is the best option for secondary prophylaxis of 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. | *The nonselective [[Β-blockers|β-blocker]] should be titrated up as tolerated. | ||
*Variceal banding should be repeated every 2 to 3 weeks until the varices are obliterated. | *Variceal [[Banding (medical)|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. | **[[Esophagogastroduodenoscopy|EGD]] must be performed 1 to 3 months after initial obliteration then every 6 to 12 months to check for [[Esophageal varices|variceal]] recurrence. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Needs content]] | [[Category:Needs content]] |
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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 secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB. 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. A combination of nonselective β-blockers plus EVL is the best option for secondary prophylaxis of UGIB from varices.
Secondary prevention
Effective measures for the secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB.[1]
UGIB from peptic ulcer disease
- Avoid using 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.
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.