Upper gastrointestinal bleeding secondary prevention

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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.

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.
• 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

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