Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding

Acute non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying...

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Main Author: Jeong Hwan Kim
Format: Article
Language:English
Published: Korean College of Helicobacter and Upper Gastrointestinal Research 2016-12-01
Series:The Korean Journal of Helicobacter and Upper Gastrointestinal Research
Subjects:
Online Access:http://www.helicojournal.org/journal/view.html?doi=10.7704/kjhugr.2016.16.4.189
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author Jeong Hwan Kim
author_facet Jeong Hwan Kim
author_sort Jeong Hwan Kim
collection DOAJ
description Acute non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitor (PPI) remains the mainstay of treatment with potent acid suppression. Maintenance of the intragastric pH level above 6 by the administration of PPI prevents hemolysis caused by acid or pepsin and thereby promotes aggregation of platelets. Intragastric acid suppression can be achieved more effectively with continuous intravenous infusion of PPI after intravenous bolus injection. A high dose intravenous PPI is effective in reducing the risk of rebleeding, the need for surgery and repeated endoscopy. However, data regarding non-high dose intravenous PPIs are limited. In the future, novel PPIs and potassium-competitove acid blocker are in the area of interest. Combination therapy with the use of endoscopic hemostatic treatment and intravenous PPI administration is known to result in the best outcome for non-variceal upper gastrointestinal bleeding.
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spelling doaj-art-bfbe6439902548efa8969dbb188a8d4c2025-08-20T03:39:04ZengKorean College of Helicobacter and Upper Gastrointestinal ResearchThe Korean Journal of Helicobacter and Upper Gastrointestinal Research1738-33312016-12-0116418919310.7704/kjhugr.2016.16.4.189kjhugr.2016.16.4.189Pharmacologic Management of Nonvariceal Upper Gastrointestinal BleedingJeong Hwan Kim0Department of Internal Medicine, Konkuk University School of Medicine, Seoul, KoreaAcute non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitor (PPI) remains the mainstay of treatment with potent acid suppression. Maintenance of the intragastric pH level above 6 by the administration of PPI prevents hemolysis caused by acid or pepsin and thereby promotes aggregation of platelets. Intragastric acid suppression can be achieved more effectively with continuous intravenous infusion of PPI after intravenous bolus injection. A high dose intravenous PPI is effective in reducing the risk of rebleeding, the need for surgery and repeated endoscopy. However, data regarding non-high dose intravenous PPIs are limited. In the future, novel PPIs and potassium-competitove acid blocker are in the area of interest. Combination therapy with the use of endoscopic hemostatic treatment and intravenous PPI administration is known to result in the best outcome for non-variceal upper gastrointestinal bleeding.http://www.helicojournal.org/journal/view.html?doi=10.7704/kjhugr.2016.16.4.189Nonvariceal upper gastrointestinal bleedingPharmacologic managementProton pump inhibitor
spellingShingle Jeong Hwan Kim
Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding
The Korean Journal of Helicobacter and Upper Gastrointestinal Research
Nonvariceal upper gastrointestinal bleeding
Pharmacologic management
Proton pump inhibitor
title Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding
title_full Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding
title_fullStr Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding
title_full_unstemmed Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding
title_short Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding
title_sort pharmacologic management of nonvariceal upper gastrointestinal bleeding
topic Nonvariceal upper gastrointestinal bleeding
Pharmacologic management
Proton pump inhibitor
url http://www.helicojournal.org/journal/view.html?doi=10.7704/kjhugr.2016.16.4.189
work_keys_str_mv AT jeonghwankim pharmacologicmanagementofnonvaricealuppergastrointestinalbleeding