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Last Updated: 2/7/2013  

Gastrointestinal Bleeding, Nonvariceal Upper

Diagnosis
  • Hematemesis, melena, or coffee-ground emesis suggest upper GI source of bleeding.

  • Bloody diarrhea can occur with bleeding sources proximal to the ligament of Trietz.

  • Evaluate for tachycardia, orthostasis, or hypotension to assess intravascular volume status.

  • Consult with a gastroenterologist about endoscopy in all patients with acute upper GI bleeding.

Therapy
  • Hospitalize patients with upper GI bleeding if they are having a large-volume bleeding episode, have comorbid conditions, or are likely to rebleed or continue to bleed.

  • Institute vigorous volume resuscitation in all patients with acute upper GI bleeding.

  • If rebleeding occurs after initial endoscopic hemostasis, perform a repeat of endoscopic therapy.

  • Immediately consult a surgeon for persistent acute bleeding that is unresponsive to endoscopic therapy.

  • High-dose PPI therapy (80-mg bolus followed by an infusion at 8 mg/hr for 72 hrs) should be given to patients with successful endoscopic hemostasis of lesions at high risk of rebleeding.

  • For patients with ulcer disease test for H. pylori and if positive, treat with regimen of two antibiotics and PPI.

DOI: 10.7326/d184
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
David J. Bjorkman, MD, MSPH (HSA), SM has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Glenn M. Eisen, MD, MPH has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Harish V. Iyer, MBBS, MRCP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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