Editing Upper GI bleed (section)

=== '''Medical management''' ===

** ICU?
** IIb and above ulcers should stay on IV PPI for 72 hours then can be discharged (can be BD high-dose - no benefit to infusion in most cases)

*** There doesn't appear to be much difference between IV and PO PPI even while still in hospital, but guidelines still recommend staying on IV

** Pause aspirin, clopidogrel, NSAIDs and SSRIs for 24 hours with ulcer bleeding
*** Aspirin can be resumed after 24 hours - rationalise ongoing need (stop it if it was primary prevention, restart for secondary prevention 1-7 days after bleeding cessation in most cases)
*** Clopidogrel can be resumed after three days in patients with stents
*** SSRIs five days
*** COX-2 selective inhibitors combined with PPIs have a low rebleeding risk, so that is an acceptable combination if anti-inflammatories must continue.
** Don't give tranexamic acid
** Clear fluids first 24 hours then normal diet. IIc and below can go straight to normal diet.
** Discharge - IIc and below can go 24 hours after endoscopy. Anyone that needs treatment for a bleeding ulcer should stay for 72 hours.
** All patients must have H. pylori status established and eradicated if present. Once it has been confirmed eradicated, there is no need for long-term PPI as it doesn't decrease the re-bleed risk of 1.3%.

[[Category:UGIS]]
[[Category:Intern education]]