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Management of specific causes of an upper GI bleed

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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When the patient has been resuscitated, then treatment of the underlying cause of the haemorrhage may be commenced.

Management of non-variceal bleeding

  • adrenaline should not be used as monotherapy for the endoscopic treatment of non-variceal upper gastrointestinal bleeding
  • for the endoscopic treatment of non-variceal upper gastrointestinal bleeding, use one of the following:
    • a mechanical method (for example, clips) with or without adrenaline
    • thermal coagulation with adrenaline fibrin or
    • thrombin with adrenaline
  • interventional radiology should be offered to unstable patients who re-bleed after endoscopic treatment
  • refer urgently for surgery if interventional radiology is not promptly available

Management of variceal bleeding

  • terlipressin should be offered to patients with suspected variceal bleeding at presentation. Stop treatment after definitive haemostasis has been achieved, or after 5 days, unless there is another indication for its use
  • prophylactic antibiotic therapy should be offered at presentation to patients with suspected or confirmed variceal bleeding
  • oesophageal varices
    • use band ligation in patients with upper gastrointestinal bleeding from oesophageal varices
    • consider transjugular intrahepatic portosystemic shunts (TIPS) if bleeding from oesophageal varices is not controlled by band ligation.
  • gastric varices
    • endoscopic injection of N-butyl-2-cyanoacrylate should be offered to patients with upper gastrointestinal bleeding from gastric varices
    • TIPS should be offered if bleeding from gastric varices is not controlled by endoscopic injection of N-butyl-2-cyanoacrylate

Reference:

  1. NICE (August 2016). Acute Upper GI bleeding.

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