How are massive gastric bleeds managed in patients with peptic ulcer disease (PUD)?

Updated: Apr 26, 2021
  • Author: BS Anand, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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Massive gastric bleeds are the most difficult complication to treat. Mainstays of resuscitation include the following:

  • Establishment of adequate intravenous (IV) access and volume replacement, initially with a crystalloid; in the face of continued hypotension after 2 L, consider blood transfusion.

  • A central venous catheter to monitor such resuscitation may be considered.

  • Airway protection with intubation should be considered in the case of massive bleeding.

  • Nasogastric suction helps to keep the stomach empty and contracted.

  • IV PPI has been shown to reduce mortality in upper GI bleeds and reduces the incidence of rebleeding and the need for surgical intervention [65] ; emergent surgical or endoscopic intervention may be required

Patients with significant or potentially significant hemorrhage require admission, usually to the intensive care unit.

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