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...
  • Print
Answer

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.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!