How is upper gastrointestinal bleeding (UGIB) prevented?

Updated: Aug 12, 2019
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

H pylori eradication therapy should be given if H pylori is present in the setting of any history of ulcer disease. Eradication of H pylori has been demonstrated to reduce the risk of recurrent ulcers and, therefore, recurrent ulcer hemorrhages.

Avoid nonsteroidal anti-inflammatory drugs (NSAIDs). If this is not possible, use the lowest dose and duration.

Proton-pump inhibitors (PPIs) or misoprostol cotherapy should be used along with NSAIDs.

The use of cyclooxygenase (COX)-2 inhibitors has been shown to reduce the risk of ulcer hemorrhage, although only when not combined with aspirin therapy. Concerns have been raised about an increase in myocardial infarction and stroke in patients taking selective COX-2 inhibitors. More recent data suggest this may be a risk with all NSAIDs. [157, 158]

As demonstrated in the study by al-Assi et al, the combination of H pylori infection and NSAID use may increase the risk of ulcer hemorrhage. [1]


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