What is the role of prokinetics in the treatment of upper gastrointestinal bleeding (UGIB)?

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

Eradication of H pylori can reduce the risk of rebleeding. [115]  Current anti-H pylori regimens include a variety of drug combinations.

The treatment regimens approved by FDA have 70%-90% H pylori eradication rates. [16]

The common regimens of “triple therapy” with a PPI, clarithromycin, and amoxicillin, or bismuth “quadruple therapy” consisting of a PPI, bismuth, tetracycline, and a nitroimidazole for 10-14 days remain as options for first-line therapy.

Clarithromycin resistance should be taken into consideration, as should previous macrolide exposure and penicillin allergy when considering a H pylori eradication regimen.

The 2017 American College of Gastroenterology (ACG) clinical guideline endorses additional regimens as potential first-line H pylori eradication therapy as follows [154] :

  • Sequential therapy: A PPI and amoxicillin for 5-7 days, followed by a PPI, clarithromycin, and a nitroimidazole for 5-7 days
  • Hybrid therapy: A PPI and amoxicillin for 7 days, followed by a PPI, amoxicillin, clarithromycin, and a nitroimidazole for 7 days
  • Fluoroquinolone sequential therapy: A PPI and amoxicillin for 5-7 days, followed by a PPI, fluoroquinolone, and nitroimidazole for 5-7 days

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