Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding

Kim, Jeong Hwan

doi:2016.16.4.189

Korean J Helicobacter Up Gastrointest Res > Volume 16(4); 2016 > Article

Review

The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2016;16(4):189-193.
DOI: https://doi.org/10.7704/kjhugr.2016.16.4.189 Published online December 10, 2016.

Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding

Jeong Hwan Kim

¹Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea. sefamily@kuh.ac.kr
²Digestive Disease Center, Konkuk University Medical Center, Seoul, Korea.

비정맥류 상부위장관 출혈의 약물 치료

김정환^1,2

건국대학교 의학전문대학원 내과학교실¹, 건국대학교병원 소화기병센터²

Received: 14 November 2016 • Accepted: 5 December 2016

Abstract

Acute non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitor (PPI) remains the mainstay of treatment with potent acid suppression. Maintenance of the intragastric pH level above 6 by the administration of PPI prevents hemolysis caused by acid or pepsin and thereby promotes aggregation of platelets. Intragastric acid suppression can be achieved more effectively with continuous intravenous infusion of PPI after intravenous bolus injection. A high dose intravenous PPI is effective in reducing the risk of rebleeding, the need for surgery and repeated endoscopy. However, data regarding non-high dose intravenous PPIs are limited. In the future, novel PPIs and potassium-competitove acid blocker are in the area of interest. Combination therapy with the use of endoscopic hemostatic treatment and intravenous PPI administration is known to result in the best outcome for non-variceal upper gastrointestinal bleeding.

Key Words: Nonvariceal upper gastrointestinal bleeding; Pharmacologic management; Proton pump inhibitor