Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes.
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Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy.
Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken.
Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer.
is eradicated and after cure is documented anti-ulcer therapy is generally not given.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used.
Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1–3 days).
Patients with idiopathic ulcers receive long-term anti-ulcer therapy.
This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding.
Hemodynamic status is first assessed, and resuscitation initiated as needed.