Management of specific causes of an upper GI bleed

When the patient has been resuscitated, then treatment of the underlying cause of the haemorrhage may be commenced.

Management of non-variceal bleeding

• adrenaline should not be used as monotherapy for the endoscopic treatment of non-variceal upper gastrointestinal bleeding
• for the endoscopic treatment of non-variceal upper gastrointestinal bleeding, use one of the following:
  • a mechanical method (for example, clips) with or without adrenaline
  • thermal coagulation with adrenaline fibrin or
  • thrombin with adrenaline
• interventional radiology should be offered to unstable patients who re-bleed after endoscopic treatment
• refer urgently for surgery if interventional radiology is not promptly available

Management of variceal bleeding

• terlipressin should be offered to patients with suspected variceal bleeding at presentation. Stop treatment after definitive haemostasis has been achieved, or after 5 days, unless there is another indication for its use
• prophylactic antibiotic therapy should be offered at presentation to patients with suspected or confirmed variceal bleeding
• oesophageal varices
  • use band ligation in patients with upper gastrointestinal bleeding from oesophageal varices
  • consider transjugular intrahepatic portosystemic shunts (TIPS) if bleeding from oesophageal varices is not controlled by band ligation.
• gastric varices
  • endoscopic injection of N-butyl-2-cyanoacrylate should be offered to patients with upper gastrointestinal bleeding from gastric varices
  • TIPS should be offered if bleeding from gastric varices is not controlled by endoscopic injection of N-butyl-2-cyanoacrylate
    
    

Reference:

1. NICE (August 2016). Acute Upper GI bleeding.