Patients presenting bleedings of the upper gastrointestinal tract not due to esophageal varices are treated according to international guidelines, which have been recently updated according to the available scientific evidence. The fundamental points are the following: - Use a standardized prognostic evaluation to establish the risk of relapsing bleeding and of death. - Make blood transfusions when the Hb level is under 7 mg/dl. - Do not delay endoscopy to correct bleeding disorders or to administer PPIs. - Discharge, in short times, patients with a low risk after an endoscopy. - Perform an early endoscopy (within 24 hours) in most patients. - PPI therapy must be performed in patients presenting a high bleeding risk after endoscopy, and these patients should be hospitalized for at least 72 hours. - At discharge, prescribe a PPI. - If endoscopic treatment fails, consider percutaneous embolization as an alternative to surgery. - In patients with peptic ulcer, perform a HP test and treat the patient if positive. - Repeat HP test if the result is negative in an acute phase. - If necessary, use NSAIDs, associate a PPI or a COX-2 inhibitor. - Aspirin at a cardiovascular dosage must be taken again as soon as the benefit overpasses the bleeding risk: clopidogrel gives a higher risk than aspirin associated with a PPI.
The consensus document is much detailed and it gives certainly useful indications, most of which, however, are not surprising, since they already belong to usual protocols.
