Endoscopic and pharmacologic management of upper GI bleeding

Upper gastrointestinal bleeding can occur from multiple sources. Broadly, upper gastrointestinal bleeding can be divided into variceal and nonvariceal etiologies. The suspected source of bleeding will drive the initial resuscitation and management. Adequate resuscitation, management of the patients prior medications, initiating medications to affect gastric pH, initiating vasoactive drugs, or administering antibiotics all occur prior to endoscopy. Endoscopy is important in the diagnosis and management of upper gastrointestinal bleeding. Pharmacologic agents are useful during the endoscopy to help achieve hemostasis. Finally, once hemostasis is achieved, decisions must be made regarding reinitiation of previous mediations like antithrombotics and which medications can be used acutely and chronically to reduce the risk of rebleeding and mortality from upper gastrointestinal bleeding.