[The medical treatment of upper gastrointestinal bleeding in the new millennium]

Abstract

Treatment is advocated for patients manifesting upper gastrointestinal bleeding. The medical arsenal consists of H2-receptor blockers and proton pump inhibitors. Studies which were performed to test the efficacy of H2-blockers for bleeding did not present consistent conclusions. In vitro studies proved that H2-blockers given parenterally lose their efficacy after 24 hours, and the pH-drops back to near pretreatment level (pH 2.7). Omeprazole, the oldest pump inhibitor on the market, when given parenterally affects pH-within 30 minutes and does not lose its efficacy in the forthcoming days. In a few studies, when given enterally/parenterally Omeprazole lowered rates of recurrent bleeding, surgery and the number and rate of blood units transfused. On the whole it seems that H2-blockers have little or no role in the treatment of patients with upper gastrointestinal bleeding, while a proton pump inhibitor is of probable therapeutic value. There is no definite answer as to whether the drug should be given enterally or parenterally. It seems logical to start treatment of high-risk patients parenterally and the rest of the patients enterally (orally or via a nasogastric tube).