ABSTRACT
Upper gastrointestinal (UGI) bleeding is a common cause of admission to the intensive care unit (ICU) and accounts for over 300,000 ICU admissions in the United States alone. Optimal outcomes depend on both the rapid identification of the etiology of the hemorrhage and the subsequent implementation of appropriate pharmacologic and procedural therapies. This chapter reviews the current evidence, including practice guidelines, for the prevention and management of UGI bleeding. The type and use of medical prophylaxis are highly dependent on the etiology of a UGI bleed. In some cases, medical prophylaxis is the primary means of prevention, while in others, secondary prevention is the goal. As ulcer disease is the most common cause of UGI bleeds, providers must identify the etiology of the ulceration. There are three principal causes: Stress-related mucosal damage (SRMD), nonsteroidal antiinflammatory drug (NSAID) use, and Helicobacter pylori infection.
