ABSTRACT
Upper gastrointestinal (GI) bleeds carry an overall 10% mortality and patients may decompensate rapidly. In addition, beware patients taking nonsteroidal anti-inflammatory drugs (NSAID) or anticoagulants – both result in an increased risk of upper GI bleeding. Suspect peptic ulcer disease with an upper GI bleed associated with epigastric pain, previous history of gastritis/ulceration, or recent treatment with NSAIDs. Two main assessment scores exist for upper GI bleeds – the Rockall and Blatchford scores. These help to predict morbidity and mortality and also the risk of rebleeding. The latter group requires immediate resuscitation followed by intervention to arrest the bleeding. Increasing gastric pH will stabilize blood clots, thus reducing further bleeding. The drug of choice is usually pantoprazole delivered either as a regular bolus dose or as a continuous intravenous infusion. Therapy is usually continued for several days post-endoscopy. Two main assessment scores exist for upper GI bleeds – the Rockall and Blatchford scores.
