Management of acute upper gastrointestinal bleeding.

The medical management of patients with acute upper gastrointestinal bleeding includes both diagnostic and therapeutic procedures. Emergency or early endoscopy has greatly improved the diagnosis, but it has not yet changed the therapeutic approach very much. The main emphasis is still on close observation of the patients in order to give blood transfusions when necessary and to identify those who need urgent operation. Most patients stop bleeding spontaneously, but the frequency of rebleeding is high. Patients with continuous bleeding or rebleeding are candidates for emergency operation. Much effort has been made to prevent rebleeding because, if the patients can be operated on electively, the frequency of complications is lower and vagotomy may be preferable to resection. Several medical treatments including antacids, H2-receptor antagonists, pepsin inhibitors and specific antifibrinolytic agents have been tried, but their value is still sub judice. Curiously, methods of treatment that are clearly effective in healing peptic ulcers seem less effective in preventing rebleeding from eroded vessels within such ulcerations.