Specific management For Non-variceal bleeding

Management of Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB) focuses on rapid stabilization, targeted endoscopic therapy, and prevention of recurrence. Here's a structured approach based on current guidelines and evidence:

🚨 Initial Assessment and Stabilization
Hemodynamic stabilization: IV fluids and blood transfusion (target hemoglobin 7–9 g/dL).

Risk stratification: Use scoring systems like Glasgow-Blatchford Score (GBS) to identify low-risk patients who may not need hospitalization.

Proton Pump Inhibitors (PPIs): High-dose IV PPI (e.g., 80 mg bolus followed by 8 mg/hour infusion) before endoscopy to reduce active bleeding and improve visualization.

🔬 Endoscopic Therapy
Timing: Perform early endoscopy within 24 hours of presentation.

Techniques:

Injection therapy: Epinephrine for temporary control, but not as monotherapy.

Thermal coagulation: Heater probe or bipolar electrocoagulation.

Mechanical methods: Hemoclips or band ligation—especially effective for Mallory-Weiss tears and Dieulafoy’s lesions1.

Topical agents: Hemostatic sprays or powders as salvage therapy.

🧪 Post-Endoscopic Management
Continue PPI therapy: IV for 72 hours post-endoscopy, then switch to oral.

H. pylori testing and eradication: If peptic ulcer is the cause.

Avoid NSAIDs: Use COX-2 inhibitors with PPI if anti-inflammatory therapy is essential.

Resume antithrombotics cautiously: Aspirin for secondary cardiovascular prevention should be restarted within 3 days if hemostasis is achieved.

🛡️ Secondary Prevention
Maintenance PPI therapy: Especially in patients with high-risk ulcers.

Surveillance endoscopy: For selected cases like gastric ulcers or neoplasms.

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