Treatment Options for Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding is a serious medical condition that requires prompt intervention. Without timely treatment, it can lead to severe complications and even be life-threatening. The following outlines the most effective approaches to managing this condition, tailored to different patient needs and scenarios.

Initial Management and Supportive Care

When upper gastrointestinal bleeding occurs, immediate supportive care is crucial. Patients should remain at rest and be closely monitored for any changes in vital signs. In cases of bleeding from ruptured esophageal varices, fasting is recommended to prevent further irritation and complications. For individuals with peptic ulcer bleeding, a liquid diet such as milk may be introduced once vomiting has ceased. Patients experiencing agitation or confusion should undergo blood ammonia testing to rule out hepatic encephalopathy. If necessary, mild sedatives like diazepam may be administered under medical supervision.

Restoring Blood Volume

One of the primary concerns in managing upper GI bleeding is stabilizing the patient's hemodynamic status. Intravenous fluids or blood transfusions may be required based on the severity of blood loss and the patient's overall condition. Blood pressure, heart rate, and laboratory values such as hemoglobin levels are closely monitored to guide fluid and blood product administration.

Pharmacological and Endoscopic Hemostasis

Several medications can aid in controlling bleeding. These include antifibrinolytic agents, hemostatic drugs like tranexamic acid, vitamin K, and herbal remedies such as Yunnan Baiyao. Histamine H2 receptor antagonists are particularly beneficial in managing bleeding from peptic ulcers and other mucosal lesions. Additionally, endoscopic interventions such as high-frequency electrocoagulation, laser therapy, and microwave coagulation are effective in achieving hemostasis and reducing the risk of rebleeding.

Surgical Intervention

When conservative treatments fail to control bleeding within 24–48 hours, surgery may be necessary. This is especially true for patients with a history of atherosclerosis or those who experience recurrent bleeding episodes. Surgical options may include procedures to remove the source of bleeding or to control hemorrhage through vessel ligation or resection of affected tissue.