Emerging Strategies in Pharmacologic Management for Non-Variceal Upper Gastrointestinal Hemorrhage

Our understanding of the pathophysiology of non-variceal upper gastrointestinal haemorrhage point to the potential role of acid suppressive therapy in improving haemostasis. Use of antihistamine antagonists in clinical studies on gastrointestinal haemorrhage did not demonstrate any significant benefit. With an improved understanding of drug pharmacokinetics, use of antihistamine antagonists are shown to have a significant tolerance effect and a failure to maintain a sustained intragastric acid suppression which may account for the lack of clinical benefit. Proton pump inhibitors have been shown to provide a sustained acid suppression and clinical studies have supported the use of proton pump inhibitors in acute upper gastrointestinal haemorrhage. A combination of pharmacological acid suppression and endoscopic therapy appears to act synergistically and provide the most effective means for achieving haemostasis particularly in the setting of actively bleeding peptic ulcers.