Recognition and management of upper gastrointestinal hemorrhage

Upper gastrointestinal hemorrhage is a frequent and severe problem in the intensive care unit. Such bleeding results from diverse gastroenterologic causes. Diagnosis and assessment of the severity of bleeding is accomplished primarily through the physical examination; endoscopy is the most sensitive means of establishing a specific site of hemorrhage. Medical management of gastrointestinal hemorrhage includes treatment with the histamine (H2)-receptor antagonists, antacids, or both. Recent studies suggest that continuous infusion of H2-receptor antagonists may be more efficacious than fixed-bolus dosing in prophylaxis of upper gastrointestinal bleeding. It is not known as yet if the continuous infusion regimen will be effective in stopping gastrointestinal bleeding that has already begun.