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The use of vasoconstrictor therapy in non-variceal upper GI bleeds
  1. Gabby May, Senior Clinical Fellow in Emergency Medicine,
  2. John Butler, Consultant in Emergency Medicine and Intensive Care
  1. Manchester Royal Infirmary

    https://doi.org/10.1136/emj.2006.040162

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      Report by Gabby May, Senior Clinical Fellow in Emergency Medicine 
 Checked by John Butler, Consultant in Emergency Medicine and Intensive Care 
 Manchester Royal Infirmary

      A short cut review was carried out to establish whether vasoconstrictor therapy is indicated for patients who present with an acute upper gastrointestinal (GI) bleed without known oesophageal varices. In total, 1123 citations were reviewed, of which 16 answered the three part question. The clinical bottom line is that somatostatin (SST) should be considered in unwell patients who are likely to be bleeding secondary to peptic ulcer disease (PUD) until definitive endoscopy, or in situations when endoscopy is contraindicated or unavailable. There is no definitive evidence for the length of time treatment should continue.

      Three part question

      [In patients with acute severe non variceal upper GI bleed] is [the use of vasoconstrictor therapy] indicated [to control bleeding and prevent re-bleeding].

      Clinical scenario

      A 65 year old man presents to …

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