Resuscitation: The first and most critical step. Address hemodynamic instability with IV crystalloids and blood products (packed RBCs) as needed. Aim for Hb >7 g/dL in most patients. Transfuse platelets if <50,000/μL and FFP for coagulopathy (elevated INR/PTT).
Pharmacotherapy:
UGIB:Start an IV PPI (e.g., pantoprazole) to stabilize clots. For suspected variceal bleeding, add Octreotide (reduces portal pressure).
Acid and pepsin impair platelet aggregation and promote clot breakdown (fibrinolysis). PPIs potently suppress gastric acid secretion, raising the intragastric pH.
Endoscopic Therapy: Primary method for treating identified lesions.
Surgery: Reserved for severe, uncontrolled bleeding refractory to endoscopic and angiographic interventions.