Prophylaxis of gastrointestinal
bleeding is attempted in widely varying situations. In
NSAID-induced
peptic ulcer, the advantage of selective
cyclooxygenase 2 inhibitors with regard to gastrointestinal damage has yet to be translated into an advantage in overall morbidity. Strategies for primary and
secondary prevention of variceal
bleeding have been established.
Therapy tailored to hepatic venous pressure gradient has the potential to achieve clinical relevance. Several methods have been developed to prevent postpolypectomy
bleeding, but their optimal risk-tailored application has yet to be demonstrated. Although
octreotide treatment seems to be beneficial in reducing the blood loss from
angiodysplasias, controlled studies to determine its optimal use are awaited. Stress-
ulcer prophylaxis is commonly applied in
critically ill patients. Although data indicate that H2-receptor antagonists and
omeprazole are effective in preventing clinically significant
bleeding, evidence for an advantage with respect to length of hospital or intensive-care-unit stay, as well as mortality, is still lacking. Since there is misuse of
acid-suppressing drugs on regular wards, in-house guidelines may offer the potential for saving costs and reducing
inappropriate prescription.