Towards personalised management for non-variceal upper gastrointestinal bleeding

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323846
Author(s):  
Joseph J Y Sung ◽  
Loren Laine ◽  
Ernst J Kuipers ◽  
Alan N Barkun
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Point Of Care ◽  
Management Strategies ◽  
Patient Characteristics ◽  
Professional Societies ◽  
Assessment And Treatment ◽  
Three Stages ◽  
Endoscopic Assessment ◽  
Upper Gastrointestinal

Guidelines from national and international professional societies on upper gastrointestinal bleeding highlight the important clinical issues but do not always identify specific management strategies pertaining to individual patients. Optimal treatment should consider the personal needs of an individual patient and the pertinent resources and experience available at the point of care. This article integrates international guidelines and consensus into three stages of management: pre-endoscopic assessment and treatment, endoscopic evaluation and haemostasis and postendoscopic management. We emphasise the need for personalised management strategies based on patient characteristics, nature of bleeding lesions and the clinical setting including available resources.

Acute upper gastrointestinal bleeding: endoscopic assessment and treatment

2020 ◽  
Vol 18 (Sup1) ◽  
pp. S26-S35
Author(s):  
Rajan Patel ◽  
Steven Mann
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Endoscopy ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Assessment And Treatment ◽  
Medical Emergencies ◽  
The Uk ◽  
Endoscopic Assessment ◽  
Upper Gastrointestinal ◽  
Significant Mortality

Acute upper gastrointestinal bleeding (AUGIB) represents 10% of medical emergencies in the UK and is associated with a significant mortality risk. Mortality has remained steady over the past 2 decades, at approximately 10%, with over 4000 deaths per annum in the UK. Patients with significant bleeding present with symptoms of haematemesis, melaena or haematochezia (rapid transit of red blood through the GI tract). An assessment of haemodynamic stability along with adequate resuscitation is vital prior to performing safe endoscopy. The performance of prompt upper gastrointestinal endoscopy is then necessary, as it has diagnostic, prognostic and therapeutic roles. Early identification of aetiology (variceal versus non-variceal bleeding) is important and directs endoscopic and medical treatment. An increasing number of endoscopic therapeutic options are now available.

scholarly journals Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Gut ◽  
2018 ◽  
Vol 67 (10) ◽  
pp. 1757-1768 ◽  
Author(s):  
Joseph JY Sung ◽  
Philip WY Chiu ◽  
Francis K L Chan ◽  
James YW Lau ◽  
Khean-lee Goh ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Working Group ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Asia Pacific ◽  
Endoscopic Management ◽  
Three Stages ◽  
Upper Gastrointestinal

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

scholarly journals In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

Ulcers ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Marcos Amorim ◽  
Alan N. Barkun ◽  
Martin Larocque ◽  
Karl Herba ◽  
Benoit DeVarennes ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Patient Characteristics ◽  
Hemodynamic Instability ◽  
Predictors Of Outcome ◽  
Surgery Patient ◽  
Endoscopic Characteristics ◽  
Upper Gastrointestinal

Background. Nonvariceal upper gastrointestinal bleeding (NVUGIB) can occur following cardiac surgery, with sparse contemporary data on patient characteristics and predictors of outcome in this setting. Aim. To describe the clinical and endoscopic characteristics of patients with NVUGIB following cardiac surgery and characterize predictors of outcome. Methods. Retrospective review of 131 consecutive patients with NVUGIB following cardiac surgery from 2002 to 2005. Demographic characteristics, therapeutic management, and predictors of outcomes were determined. Results. 69.5% were male, mean age: 68.8 ± 10.2 yrs, mean Parsonnet score: 24.6 ± 14.2. Commonest symptoms included melena (59.4%) or coffee ground emesis (25.8%). In-hospital medications included ASA (88.5%), heparin (95.4%, low molecular weight 6.9%), coumadin (48.1%), clopidogrel (22.9%), and NSAIDS (42%). Initial hemodynamic instability was noted in 47.1%. Associated laboratory results included hematocrit 26 ± 6, platelets 243 ± 133 109/L, INR 1.7 ± 1.6, and PTT 53.3 ± 35.6 s. Endoscopic evaluation (122 patients) yielded ulcers (85.5%) with high-risk lesions in 45.5%. Ulcers were located principally in the stomach (22.5%) or duodenum (45.9%). Many patients had more than one lesion, including esophagitis (28.7%) or erosions (26.8%). 48.8% received endoscopic therapy. Mean lengths of intensive care unit and overall stays were 10.4 ± 18.4 and 39.4 ± 46.9 days, respectively. Overall mortality was 19.1%. Only mechanical ventilation under 48 hours predicted mortality (O.R = 0.11; 95% CI = 0.04−0.34). Conclusions. This contemporary cohort of consecutive patients with NVUGIB following cardiac surgery bled most often from ulcers or esophagitis; many had multiple lesions. ICU and total hospital stays as well as mortality were significant. Mechanical ventilation for under 48 hours was associated with improved survival.

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