Table of Contents
Ulcers
Volume 2012, Article ID 361425, 8 pages
http://dx.doi.org/10.1155/2012/361425
Review Article

The Acute Management of Nonvariceal Upper Gastrointestinal Bleeding

Department of Gastroenterology, McGill University Health Center, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4

Received 10 August 2012; Accepted 3 October 2012

Academic Editor: T. Arakawa

Copyright © 2012 Hisham AL Dhahab and Alan Barkun. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. A. Barkun and G. Leontiadis, “Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease,” American Journal of Medicine, vol. 123, no. 4, pp. 358.e2–366.e2, 2010. View at Publisher · View at Google Scholar · View at Scopus
  2. D. A. Gilbert, “Epidemiology of upper gastrointestinal bleeding,” Gastrointestinal Endoscopy, vol. 36, supplement 5, pp. S8–S13, 1990. View at Google Scholar
  3. G. F. Longstreth, “Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study,” American Journal of Gastroenterology, vol. 90, no. 2, pp. 206–210, 1995. View at Google Scholar · View at Scopus
  4. M. E. Van Leerdam, E. M. Vreeburg, E. A. J. Rauws et al., “Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000,” American Journal of Gastroenterology, vol. 98, no. 7, pp. 1494–1499, 2003. View at Google Scholar · View at Scopus
  5. P. W. Chiu and E. K. Ng, “Predicting poor outcome from acute upper gastrointestinal hemorrhage,” Gastroenterology Clinics of North America, vol. 38, no. 2, pp. 215–230, 2009. View at Google Scholar
  6. A. N. Barkun, M. Bardou, E. J. Kuipers et al., “International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding,” Annals of Internal Medicine, vol. 152, no. 2, pp. 101–113, 2010. View at Google Scholar · View at Scopus
  7. M. A. Almadi, A. Barkun, and J. Brophy, “Antiplatelet and anticoagulant therapy in patients with gastrointestinal bleeding: an 86-year-old woman with peptic ulcer disease,” JAMA, vol. 306, no. 21, pp. 2367–2374, 2011. View at Google Scholar
  8. V. Jairath and A. N. Barkun, “The overall approach to the management of upper gastrointestinal bleeding,” Gastrointestinal Endoscopy Clinics of North America, vol. 21, no. 4, pp. 657–670, 2011. View at Google Scholar
  9. T. A. Rockall, R. F. A. Logan, H. B. Devlin, and T. C. Northfield, “Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom,” British Medical Journal, vol. 311, no. 6999, pp. 222–226, 1995. View at Google Scholar · View at Scopus
  10. O. Blatchford, L. A. Davidson, W. R. Murray, M. Blatchford, and J. Pell, “Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study,” British Medical Journal, vol. 315, no. 7107, pp. 510–514, 1997. View at Google Scholar · View at Scopus
  11. J. P. Wallis, A. W. Wells, and C. E. Chapman, “Changing indications for red cell transfusion from 2000 to 2004 in the North of England,” Transfusion Medicine, vol. 16, no. 6, pp. 411–417, 2006. View at Publisher · View at Google Scholar · View at Scopus
  12. S. A. Hearnshaw, R. F. A. Logan, K. R. Palmer, T. R. Card, S. P. L. Travis, and M. F. Murphy, “Outcomes following early red blood cell transfusion in acute upper gastrointestinal bleeding,” Alimentary Pharmacology and Therapeutics, vol. 32, no. 2, pp. 215–224, 2010. View at Publisher · View at Google Scholar · View at Scopus
  13. C. P. Engelfriet, H. W. Reesink, J. McCullough et al., “Perioperative triggers for red cell transfusions,” Vox Sanguinis, vol. 82, no. 4, pp. 215–226, 2002. View at Publisher · View at Google Scholar · View at Scopus
  14. P. C. Hébert, G. Wells, M. A. Blajchman et al., “A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care,” The New England Journal of Medicine, vol. 340, no. 6, pp. 409–417, 1999. View at Publisher · View at Google Scholar · View at Scopus
  15. A. Shingina, A. N. Barkun, A. Razzaghi, M. Martel, M. Bardou, and I. Gralnek, “Systematic review: the presenting international normalised ratio (INR) as a predictor of outcome in patients with upper nonvariceal gastrointestinal bleeding,” Alimentary Pharmacology and Therapeutics, vol. 33, no. 9, pp. 1010–1018, 2011. View at Publisher · View at Google Scholar · View at Scopus
  16. R. Baradarian, S. Ramdhaney, R. Chapalamadugu et al., “Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality,” American Journal of Gastroenterology, vol. 99, no. 4, pp. 619–622, 2004. View at Publisher · View at Google Scholar · View at Scopus
  17. C. P. Choudari, C. Rajgopal, and K. R. Palmer, “Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment,” Gut, vol. 35, no. 4, pp. 464–466, 1994. View at Google Scholar · View at Scopus
  18. J. F. Guest, H. G. Watson, and S. Limaye, “Modeling the cost-effectiveness of prothrombin complex concentrate compared with fresh frozen plasma in emergency warfarin reversal in the United kingdom,” Clinical Therapeutics, vol. 32, no. 14, pp. 2478–2493, 2010. View at Publisher · View at Google Scholar · View at Scopus
  19. J. S. Healey, J. Eikelboom, J. Douketis, L. Wallentin, J. Oldgren, S. Yang et al., “Periprocedural bleeding and thromboembolic events with dabigatran compared with warfarin: results from the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) randomized trial,” Circulation, vol. 126, no. 3, pp. 343–348, 2012. View at Google Scholar
  20. A. M. Aljebreen, C. A. Fallone, and A. N. Barkun, “Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding,” Gastrointestinal Endoscopy, vol. 59, no. 2, pp. 172–178, 2004. View at Publisher · View at Google Scholar · View at Scopus
  21. D. A. Gilbert, F. E. Silverstein, and F. J. Tedesco, “The national ASGE survey on upper gastrointestinal bleeding. III. Endoscopy in upper gastrointestinal bleeding,” Gastrointestinal Endoscopy, vol. 27, no. 2, pp. 94–102, 1981. View at Google Scholar · View at Scopus
  22. D. A. Corley, A. M. Stefan, M. Wolf, E. F. Cook, and T. H. Lee, “Early indicators of prognosis in upper gastrointestinal hemorrhage,” American Journal of Gastroenterology, vol. 93, no. 3, pp. 336–340, 1998. View at Publisher · View at Google Scholar · View at Scopus
  23. A. Barkun, M. Bardou, and J. K. Marshall, “Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding,” Annals of internal medicine, vol. 139, no. 10, pp. 843–857, 2003. View at Google Scholar · View at Scopus
  24. P. Almela, A. Benages, S. Peiro, R. Anon, M. M. Perez, A. Pena et al., “A risk score system for identification of patients with upper-GI bleeding suitable for outpatient management,” Gastrointestinal Endoscopy, vol. 59, no. 7, pp. 772–781, 2004. View at Google Scholar
  25. T. F. Imperiale, J. A. Dominitz, D. T. Provenzale et al., “Predicting poor outcome from acute upper gastrointestinal hemorrhage,” Archives of Internal Medicine, vol. 167, no. 12, pp. 1291–1296, 2007. View at Publisher · View at Google Scholar · View at Scopus
  26. T. A. Rockall, R. F. A. Logan, H. B. Devlin, and T. C. Northfield, “Risk assessment after acute upper gastrointestinal haemorrhage,” Gut, vol. 38, no. 3, pp. 316–321, 1996. View at Google Scholar · View at Scopus
  27. O. Blatchford, W. R. Murray, and M. Blatchford, “A risk score to predict need for treatment for upper-gastrointestinal haemorrhage,” The Lancet, vol. 356, no. 9238, pp. 1318–1321, 2000. View at Google Scholar · View at Scopus
  28. I. M. Gralnek and G. S. Dulai, “Incremental value of upper endoscopy for triage of patients with acute non-variceal upper-GI hemorrhage,” Gastrointestinal Endoscopy, vol. 60, no. 1, pp. 9–14, 2004. View at Publisher · View at Google Scholar · View at Scopus
  29. S. B. Laursen, J. M. Hansen, and O. B. Schaffalitzky de Muckadell, “The glasgow blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage,” Clinical Gastroenterology and Hepatology, vol. 10, no. 10, pp. 1130.e1–1135.e1, 2012. View at Google Scholar
  30. A. J. Stanley, D. Ashley, H. R. Dalton et al., “Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation,” The Lancet, vol. 373, no. 9657, pp. 42–47, 2009. View at Publisher · View at Google Scholar · View at Scopus
  31. S. H. Pang, J. Y. L. Ching, J. Y. W. Lau, J. J. Y. Sung, D. Y. Graham, and F. K. L. Chan, “Comparing the Blatchford and pre-endoscopic Rockall score in predicting the need for endoscopic therapy in patients with upper GI hemorrhage,” Gastrointestinal Endoscopy, vol. 71, no. 7, pp. 1134–1140, 2010. View at Publisher · View at Google Scholar · View at Scopus
  32. J. J. Y. Sung, K. K. F. Tsoi, L. H. Lai, J. C. Y. Wu, and J. Y. W. Lau, “Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis,” Gut, vol. 56, no. 10, pp. 1364–1372, 2007. View at Publisher · View at Google Scholar · View at Scopus
  33. S. El Ouali, A. N. Barkun, J. Wyse, J. Romagnuolo, J. J. Sung, I. M. Gralnek et al., “Is routine second-look endoscopy effective after endoscopic hemostasis in acute peptic ulcer bleeding? A meta-analysis,” Gastrointestinal Endoscopy, vol. 76, no. 2, pp. 283–292, 2012. View at Google Scholar
  34. G. I. Leontiadis, A. Sreedharan, S. Dorward et al., “Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding,” Health Technology Assessment, vol. 11, no. 51, pp. 1–164, 2007. View at Google Scholar · View at Scopus
  35. A. N. Barkun, “Should every patient with suspected upper GI bleeding receive a proton pump inhibitor while awaiting endoscopy?” Gastrointestinal Endoscopy, vol. 67, no. 7, pp. 1064–1066, 2008. View at Publisher · View at Google Scholar · View at Scopus
  36. A. N. Barkun, M. Martel, Y. Toubouti, E. Rahme, and M. Bardou, “Endoscopic hemostasis in peptic ulcer bleeding for patients with high-risk lesions: a series of meta-analyses,” Gastrointestinal Endoscopy, vol. 69, no. 4, pp. 786–799, 2009. View at Publisher · View at Google Scholar · View at Scopus
  37. P. Tsibouris, E. Zintzaras, C. Lappas et al., “High-dose pantoprazole continuous infusion is superior to somatostatin after endoscopic hemostasis in patients with peptic ulcer bleeding,” American Journal of Gastroenterology, vol. 102, no. 6, pp. 1192–1199, 2007. View at Publisher · View at Google Scholar · View at Scopus
  38. M. Vergara, X. Calvet, and J. P. Gisbert, “Epinephrine injection versus epinephrine injection and a second endoscopic method in high risk bleeding ulcers,” Cochrane Database of Systematic Reviews, no. 2, p. CD005584, 2007. View at Google Scholar · View at Scopus
  39. A. N. Barkun, M. Bardou, M. Martel, I. M. Gralnek, and J. J. Y. Sung, “Prokinetics in acute upper GI bleeding: a meta-analysis,” Gastrointestinal Endoscopy, vol. 72, no. 6, pp. 1138–1145, 2010. View at Publisher · View at Google Scholar · View at Scopus
  40. B. Coffin, M. Pocard, Y. Panis et al., “Erythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study,” Gastrointestinal Endoscopy, vol. 56, no. 2, pp. 174–179, 2002. View at Google Scholar · View at Scopus
  41. N. Carbonell, A. Pauwels, L. Serfaty, P. Y. Boelle, L. Becquemont, and R. Poupon, “Erythromycin infusion prior to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial,” American Journal of Gastroenterology, vol. 101, no. 6, pp. 1211–1215, 2006. View at Publisher · View at Google Scholar · View at Scopus
  42. J. L. Frossard, L. Spahr, P. E. Queneau et al., “Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial,” Gastroenterology, vol. 123, no. 1, pp. 17–23, 2002. View at Publisher · View at Google Scholar · View at Scopus
  43. N. S. Winstead and C. M. Wilcox, “Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage: a cost-effectiveness analysis,” Alimentary Pharmacology and Therapeutics, vol. 26, no. 10, pp. 1371–1377, 2007. View at Publisher · View at Google Scholar · View at Scopus
  44. L. Cipolletta, M. A. Bianco, G. Rotondano, R. Marmo, and R. Piscopo, “Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial,” Gastrointestinal Endoscopy, vol. 55, no. 1, pp. 1–5, 2002. View at Publisher · View at Google Scholar · View at Scopus
  45. H. J. Lin, K. Wang, C. L. Perng et al., “Early or delayed endoscopy for patients with peptic ulcer bleeding: a prospective randomized study,” Journal of Clinical Gastroenterology, vol. 22, no. 4, pp. 267–271, 1996. View at Publisher · View at Google Scholar · View at Scopus
  46. A. N. Ananthakrishnan, E. L. McGinley, and K. Saeian, “Outcomes of weekend admissions for upper gastrointestinal hemorrhage: a nationwide analysis,” Clinical Gastroenterology and Hepatology, vol. 7, no. 3, pp. 296.e1–302.e1, 2009. View at Publisher · View at Google Scholar · View at Scopus
  47. J. G. Lee, S. Turnipseed, P. S. Romano et al., “Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial,” Gastrointestinal Endoscopy, vol. 50, no. 6, pp. 755–761, 1999. View at Publisher · View at Google Scholar · View at Scopus
  48. J. Chen, Y. C. Yuan, G. I. Leontiadis, and C. W. Howden, “Recent safety concerns with proton pump inhibitors,” Journal of Clinical Gastroenterology, vol. 46, no. 2, pp. 93–114, 2012. View at Google Scholar
  49. S. A. Giday, Y. Kim, D. M. Krishnamurty et al., “Long-term randomized controlled trial of a novel nanopowder hemostatic agent (TC-325) for control of severe arterial upper gastrointestinal bleeding in a porcine model,” Endoscopy, vol. 43, no. 4, pp. 296–299, 2011. View at Publisher · View at Google Scholar · View at Scopus
  50. R. Marmo, G. Rotondano, R. Piscopo, M. A. Bianco, R. D'Angella, and L. Cipolletta, “Dual therapy versus monotherapy in the endoscopic treatment of high-risk bleeding ulcers: a meta-analysis of controlled trials,” American Journal of Gastroenterology, vol. 102, no. 2, pp. 279–289, 2007. View at Publisher · View at Google Scholar · View at Scopus
  51. L. Laine and K. R. McQuaid, “Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials,” Clinical Gastroenterology and Hepatology, vol. 7, no. 1, pp. 33–47, 2009. View at Publisher · View at Google Scholar · View at Scopus
  52. B. L. Bleau, C. J. Gostout, K. E. Sherman et al., “Recurrent bleeding from peptic ulcer associated with adherent clot: a randomized study comparing endoscopic treatment with medical therapy,” Gastrointestinal Endoscopy, vol. 56, no. 1, pp. 1–6, 2002. View at Publisher · View at Google Scholar · View at Scopus
  53. C. J. Kahi, D. M. Jensen, J. J. Y. Sung et al., “Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis,” Gastroenterology, vol. 129, no. 3, pp. 855–862, 2005. View at Publisher · View at Google Scholar · View at Scopus
  54. J. J. Y. Sung, F. K. L. Chan, J. Y. W. Lau et al., “The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison,” Annals of Internal Medicine, vol. 139, no. 4, pp. 237–I12, 2003. View at Google Scholar · View at Scopus
  55. J. Y. W. Lau, S. C. S. Chung, J. W. Leung, K. K. Lo, M. Y. Yung, and A. K. C. Li, “The evolution of stigmata of hemorrhage in bleeding peptic ulcers: a sequential endoscopic study,” Endoscopy, vol. 30, no. 6, pp. 513–518, 1998. View at Google Scholar · View at Scopus
  56. S. Dorward, A. Sreedharan, G. I. Leontiadis, C. W. Howden, P. Moayyedi, and D. Forman, “Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding,” Cochrane Database of Systematic Reviews, no. 4, p. CD005415, 2006. View at Google Scholar · View at Scopus
  57. S. A. Giday, “Preliminary data on the nanopowder hemostatic agent TC-325 to control gastrointestinal bleeding.,” Journal of Gastroenterology and Hepatology, vol. 7, no. 9, pp. 620–622, 2011. View at Google Scholar
  58. P. I. Hsu, G. H. Lo, C. C. Lo et al., “Intravenous pantoprazole versus ranitidine for prevention of rebleeding after endoscopic hemostasis of bleeding peptic ulcers,” World Journal of Gastroenterology, vol. 10, no. 24, pp. 3666–3669, 2004. View at Google Scholar · View at Scopus
  59. G. I. Leontiadis and C. W. Howden, “The role of proton pump inhibitors in the management of upper gastrointestinal bleeding,” Gastroenterology Clinics of North America, vol. 38, no. 2, pp. 199–213, 2009. View at Publisher · View at Google Scholar · View at Scopus
  60. G. I. Leontiadis, V. K. Sharma, and C. W. Howden, “Proton pump inhibitor treatment for acute peptic ulcer bleeding,” Cochrane Database of Systematic Reviews, no. 1, p. CD002094, 2006. View at Google Scholar · View at Scopus
  61. G. Leontiadis and A. Barkun, “Commentary: what is the optimal PPI dosing following endoscopic haemostasis in acute ulcer bleeding?” Alimentary Pharmacology & Therapeutics, vol. 35, no. 11, pp. 1351–1352, 2012. View at Google Scholar
  62. K. E. McColl, “Clinical practice. Helicobacter pylori infection,” The New England Journal of Medicine, vol. 362, no. 17, pp. 1597–1604, 2010. View at Google Scholar
  63. M. Derogar, G. Sandblom, L. Lundell, N. Orsini, M. Bottai, Y. Lu et al., “discontinuation of low-dose aspirin therapy after peptic ulcer bleeding increases risk of death and acute cardiovascular events,” Clinical Gastroenterology and Hepatology, 2012. In press.