Document Detail


Acute nonvariceal upper gastrointestinal bleeding.
MedLine Citation:
PMID:  20703110     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: To review recent literature (2009-2010) on acute nonvariceal upper gastrointestinal hemorrhage.
RECENT FINDINGS: There is a decreasing trend in the incidence and hospitalization for acute nonvariceal upper gastrointestinal hemorrhage worldwide, with significant improvement in rebleeding and mortality. One study showed that Glasgow-Blatchford score was superior to Rockall score in predicting the need of intervention or death. None of those categorized as low risk required any intervention. Another database research from United States demonstrated that those managed as outpatients upon clinician decision had 6.3% mortality. Recent meta-analysis demonstrated that epinephrine injection should be used in combination with one other modality for hemostasis in bleeding ulcers, whereas thermal, sclerosant, clips and thrombin/fibrin glue appeared to be effective alone. Despite meta-analysis showing that second look endoscopy with thermal therapy reduced rebleeding, international consensus from experts recommended proton pump inhibitor infusion as the preferred strategy to prevent ulcer rebleeding.
SUMMARY: Epidemiological studies worldwide confirmed reduction in the incidence and improvement in clinical outcomes for acute nonvariceal upper gastrointestinal bleeding. Patients categorized as low risk may be managed as outpatients. Endoscopic therapy remained the mainstay of ulcer hemostasis and high dose proton pump inhibitor infusion should be employed to prevent rebleeding.
Authors:
Philip W Y Chiu; Joseph J Y Sung
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in gastroenterology     Volume:  26     ISSN:  1531-7056     ISO Abbreviation:  Curr. Opin. Gastroenterol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-12     Completed Date:  2010-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8506887     Medline TA:  Curr Opin Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  425-8     Citation Subset:  IM    
Affiliation:
Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Diagnosis, Differential
Duodenal Ulcer*
Endoscopy, Gastrointestinal / methods*
Hemostasis, Endoscopic / methods*
Hospitalization / trends
Humans
Incidence
Peptic Ulcer Hemorrhage* / diagnosis,  etiology,  therapy
Prognosis
Stomach Ulcer*
United States / epidemiology

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