 |
 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
18 November 2003 | Volume 139 Issue 10 | Pages 843-857
Background: The management of patients with acute nonvariceal upper gastrointestinal bleeding has evolved substantially over the past 10 years amid a paucity of published consensus guidelines.
Purpose: To provide evidence-based management recommendations that address clinically relevant issues.
Review and Consensus Processes: A multidisciplinary consensus group of 25 voting participants representing 11 national societies used a 7-step approach to develop recommendation statements according to accepted standards. Sources of data included narrative and systematic reviews as well as published and new meta-analyses. The quality of the evidence, the strength of the recommendation, and the level of consensus were graded according to recognized classifications.
Main Findings: Recommendations emphasize appropriate initial resuscitation of the patient and a multidisciplinary approach to clinical risk stratification that determines the need for early endoscopy. Early endoscopy allows safe and prompt discharge of selected patients classified as low risk. Endoscopic hemostasis is reserved for patients with high-risk endoscopic lesions. Although monotherapy with injection or thermal coagulation is effective, the combination is superior to either treatment alone. The placement of endoscopic clips for endoscopic hemostasis appears promising. High-dose intravenous proton-pump inhibition is recommended in patients who have undergone successful endoscopic therapy. Routine second-look endoscopy is not recommended. Patients with upper gastrointestinal bleeding should be tested for Helicobacter pylori infection and receive eradication therapy if infection is present.
Future Directions: The efficacy of newer endoscopic therapeutic technologies, the optimal regimen of proton-pump inhibition, and the roles of other pharmacologic agents require further research.
*For a list of the voting participants in the Nonvariceal Upper GI Bleeding Consensus Conference Group, see the Appendix.
Author and Article Information
From McGill University, Montreal, Quebec, Canada; Faculté de Médecine, Dijon Cedex, France; and McMaster University, Hamilton, Ontario, Canada.
Acknowledgments: The authors thank Pauline Lavigne for the preparation of the manuscript. They also acknowledge the contributions of Dalila Benhaberou-Brun, Mary Muccino, Debbie Ross, and Shelley Natovitch, as well as Paul Sinclair and Sandra Daniels, in assisting in the organization of the Consensus Conference. The Canadian Association of Gastroenterology thanks the sponsors of the Banff Consensus Conference: Abbott Laboratories Ltd., Altana Canada Inc., AstraZeneca Canada, and Janssen-Ortho Inc. It also thanks the conference's supporters: Carsen Group Inc. and Pentax Precision Instrument Corp.
Grant Support: In part by "arms-length" grants to the Canadian Association of Gastroenterology from Abbott Laboratories Ltd., Altana Pharma Canada Inc., AstraZeneca Canada, Carsen Group Inc. (distributors for Olympus in Canada), Janssen-Ortho Inc., and Pentax Precision Instrument Corp.; a peer-reviewed grant from the Canadian Institutes for Health Research; and an institutional award from the McGill University Health Centre Research Institute. The RUGBE initiative referred to in the consensus document was a collaborative effort supported by the Canadian Association of Gastroenterology and an unrestricted grant from Altana Pharma Canada (formerly Byk Canada Inc.).
Potential Financial Conflicts of Interest:Consultancies: A. Barkun (Altana Pharma Canada Inc.); Honoraria: A. Barkun (Altana Pharma Canada Inc.); Grants received: A. Barkun (Altana Pharma Canada Inc.).
Requests for Single Reprints: Alan Barkun, MD, MSc, Division of Gastroenterology, Montreal General Hospital Site, McGill University Health Centre, 1650 Cedar Avenue, Room D7.148, Montreal, Quebec H3G 1A4, Canada.
This consensus conference was endorsed and organized by the Canadian Association of Gastroenterology and was held in Banff, Alberta, Canada, on 8–9 June 2002.
Current Author Addresses: Dr. Barkun: Division of Gastroenterology, Montreal General Hospital Site, McGill University Health Centre, 1650 Cedar Avenue, Room D7.148, Montreal, Quebec H3G 1A4, Canada.
Dr. Bardou: Faculté de Médecine de Dijon, 7, boulevard Jeanne d'Arc, BP 87900, 21079 Dijon Cedex, France.
Dr. Marshall: Division of Gastroenterology, Room 4W8, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. CLINICAL GUIDELINES
Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  I. M. Gralnek, A. N. Barkun, and M. Bardou Management of Acute Bleeding from a Peptic Ulcer N. Engl. J. Med., August 28, 2008; 359(9): 928 - 937. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Christensen, R. W. Thomsen, M. L. Torring, A. Riis, M. Norgaard, and H. T. Sorensen Impact of COPD on Outcome Among Patients With Complicated Peptic Ulcer Chest, June 1, 2008; 133(6): 1360 - 1366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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, October 1, 2007; 56(10): 1364 - 1373. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF]
|
|
|
|
|
|
J. Y. Lau, W. K. Leung, J. C.Y. Wu, F. K.L. Chan, V. W.S. Wong, P. W.Y. Chiu, V. W.Y. Lee, K. K.C. Lee, F. K.Y. Cheung, P. Siu, et al. Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding N. Engl. J. Med., April 19, 2007; 356(16): 1631 - 1640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. I. Leontiadis, V. K. Sharma, and C. W. Howden Proton Pump Inhibitor Therapy for Peptic Ulcer Bleeding: Cochrane Collaboration Meta-analysis of Randomized Controlled Trials Mayo Clin. Proc., March 1, 2007; 82(3): 286 - 296. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Rahme, M. Bardou, K. Dasgupta, Y. Toubouti, J. Ghosn, and A. N. Barkun Hospitalization for gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs among elderly patients using low-dose aspirin: a retrospective cohort study Rheumatology, February 1, 2007; 46(2): 265 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W. Thomsen, A. Riis, S. Christensen, M. Norgaard, and H. T. Sorensen Diabetes and 30-Day Mortality From Peptic Ulcer Bleeding and Perforation: A Danish population-based cohort study Diabetes Care, April 1, 2006; 29(4): 805 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Cohen and J. A. Rebuck Proton-pump inhibitors for upper-gastrointestinal bleeding Am. J. Health Syst. Pharm., February 1, 2006; 63(3): 214 - 216. [Full Text] [PDF]
|
|
|
|
 |
|
 J. W Devlin, L. S Welage, and K. M Olsen Proton Pump Inhibitor Formulary Considerations in the Acutely Ill Part 2: Clinical Efficacy, Safety, and Economics Ann. Pharmacother., November 1, 2005; 39(11): 1844 - 1851. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W Devlin, L. S Welage, and K. M Olsen Proton Pump Inhibitor Formulary Considerations in the Acutely Ill Part 1: Pharmacology, Pharmacodynamics, and Available Formulations Ann. Pharmacother., October 1, 2005; 39(10): 1667 - 1677. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Rivkin and A. Lyakhovetskiy Treatment of nonvariceal upper gastrointestinal bleeding Am. J. Health Syst. Pharm., June 1, 2005; 62(11): 1159 - 1170. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Olsen Use of acid-suppression therapy for treatment of non-variceal upper gastrointestinal bleeding Am. J. Health Syst. Pharm., May 15, 2005; 62(10_Supplement_2): S18 - S23. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Devlin Proton pump inhibitors for acid suppression in the intensive care unit: Formulary considerations Am. J. Health Syst. Pharm., May 15, 2005; 62(10_Supplement_2): S24 - S30. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R P Arasaradnam and M T Donnelly Acute endoscopic intervention in non-variceal upper gastrointestinal bleeding Postgrad. Med. J., February 1, 2005; 81(952): 92 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Andriulli, V. Annese, and G. Leandro Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Ann Intern Med, July 6, 2004; 141(1): 78 - 79. [Full Text] [PDF]
|
|
|
|
|
|
K. M. Kessler Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Ann Intern Med, July 6, 2004; 141(1): 79 - 79. [Full Text] [PDF]
|
|
|
|
|
|
M. S. Khuroo and M. S. Khuroo Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Ann Intern Med, July 6, 2004; 141(1): 79 - 80. [Full Text] [PDF]
|
|
|
|
 |
|
 Practice Guideline: Management of Nonvariceal Upper GI Bleeding Journal Watch (General), December 26, 2003; 2003(1226): 1 - 1. [Full Text]
|
|
Article
