PMID- 22310222
OWN - NLM
STAT- MEDLINE
DCOM- 20120427
LR  - 20220409
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 107
IP  - 3
DP  - 2012 Mar
TI  - Management of patients with ulcer bleeding.
PG  - 345-60; quiz 361
LID - 10.1038/ajg.2011.480 [doi]
AB  - This guideline presents recommendations for the step-wise management of patients 
      with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, 
      and resuscitation initiated as needed. Patients are risk-stratified based on 
      features such as hemodynamic status, comorbidities, age, and laboratory tests. 
      Pre-endoscopic erythromycin is considered to increase diagnostic yield at first 
      endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to 
      decrease the need for endoscopic therapy but does not improve clinical outcomes. 
      Upper endoscopy is generally performed within 24h. The endoscopic features of 
      ulcers direct further management. Patients with active bleeding or non-bleeding 
      visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, 
      heater probe, sclerosant, clips) and those with an adherent clot may receive 
      endoscopic therapy; these patients then receive intravenous PPI with a bolus 
      followed by continuous infusion. Patients with flat spots or clean-based ulcers 
      do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding 
      after endoscopic therapy is treated with a second endoscopic treatment; if 
      bleeding persists or recurs, treatment with surgery or interventional radiology 
      is undertaken. Prevention of recurrent bleeding is based on the etiology of the 
      bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer 
      therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are 
      stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. 
      Patients with established cardiovascular disease who require aspirin should start 
      PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days 
      and ideally 1-3 days). Patients with idiopathic ulcers receive long-term 
      anti-ulcer therapy.
FAU - Laine, Loren
AU  - Laine L
AD  - Section of Digestive Diseases, Yale University School of Medicine, New Haven, 
      Connecticut 06520-8019, USA. loren.laine@yale.edu
FAU - Jensen, Dennis M
AU  - Jensen DM
LA  - eng
PT  - Journal Article
PT  - Practice Guideline
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20120207
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Proton Pump Inhibitors)
RN  - 63937KV33D (Erythromycin)
SB  - IM
CIN - Am J Gastroenterol. 2012 Oct;107(10):1590-1; author reply 1591. PMID: 23034618
MH  - Blood Transfusion
MH  - Clinical Trials as Topic
MH  - Endoscopy, Gastrointestinal
MH  - Erythromycin/therapeutic use
MH  - Evidence-Based Medicine
MH  - Fluid Therapy
MH  - Gastric Lavage
MH  - Hemostasis, Endoscopic/*methods
MH  - Humans
MH  - Meta-Analysis as Topic
MH  - Patient Selection
MH  - Peptic Ulcer Hemorrhage/diagnosis/*therapy
MH  - Prognosis
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Resuscitation/methods
MH  - Retreatment
MH  - Risk Assessment
MH  - Secondary Prevention
EDAT- 2012/02/09 06:00
MHDA- 2012/04/28 06:00
CRDT- 2012/02/08 06:00
PHST- 2012/02/08 06:00 [entrez]
PHST- 2012/02/09 06:00 [pubmed]
PHST- 2012/04/28 06:00 [medline]
AID - ajg2011480 [pii]
AID - 10.1038/ajg.2011.480 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2012 Mar;107(3):345-60; quiz 361. doi: 10.1038/ajg.2011.480. 
      Epub 2012 Feb 7.