Current concepts: Management of acute bleeding from a peptic ulcer

Department of Gastroenterology and Gastrointestinal Outcomes Unit, Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
New England Journal of Medicine (Impact Factor: 54.42). 09/2008; 359(9):928-37. DOI: 10.1056/NEJMra0706113
Source: PubMed


Available from: Marc Bardou, Jun 15, 2015
  • Gastroenterology 11/2014; 28(10):543-8. DOI:10.1016/S0016-5085(14)60738-1 · 13.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Bleeding from stress-related mucosal disease in critically ill patients remains an important clinical management issue. Although only a small proportion (1-6%) of patients admitted to an intensive care unit (ICU) will bleed, a substantial proportion exhibit clinical risk factors (mechanical ventilation for >48 h and a coagulopathy) that predict an increased risk of bleeding. Furthermore, upper gastrointestinal mucosal lesions can be found in 75-100% of patients in ICUs. Although uncommon, stress-ulcer bleeding is a severe complication with an estimated mortality of 40-50%, mostly from decompensating an underlying condition or multiorgan failure. Although the vast majority of patients in ICUs receive stress-ulcer prophylaxis, largely with PPIs, some controversy surrounds their efficacy and safety. Indeed, no single trial has shown that stress-ulcer prophylaxis reduces mortality. Some reports suggest that the use of PPIs increases the risk of nosocomial infections. However, several meta-analyses and cost-effectiveness studies suggest PPIs to be more clinically effective and cost-effective than histamine-2 receptor antagonists, without considerable increases in nosocomial pneumonia. To help clinicians use the most appropriate strategy for treatment of patients in the ICU, this Review presents the latest information on all aspects of stress-related mucosal disease.
    Nature Reviews Gastroenterology &#38 Hepatology 01/2015; DOI:10.1038/nrgastro.2014.235 · 10.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective. Nonvariceal acute upper gastrointestinal bleeding (AUGIB) is often associated with significant blood loss and anemia. Both the bleeding episode itself and the subsequent anemia are likely to significantly impact a patient's health-related quality of life (HRQoL). Treating the anemia is essential to increase the hemoglobin levels. The HRQoL impact has not been investigated. This longitudinal study aimed to determine the relationship between anemia, HRQoL, and fatigue in patients after nonvariceal AUGIB. Materials and methods. A total of 97 patients (51 males and 46 females; mean age 70 years) were followed in a longitudinal study with a 6-month follow-up. All patients had AUGIB and were anemic at inclusion. Anemia, HRQoL (EQ-5D-3L), and fatigue (using the Multidimensional Fatigue Inventory) were assessed at baseline, and at 1, 3, and 6 months. The patients were initially included in an iron supplementation study. Results. The patients' HRQoL increased and their fatigue levels decreased from baseline to month 3 and month 6. Approximately half of the patients had full health at month 3; similar results were observed in the general population. Three and six months after the bleeding episodes, neither the HRQoL nor fatigue was affected by the anemia. Conclusion. This study did not uncover relationships between anemia and HRQoL or anemia and fatigue after nonvariceal AUGIB.
    Scandinavian Journal of Gastroenterology 06/2014; DOI:10.3109/00365521.2014.910544 · 2.33 Impact Factor