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: 55.87). 09/2008; 359(9):928-37. DOI: 10.1056/NEJMra0706113
Source: PubMed
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Available from: Marc Bardou,
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    • "Discussion UGIB is a common cause of hospital visits and admissions, at a cost estimated as US$2.5 billion annually [Albeldawi et al. 2010]. It carries a mortality of up to 10% [Gralnek et al. 2008]. "
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    ABSTRACT: Background: Upper gastrointestinal bleeding (UGIB) accounts for 400,000 hospital admissions in the US each year. Despite advances, mortality rates remain high and are estimated to be 5–10%. Early therapeutic endoscopy is widely recommended as a means of reducing morbidity and mortality. The Rockall and Blatchford scores are clinical scoring systems devised to assist in risk stratifying patients with UGIB. In a prior study we found that rapid live bedside video capsule endoscopy (VCE) utilizing Pillcam ESO® correctly identified patients with high-risk stigmata of bleeding seen on upper endoscopy. In this study, we compare the accuracy of the Rockall and Blatchford scores with Pillcam ESO® in predicting high-risk endoscopic stigmata.
    Therapeutic Advances in Gastroenterology 05/2013; 6(3):193-8. DOI:10.1177/1756283X13481020 · 3.93 Impact Factor
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    • "The natural history of ulcer disease shows a rebleeding rate of approximately 5% only in the case of Forrest type IIc or III (Table 4) [44]. "
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    ABSTRACT: Intensivists are regularly confronted with the question of gastrointestinal bleeding. To date, the latest international recommendations regarding prevention and treatment for gastrointestinal bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of gastrointestinal bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Societe de Reanimation de Langue Francaise (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of gastrointestinal bleeding before endoscopic diagnosis, treatment of upper gastrointestinal bleeding unrelated to portal hypertension, treatment of upper gastrointestinal bleeding related to portal hypertension, management of presumed lower gastrointestinal bleeding, and prevention of upper gastrointestinal bleeding in intensive care.
    Annals of Intensive Care 11/2012; 2(1):46. DOI:10.1186/2110-5820-2-46 · 3.31 Impact Factor
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    • "Renal function was evaluated by estimated glomerular filtration rate calculated using the 4-variable Modification of Diet in Renal Disease Study equations and classified according to the K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease [15]. High-risk ulcers were defined as Forrest grade higher or equal to 2b [3]. Rebleeding was defined as new onset of hematemesis, coffee-ground vomitus, or hematochezia, with an increasing pulse rate >110 beats/min and decreasing blood pressure below 90 mmHg after a 24-hour period of stable vital signs and hematocrit following endoscopic treatment [11, 16–18]. "
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    ABSTRACT: Background and Study Aims. The optimal dose of intravenous proton-pump inhibitor (PPI) therapy for the prevention of peptic ulcer (PU) rebleeding remains controversial. This study aimed to understand the real world experiences in prescribing high-dose PPI and non-high-dose PPI for preventing rebleeding after endoscopic treatment of high-risk PU. Patients and Methods. A total of 220 subjects who received high-dose and non-high-dose pantoprazole for confirmed acute PU bleeding that were successfully treated endoscopically were enrolled. They were divided into rebleeding (n = 177) and non-rebleeding groups (n = 43). Randomized matching of the treatment-control group was performed. Patients were randomly selected for non-high-dose and high-dose PPI groups (n = 44 in each group). Results. Univariate analysis showed, significant variables related to rebleeding were female, higher creatinine levels, and higher Rockall scores (≧6). Before case-control matching, the high-dose PPI group had higher creatinine level, higher percentage of shock at presentation, and higher Rockall scores. After randomized treatment-control matching, no statistical differences were observed for rebleeding rates between the high-dose and non-high-dose groups after case-control matching. Conclusion. This study suggests that intravenous high-dose pantoprazole may not be superior to non-high-dose regimen in reducing rebleeding in high-risk peptic ulcer bleeding after successful endoscopic therapy.
    Gastroenterology Research and Practice 07/2012; 2012(3):858612. DOI:10.1155/2012/858612 · 1.75 Impact Factor
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