Journal ArticleDOI
Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit
TLDR
AUGIB continues to result in substantial mortality although it appears to be lower than in 1993, and Mortality is particularly high among inpatients and those bleeding from varices or upper gastrointestinal malignancy.Abstract:
Objective To describe the patient characteristics, diagnoses and clinical outcomes of patients presenting with acute upper gastrointestinal bleeding (AUGIB) in the 2007 UK Audit. Design Multi-centre survey. Setting All UK hospitals admitting patients with AUGIB. Participants All adults (>16 years) presenting in or to UK hospitals with AUGIB between 1 May and 30 June 2007. Results Data on 6750 patients (median age 68 years) was collected from 208 participating hospitals. New admissions (n=5550) were younger (median age 65 years) than inpatients (n=1107, median age 71 years), with less co-morbidity (any co-morbidity 46% vs 71%, respectively). At presentation 9% (599/6750) had known cirrhosis, 26% a history of alcohol excess, 11% were taking non-steroidal anti-inflammatory drugs and 28% aspirin. Peptic ulcer disease accounted for 36% of AUGIB and bleeding varices 11%. In 13% there was evidence of further bleeding after the first endoscopy. 1.9% underwent surgery and 1.2% interventional radiology for AUGIB. Median length of stay was 5 days. Overall mortality in hospital was 10% (675/6750, 95% CI 9.3 to 10.7), 7% in new admissions and 26% among inpatients. Mortality was highest in those with variceal bleeding (15%) and with malignancy (17%). Conclusions AUGIB continues to result in substantial mortality although it appears to be lower than in 1993. Mortality is particularly high among inpatients and those bleeding from varices or upper gastrointestinal malignancy. Surgical or radiological interventions are little used currently.read more
Citations
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Journal ArticleDOI
Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Ian M. Gralnek,Ian M. Gralnek,Jean-Marc Dumonceau,Ernst J. Kuipers,Angel Lanas,David S Sanders,Matthew Kurien,Gianluca Rotondano,Tomas Hucl,Mário Dinis-Ribeiro,Riccardo Marmo,I. Racz,Alberto Arezzo,Ralf Thorsten Hoffmann,Gilles Lesur,Roberto de Franchis,Lars Aabakken,Andrew Veitch,Franco Radaelli,Paulo Salgueiro,Ricardo S. Cardoso,Luís Maia,Angelo Zullo,Livio Cipolletta,Cesare Hassan +24 more
TL;DR: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy and addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH).
Journal ArticleDOI
Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study.
Adrian J. Stanley,Loren Laine,Harry R. Dalton,Jing Hieng Ngu,Michael Schultz,Roseta Abazi,Liam Zakko,Susan Thornton,Kelly Wilkinson,Cristopher J L Khor,Iain A. Murray,Stig Borbjerg Laursen +11 more
TL;DR: The Glasgow Blatchford score has high accuracy at predicting need for hospital based intervention or death and scores of ≤1 appear the optimum threshold for directing patients to outpatient management.
Journal ArticleDOI
Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients
Angèle Gayet-Ageron,Angèle Gayet-Ageron,David Prieto-Merino,Katharine Ker,Haleema Shakur,François-Xavier Ageron,Ian Roberts,Aasia Kayani,Amber Geer,Bernard Ndungu,Bukola Fawole,Catherine Gilliam,Cecelia Adetayo,Collette Barrow,Danielle Beaumont,Danielle Prowse,David I'Anson,Eni Balogun,Hakim Miah,Imogen Brooks,Julio Onandia,Kiran Javaid,Laura Suncuan,Lauren Frimley,Mia Reid,Monica Arribas,Myriam Benyahia,Olujide Okunade,Phil Edwards,Rizwana Chaudhri,Sergey Kostrov,Sneha Kansagra,Tracey Pepple +32 more
TL;DR: An individual patient-level data meta-analysis of randomised trials done with more than 1000 patients that assessed antifibrinolytics in acute severe bleeding found death from bleeding occurs soon after onset and even a short delay in treatment reduces the benefit of tranexamic acid administration.
Journal ArticleDOI
Challenges in the management of the blood supply
TL;DR: Modelling suggests that during the next 5-10 years, blood availability in developed countries will need to increase again to meet the demands of ageing populations.
Journal ArticleDOI
Challenges in the management of acute peptic ulcer bleeding
James Y.W. Lau,Alan N. Barkun,Dai-ming Fan,Ernst J. Kuipers,Yun-sheng Yang,Francis K.L. Chan +5 more
TL;DR: The published scientific literature about the management of patients with bleeding peptic ulcers is summarised, directions for future clinical research are identified, and how mortality can be reduced are suggested.
References
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Journal ArticleDOI
Risk assessment after acute upper gastrointestinal haemorrhage.
TL;DR: It was found that age, shock, comorbidity, diagnosis, major stigmata of recent haemorrhage, and rebleeding are all independent predictors of mortality when assessed using multiple logistic regression and a numerical score that closely follows the predictions generated by logistical regression equations was developed.
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International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding
Alan N. Barkun,Marc Bardou,Ernst J. Kuipers,Joseph J.Y. Sung,Richard H. Hunt,Myriam Martel,Paul Sinclair +6 more
TL;DR: Recommendations emphasize early risk stratification, by using validated prognostic scales, and early endoscopy, whereas data support attempts to dislodge clots with hemostatic, pharmacologic, or combination treatment of the underlying stigmata.
Journal ArticleDOI
Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom
TL;DR: The incidence of acute upper gastrointestinal haemorrhage is twice that previously reported in England and similar to that reported in Scotland, and the incidence increases appreciably with age.
Journal ArticleDOI
Endoscopy in gastrointestinal bleeding
TL;DR: Patients with haematemesis were admitted to hospital earlier and had endoscopy more quickly than patients with melaena alone; this probably accounted for the higher endoscopic success-rate in this group.
Journal ArticleDOI
Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice.
Angel Lanas,Luis A García-Rodríguez,Mónica Polo-Tomás,Marta Ponce,Inmaculada Alonso-Abreu,Maria Ángeles Pérez-Aisa,Javier Perez-Gisbert,Luis Bujanda,Manuel J. Castro,María Jesús Muñoz,Luis Rodrigo,Xavier Calvet,Dolores Del-Pino,Santiago García +13 more
TL;DR: Over the past decade, there has been a progressive change in the overall picture of GI events leading to hospitalization, with a clear decreasing trend in upper GI events and a significant increase in lower GI events, causing the rates of these two GI complications to converge.