Does This Patient Have a Severe Upper Gastrointestinal Bleed?

Srygley, Fletcher D.; Gerardo, Charles J.; Tran, Tony H.; Fisher, Deborah A.

doi:10.1001/jama.2012.253

Cited by 185 publications

(109 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The study subjects consisted of consecutive cases, and the need for an EI was evaluated based on high-risk stigmata of recorded endoscopic images that were reviewed retrospectively in this relatively large-scale study. The present study revealed that the BUN-Cr ratio and GBS were also independent risk factors in predicting the need for EI; these results are consistent with those of a previous study [8]. Therefore, our study results seem to be reliable.…”

Section: Discussionsupporting

confidence: 93%

The Role of History of Gastro-Duodenal Ulcer in Patients with Upper Gastrointestinal Bleeding

Takatori

Kato

Sunata

et al. 2018

Dig Dis

View full text Add to dashboard Cite

Background: Some scoring systems have been introduced to predict the need for performing urgent endoscopy in patients with upper gastrointestinal bleeding (UGIB). However, in an emergency situation, this intervention is insufficient and cannot easily provide the required treatment. Aim: To identify new risk factors that can predict the need for endoscopic intervention (EI) in UGIB patients. Methods: This is a retrospective cross-sectional study. Patients with UGIB admitted from April 2011 to August 2014 were included. The proportion of cases requiring EI and clinical factors (age, gender, antiplatelet/anticoagulant therapy, history of gastro-duodenal ulcer (GDU), systolic blood pressure, heart rate, hemoglobin, mean corpuscular volume, blood urea nitrogen-creatinine ratio (BUN/Cr ratio), prothrombin time-international normalized ratio, and Glasgow-Blatchford Score (GBS) were analyzed using logistic regression models. Result: Of 378 patients who were included in this study, 180 were found to be with GDU. The proportion of cases requiring EI was significantly higher in those with GDU than in other causes except variceal bleeding (53.5 vs. 37.0%, p < 0.01). Multivariate analysis revealed that a history of GDU was an independent risk factor (OR 1.78, 95% CI 1.06–3.00) in addition to BUN/Cr ratio (OR 1.02, 95% CI 1.00–1.03) and GBS (OR 1.19, 95% CI 1.08–1.33). Conclusion: A history of GDU was an independent risk factor for predicting the need for EI in UGIB in addition to BUN/Cr ratio and GBS.

show abstract

Section: Discussionsupporting

confidence: 93%

The Role of History of Gastro-Duodenal Ulcer in Patients with Upper Gastrointestinal Bleeding

Takatori

Kato

Sunata

et al. 2018

Dig Dis

View full text Add to dashboard Cite

show abstract

“…Initial patient assessment and hemodynamic resuscitation should be performed simultaneously (strong recommendation, very low-quality evidence). 8, 10 …”

Section: Initial Assessmentmentioning

confidence: 99%

ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding

Strate

Gralnek

2016

American Journal of Gastroenterology

439

440

View full text Add to dashboard Cite

This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery for the prevention of recurrent lower gastrointestinal bleeding should be individualized and the source of bleeding should be carefully localized prior to resection.

show abstract

“…In another randomized controlled study, 4 of 112 patients (3.6%) with severe hematochezia had upper GI bleeding [35]. According to a meta-analysis, clinical findings indicating upper GI bleeding are black stool, bloody or coffee grounds aspirate from the nasogastric tube, and BUN:Cr ≥30 [37]. Therefore, in patients with severe dark or bright red stool, upper GI bleeding needs to be ruled out by calculating BUN:Cr and inserting a nasogastric tube or performing upper GI endoscopy.…”

Section: Explanationmentioning

confidence: 99%

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

View full text Add to dashboard Cite

Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

show abstract

Does This Patient Have a Severe Upper Gastrointestinal Bleed?

Cited by 185 publications

References 52 publications

The Role of History of Gastro-Duodenal Ulcer in Patients with Upper Gastrointestinal Bleeding

The Role of History of Gastro-Duodenal Ulcer in Patients with Upper Gastrointestinal Bleeding

ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Contact Info

Product

Resources

About