Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation

Stanley, Adrian J.; Ashley, D; Dalton, Harry R.; Mowat, Craig; Gaya,; Thompson, Emma J.; Warshow, Usama; Groome, M; Cahill, A; Benson, George S.; Blatchford, Oliver; Murray, William R.

doi:10.1016/s0140-6736(08)61769-9

Cited by 317 publications

(332 citation statements)

References 21 publications

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“…Several trials have demonstrated that patients with UGIB who have low-risk features may be discharged on the fi rst hospital day (or worked up and discharged as an outpatient) without negative consequences ( 9,33,98 ). Criteria vary across studies but generally include low-risk clinical features (e.g., stable vital signs and hemoglobin, no serious comorbidities), low-risk endoscopic features (e.g., clean-based ulcer, erosive disease, Mallory-Weiss tear), and satisfactory home / social support.…”

Section: Hospitalization For Patients With Ugibmentioning

confidence: 99%

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Management of Patients With Ulcer Bleeding

Laine

Jensen

2012

American Journal of Gastroenterology

658

547

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Ulcers are the most common cause of hospitalization for upper gastrointestinal bleeding (UGIB), and the vast majority of clinical trials of therapy for nonvariceal UGIB focus on ulcer disease. Th is guideline provides recommendations for the management of patients with overt UGIB due to gastric or duodenal ulcers. "Overt" indicates that patients present with symptoms of hematemesis, melena, and/or hematochezia. We fi rst discuss the initial management of UGIB in patients without known portal hypertension, including initial assessment and risk stratifi cation, pre-endoscopic use of medications and gastric lavage, and timing of endoscopy. We then focus on the endoscopic and medical management of ulcer disease, including endoscopic fi ndings and their prognostic implications, endoscopic hemostatic therapy, post-endoscopic medical therapy and disposition, and prevention of recurrent ulcer bleeding.Each section of the document presents the key recommendations related to the section topic, followed by a summary of the supporting evidence. A summary of recommendations is provided in Table 1 .A search of MEDLINE via the OVID interface using the MeSH term " gastrointestinal hemorrhage " limited to " all clinical trials " and " meta-analysis " for years 1966 -2010 without language restriction as well as review of clinical trials and reviews known to the authors were performed for preparation of this document. Th e GRADE system was used to grade the strength of recommendations and the quality of evidence ( 1 ). Th e quality of evidence, which infl uences the strength of recommendation, ranges from " high " (further research is very unlikely to change our confi dence in the estimate of eff ect) to " moderate " (further research is likely to have an important impact on our confi dence in the estimate of eff ect and may change the estimate) to " low " (further research is very likely to have an important impact on our confi dence in the estimate of eff ect and is likely to change the estimate), and " very low " (any estimate of eff ect is very uncertain). Th e strength of a recommendation is graded as strong when the desirable eff ects of an intervention clearly outweigh the undesirable eff ects and is graded as conditional when uncertainty exists about the trade-off s ( 1 ). In addition to quality of evidence and balance between desirable and undesirable eff ects, other factors aff ecting the strength of recommendation include variability in values and preferences of patients, and whether an intervention represents a wise use of resources ( 1 ). 2. Blood transfusions should target hemoglobin ≥ 7 g / dl, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or comorbidities, such as coronary artery disease (Conditional recommendation). Management of Patients With Ulcer Bleeding3. Risk assessment should be performed to stratify patients into higher and lower risk categories and may assist in initial decisions such as timing of endoscopy, time of discharge, and level of care (Cond...

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Section: Hospitalization For Patients With Ugibmentioning

confidence: 99%

“…In a prospective series, Stanley et al ( 9 ) did not admit patients presenting to emergency departments with UGIB who had Blatchford scores of 0 unless necessary for other reasons. Of…”

mentioning

confidence: 99%

Management of Patients With Ulcer Bleeding

Laine

Jensen

2012

American Journal of Gastroenterology

658

547

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“…Well validated scores include the Rockall and Blatchford scores 63,64 which allow selection of the lowest risk patients for early discharge. [65][66][67] Major risk factors predicting death included old age, comorbidities, shock at presentation, continued or recurrent bleeding, and onset of bleeding while hospitalized for other causes. Ulcers with active bleeding or stigmata of recent bleeding, such as a visible vessel or an adherent clot, also predict re bleeding and mortality risk.…”

Section: Recent Trends In Short Term Case Fatality For Non Variceal Bmentioning

confidence: 99%

Epidemiology of Upper Gastrointestinal Bleeding

Crooks¹,

Sung²,

Card³

2014

GI Epidemiology

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“…A number of risk scoring systems exist to predict clinical outcomes in patients with UGIB. The most widely quoted are the Glasgow-Blatchford Bleeding Score (GBS) 2 and the clinical Rockall score, 3 both of which consider only pre-endoscopy criteria, and the full Rockall score, with additional endoscopic criteria. 4 It is unclear if any of these tools are sufficiently predictive to serve as a decision guide for emergency physicians.…”

Section: Introductionmentioning

confidence: 99%