The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): Endoscopic Hemostasis and Proton Pump Inhibition are Associated with Improved Outcomes in a Real-Life Setting

Abstract

These results appear to confirm the protective role of endoscopic therapy in patients with high-risk stigmata, and suggest that acute use of PPIs may be associated with a reduction of rebleeding in all patients, and lower mortality in patients with high-risk stigmata. Independent prospective validation of these observational findings is now required.

Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding

“…The number of comorbidities was significantly higher in patients who died and it was an independent predictor of death (OR: 1.6; 95% CI: 1-2.5, p = 0.045). This finding is similar to that observed in other studies, particularly RUGBE and PNED studies (3,5,8). On the other hand, hypovolemic shock as cause of death was significantly higher in patients without comorbidities than in those with comorbidities (48 vs. 21%, p = 0.02).…”

“…Recent prospective studies have identified different predictors of mortality; it is worth noting that the use of proton pump inhibitors (PPIs) significantly reduces mortality in patients both with and without high risk stigmata of rebleeding. Moreover, the use of endoscopic treatment has been demonstrated to reduce mortality in greater proportion than drug treatment (3)(4)(5)(6). However, it has been shown that the risk factors, complications and mortality rates described in controlled trials are lower than those reported in patients who received their attention on "day-today conditions" in a tertiary care community hospital (7), which illustrates more accurately the actual conditions of medical care.…”

“…Age, gender, clinical manifestations of bleeding, history of prior gastrointestinal bleeding, use of tobacco and non-steroidal anti-inflammatory drugs (NSAIDs), and intake of alcohol were included in this database. Diabetes mellitus, cardiovascular disease (defined by the presence of hypertension, stroke or myocardial ischemia), chronic liver disease, chronic obstructive pulmonary disease and cancer were considered as severe comorbidities (3,8). In addition, hemodynamic instability, laboratory results on admission (serum hemoglobin, blood urea nitrogen, and blood albumin), number of units of blood transfused, the prescription of acid secretion blocking drugs (proton pump inhibitors or H2-receptor antagonists) were recorded.…”

Emergency department risk stratification in upper gastrointestinal bleeding

“…Of note, external studies have found that red blood hematemesis is a high-risk feature for negative outcomes. 11 The GBS offers a high sensitivity with narrow confidence intervals, making this a useful tool to rule out high-risk UGIB.…”

BLEEDING AND STARVING: fasting and delayed refeeding after upper gastrointestinal bleeding

“…Recent clinical studies demonstrate that the outcome of these patients can be improved when clinical resources are improved, decreasing the recurrence of bleeding (2,13,15,19) , the need for transfusion (13,19) and surgery (13) and reducing the length of stay and hospital costs (13,19) . A simple measure to enhance the outcome of NVUGIB patients could be the improvement of the timing when resuming a regular diet.…”