Management of nonvariceal upper gastrointestinal bleeding: an updated interpretation of 2019 International Consensus Group guideline_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Xueping ,  ZHU Liang , CHEN Youxiang

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, P.R.China;

Corresponding author：

ZHU Liang, Email: 89493075@qq.com

Keywords：

Nonvariceal upper gastrointestinal bleeding; Management; Guideline; Recommendations; Interpretation

DOI：

10.7507/1672-2531.201912104

Video：

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Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common emergencies of the digestive system. With the continuous development of digestive endoscopy technology and widespread use of proton pump inhibitors, the morbidity and mortality of ANVUGIB have declined, but there are still numerous difficulties to be solved in clinical treatment. The International Consensus Group in 2019 updated the international consensus guideline in 2003 and 2010 with new clinical recommendations on fluid resuscitation, risk assessment, pre-endoscopic treatment, endoscopic treatment, drug therapy, and secondary prevention, etc. This paper interprets the update to provide references for the clinical treatment of ANVUGIB.

Citation： YANG Xueping, ZHU Liang, CHEN Youxiang. Management of nonvariceal upper gastrointestinal bleeding: an updated interpretation of 2019 International Consensus Group guideline. Chinese Journal of Evidence-Based Medicine, 2020, 20(9): 1000-1003. doi: 10.7507/1672-2531.201912104 Copy

1.	Lanas A, Dumonceau JM, Hunt RH, <italic>et al</italic>. Non-variceal upper gastrointestinal bleeding. Nat Rev Dis Primers, 2018, 4: 18020.
2.	Rosenstock SJ, Møller MH, Larsson H, <italic>et al</italic>. Improving quality of care in peptic ulcer bleeding: nationwide cohort study of 13, 498 consecutive patients in the Danish Clinical Register of Emergency Surgery. Am J Gastroenterol, 2013, 108(9): 1449-1457.
3.	Barkun A, Bardou M, Marshall JK, <italic>et al</italic>. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med, 2003, 139(10): 843-857.
4.	Barkun AN, Bardou M, Kuipers EJ, <italic>et al</italic>. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med, 2010, 152(2): 101-113.
5.	Shea BJ, Reeves BC, Wells G, <italic>et al</italic>. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
6.	Guyatt GH, Oxman AD, Vist GE, <italic>et al</italic>. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
7.	Stanley AJ, Laine L, Dalton HR, <italic>et al</italic>. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ, 2017, 356: i6432.
8.	Saltzman JR, Tabak YP, Hyett BH, <italic>et al</italic>. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc, 2011, 74(6): 1215-1224.
9.	Odutayo A, Desborough MJ, Trivella M, <italic>et al</italic>. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol, 2017, 2(5): 354-360.
10.	Choudari CP, Rajgopal C, Palmer KR. Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment. Gut, 1994, 35(4): 464-466.
11.	Thomopoulos KC, Mimidis KP, Theocharis GJ, <italic>et al</italic>. Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: endoscopic findings, clinical management and outcome. World J Gastroenterol, 2005, 11(9): 1365-1368.
12.	Bjorkman DJ, Zaman A, Fennerty MB, <italic>et al</italic>. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc, 2004, 60(1): 1-8.
13.	Laursen SB, Leontiadis GI, Stanley AJ, <italic>et al</italic>. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc, 2017, 85(5): 936-944.
14.	Garcia-Tsao G, Sanyal AJ, Grace ND, <italic>et al</italic>. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol, 2007, 102(9): 2086-2102.
15.	Chen YI, Barkun AN. Hemostatic powders in gastrointestinal bleeding: a systematic review. Gastrointest Endosc Clin N Am, 2015, 25(3): 535-552.
16.	Chen YI, Barkun A, Nolan S. Hemostatic powder TC-325 in the management of upper and lower gastrointestinal bleeding: a two-year experience at a single institution. Endoscopy, 2015, 47(2): 167-171.
17.	Haddara S, Jacques J, Lecleire S, <italic>et al</italic>. A novel hemostatic powder for upper gastrointestinal bleeding: a multicenter study (the "GRAPHE" registry). Endoscopy, 2016, 48(12): 1084-1095.
18.	Barkun AN, Adam V, Lu Y, <italic>et al</italic>. Using Hemospray improves the cost-effectiveness ratio in the management of upper gastrointestinal nonvariceal bleeding. J Clin Gastroenterol, 2018, 52(1): 36-44.
19.	Neumann I, Letelier LM, Rada G, <italic>et al</italic>. Comparison of different regimens of proton pump inhibitors for acute peptic ulcer bleeding. Cochrane Database Syst Rev, 2013, (6): CD007999.
20.	Leontiadis GI, Sharma VK, Howden CW. Proton pump inhibitor treatment for acute peptic ulcer bleeding. Cochrane Database Syst Rev, 2006, (1): CD002094.
21.	Cheng HC, Wu CT, Chang WL, <italic>et al</italic>. Double oral esomeprazole after a 3-day intravenous esomeprazole infusion reduces recurrent peptic ulcer bleeding in high-risk patients: a randomised controlled study. Gut, 2014, 63(12): 1864-1872.
22.	Chan FK, Chung SC, Suen BY, <italic>et al</italic>. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med, 2001, 344(13): 967-973.
23.	Chan FK, Ching JY, Suen BY, <italic>et al</italic>. Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users. Gastroenterology, 2013, 144(3): 528-535.
24.	Ray WA, Chung CP, Murray KT, <italic>et al</italic>. Association of proton pump inhibitors with reduced risk of warfarin-related serious upper gastrointestinal bleeding. Gastroenterology, 2016, 151(6): 1105-1112.
25.	Islam MM, Poly TN, Walther BA, <italic>et al</italic>. Adverse outcomes of long-term use of proton pump inhibitors: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol, 2018, 30(12): 1395-1405.
26.	Chan EW, Lau WC, Leung WK, <italic>et al</italic>. Prevention of dabigatran-related gastrointestinal bleeding with gastroprotective agents: a population-based study. Gastroenterology, 2015, 149(3): 586-595.

1. Lanas A, Dumonceau JM, Hunt RH, <italic>et al</italic>. Non-variceal upper gastrointestinal bleeding. Nat Rev Dis Primers, 2018, 4: 18020.
2. Rosenstock SJ, Møller MH, Larsson H, <italic>et al</italic>. Improving quality of care in peptic ulcer bleeding: nationwide cohort study of 13, 498 consecutive patients in the Danish Clinical Register of Emergency Surgery. Am J Gastroenterol, 2013, 108(9): 1449-1457.
3. Barkun A, Bardou M, Marshall JK, <italic>et al</italic>. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med, 2003, 139(10): 843-857.
4. Barkun AN, Bardou M, Kuipers EJ, <italic>et al</italic>. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med, 2010, 152(2): 101-113.
5. Shea BJ, Reeves BC, Wells G, <italic>et al</italic>. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
6. Guyatt GH, Oxman AD, Vist GE, <italic>et al</italic>. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
7. Stanley AJ, Laine L, Dalton HR, <italic>et al</italic>. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ, 2017, 356: i6432.
8. Saltzman JR, Tabak YP, Hyett BH, <italic>et al</italic>. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc, 2011, 74(6): 1215-1224.
9. Odutayo A, Desborough MJ, Trivella M, <italic>et al</italic>. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol, 2017, 2(5): 354-360.
10. Choudari CP, Rajgopal C, Palmer KR. Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment. Gut, 1994, 35(4): 464-466.
11. Thomopoulos KC, Mimidis KP, Theocharis GJ, <italic>et al</italic>. Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: endoscopic findings, clinical management and outcome. World J Gastroenterol, 2005, 11(9): 1365-1368.
12. Bjorkman DJ, Zaman A, Fennerty MB, <italic>et al</italic>. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc, 2004, 60(1): 1-8.
13. Laursen SB, Leontiadis GI, Stanley AJ, <italic>et al</italic>. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc, 2017, 85(5): 936-944.
14. Garcia-Tsao G, Sanyal AJ, Grace ND, <italic>et al</italic>. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol, 2007, 102(9): 2086-2102.
15. Chen YI, Barkun AN. Hemostatic powders in gastrointestinal bleeding: a systematic review. Gastrointest Endosc Clin N Am, 2015, 25(3): 535-552.
16. Chen YI, Barkun A, Nolan S. Hemostatic powder TC-325 in the management of upper and lower gastrointestinal bleeding: a two-year experience at a single institution. Endoscopy, 2015, 47(2): 167-171.
17. Haddara S, Jacques J, Lecleire S, <italic>et al</italic>. A novel hemostatic powder for upper gastrointestinal bleeding: a multicenter study (the "GRAPHE" registry). Endoscopy, 2016, 48(12): 1084-1095.
18. Barkun AN, Adam V, Lu Y, <italic>et al</italic>. Using Hemospray improves the cost-effectiveness ratio in the management of upper gastrointestinal nonvariceal bleeding. J Clin Gastroenterol, 2018, 52(1): 36-44.
19. Neumann I, Letelier LM, Rada G, <italic>et al</italic>. Comparison of different regimens of proton pump inhibitors for acute peptic ulcer bleeding. Cochrane Database Syst Rev, 2013, (6): CD007999.
20. Leontiadis GI, Sharma VK, Howden CW. Proton pump inhibitor treatment for acute peptic ulcer bleeding. Cochrane Database Syst Rev, 2006, (1): CD002094.
21. Cheng HC, Wu CT, Chang WL, <italic>et al</italic>. Double oral esomeprazole after a 3-day intravenous esomeprazole infusion reduces recurrent peptic ulcer bleeding in high-risk patients: a randomised controlled study. Gut, 2014, 63(12): 1864-1872.
22. Chan FK, Chung SC, Suen BY, <italic>et al</italic>. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med, 2001, 344(13): 967-973.
23. Chan FK, Ching JY, Suen BY, <italic>et al</italic>. Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users. Gastroenterology, 2013, 144(3): 528-535.
24. Ray WA, Chung CP, Murray KT, <italic>et al</italic>. Association of proton pump inhibitors with reduced risk of warfarin-related serious upper gastrointestinal bleeding. Gastroenterology, 2016, 151(6): 1105-1112.
25. Islam MM, Poly TN, Walther BA, <italic>et al</italic>. Adverse outcomes of long-term use of proton pump inhibitors: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol, 2018, 30(12): 1395-1405.
26. Chan EW, Lau WC, Leung WK, <italic>et al</italic>. Prevention of dabigatran-related gastrointestinal bleeding with gastroprotective agents: a population-based study. Gastroenterology, 2015, 149(3): 586-595.

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