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Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group

Barkun, Alan N ; Almadi, Majid ; Kuipers, Ernst J ; Laine, Loren ; Sung, Joseph ; Tse, Frances ; Leontiadis, Grigorios I ; Abraham, Neena S ; Calvet, Xavier ; Chan, Francis K L ; Douketis, James ; Enns, Robert ; Gralnek, Ian M ; Jairath, Vipul ; Jensen, Dennis ; Lau, James ; Lip, Gregory Y H ; Loffroy, Romaric ; Maluf-Filho, Fauze ; Meltzer, Andrew C ; Reddy, Nageshwar ; Saltzman, John R ; Marshall, John K ; Bardou, Marc

Annals of internal medicine, 2019-12, Vol.171 (11), p.805-822 [Periódico revisado por pares]

United States: American College of Physicians

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  • Título:
    Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group
  • Autor: Barkun, Alan N ; Almadi, Majid ; Kuipers, Ernst J ; Laine, Loren ; Sung, Joseph ; Tse, Frances ; Leontiadis, Grigorios I ; Abraham, Neena S ; Calvet, Xavier ; Chan, Francis K L ; Douketis, James ; Enns, Robert ; Gralnek, Ian M ; Jairath, Vipul ; Jensen, Dennis ; Lau, James ; Lip, Gregory Y H ; Loffroy, Romaric ; Maluf-Filho, Fauze ; Meltzer, Andrew C ; Reddy, Nageshwar ; Saltzman, John R ; Marshall, John K ; Bardou, Marc
  • Assuntos: Best practice ; Biological Physics ; Blood Transfusion ; Cardiovascular Diseases - complications ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastrointestinal diseases ; Gastrointestinal Hemorrhage - diagnosis ; Gastrointestinal Hemorrhage - physiopathology ; Gastrointestinal Hemorrhage - prevention & control ; Gastrointestinal Hemorrhage - therapy ; Guidelines ; Hemodynamics ; Hemorrhage ; Hemostatic Techniques ; Humans ; Peptic Ulcer - complications ; Physics ; Proton Pump Inhibitors - therapeutic use ; Risk Assessment ; Secondary Prevention
  • É parte de: Annals of internal medicine, 2019-12, Vol.171 (11), p.805-822
  • Notas: ObjectType-News-1
    ObjectType-Feature-4
    ObjectType-Conference-2
    SourceType-Conference Papers & Proceedings-1
    ObjectType-Instructional Material/Guideline-5
    ObjectType-Article-3
    PMCID: PMC7233308
    Dr. Reddy: Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad–500 082, India.
    Administrative, technical, or logistic support: A.N. Barkun, G.I. Leontiadis, M. Bardou.
    Author Contributions: Conception and design: A.N. Barkun, M. Almadi, E.J. Kuipers, L. Laine, F. Tse, G.I. Leontiadis, I.M. Gralnek, A.C. Meltzer, J.K. Marshall, M. Bardou.
    Final approval of the article: A.N. Barkun, M. Almadi, E.J. Kuipers, L. Laine, J. Sung, F. Tse, G.I. Leontiadis, N.S. Abraham, X. Calvet, F.K.L. Chan, J. Douketis, R. Enns, I.M. Gralnek, V. Jairath, D. Jensen, J. Lau, G.Y.H. Lip, R. Loffroy, F. Maluf-Filho, A.C. Meltzer, N. Reddy, J.R. Saltzman, J.K. Marshall, M. Bardou.
    Dr. Jairath: London Health Sciences Centre, Room A10-228, University Hospital, London, Ontario N6A 4V2, Canada.
    Dr. Tse: Division of Gastroenterology, Department of Medicine, McMaster University, Room 2F53, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
    Statistical expertise: A.N. Barkun, M. Almadi, L. Laine, G.I. Leontiadis.
    Dr. Jensen: Ronald Reagan UCLA Medical Center, Digestive Diseases–Westwood, 200 MP, 200 UCLA Medical Plaza, Suite 365C, Los Angeles, CA 90024.
    Critical revision for important intellectual content: A.N. Barkun, M. Almadi, E.J. Kuipers, L. Laine, J. Sung, F. Tse, G.I. Leontiadis, N.S. Abraham, X. Calvet, F.K.L. Chan, J. Douketis, I.M. Gralnek, V. Jairath, D. Jensen, G.Y.H. Lip, R. Loffroy, F. Maluf-Filho, A.C. Meltzer, N. Reddy, J.R. Saltzman, J.K. Marshall.
    Dr. Sung: Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
    Dr. Bardou: Clinical Investigation Centre INSERM 1432, Hospitalisation Unit and Gastroenterology and Liver Department, CHU Dijon-Bourgogne, Hopital Francois Mitterrand, 14 rue Gaffarel, BP77908, 21079 Dijon Cedex, France.
    Obtaining of funding: A.N. Barkun, M. Almadi.
    Collection and assembly of data: A.N. Barkun, F. Tse, G.I. Leontiadis, X. Calvet, R. Enns, I.M. Gralnek, F. Maluf-Filho, A.C. Meltzer, J.K. Marshall, M. Bardou.s
    Dr. Lau: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. Dr. Lip: Liverpool Centre for Cardiovascular Science, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, United Kingdom.
    Dr. Chan: Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR.
    Dr. Loffroy: Department of Interventional Radiology, ImageGuided Therapy Centre, Dijon-Bourgogne University Hospital, 14 rue Gaffarel, 21000 Dijon, France.
    Dr. Almadi: Division of Gastroenterology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University 12372, Riyadh, Saudi Arabia. Dr. Kuipers: Erasmus MC University Medical Center, P.O. Box 2040, 3000CA Rotterdam, the Netherlands. Dr. Laine: Section of Digestive Diseases, Yale School of Medicine, P.O. Box 208019, New Haven, CT 06520.
    Dr. Douketis: Department of Medicine, McMaster University and St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
    Dr. Marshall: Division of Gastroenterology, McMaster University, 1280 Main Street West, Room 2F59, Hamilton, Ontario L8S 4K1, Canada.
    Dr. Enns: Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia V6Z 2K5, Canada. Dr. Gralnek: Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
    Drafting of the article: A.N. Barkun, M. Almadi, J. Sung, F. Tse, G.I. Leontiadis, N.S. Abraham, F.K.L. Chan, R. Enns, I.M. Gralnek, M. Bardou.
    Dr. Saltzman: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115.
    Analysis and interpretation of the data: A.N. Barkun, M. Almadi, E.J. Kuipers, L. Laine, J. Sung, F. Tse, G.I. Leontiadis, N.S. Abraham, X. Calvet, J. Douketis, R. Enns, I.M. Gralnek, V. Jairath, J. Lau, G.Y.H. Lip, R. Loffroy, F. Maluf-Filho, A.C. Meltzer, J.R. Saltzman, M. Bardou.
    Current Author Addresses: Dr. Barkun: Division of Gastroenterology, McGill University and the McGill University Health Centre, 1650 Cedar Avenue, Room D7.346, Montreal, Quebec H3G 1A4, Canada.
    Dr. Leontiadis: Division of Gastroenterology, Department of Medicine, McMaster University, 1280 Main Street West, Health Sciences Centre, Suite 3V3, Hamilton, Ontario L8S 4K1, Canada. Dr. Abraham: Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259.
    Dr. Calvet: Servei d’Aparell Digestiu, Coproració Sanitária Universitária Parc TaulƖ´, Parc TaulƖ´ 1, 08208 Sabadell, Barcelona, Catalunya, Spain.
    Dr. Maluf-Filho: Cancer Institute of São Paulo–ICESP–USP, Av. Dr. Arnaldo, 251, CEP 01246-000, São Paulo–SP, Brazil. Dr. Meltzer: Department of Emergency Medicine, GW Medical Faculty Associates, 2120 L Street Northwest, Washington, DC 20037.
  • Descrição: This update of the 2010 International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding (UGIB) refines previous important statements and presents new clinically relevant recommendations. An international multidisciplinary group of experts developed the recommendations. Data sources included evidence summarized in previous recommendations, as well as systematic reviews and trials identified from a series of literature searches of several electronic bibliographic databases from inception to April 2018. Using an iterative process, group members formulated key questions. Two methodologists prepared evidence profiles and assessed quality (certainty) of evidence relevant to the key questions according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Group members reviewed the evidence profiles and, using a consensus process, voted on recommendations and determined the strength of recommendations as strong or conditional. Preendoscopic management: The group suggests using a Glasgow Blatchford score of 1 or less to identify patients at very low risk for rebleeding, who may not require hospitalization. In patients without cardiovascular disease, the suggested hemoglobin threshold for blood transfusion is less than 80 g/L, with a higher threshold for those with cardiovascular disease. Endoscopic management: The group suggests that patients with acute UGIB undergo endoscopy within 24 hours of presentation. Thermocoagulation and sclerosant injection are recommended, and clips are suggested, for endoscopic therapy in patients with high-risk stigmata. Use of TC-325 (hemostatic powder) was suggested as temporizing therapy, but not as sole treatment, in patients with actively bleeding ulcers. Pharmacologic management: The group recommends that patients with bleeding ulcers with high-risk stigmata who have had successful endoscopic therapy receive high-dose proton-pump inhibitor (PPI) therapy (intravenous loading dose followed by continuous infusion) for 3 days. For these high-risk patients, continued oral PPI therapy is suggested twice daily through 14 days, then once daily for a total duration that depends on the nature of the bleeding lesion. Secondary prophylaxis: The group suggests PPI therapy for patients with previous ulcer bleeding who require antiplatelet or anticoagulant therapy for cardiovascular prophylaxis.
  • Editor: United States: American College of Physicians
  • Idioma: Inglês
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