Non-variceal upper gastrointestinal bleeding
Por:
Lanas, A, Dumonceau, JM, Hunt, RH, Fujishiro, M, Scheiman, JM, Gralnek, IM, Campbell, HE, Rostom, A, Villanueva, C, Sung, JJY
Publicada:
19 abr 2018
Resumen:
Non-variceal upper gastrointestinal bleeding (NVUGIB) is bleeding that develops in the oesophagus, stomach or proximal duodenum. Peptic ulcers, caused by Helicobacter pylori infection or use of NSAIDs and low-dose aspirin (LDA), are the most common cause. Although the incidence and mortality associated with NVUGIB have been decreasing owing to considerable advances in the prevention and management of NVUGIB over the past 20 years, it remains a common clinical problem with an annual incidence of similar to 67 per 100,000 individuals in the United States in 2012. NVUGIB is a medical emergency, and mortality is in the range similar to 1-5%. After resuscitation and initial assessment, early (within 24 hours) diagnostic and therapeutic endoscopy together with intragastric pH control with proton pump inhibitors (PPIs) form the basis of treatment. With a growing ageing population treated with antiplatelet and/or anticoagulant medications, the clinical management of NVUGIB is complex as the risk between gastrointestinal bleeding events and adverse cardiovascular events needs to be balanced. The best clinical approach includes identification of risk factors and prevention of bleeding; available strategies include continuous treatment with PPIs or H. pylori eradication in those at increased risk of developing NVUGIB. Treatment with PPIs and/or use of cyclooxygenase-2-selective NSAIDs should be implemented in those patients at risk of NVUGIB who need NSAIDs and/or LDA.
Filiaciones:
Lanas, A:
Univ Zaragoza, Univ Clin Hosp Lozano Blesa, Serv Digest Dis, IIS Aragon, Zaragoza, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Dumonceau, JM:
Gedyt Endoscopy Ctr, Buenos Aires, DF, Argentina
Hunt, RH:
McMaster Univ, Div Gastroenterol, Hamilton, ON, Canada
McMaster Univ, Farncombe Family Digest Hlth Res Inst, Hamilton, ON, Canada
Fujishiro, M:
Univ Tokyo, Grad Sch Med, Dept Endoscopy & Endoscop Surg, Tokyo, Japan
Scheiman, JM:
Univ Virginia, Div Gastroenterol, Charlottesville, VA USA
Gralnek, IM:
Emek Med Ctr, Ellen & Pinchas Mamber Inst Gastroenterol, Afula, Israel
Campbell, HE:
Univ Oxford, Nuffield Dept Populat Hlth, Natl Perinatal Epidemiol Unit, Oxford, England
Rostom, A:
Univ Ottawa, Div Gastroenterol, Ottawa, ON, Canada
Villanueva, C:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Autonoma Barcelona, Hosp Santa Creu & Sant Pau, Barcelona, Spain
Sung, JJY:
Chinese Univ Hong Kong, Div Gastroenterol, Hong Kong, Hong Kong, Peoples R China
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