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Current therapy for nonvariceal upper gastrointestinal bleeding

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Abstract

Upper gastrointestinal bleeding continues to plague physicians despite the discovery of Helicobacter pylori and advances in medical therapy for peptic ulcer disease. Medical therapy with new nonsteroidal anti-inflammatory medications and somatostatin/octreotide and intravenous proton pump inhibitors provides hope for reducing the incidence of and treating bleeding peptic ulcer disease. Endoscopic therapy remains the mainstay for diagnosis and treatment of upper gastrointestinal bleeding. Many methods of endoscopic hemostasis have proven useful in upper gastrointestinal hemorrhage. Currently, combination therapy with epinephrine injection and bicap or heater probe therapy is most commonly employed in the United States. Angiography and embolization play a role primarily when endoscopic therapy is unsuccessful.

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References

  1. O Blatchford WR Murray (2000) ArticleTitleA risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 356 1318–1321 Occurrence Handle10.1016/S0140-6736(00)02816-6 Occurrence Handle1:STN:280:DC%2BD3crhsVSluw%3D%3D Occurrence Handle11073021

    Article  CAS  PubMed  Google Scholar 

  2. M Bustamante N Stollman (2000) ArticleTitleThe efficacy of proton-pump inhibitors in acute ulcer bleeding: a qualitative review. J Clin Gastroenterol 30 7–13 Occurrence Handle10.1097/00004836-200001000-00004 Occurrence Handle1:STN:280:DC%2BD3c7gtVWlsg%3D%3D Occurrence Handle10636205

    Article  CAS  PubMed  Google Scholar 

  3. IK Chung JS Ham HS Kim et al. (1999) ArticleTitleComparison of the hemostatic efficiency of the endoscopic hemoclip method with hypertonic saline–epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc 49 13–18 Occurrence Handle1:STN:280:DyaK1M%2Fosl2qsA%3D%3D Occurrence Handle9869717

    CAS  PubMed  Google Scholar 

  4. IK Chung EJ Kim MS Lee et al. (2000) ArticleTitleBleeding Dieulafoy’s lesion and the choice of endoscopic method: comparing the hemostatic efficacy of mechanical and injection methods. Gastrointest Endosc 52 721–724 Occurrence Handle10.1067/mge.2000.108040 Occurrence Handle1:STN:280:DC%2BD3M%2FovVKitQ%3D%3D Occurrence Handle11115902

    Article  CAS  PubMed  Google Scholar 

  5. SC Chung (1997) ArticleTitleSurgery and gastrointestinal bleeding. Gastrointest Endosc Clin North Am 7 687–701

    Google Scholar 

  6. L Cipolleta MA Bianco R Marmo et al. (2001) ArticleTitleEndoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointest Endosc 53 147–151

    Google Scholar 

  7. B Coffin M Pocard F Riche et al. (2002) ArticleTitleErythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study. Gastrointest Endosc 56 174–179 Occurrence Handle12145593

    PubMed  Google Scholar 

  8. J Cohen M Abedi G Haber et al. (1996) ArticleTitleArgon plasma coagulation: a new effective technique of noncontact thermal coagulation. Experience in 44 cases of GI angiomata. Gastrointest Endosc 43 293

    Google Scholar 

  9. DA Corley AM Stefan M Wolf et al. (1998) ArticleTitleEarly indicators of prognosis in upper gastrointestinal hemorrhage. Am J Gastroenterol 93 336–340 Occurrence Handle10.1016/S0002-9270(97)00101-9 Occurrence Handle1:STN:280:DyaK1c7ns1yisA%3D%3D Occurrence Handle9517635

    Article  CAS  PubMed  Google Scholar 

  10. RA Cowles MW Mulholland (2000) ArticleTitleSurgical management of peptic ulcer disease in the helicobacter era: management of bleeding peptic ulcer. Surg Laparosc Endosc Percutan Tech 11 2–8 Occurrence Handle10.1097/00019509-200102000-00002

    Article  Google Scholar 

  11. GM Eisen JA Dominitz DO Faigel et al. (2001) ArticleTitleAn annotated algorithmic approach to upper gastrointestinal bleeding. Gastrointest Endosc 53 853–858 Occurrence Handle1:STN:280:DC%2BD3M3pt1GksQ%3D%3D Occurrence Handle11375617

    CAS  PubMed  Google Scholar 

  12. BL Erstad (2001) ArticleTitleProton-pump inhibitors for acute peptic ulcer bleeding. Ann Pharmacother 35 730–740 Occurrence Handle10.1345/aph.10306 Occurrence Handle1:CAS:528:DC%2BD3MXltVOhur0%3D Occurrence Handle11408992

    Article  CAS  PubMed  Google Scholar 

  13. IM Gralnek DM Jensen TO Kovacs et al. (1997) ArticleTitleAn economic analysis of patients with active arterial peptic ulcer hemorrhage treated with endoscopic heater probe, injection schlerosis, or surgery in a prospective, randomized trial. Gastrointest Endosc 46 105–112 Occurrence Handle1:STN:280:ByiH38bltVw%3D Occurrence Handle9283858

    CAS  PubMed  Google Scholar 

  14. JA Hay L Maldonado SR Weingarten et al. (1997) ArticleTitleProspective evaluation of a clinical guideline recommending hospital length of stay in upper gastrointestinal tract hemorrhage. J Am Med Assoc 278 2151–2156 Occurrence Handle10.1001/jama.278.24.2151 Occurrence Handle1:STN:280:DyaK1c%2FnslCqsg%3D%3D

    Article  CAS  Google Scholar 

  15. TF Imperiale S Birgisson (1997) ArticleTitleSomatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage. Ann Int Med 127 1062–1071 Occurrence Handle1:CAS:528:DyaK1cXhtF2ruw%3D%3D Occurrence Handle9412308

    CAS  PubMed  Google Scholar 

  16. DM Jensen TO Kovacs R Jutahba et al. (2002) ArticleTitleRandomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 123 632–636 Occurrence Handle10.1053/gast.2002.34782 Occurrence Handle12145815

    Article  PubMed  Google Scholar 

  17. AN Kalloo MI Canto KS Wadwa et al. (1999) ArticleTitleClinical usefulness of 3% hydrogen peroxide in acute upper GI bleeding: a pilot study. Gastrointest Endosc 49 518–521 Occurrence Handle1:STN:280:DyaK1M3hvVWgtA%3D%3D Occurrence Handle10202071

    CAS  PubMed  Google Scholar 

  18. MS Khuroo GN Yatoo G Javid et al. (1997) ArticleTitleA comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med 336 1054–1058 Occurrence Handle1:CAS:528:DyaK2sXis1SksLw%3D Occurrence Handle9091801

    CAS  PubMed  Google Scholar 

  19. L Laine (1987) ArticleTitleMultipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage: a prospective controlled trial. N Engl J Med 316 1613–1617 Occurrence Handle1:STN:280:BiiB38fovFE%3D Occurrence Handle3295547

    CAS  PubMed  Google Scholar 

  20. FL Lanza (1998) ArticleTitleA guideline for the prevention and treatment of NSAID-induced ulcers. Am J Gastroenterol 93 2037–2046 Occurrence Handle10.1016/S0002-9270(98)00469-9 Occurrence Handle1:CAS:528:DyaK1cXnsFGns7o%3D Occurrence Handle9820370

    Article  CAS  PubMed  Google Scholar 

  21. JY Lau JJ Sung KK Lee et al. (2000) ArticleTitleEffect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med 343 310–316 Occurrence Handle10.1056/NEJM200008033430501 Occurrence Handle1:CAS:528:DC%2BD3cXlvVOltb8%3D Occurrence Handle10922420

    Article  CAS  PubMed  Google Scholar 

  22. Z Lefkovitz MS Cappell M Kaplan et al. (2000) ArticleTitleRadiology in the diagnosis and management of gastrointestinal bleeding. Gastroenterol Clin North Am 29 489–512

    Google Scholar 

  23. HJ Lin YH Hsieh GY Tseng et al. (2002) ArticleTitleA prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding. Am J Gastroenterol 97 2161–2165 Occurrence Handle10.1016/S0002-9270(02)04323-X Occurrence Handle12358226

    Article  PubMed  Google Scholar 

  24. HJ Lin WC Lo FY Lee et al. (1998) ArticleTitleA prospective, randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy. Arch Intern Med 158 54–58 Occurrence Handle10.1001/archinte.158.1.54 Occurrence Handle1:CAS:528:DyaK1cXmsFSgsA%3D%3D Occurrence Handle9437379

    Article  CAS  PubMed  Google Scholar 

  25. HJ Lin GY Tseng CL Perng et al. (1999) ArticleTitleComparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding. Gut 44 715–719 Occurrence Handle1:CAS:528:DyaK1MXjtF2ktrc%3D Occurrence Handle10205211

    CAS  PubMed  Google Scholar 

  26. HJ Lin K Wang CL Perng et al. (1996) ArticleTitleEarly or delayed endoscopy for patients with peptic ulcer bleeding: a prospective randomized study. J Clin Gastroenterol 22 267–271 Occurrence Handle10.1097/00004836-199606000-00005 Occurrence Handle1:STN:280:BymA28jjtVI%3D Occurrence Handle8771420

    Article  CAS  PubMed  Google Scholar 

  27. GF Longstreth (1995) ArticleTitleEpidemiology of hospitalization for acute upper gastrointestinal bleeding. Am J Gastroenterol 90 206–210 Occurrence Handle1:STN:280:ByqC2cbptlI%3D Occurrence Handle7847286

    CAS  PubMed  Google Scholar 

  28. GF Longstreth SP Feitelberg (1998) ArticleTitleSuccessful outpatient management of acute upper gastrointestinal hemorrhage: use of practice guidelines in a large patient series. Gastrointest Endosc 47 219–222 Occurrence Handle1:STN:280:DyaK1c7pvF2nsg%3D%3D Occurrence Handle9540873

    CAS  PubMed  Google Scholar 

  29. G Macri S Milani E Surrenti et al. (1999) ArticleTitleEradication of Helicobacter pylori reduces the rate of duodenal ulcer re-bleeding: a long term follow-up study. Curr Surg 56 309–311 Occurrence Handle10.1016/S0149-7944(99)00103-8

    Article  Google Scholar 

  30. InstitutionalAuthorNameNational Institutes of Health Consensus Conference (1989) ArticleTitleTherapeutic endoscopy and bleeding ulcers. J Am Med Assoc 262 1369–1372

    Google Scholar 

  31. R Pellicano S Peyre N Leone et al. (2001) ArticleTitleThe effect of the eradication of Helicobacter pylori infection on hemorrhage because of duodenal ulcer. J Clin Gastroenterol 32 222–224 Occurrence Handle10.1097/00004836-200103000-00008 Occurrence Handle1:STN:280:DC%2BD3M7mslGrsA%3D%3D Occurrence Handle11246348

    Article  CAS  PubMed  Google Scholar 

  32. TA Rockall RF Logan HB Devlin et al. (1995) ArticleTitleIncidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Br Med J 311 222–226 Occurrence Handle1:STN:280:ByqA2MzhtF0%3D

    CAS  Google Scholar 

  33. TA Rockall RF Logan HB Devlin et al. (1996) ArticleTitleRisk assessment after acute upper GI hemorrhage. Gut 38 316–321 Occurrence Handle1:STN:280:BymB2cnpt1c%3D Occurrence Handle8675081

    CAS  PubMed  Google Scholar 

  34. G Rodriguez C Cattaruzi MG Troncon L Agostinis (1998) ArticleTitleRisk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists and other antihypertensive drugs. Arch Intern Med 158 33–39 Occurrence Handle10.1001/archinte.158.1.33 Occurrence Handle9437376

    Article  PubMed  Google Scholar 

  35. TJ Savides DM Jensen (2000) ArticleTitleTherapeutic endoscopy for nonvariceal gastrointestinal bleeding. Gastroenterol Clin North Am 29 465–487

    Google Scholar 

  36. A Sonnenberg C Olson J Zhang (1999) ArticleTitleThe effect of antibiotic therapy on bleeding from duodenal ulcer. Am J Gastroenterol 94 950–954

    Google Scholar 

  37. G Spencer (1989) Projections of the population of the United States—age, sex, and race: 1988 to 2080. U.S. Bureau of the Census Washington, DC

    Google Scholar 

  38. BM Spiegel NB Vakil JJ Ofman (2001) ArticleTitleEndoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? Arch Intern Med 161 1393–1404 Occurrence Handle10.1001/archinte.161.11.1393 Occurrence Handle1:STN:280:DC%2BD3MvjsFygtg%3D%3D Occurrence Handle11386888

    Article  CAS  PubMed  Google Scholar 

  39. CP Steffes C Sugawa (1992) ArticleTitleEndoscopic management of nonvariceal gastrointestinal bleeding. World J Surg 16 1025–1033 Occurrence Handle1:STN:280:ByyD1cfotV0%3D Occurrence Handle1455870

    CAS  PubMed  Google Scholar 

  40. C Sugawa (1999) Control of nonvariceal upper GI bleeding. CE Scott-Conner (Eds) The SAGES manual: fundamentals of laparoscopy and GI endoscopy. Springer-Verlag New York 448–456

    Google Scholar 

  41. C Sugawa Y Fujita T Ikeda AJ Walt (1986) ArticleTitleEndoscopic hemostasis of bleeding of the upper gastrointestinal tract by local injection of ninety eight percent dehydrated ethanol. Surg Gynecol Obstet 162 159–163

    Google Scholar 

  42. C Sugawa AL Joseph (1992) ArticleTitleEndoscopic interventional management of bleeding duodenal and gastric ulcers. Surg Clin North Am 72 317–334

    Google Scholar 

  43. C Sugawa AL Joseph (1994) Management of nonvariceal upper gastrointestinal bleeding. FL Greene JL Ponsky (Eds) Endoscopic surgery. Saunders Philadelphia 125–140

    Google Scholar 

  44. JJ Sung WK Leung R Suen et al. (1997) ArticleTitleOne-week antibiotics versus maintenance acid suppression therapy for Helicobacter pylori-associated peptic ulcer bleeding. Dig Dis Sci 42 2524–2528 Occurrence Handle10.1023/A:1018816729449 Occurrence Handle1:CAS:528:DyaK1cXnt1KltA%3D%3D Occurrence Handle9440631

    Article  CAS  PubMed  Google Scholar 

  45. CP Swain (1992) Pathology of the bleeding lesions. C Sugawa BM Schuman CE Lucas (Eds) Gastrointestinal bleeding. Igaku-Shoin New York

    Google Scholar 

  46. JP Terdiman (1998) ArticleTitleUpdate on gastrointestinal breeding. Postgrad Med 103 43–64 Occurrence Handle1:STN:280:DyaK1c3pslWqug%3D%3D

    CAS  Google Scholar 

  47. RM Walsh P Amain M Geisinger et al. (1999) ArticleTitleRole of angiography and embolization for massive gastroduodenal hemorrhage. J Gastrointest Surg 3 61–66 Occurrence Handle1:STN:280:DyaK1MzovVWrsA%3D%3D Occurrence Handle10457326

    CAS  PubMed  Google Scholar 

  48. MM Wolfe DR Lichtenstein G Singh (1999) ArticleTitleGastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med 340 1888–1899 Occurrence Handle1:CAS:528:DyaK1MXktFKrtbs%3D Occurrence Handle10369853

    CAS  PubMed  Google Scholar 

  49. Y Yamaguchi T Yamato N Katsumi et al. (2001) ArticleTitleEndoscopic hemoclipping for upper GI bleeding due to Mallory-Weiss syndrome. Gastrointest Endosc 53 427–430 Occurrence Handle10.1067/mge.2001.111774 Occurrence Handle1:STN:280:DC%2BD3M7oslSjtQ%3D%3D Occurrence Handle11275881

    Article  CAS  PubMed  Google Scholar 

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Blocksom, J., Tokioka, S. & Sugawa, C. Current therapy for nonvariceal upper gastrointestinal bleeding . Surg Endosc 18, 186–192 (2004). https://doi.org/10.1007/s00464-003-8155-4

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