ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding

We performed systematic reviews addressing predefined clinical questions to develop recommendations with the GRADE approach regarding management of patients with overt upper gastrointestinal bleeding. We suggest risk assessment in the emergency department to identify very-low-risk patients (e.g., Gl...

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Bibliographic Details
Published in:The American journal of gastroenterology Vol. 116; no. 5; pp. 899 - 917
Main Authors: Laine, Loren, Barkun, Alan N., Saltzman, John R., Martel, Myriam, Leontiadis, Grigorios I.
Format: Journal Article
Language:English
Published: United States Wolters Kluwer 01.05.2021
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Subjects:
Antibiotics
Confidence
Electrocoagulation
Embolization, Therapeutic
Endoscopy
Endoscopy, Gastrointestinal
Erythrocyte Transfusion
Estimates
Gastroenterology
Hemostasis, Surgical
Hospitalization
Humans
Intervention
Mortality
Patient Acuity
Patients
Peptic Ulcer Hemorrhage - therapy
Population
Proton Pump Inhibitors - administration & dosage
Risk assessment
Risk Factors
Ulcers
Upper Gastrointestinal Tract
United States > US
ISSN:0002-9270, 1572-0241, 1572-0241
Online Access:Get full text
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Summary:We performed systematic reviews addressing predefined clinical questions to develop recommendations with the GRADE approach regarding management of patients with overt upper gastrointestinal bleeding. We suggest risk assessment in the emergency department to identify very-low-risk patients (e.g., Glasgow-Blatchford score = 0–1) who may be discharged with outpatient follow-up. For patients hospitalized with upper gastrointestinal bleeding, we suggest red blood cell transfusion at a threshold of 7 g/dL. Erythromycin infusion is suggested before endoscopy, and endoscopy is suggested within 24 hours after presentation. Endoscopic therapy is recommended for ulcers with active spurting or oozing and for nonbleeding visible vessels. Endoscopic therapy with bipolar electrocoagulation, heater probe, and absolute ethanol injection is recommended, and low- to very-low-quality evidence also supports clips, argon plasma coagulation, and soft monopolar electrocoagulation; hemostatic powder spray TC-325 is suggested for actively bleeding ulcers and over-the-scope clips for recurrent ulcer bleeding after previous successful hemostasis. After endoscopic hemostasis, high-dose proton pump inhibitor therapy is recommended continuously or intermittently for 3 days, followed by twice-daily oral proton pump inhibitor for the first 2 weeks of therapy after endoscopy. Repeat endoscopy is suggested for recurrent bleeding, and if endoscopic therapy fails, transcatheter embolization is suggested.
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ISSN:0002-9270
1572-0241
1572-0241
DOI:10.14309/ajg.0000000000001245