Improving outcomes from acute upper gastrointestinal bleeding
- 1Translational Gastroenterology Unit and NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
- 2McGill University Health Centre, Montreal, Canada
- Correspondence to Dr Vipul Jairath, Translational Gastroenterology Unit and NHS Blood and Transplant, John Radcliffe Hospital, Oxford OX3 9DU, UK;
Contributors VJ and ANB contributed equally to this manuscript.
- Revised 2 December 2011
- Accepted 26 December 2011
- Published Online First 20 January 2012
- Gastrointestinal bleeding
- biliary endoscopy
- bile duct stones
- gastrointestinal bleeding
- gastrointesinal endoscopy
- biliary obstruction
Upper gastrointestinal bleeding (UGIB) is predominantly non-variceal in origin and remains one of the most common challenges faced by gastroenterologists and endoscopists in daily clinical practice. Despite major advances in the approach to the management of non-variceal upper gastrointestinal bleeding (NVUGIB) over the past decade including prevention of peptic ulcer bleeding, optimal use of endoscopic therapy1 and high-dose proton pump inhibition,2 it still carries considerable morbidity, mortality and health economic burden. Although many modernised healthcare systems report reductions in case death over time,3–5 most likely attributable to the aforementioned advances in addition to general supportive care, mortality remains appreciably high. Of particular note, rebleeding rates—one of the most important predictive factors of mortality and arguably the best reflection of interventions directly targeted at bleeding—have not significantly improved from longitudinal data in the past 15 years.6 ,7 In addition to high-quality trials that have informed best evidence-based practice guidelines in recent years,8 we have been provided with a plethora of detailed ‘real-life’ outcome data from multicentre observational studies of UGIB originating from Canada (RUGBE,9 REASON10 AND REASON-211), Italy (PNED-112 and PNED-213) and the UK,14 enabling an assessment of how well such guidelines are adhered to and serving to highlight deficiencies in existing aspects of care which could be improved upon. These studies are further described in table 1.
Using data from published papers of the aforementioned studies, we highlight a number of areas in the management of NVUGIB where efforts could be targeted to improve existing shortcomings in care. In addition we provide suggestions for parameters upon which improvements in care may be monitored in longitudinal studies as well as highlighting key areas …