Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding
Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding
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DOI：
10.7326/0003-4819-139-10-200311180-00012
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发表时间：
2003-11-18
影响因子：
39.2
通讯作者：
Marshall, JK
中科院分区：
文献类型：
--
作者：
Barkun, A;Bardou, M;Marshall, JK
背景资料：急性非静脉曲张性上消化道出血患者的治疗在过去的10年里有了很大的发展，但缺乏已发表的共识指南。目的：提供基于证据的治疗建议，解决临床相关问题。审查和共识过程：一个由代表11个国家学会的25名投票参与者组成的多学科共识小组使用了一个7-根据公认标准逐步制定建议声明。包括数据来源。叙述性和系统性综述以及已发表和新的荟萃分析。根据公认的classification.Main结果：建议强调适当的初始复苏的病人和多学科的方法来确定需要早期内镜检查的临床风险分层的证据的质量，强度的建议，和共识的水平进行了分级。早期内窥镜检查允许被归类为低风险的选定患者安全和迅速出院。内镜下止血仅用于高危内镜病变患者。虽然注射或热凝固的单药治疗是有效的，但联合治疗上级优于单独治疗。放置内镜夹进行内镜止血似乎很有希望。在成功接受内镜治疗的患者中，推荐使用大剂量静脉质子泵抑制剂。不推荐常规二次内镜检查。上消化道出血患者应进行幽门螺杆菌感染和根除治疗，如果感染present.Future Directions：新的内镜治疗技术的疗效，质子泵抑制的最佳方案，和其他药物的作用需要进一步研究。
Background: The management of patients with acute non-variceal upper gastrointestinal bleeding has evolved substantially over the past 10 years amid a paucity of published consensus guidelines.Purpose: To provide evidence-based management recommendations that address clinically relevant issues.Review and Consensus Processes: A multidisciplinary consensus group of 25 voting participants representing 11 national societies used a 7-step approach to develop recommendation statements according to accepted standards. Sources of data included. narrative and systematic reviews as well as published and new meta-analyses. The quality of the evidence, the strength of the recommendation, and the level of consensus were graded according to recognized classifications.Main Findings: Recommendations emphasize appropriate initial resuscitation of the patient and a multidisciplinary approach to clinical risk stratification that determines the need for early endoscopy. Early endoscopy allows safe and prompt discharge of selected patients classified as low risk. Endoscopic hemostasis is reserved for patients with high-risk endoscopic lesions. Although monotherapy with injection or thermal coagulation is effective, the combination is superior to either treatment alone. The placement of endoscopic clips for endoscopic hemostasis appears promising. High-dose intravenous proton-pump inhibition is recommended in patients who have undergone successful endoscopic therapy. Routine second-look endoscopy is not recommended. Patients with upper gastrointestinal bleeding should be tested for Helicobacter pylori infection and receive eradication therapy if infection is present.Future Directions: The efficacy of newer endoscopic therapeutic technologies, the optimal regimen of proton-pump inhibition, and the roles of other pharmacologic agents require further research.