Upper gastrointestinal bleeding (UGIB), especially pepticulcer bleeding, remains one of the most important causeof hospitalisation and mortality world wide. In Asia,with a high prevalence of Helicobacter pylori infection,a potential difference in drug metabolism, anda difference in clinical management of UGIB due tovariable socioeconomic environments, it is considerednecessary to re-examine the International Consensus ofNon-variceal Upper Gastrointestinal Bleeding withemphasis on data generated from the region. Theworking group, which comprised experts from 12countries from Asia, recommended the use of theBlatchford score for selection of patients who requireendoscopic intervention and which would allow earlydischarge of patients at low risk. Patients’ comorbidconditions should be included in risk assessment.A pre-endoscopy proton pump inhibitor (PPI) isrecommended as a stop-gap treatment when endoscopywithin 24 h is not available. An adherent clot on a pepticulcer should be treated with endoscopy combined witha PPI if the clot cannot be removed. Routine repeatedendoscopy is not recommended. High-dose intravenousand oral PPIs are recommended but low-doseintravenous PPIs should be avoided. COX-2 selectivenon-steroidal anti-inflammatory drugs combined witha PPI are recommended for patients with very high risk ofUGIB. Aspirin should be resumed soon after stabilisationand clopidogrel alone is no safer than aspirin plus a PPI.When dual antiplatelet agents are used, prophylactic useof a PPI reduces the risk of adverse gastrointestinal
BACKGROUND
Although there is a general declining trend inthe incidence of peptic ulcer disease, non-varicealupper gastrointestinal bleeding (NVUGIB) remainsa major prevalent and clinically significant conditionworld wide. Recent studies suggest that the inci-dence of NVUGIB ranges from 20 to 60 per 100 000population in North America and in Europe,1e3withan increasing elderly population with comorbidillness.The Inter national Consensus Recommendationsonthe Management of Patients with Non-varicealUpper Gastrointestinal Bleeding (ICON-UGIB)published in 2010 was a collective wisdom of 34voters from 15 countries.
It takes into account theupdated literature on the management of NVUGIB and draws up consensus guidelines based on the
modifi ed Delphi process. It has five sectionsdnamely, 1. resuscitation, risk assessment andpre-endoscopy management; 2. endoscopic manage-ment; 3. pharm acological management; 4. non-phar macological and non-endoscopic in-hospitalmanagement; 5. postdischarge management,including the use of aspirin and non-steroidal anti-in fl ammator y dr ugs (NSAIDs). Although theguidelines present comprehensive recommendationsand the latest update of the literature, they do notallow for the speci fi c needs of resource-limited countries anddifferences due to ethnicity. For example, the use of pre-endo -scopic proton pump inhibitor (PPI) treatment to down-stageendoscopic lesions and decrease the need for endoscopic inter-vention is considered in the ICON-UGIB. This causes fi nancialburden to resource-limited countries in the Asia-Pacific region.High-dose infusion of a PPI is recommended as an adjuvant toendoscopic treatment but, after considering all the studiesavailable, the ICON-UGIB did not reach a conclusion aboutthe ef fi cacy of either lower intravenous doses or high-dose oralPPI treatment. Further more, there are regional differences inHelicobacter pyloriinfection, metabolism of dru gs such as PPIs andantiplatelet agents, which may have implications for the management of NVUGIB.

亞太地區非靜脈曲張性上消化道出血的共識原文下載http://ziyuan.iiyi.com/source/down/2388983.html