Clinical Edge

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Updated International Consensus Recommendations on Management of Acute Upper GI Bleeding

Key clinical point: Updated guidelines on acute upper GI bleeding management have been published.

Major finding: Updated acute GI bleeding guidelines recommend endoscopy within 24 hours and treatment with proton pump inhibitor even in patients on cardiovascular prophylaxis.

Study details: Guidelines.

Disclosures: The group was supported by a grant from CIHR Institute of Nutrition, Metabolism and Diabetes and from the Saudi Gastroenterology Association. Nine authors declared grants, personal fees, honoraria, and other funding from the pharmaceutical and medical device sector outside the submitted work. No other conflicts of interest were declared.

Citation:

Barkun A et al. Ann Intern Med 2019, October 22. doi: 10.7326/M19-1795.

Commentary:

These updated consensus guidelines provide a rigorous review of evidence on managing nonvariceal upper gastrointestinal bleeding. The recommendations for patients on anticoagulant or antiplatelet therapy will be particularly helpful because of increasing use of these medications. The advice on proton pump inhibitor therapy in patients on these drugs who have had previous ulcer bleeding can help allay concerns about possible integrations between PPIs and clopidogrel.

While the guidelines recommend using the Glasgow Blatchford scale to guide hospitalization decisions, prognostic scores are not commonly used in the emergency department, and many patients present with a Glasgow Blatchford score greater than 1, so this tool may have little impact on hospitalization rates. More studies are needed to compare clinical judgment with these prognostic scores.

Angel Lanas, MD, is from the University Clinic Hospital at the University of Zaragoza (Spain). These comments are adapted from an accompanying editorial (Ann Intern Med 2019, October 22. doi: 10.7326/M19-2789). Dr. Lanas declared unrelated personal fees from the pharmaceutical sector.