Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Abstract

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

Second‐look endoscopy‐guided therapy under sedation prevents early rebleeding after variceal ligation for acute variceal bleeding

“…Some RCTs and meta‐analyses have shown that SLE prevented rebleeding in patients having peptic ulcers with a very high risk of active bleeding, while other studies had controversial results . To our knowledge, our study is the first to investigate the effect of SLE on post‐EVL bleeding in patients with cirrhosis and large EV.…”

“…The prevalence of post‐EVL bleeding has been reported to range from 7.8% within 6 weeks to 26% within one year from the index EVL . Several studies have focused on the effects of second‐look endoscopy (SLE) after therapeutic endoscopy for non‐variceal gastrointestinal bleeding (GIB) . However, to our knowledge, there have been no studies evaluating the efficacy of SLE in preventing early post‐EVL rebleeding so far.…”

Efficacy, safety and pharmacokinetics of ilaprazole infusion in healthy subjects and patients with esomeprazole as positive control

“…The general strategy of intravenous PPI treatment for peptic ulcer bleeding is giving a high dose followed by continuous infusions . Since the effect of ilaprazole 20 mg was comparable to that of 30 mg, the lower was selected as the loading dose.…”

“…The general strategy of intravenous PPI treatment for peptic ulcer bleeding is giving a high dose followed by continuous infusions. [13][14][15] Since the effect of ilaprazole 20 mg was comparable to that of 30 mg, the lower was selected as the loading dose. The following infusion of 10 mg once daily for 2 days was selected because: (i) a previous study indicated that ilaprazole 10 once daily for 5 days provided stable PK and PD, and was well tolerated in healthy subjects 17 ; (ii) after receiving a bolus of 20 mg, ilaprazole 10 mg once daily for 2 days was assumed to produce comparable effect to that of 20 mg for 2 days based on a simulation using a mechanism-based PK/PD model (not published).…”

“…12 Intravenous PPI therapy is critical for the patients who are unable to take oral medications, or for some emergent situations such as non-varicella upper gastrointestinal bleeding, in which a rapid onset of action is desired. [13][14][15] Currently ilaprazole infusion is being evaluated in China. The PK, PD and safety of ilaprazole infusion have been investigated in healthy subjects.…”