Prevention of upper gastrointestinal haemorrhage: current controversies and clinical guidance

Abstract

Acute upper gastrointestinal (GI) bleeding is a common medical emergency and associated with significant morbidly and mortality. The risk of bleeding from peptic ulceration and oesophagogastric varices can be reduced by appropriate primary and secondary preventative strategies. Helicobacter pylori eradication and risk stratification with appropriate gastroprotection strategies when used with antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in preventing peptic ulcer bleeding, whilst endoscopic screening and either nonselective beta blockade or endoscopic variceal ligation are effective at reducing the risk of variceal haemorrhage. For secondary prevention of variceal haemorrhage, the combination of beta blockade and endoscopic variceal ligation is more effective. Recent data on the possible interactions of aspirin and NSAIDs, clopidogrel and proton pump inhibitors (PPIs), and the increased risk of cardiovascular adverse events associated with all nonaspirin cyclo-oxygenase (COX) inhibitors have increased the complexity of choices for preventing peptic ulcer bleeding. Such choices should consider both the GI and cardiovascular risk profiles. In patients with a moderately increased risk of GI bleeding, a NSAID plus a PPI or a COX-2 selective agent alone appear equivalent but for those at highest risk of bleeding (especially those with previous ulcer or haemorrhage) the COX-2 inhibitor plus PPI combination is superior. However naproxen seems the safest NSAID for those at increased cardiovascular risk. Clopidogrel is associated with a significant risk of GI haemorrhage and the most recent data concerning the potential clinical interaction of clopidogrel and PPIs are reassuring. In clopidogrel-treated patients at highest risk of GI bleeding, some form of GI prevention is indicated.

Treatment of Elderly Patients With Dorsopathy

“…В такой ситуации больной нуждается в длительном приеме НПВП, что резко повышает риск развития соматических заболева-ний. Значимым фактором, повышающим вероятность раз-вития язв желудочно-кишечного тракта, помимо пожило-го возраста, является необходимость в постоянном прие-ме антиагрегантов, бисфосфонатов, ингибиторов обрат-ного захвата серотонина [11].…”

Low Dose Capsule Based 13c-Urea Breath Test Compared With the Conventional 13c-Urea Breath Test and Invasive Tests

“…In this report four patients that did not stop taking omeprazole also had positive breath test. This is an important finding, as some patients with continuous proton pump inhibitor therapy may not discontinue medication with risk of gastrointestinal bleeding (2) . Although the recommendation is to avoid all proton pump inhibitors and H 2 -receptor antagonists, among omeprazole, lansoprazole and pantoprazole, the latter did not interfere in the accuracy of 13 C-urea breath test.…”

Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients

“…Concomitant drugs included oral aspirin[3,8,11,15,21], other antiplatelet agents including cilostazol and clopidogrel[3,11], NSAIDs[3,8,10,11,16,29], steroids[3,19], anticoagulants including warfarin, rivaroxaban, dabigatran, and apixaban[3,10,11], and selective serotonin reuptake inhibitors[3,23,24]. As selective cyclooxygenase (COX)-2 inhibitors had been prescribed to reduce the gastrointestinal complications, these drugs were not included as concomitant drugs[31,34,35]. Personal habits included smoking[8,10,11], and alcohol consumption[8,10,11].…”