Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding

Management of non-variceal upper gastrointestinal tract hemorrhage: Controversies and areas of uncertainty

“…Predictors of poor prognosis include: age > 65 years, shock, poor overall health, comorbid conditions, low initial hemoglobin/hematocrit, active bleeding (red blood per rectum or hematemesis), sepsis, and elevated creatinine or serum transaminases [2,8,9] . Several scoring systems have been created and/or validated for this purpose, including APACHE Ⅱ, Forrest Classification, Blatchford, pre-endoscopic Rockall, Baylor College, Cedars-Sinai Medical Center and Rockall indexes (Table 1 compares 6 commonly used scoring systems) [10,11] . Some of these may be cumbersome (APACHE Ⅱ) or require data not immediately available based on initial clinical assessment (the Rockall Scoring System, for instance, requires endoscopic data) and therefore may be of limited utility in the acute setting [12] .…”

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“…Although some have argued for the broader use of decision support like the GBS in managing patients with UGIB [21], implementing its use in the ED to specifically identify the few low-risk patients who present does not seem to justify the costs and organizational effort required, especially with many competing needs to improve value of care. GBS is consistently superior to other tools in identifying lowrisk patients [4,5,22]. It also has been shown that higher GBS at admission is associated with recurrent bleeding after discharge [23].…”

Prophylactic injection therapy is necessary for Forrest type 2b duodenal ulcers.

“…Since the CLO test is not reliable in patients with UGIB, the test was not carried out, and a combined antibiotherapy with clarithromycin (1000 mg/day, peroral) and amoxicillin (2000 mg/day, peroral) for H. pylori eradication was prescribed on a routine basis as well. [4] Exclusion criteria were: 1. Hemodynamic instability on admission; 2.…”

“…[3] In addition, endoscopic findings form the major component of various scoring systems used for stratification of the patients with UGIB. [4] Forrest classification, one of the most popular scoring systems, depends solely on endoscopic findings and divides the patients with UGIB into three categories (Table 1). [3] Forrest classification serves as a useful tool to estimate the rebleeding rate, which is considered to be the major determinant for prognosis in patients with bleeding duodenal ulcer.…”

“…[3] Forrest classification serves as a useful tool to estimate the rebleeding rate, which is considered to be the major determinant for prognosis in patients with bleeding duodenal ulcer. [3,4] Whereas therapeutic endoscopy for Forrest type 1 lesions and prophylactic endoscopic treatment for Forrest type 2a lesions are widely accepted as the standard care in patients with UGIB, the necessity of prophylactic endoscopic treatment for Forrest type 2b lesions remains controversial. [5,6] In this respect, we conducted a retrospective study to assess the efficacy of prophylactic endoscopic treatment with injection therapy in patients with Forrest type 2b bleeding duodenal ulcer.…”