When to discharge patients with bleeding peptic ulcers: a prospective study of residual risk of rebleeding

Hsu, Ping‐I; Lai, Kwok‐Hung; Lin, Xi‐Zhang; Yang, Yun-Fu; Lin, Mike; Shin, Jeng‐Shiann; Lo, Gin‐Ho; Huang, Rong-Long; Chang, Cheng-Pei; Lin, Chiun‐Ku; Ger, Luo‐Ping

doi:10.1016/s0016-5107(96)70085-8

Cited by 53 publications

(29 citation statements)

References 19 publications

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“…Among patients who rebled, 55.6% did so within three days. This is higher than what has been reported in the literature, with rebleeding rates of up to 95% in the first three days (7,8,11,26).…”

Section: Discussioncontrasting

confidence: 61%

“…Most of the current data regarding the timing of peptic ulcer rebleeding are obtained from studies using endoscopic hemostatic techniques and pharmacological therapies that are not consistent with current recommendations, with no PPI pharmacotherapy or low PPI doses, as well as epinephrine injection alone. The finding that most rebleeding occurs within the first three days is also supported by several landmark studies in which endoscopic follow-up of ulcers showed healing with a clean base by day 3 to 4; however, most of these older studies excluded patients on NSAIDs or anticoagulants, and patients with any comorbidities, which is not reflective of a contemporary patient population (7,9,11).…”

Section: Discussionmentioning

confidence: 89%

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Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review

Ouali

Barkun

Martel

et al. 2014

Canadian Journal of Gastroenterology and Hepatology

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BACKGROUND: Peptic ulcer rebleeding (PUR) usually occurs within three days following endoscopic hemostasis. However, recent data have increasingly suggested delayed rebleeding.OBJECTIVE: To better characterize the timing of PUR (Forrest Ia to IIb) following initially successful endoscopic hemostasis.METHODS: An exhaustive literature search (1989 to 2013), with cross-referencing, was performed to identify pertinent randomized controlled trial (RCT) arms. Patients receiving high-dose proton pump inhibitor (PPI) infusion following successful modern-day endoscopic hemostasis were included. A sensitivity analysis included any patients receiving PPI doses >40 mg daily. The main outcome measure was 30-day rebleeding, while weighted mean averages at t = three, seven, 14 and 28 to 30 days are also reported.RESULTS: Of 756 citations, six RCTs were included (561 patients; 58.5% to 89.5% male; 55.3 to 67.5 years of age). Among patients receiving high-dose PPI (five RCTs [393 patients]), 11.5% (95% CI 8.4% to 14.7%) experienced rebleeding, 55.6% (95% CI 41.1% to 70.1%) rebled within three days, 20% (95% CI 8.3% to 31.7%) between four and seven days, 17.8% (95% CI 6.6% to 28.9%) at eight to 14 days, and 6.7% (95% CI 0% to 14%) at 15 to 28 to 30 days. Using the relaxed lower PPI dosing threshold, similar respective rates were 14.4% (95% CI 11.5% to 17.3%) overall, with interval rates of 39.5% (95% CI 28.9% to 50.15%), 34.6% (95% CI 24.2% to 44.9%), 19.7% (95% CI 11% to 28.4%) and 6.2% (95% CI 0.95% to 11.5%). Qualitative review of patient characteristics, limited by small sample size, possible bias and study heterogeneity, suggested increased patient comorbidity and postendoscopic use of lower PPI dosing may predict delayed rebleeding.CONCLUSION: In patients with high-risk PUR undergoing successful endoscopic hemostasis, most rebled within three days, with many experiencing later rebleeding. Additional research is needed to better predict such an outcome.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 89%

Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review

Ouali

Barkun

Martel

et al. 2014

Canadian Journal of Gastroenterology and Hepatology

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“…Achado endoscópico tes jovens, sem instabilidade hemodinâmica, com lesões de baixo risco de ressangramento, podem receber alta para ulterior acompanhamento ambulatorial 16 . O exame de endoscopia digestiva alta (EDA) é considerado método de eleição para o diagnóstico e tratamento da úlcera péptica hemorrágica 6 podendo mudar a evolução e as taxas de mortalidade 6 .…”

Section: Classificação De Forrestunclassified

“…O exame endoscópico deve ser realizado nas primeiras 12 horas, após a avaliação e estabilização hemodinâmica (Tabela 6). A EDA realizada precocemente oferece importantes vantagens: a) permite detectar aqueles pacientes com lesões de baixo risco e que podem receber alta precocemente 16,17 ; b) possibilita que os pacientes com lesões de alto risco sejam submetidos ao tratamento hemostático que diminui a recidiva, pode evitar o tratamento cirúrgico e diminuir a mortalidade 18,19 ; c) apresenta relação custo-benefício favorável já que diminui o período de internação dos pacientes com alto risco e as readmissões hospitalares 18 .…”

Section: Classificação De Forrestunclassified

Aspectos endoscópicos no manejo da úlcera péptica gastroduodenal

Giordano-Nappi

2008

Rev. Col. Bras. Cir.

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“…With advancement of endoscopic hemostatic procedures and availability of proton pump inhibitors (PPI), the incidence rate of hemorrhagic peptic ulcers significantly decreased (1)(2)(3)(4)(5)(6)(7)(8)(9) F i g u r e 2 . E me r g e n t a…”

Section: Introductionmentioning

confidence: 99%

Late-onset Life Threatening Hemorrhage of Omeprazole-Resistant Duodenal Ulcer Managed by Interventional Radiology: Report of a Case

et al. 2006

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When to discharge patients with bleeding peptic ulcers: a prospective study of residual risk of rebleeding

Cited by 53 publications

References 19 publications

Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review

Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review

Aspectos endoscópicos no manejo da úlcera péptica gastroduodenal

Late-onset Life Threatening Hemorrhage of Omeprazole-Resistant Duodenal Ulcer Managed by Interventional Radiology: Report of a Case

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