Treatment of nonvariceal upper gastrointestinal bleeding.
PURPOSE: The etiology, pathophysiology, prognostic factors, pharmacologic treatment, and pharmacoeconomic considerations of nonvariceal upper-gastrointestinal-tract bleeding (UGB) are reviewed. SUMMARY: UGB is associated with substantial morbidity and mortality. While UGB can be caused by a wide var...
| Publicado en: | American Journal of Health-System Pharmacy Vol. 62; no. 11; pp. 1159 - 1171 |
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| Autores principales: | , |
| Formato: | review tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
6/1/2005
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106393866&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106393866 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10792082 1X3 jtl: American Journal of Health-System Pharmacy issn: 10792082 maglogo: N pubinfo: dt: 6/1/2005 vid: 62 iid: 11 pid: 622 pub: Oxford University Press / USA artinfo: ui: 106393866 2009094624 10.1093/ajhp/62.11.1159 NLM15914876 106393866 ppf: 1159 ppct: 12 formats: fmt: @attributes: type: P tig: atl: Treatment of nonvariceal upper gastrointestinal bleeding. aug: au: Rivkin K Lyakhovetskiy A affil: Clinical Pharmacy Specialist, Lincoln Medical and Mental Center, 234 East 149 Street, Bronx, NY 10451; kirfa@hotmail.com sug: subj: Gastrointestinal Hemorrhage Peptic Ulcer Complications Clinical Trials Drug Therapy Economics Endoscopy, Gastrointestinal Gastrointestinal Hemorrhage Drug Therapy Gastrointestinal Hemorrhage Etiology Gastrointestinal Hemorrhage Mortality Gastrointestinal Hemorrhage Physiopathology Gastrointestinal Hemorrhage Prognosis Gastrointestinal Hemorrhage Surgery Histamine H2 Antagonists Hydrogen-Ion Concentration Peptic Ulcer Classification Proton Pump Inhibitors ab: PURPOSE: The etiology, pathophysiology, prognostic factors, pharmacologic treatment, and pharmacoeconomic considerations of nonvariceal upper-gastrointestinal-tract bleeding (UGB) are reviewed. SUMMARY: UGB is associated with substantial morbidity and mortality. While UGB can be caused by a wide variety of medical conditions, 50% of UGB cases are caused by peptic ulcers. Approximately 80% of all UGB episodes stop bleeding spontaneously. Recurrence of gastrointestinal hemorrhage is associated with an increased mortality rate, a greater need for surgery, blood transfusions, a prolonged length of hospital stay, and increased overall health care costs. All patients with UGB should be evaluated for signs and symptoms of hemodynamic instability and active hemorrhage. Endoscopy within the first 24 hours of a UGB episode is considered the standard of therapy for the management of the initial hemorrhage. However, approximately 20% of patients will experience a rebleeding episode. Acid-suppressive therapy with proton-pump inhibitors (PPIs) in addition to endoscopic hemostasis is effective in reducing the frequency of rebleeding, the need for surgery, transfusion requirements, and the length of hospital stay, but not mortality rates. There are multiple dosing options for administration of PPIs in this setting. More studies are necessary to elucidate the best therapeutic approach to manage UGB. CONCLUSION: Acid-suppressive therapy is beneficial in the management of UGB. It reduces the frequency of rebleeding, the need for surgery, transfusion requirements, and the length of hospital stay. To date, no pharmacologic intervention has demonstrated a reduction in the mortality rates of patients with UGB. An optimal acid-suppressive regimen has not yet been clearly established. pubtype: Academic Journal doctype: review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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