Acute upper gastrointestinal bleeding : management
The reported expertise of endoscopists varied widely with approximately 30% being unable to manage bleeding oesophageal varices, yet it is obvious that rotas must be populated by teams trained to deliver all aspects of endoscopic haemostatic therapy. A guideline is therefore required to demonstrate...
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Published by the National Clinical Guideline Centre at The Royal College of Physicians
June 2012, 2012
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|Summary:||The reported expertise of endoscopists varied widely with approximately 30% being unable to manage bleeding oesophageal varices, yet it is obvious that rotas must be populated by teams trained to deliver all aspects of endoscopic haemostatic therapy. A guideline is therefore required to demonstrate the clinical utility of the diagnostic and therapeutic steps needed to manage patients, and to stimulate hospitals to develop a structure to enable clinical teams to deliver the optimum service. The guideline concerns patients who present with haematemesis (vomiting of blood) and/ or melaena (the passage of black, tarry stools). Acute blood loss leads to collapse with low blood pressure, rapid pulse, sweating and pallor. In severe cases poor blood flow to the kidneys leads to acute renal failure and in patients with underlying vascular disease to stroke or myocardial infarction.|
The incidence of acute upper gastrointestinal haemorrhage in the United Kingdom ranges between 84-172 /100,000/year, equating to 50-70,000 hospital admissions per year. This is therefore a relatively common medical emergency; it is also one that more often affects socially deprived communities. A recent large UK wide audit showed that the hospital mortality of patients admitted to hospitals in the UK for acute gastrointestinal bleeding is about 7%, rising to approximately 30% in patients who bleed as inpatients. A recent analysis has shown only modest age and co-morbidity corrected mortality decreases in recent years. The audit demonstrated considerable inequities in clinical care; some hospitals provided a comprehensive 24/7 service involving endoscopy, interventional radiology and emergency surgery, whilst others did not provide out of hours endoscopy or interventional radiology.
Elderly patients and those with chronic medical diseases withstand acute gastrointestinal bleeding less well than young fitter patients and have a higher risk of death. Almost all patients who develop acute gastrointestinal bleeding are managed in hospital (rather than in the community), there is no published literature concerning primary care and the guideline is therefore focused upon hospital care
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