Risk assessment in UGIB: recent PCI & ACS. Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass
|
|
|
- Ethelbert Cooper
- 6 years ago
- Views:
Transcription
1 Risk assessment in UGIB: recent PCI & ACS Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass
2 Clinical scenario 65 yr male Previous smoker, hyperlipidaemia, DM PCI < 48 hours Dual antiplatelet therapy & LMWH Active bleeding melaena, hypotension, tachycardia GBS 12; pre-endo Rockall score 5
3 ECG
4 Glasgow-Blatchford Bleeding Score Requires FBC, U&E and basic clinical assessment Simple Ready within 1 hour Assessed against composite end-point of: Clinical intervention (transfusion, endoscopic treatment or surgery) Death 30d
5 Rockall et al 1996
6 Glasgow-Blatchford Bleeding Score Stanley Lancet 2009
7 Stanley Lancet 2009
8 Rockall Score Risk Score Rebleed % Mortality % Rockall et al 1996
9 Key questions How common & what causes GI bleeding after ACS/PCI? Efficacy & risks of conservative measures? Likelihood of therapeutic intervention? What is the clinical outcome? Risks associated with endoscopy post ACS? Should antiplatelets/anticoagulation be stopped?
10 Key questions How common & what causes GI bleeding after ACS/PCI? Efficacy & risks of conservative measures Likelihood of therapeutic intervention? What is the clinical outcome? Risks associated with endoscopy post ACS? Should antiplatelets/anticoagulation be stopped?
11 Secondary prevention - evidence Study Year n Follow up Drugs CVS event Bleeding COGENT (dual therapy) 2010 NEJM m ASA/Clopi +Omeprazole ASA/Clopi +placebo 4.9% 1.1% 5.7% 2.9% CHARISMA (ACS pts) 2010 NEJM 15,600 28m Aspirin % 1.7% OASIS-7 (PCI) PROFESS (CVA) Aspirin 75/ Clopi NEJM 25,000 30d Clopi HD/ Aspirin 75 Clopi LD /aspirin 2008 NEJM 20, y Aspirin/ dipyridamole 6.8% 1.3% 4.2% 2.5% 4.4% 2.0% 9.0% 4.1% Clopidogrel 8.8% 3.6%
12 Bleeding events post PCI Koscinas ; Circ Cardiovent Intervent 2015
13 Causes of UGIB after ACS/PCI COMMON (90%): Peptic ulceration Gastritis, duodenitis Oesophagitis UNCOMMON (10%): Variceal haemorrhage UGI malignancy Dieulafoy Lesion Mallory Weiss tear Shalev Int J Cardiol 2012 Ng Am J Gastro 2008 Yachimski Dig Dis Sci 2011
14 Key questions How common & what causes GI bleeding after ACS/PCI? Efficacy & risks of conservative measures Likelihood of therapeutic intervention? What is the clinical outcome? Risks associated with endoscopy post ACS? Should antiplatelets/anticoagulation be stopped?
15 Rebleed rates Rebleed <5 days; PPI alone 11-34% Rebleed <5 days; following endoscopic therapy 9% in high risk lesion 3% in low risk lesion Khurooo NEJM 1997 Jung AM J Gastro 2002 Bleau GIE 2002 Bini GIE 2003 Yachimski Dig Dis Sci 2011
16 Stigmata of Bleeding Risks of Re-bleeding and Prevalence Clean base 49% bleeder 7% NBVV 8% dot 23% clot 13% 20 0 Active bleeder NBVV Clot Dot Clean base
17 Key questions How common & what causes GI bleeding after ACS/PCI? Efficacy & risks of conservative measures Likelihood of therapeutic intervention? What is the clinical outcome? Risks associated with endoscopy post ACS? Should antiplatelets/anticoagulation be stopped?
18 Clinical outcomes UGIB in ACS Findings in acute severe overt GI bleeding: Identify bleeding source 90% Need for endoscopic intervention: 39% Procedure related mortality 1% 30d mortality in ACS and UGIB 10-33% Cappell Am J Med 1999 Cappell Dig Dis Sci 2005 Lin Dig Dis Sci 2005 Yachimski Dig Dis Sci 2011
19 Haemoglobin targets? Villaneuva NEJM 2013
20 NEJM; VILLANAEUVA NEJM 2013
21 TRIGGER STUDY; Jairath LANCET 2015
22 TRIGGER Subgroup analyses Hb <12 g/dl Outcome Liberal (n=383) Restrictive (n=257) Difference and 95% CI P-value Ischaemic heart disease Further bleeding (Day 28) no. (%) 6/66 (9) 3/46 (7) -2.7 (-20.8 to 15.4) 0.85 Mortality no. (%) 2/67 (3) 6/49 (12) (-9.8 to 31.2) 0.11 Variceal bleeding Further bleeding (Day 28) no. (%) 7/51 (14) 4/22 (18) -0.7 (-40.2 to 41.6) 0.73 Mortality no. (%) 6/55 (11) 1/23 (4) -7.1 (-20.3 to
23 Anaesthetic Support in Major Upper Gastrointestinal Bleeding?
24 Current NUH Algorithm NICE 2012 Cardio-respiratory support not specifically addressed SIGN 2008 Highlights risk of airway compromise and need for appropriately trained staff but no specific guidelines regarding use of anaesthetic support BSG 2006 Anaesthetic support recommended for large UGIB where there is depressed LOC or reduced patient co-operation. Also considers those who may be at risk of oversedation and aspiration pneumonia Yes to any Perform endoscopy in emergency theatre Initial patient assessment indicates urgent endoscopy is required Exsanguinating (ongoing haemodynamic compromise after initial resuscitation) Active fresh haematemesis with haemodynamic compromise Risk of airway compromise (reduced consciousness, vomiting, agitation, uncooperative) Urgent endoscopy needed out of office hours No Stabilise and endoscopy <12 hours
25 Principal recommendations: Hospitals must provide 24/7 access to on-site endoscopy, IR, GI surgery and critical care anaesthesia Patients with major GIB should be discussed with duty on-call endoscopist within 1 hour GIB + haemodynamic instability require OGD within 2 hours of optimal resuscitation Ongoing management of major bleeds rests with named consultant Gastroenterologist Clearly documented re-bleed plans
26 Patient Characteristics NUH UGIB GA cases 2015 Gender Male:Female ratio 60:35 Age (years) mean ± SD Males 59.2 ± 19.1 Females 55.2 ± 28.4 ASA (%) Grade Grade Grade Grade Grade Urgency Code (%) GBS Score Yes (%) 17 (18%) Median (range) 12 (1 19)
27 Post-OGD complications MI: n=5 (5.3%) ARF: n=24 (25%) Respiratory failure: n=15 (15.8%) Heart failure: n= 11 (11.6%) Sepsis: n=22 (23.2%) Mortality: n=20 (21 %)
28 Key questions How common & what causes GI bleeding after ACS/PCI? Efficacy & risks of conservative measures Likelihood of therapeutic intervention? What is the clinical outcome? Risks associated with endoscopy post ACS? Should antiplatelets/anticoagulation be stopped?
29 Risks of endoscopy post ACS/MI Overall 30% Mostly self-limiting Hypotension arrhythmia 16% evidence of myocardial ischaemia Procedure related mortality 1%
30
31 Key questions How common & what causes GI bleeding after ACS/PCI? Efficacy & risks of conservative measures Likelihood of therapeutic intervention? What is the clinical outcome? Risks associated with endoscopy post ACS? Should antiplatelets/anticoagulation be stopped?
32
33 Methods Patients on aspirin for secondary prophylaxis Bleeding controlled endoscopically All had 72h PPI then po pantoprazole 40mg Randomised to aspirin 80mg or placebo for 8 weeks RCDBT Single institution Follow-up at 30 and 56 days No Hp eradication
34 Primary outcome Aspirin re-bleeding (n=8): 1 GU/ 7DU Same site as index bleed 6 within 10 days Placebo (n=4) 4 DU re-bleeds (2 others likely re-bleed but too unwell for OGD) 3 within 10 days
35 Secondary Outcomes
36 NICE UGIB 2012
37 Conclusions 2% ACS/PCI patients have acute UGIB & are high risk 90% will have OGD findings Mostly UGI ulceration or inflammatory changes 40% require endo therapy Monitoring & anaesthetic support Blood transfusion targets? Post-procedure monitoring & re-bleed plans
38 Algorithmic approach? PCI/ACS & significant UGIB bleed Resuscitate & stabilise Hb 10g/L Risk assess GBS/ Pre-endo Rockall Anaesthetic support and monitoring Upper GI endoscopy -identify source -dual endo therapy Post endoscopy PPI, anti-platelets, monitoring Close liaison with cardiologists & patient
Simon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor
Simon Everett Consultant Gastroenterologist, SJUH, Leeds if this is what greets you in the morning, you probably need to go see a doctor Presentation Audit data and mortality NICE guidance Risk assessment
Acute Upper Gastro Intestinal (UGI) Bleeding
T Acute Upper Gastro Intestinal (UGI) Bleeding University Hospitals of Leicester NHS Trust Guidelines for Management of Acute Medical Emergencies 1. Has there been a GI bleed? There are also UHL trust
Early Management of the Patient with Acute GI Bleeding
Early Management of the Patient with Acute GI Bleeding Dr Sarah Hearnshaw Consultant Gastroenterologist Newcastle upon Tyne NHS Trust Go through.. Stats Transfusion / resuscitation PPIs When to call us
Acute Gastrointestinal Haemorrhage. Dr Reena Sidhu Consultant Gastroenterologist Hon Sen Lecturer University of Sheffield
Acute Gastrointestinal Haemorrhage Dr Reena Sidhu Consultant Gastroenterologist Hon Sen Lecturer University of Sheffield Scope of Talk Introduction Upper GI haemorrhage-non variceal - Pathology/ risk stratification/management
Upper GI Bleeding. HH Tsai MD FRCP FECG Consultant Gastroenterologist
Upper GI Bleeding HH Tsai MD FRCP FECG Consultant Gastroenterologist Financial Disclosures I have no financial relationship with any manufacturer or supplier of any product mentioned in this talk. GI Audits:
Blood and guts.. Haemodynamics / resuscitation. Haemodynamics / resuscitation. Blood and guts. Dr Jonathan Hoare
Blood and guts. Dr Jonathan Hoare Consultant St Mary s Hospital Dr Jonathan Hoare Consultant St Mary s Hospital, Paddington Blood and guts.. Presentation Initial assessment and management risk stratification
Antiplatelets in cardiac patients with suspected GI bleeding
Antiplatelets in cardiac patients with suspected GI bleeding Acute GI bleeding is a common major medical emergency. In the 2007 UK-wide audit, overall mortality of patients admitted with acute GI bleeding
James Irwin Gastroenterology Department Palmerston North Hospital. Acute Medicine Meeting Hutt Hospital. June 21, 2015
The Management of Acute Upper Gastrointestinal Bleeding James Irwin Gastroenterology Department Palmerston North Hospital Acute Medicine Meeting Hutt Hospital June 21, 2015 Outline Common Definitions and
British Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion
British Society of Gastroenterology UK Com parat ive Audit of Upper Gast roint est inal Bleeding and t he Use of Blood Transfusion Extract December 2007 St. Elsewhere's Hospital National Comparative Audit
Picking up their Pieces: Emergency Management of GI Bleeds
Picking up their Pieces: Emergency Management of GI Bleeds Dr Sean L Preston Consultant Gastroenterologist Stemming the Flow.. Clinical Cases (who s to blame?) Initial assessment and management risk stratification
Turning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient
Turning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient John Greenaway 1 Turning off the tap: Endoscopy Answer the questions Benefits and risks of endoscopy Urgency
Sangrado Gastrointestinal Alto Upper GI Bleeding
Sangrado Gastrointestinal Alto Upper GI Bleeding Curso Internacional Retos Clinicos en la Gastroenterologia de Urgencias Asociacion Colombiana de Gastroenterologia 31 de Agosto, 2012 Pereira, Risaralda
Anticoagulants are a contributing factor. Other causes are Mallory-Weiss tears, AV malformations, and malignancy and aorto-enteric fistula.
Upper GI Bleeding EMU2018 Dr. Walter Himmel MD Incidence: In non-cirrhotics, the commonest causes are peptic ulcer disease (50%) followed by erosive gastritis. In cirrhotic patients, variceal bleeding
Early Management of the Patient with Acute GI Bleeding
Early Management of the Patient with Acute GI Bleeding Dr Sarah Hearnshaw Consultant Gastroenterologist Newcastle upon Tyne NHS Trust Go through.. Transfusion / resuscitation Anticoagulants new and old..
Article Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children s Hospital Experience
Article Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children s Hospital Experience Omar Nasher 1, *, David Devadason 2 and Richard J. Stewart 1 1 Department of Paediatric Surgery,
Gastrointestinal bleed- what saves life?
Gastrointestinal bleed- what saves life? Prof Sauid Ishaq Gastroenterologist, DGH BCU, SGU and Fudan University Physician Associates conference Friday 16 February 2018 Reality What is the mortality of
ICU Volume 14 - Issue 2 - Summer Matrix
ICU Volume 14 - Issue 2 - Summer 2014 - Matrix Upper Gastrointestinal Bleeding Authors David Osman, MD Medical Intensive Care Unit Paris-South University Hospitals Assistance Publique-Hôpitaux de Paris
On-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding
On-Call Upper GI Bleeding John R Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Upper Gastrointestinal Bleeding 300,000000 hospitalizations/year
Low risk upper GI bleeding pathway
Low risk upper GI bleeding pathway Background Low risk upper GI bleeding may be safely managed without an emergency admission to NUH following presentation to the ED. NUH uses the Glasgow Blatchford score
Clinical guideline Published: 13 June 2012 nice.org.uk/guidance/cg141
Acute upper gastrointestinal bleeding in over 16s: management Clinical guideline Published: June 2012 nice.org.uk/guidance/cg141 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap. Simon McPherson, Vascular Interventional Radiologist, Leeds
Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap Simon McPherson, Vascular Interventional Radiologist, Leeds Scale UK 100,000 /year Commonest Vascular IR on-call 75% UGIB 65% NVUGIB
Scottish Medicines Consortium
Scottish Medicines Consortium esomeprazole, 40mg vial of powder for solution for intravenous injection or infusion (Nexium I.V. ) No. (578/09) AstraZeneca 09 October 2009 The Scottish Medicines Consortium
UGI BLEED. Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore
UGI BLEED Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore Outline UGI bleed: etiology and presentation Management: Non variceal / variceal bleed
UGI Bleeding: Impact and Outcome of Early Endoscopy at the Referral Community Hospital ABSTRACT
Original Article Jewsuebpong T THAI J GASTROENTEROL 2008 Vol. 9 No. 2 May - Aug. 2008 67 UGI Bleeding: Impact and Outcome of Early Endoscopy at the Referral Community Hospital Jewsuebpong T ABSTRACT Background:
A bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk?
Focus on CME at the University of British Columbia A bleeding ulcer: What can the GP do? By Robert Enns, MD, FRCP Gastrointestinal bleeding is a relatively common disorder affecting thousands of Canadians
Complicated issues in GI bleeding for internists? Nonthalee Pausawasdi, M.D. Faculty of Medicine Siriraj Hospital
Complicated issues in GI bleeding for internists? Nonthalee Pausawasdi, M.D. Faculty of Medicine Siriraj Hospital Complicated issues in GI bleeding; Survey results from internists Optimal resuscitation
Managing acute upper gastrointestinal bleeding in the acute assessment unit
Clinical Medicine, Vol, No : 589 59 Managing acute upper gastrointestinal bleeding in the acute assessment unit Lotte Dinesen, SpR in gastroenterology; Martin Benson, consultant gastroenterologist and
Emergency - Upper gastrointestinal haemorrhage
Emergency - Upper gastrointestinal haemorrhage Definitions in upper gastrointestinal (UGI) haemorrhage UGI haemorrhage: bleeding that arises proximal to the ligament of Treitz i.e. from the oesophagus,
Bleeding Prevention in an Era of Expanding Combination Antithrombotic Therapies
Bleeding Prevention in an Era of Expanding Combination Antithrombotic Therapies Muthiah Vaduganathan, MD MPH Cardiovascular Medicine Brigham and Women s Hospital December 8 th, 2017 Disclosures None Key
Upper GI Bleeds. AMU Nurse Teaching Dr Clare Pollard ST6 AIM & GIM
Upper GI Bleeds AMU Nurse Teaching Dr Clare Pollard ST6 AIM & GIM Peptic ulcer disease - GU - DU Talk Plan Important considerations in this group of patients- what you need to know Mallory Weis Tear Other
Nothing to disclose. Annually ~ 300,000 hospitalizations and ~ 20,000 deaths in US*
Gastrointestinal Bleeding Disclosures Nothing to disclose Bennie Ray Upchurch III, MD, FACP, FASGE Clinical Associate Professor of Medicine Division of Gastroenterology, Hepatology & Nutrition The Ohio
NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.
bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.
Guideline for the Management of Upper Gastrointestinal Bleeding in Children
Guideline for the Management of Upper Gastrointestinal Bleeding in Children 1. Introduction Upper gastrointestinal (UGI) bleeding in children poses a challenge to paediatricians and paediatric surgeons.
When to Scope in Lower GI Bleeding: It Must Be Done Now. Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA
When to Scope in Lower GI Bleeding: It Must Be Done Now Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA Outline Epidemiology Overview of available tests Urgent
MANAGING GI BLEEDING IN A COMMUNITY HOSPITAL SETTING DR M. F. M. BRULE
MANAGING GI BLEEDING IN A COMMUNITY HOSPITAL SETTING DR M. F. M. BRULE DISCLOSURES Presenter: Dr Michele Brule Relationships with commercial interests: None OBJECTIVES Assess the severity of GI bleeding
Emergency Surgery Course Graz, March UPPER GI BLEEDING. Carlos Mesquita Coimbra
UPPER GI BLEEDING Carlos Mesquita Coimbra Aim Causes Management Problem Above angle of Treitz Common emergency 1-2/1000 pts 10% rebleeed 1% angioembolization 20% over 60
Guidelines for the Management of Upper gastrointestinal bleeding
Guidelines for the Management of Upper gastrointestinal bleeding By Dr. Sinan Butrus F.I.C.M.S Clinical Standards & Guidelines Kurdistan Board For Medical Specialties Upper gastrointestinal bleeding is
Optimal Duration and Dose of Antiplatelet Therapy after PCI
Optimal Duration and Dose of Antiplatelet Therapy after PCI Donghoon Choi, MD, PhD Severance Cardiovascular Center Yonsei University College of Medicine Optimal Duration of Antiplatelet Therapy after PCI
Definitive Surgical Treatment When Endoscopy Fails. Erik Peltz D.O. Resident Debate February 26 th 2007 University of Colorado Dept.
Nonvariceal Gastrointestinal Hemorrhage: Definitive Surgical Treatment When Endoscopy Fails Erik Peltz D.O. Resident Debate February 26 th 2007 University of Colorado Dept. Surgery Non-Variceal Upper GI
Improved risk assessment in upper GI bleeding
EDITORIAL Improved risk assessment in upper GI bleeding Acute upper GI bleeding is the most common GI emergency, with a reported incidence in various epidemiological studies ranging from 50 to over 100
New Techniques. Incidence of Peptic Ulcer. Changing. Contents - with an emphasis on peptic ulcer bleeding. Cause of death in peptic ulcer bleeding
Contents - with an emphasis on peptic ulcer bleeding New Techniques in Treating GI Bleeding Incidence and cause of death Acid suppression Endoscopic hemostasis Prediction of rebleeding and death Second
Hemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy
Original article Hemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy Authors Yeong Jin Kim, Jun Chul Park, Eun Hye Kim, Sung Kwan Shin,
Note No nausea or vomiting before collapse increases the risk of an arrhythmia. A
174 40 TACHYCARDIAS SYMPTOMS AND SIGNS Think about cardiac arrhythmias in patients with: palpitations D dyspnoea B chest pain D dizziness or syncope D cardiac arrest. D Ask about: any nausea or vomiting
Risk of GI Bleeding and Use of PPIs
Risk of GI Bleeding and Use of PPIs ESC 211 August 28, 211 Marc S. Sabatine, MD, MPH Chairman, TIMI Study Group Associate Physician, Cardiovascular Division, BWH Associate Professor of Medicine, Harvard
Clopidogrel Use in ACS and PCI: Clinical Trial Update
Clopidogrel Use in ACS and PCI: Clinical Trial Update Matthew J. Price MD Director, Cardiac Catheterization Laboratory, Scripps Clinic, La Jolla, CA Assistant Professor, Scripps Translational Science Institute
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Gastrointestinal bleeding: the management of acute upper gastrointestinal bleeding 1.1 Short title Acute upper GI bleeding
Upper Gastrointestinal Bleeding Score for Differentiating Variceal and Nonvariceal Upper Gastrointestinal Bleeding ABSTRACT
44 Original Article Upper Gastrointestinal Bleeding Score for Differentiating Variceal and Jaroon Chasawat Varayu Prachayakul Supot Pongprasobchai ABSTRACT Background: Upper gastrointestinal bleeding (UGIB)
Clopidogrel vs New Antiplatelet Therapy (Prasugrel) Adnan Kastrati, MD Deutsches Herzzentrum, Technische Universität München, Germany
Clopidogrel vs New Antiplatelet Therapy () Adnan Kastrati, MD Deutsches Herzzentrum, Technische Universität München, Germany Seoul, April 3, 21 Dual Antiplatelet Therapy for Stenting MACE, % 12 1 8 6 In
Management of acute upper GI bleeding
BJA Education, 17 (4): 117 123 (2017) Matrix reference 1A01, 2A05, 3C00 doi: 10.1093/bjaed/mkw054 Advance Access Publication Date: 10 December 2016 Management of acute upper GI bleeding Ingi Adel Salah
Upper gastrointestinal bleeding in children. Nguyễn Diệu Vinh, MD Department of Gastroenterology
Upper gastrointestinal bleeding in children Nguyễn Diệu Vinh, MD Department of Gastroenterology INTRODUCTION Upper gastrointestinal (UGI) bleeding : arising proximal to the ligament of Treitz in the distal
Red Cell Transfusion triggers: A moving target When, who, and how much?
Red Cell Transfusion triggers: A moving target When, who, and how much? Tim Walsh Professor of Critical Care, Edinburgh University A transfusion threshold of 70 g/l or below, with a target Hb range of
MANAGEMENT OF DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT OF DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD) Routine endoscopic investigation of patients of any age, presenting with dyspepsia
CV Update Guidelines & Debates Royal Pharmaceutical Society, Great Britain Barnet 27/01/09
CV Update Guidelines & Debates Royal Pharmaceutical Society, Great Britain Barnet 27/01/09 Dr Ameet Bakhai, FRCP Cardiologist, Clinical Trials, Health Economics Barnet & Chase Farm NHS Trust Royal Free
Gastrointestinal Hemorrhage
Gastrointestinal Hemorrhage Quality Measures Length of Stay RCC Costs per Case Mortality Rate Eligible Readmission Within 30 Days. Critical Event(s) Evaluation Phase/Acute Phase Baseline pain assessment
Lei Gu 1, Fei Xu 2,3 and Jie Yuan 1*
Gu et al. BMC Gastroenterology (2018) 18:98 https://doi.org/10.1186/s12876-018-0828-5 RESEARCH ARTICLE Open Access Comparison of AIMS65, Glasgow Blatchford and Rockall scoring approaches in predicting
Rockall risk score in predicting 30 days non-variceal upper gastrointestinal rebleeding in a Malaysian population
ORIGINAL ARTICLE Rockall risk score in predicting 30 days non-variceal upper gastrointestinal rebleeding in a Malaysian population Henry Tan Chor Lip, MD 1,2, Heah Hsin Tak, MMed Surg 1, Tan Jih Huei,
Do PPIs Reduce Bleeding in ICU? Revisiting Stress Ulcer Prophylaxis. Deborah Cook
Do PPIs Reduce Bleeding in ICU? Revisiting Stress Ulcer Prophylaxis Deborah Cook ICU-Acquired Upper GI Bleeding Case series of 300 ICU patients describing stressrelated erosive syndrome Frequent Fatal
Multidisciplinary management strategies for acute non-variceal upper gastrointestinal bleeding
Review Multidisciplinary management strategies for acute non-variceal upper gastrointestinal bleeding Y. Lu 1, R. Loffroy 3,J.Y.W.Lau 4 and A. Barkun 1,2 1 Division of Gastroenterology and 2 Department
Gastrointestinal bleeding and life threating conditions in surgery
CM w Bydgoszczy UMK w Toruniu Włodzimierz Gniłka Gastrointestinal bleeding and life threating conditions in surgery Gastrointestinal hemorrhage Upper GI hemorrhage proximal to the Treitz ligament (accounts
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding (Review)
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding (Review) Sreedharan A, Martin J, Leontiadis GI, Dorward S, Howden CW, Forman D, Moayyedi P This
Stress Ulcer Prophylaxis In The ICU. Scott W. Wolf Anesthesiology Critical Care Medicine
Stress Ulcer Prophylaxis In The ICU Scott W. Wolf Anesthesiology Critical Care Medicine Some history Stress Ulceration described in ICU patients as long as 45 years ago Patients had a constellation of
MANAGEMENT OF NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING: A REVIEW
MANAGEMENT OF NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING: A REVIEW Dr. Laxmi Narayan Goit 1 * and Prof. Dr. Yang Shaning 2 1Department of Cardiology, the first affiliated Hospital of Yangtze University,
Early clinical experience of the safety and efficacy of EndoClot in the management of non-variceal upper gastrointestinal bleeding
E605 Early clinical experience of the safety and efficacy of EndoClot in the management of non-variceal upper gastrointestinal bleeding Authors Institution Sabina Beg, Ibrahim Al-Bakir, Meha Bhuva, Jay
Helicobacter pylori. Objectives. Upper Gastrointestinal Bleeding Peptic Ulcer Disease
Upper Gastrointestinal Bleeding Peptic Ulcer Disease Pharmacotherapy Issues in Acute Management and Secondary Prevention Peter J. Zed, B.Sc., B.Sc.(Pharm), Pharm.D. Pharmacotherapeutic Specialist - Emergency
Approach to upper gastrointestinal bleeding
Approach to upper gastrointestinal bleeding Upper GI bleeding is the most common complication of peptic ulceration and portal hypertension. S R Thomson, ChM, FRCS (Edin&Eng) Professor and Head of Department,
Kathy P. Bull-Henry, MD, FACG Dr. Bull-Henry has indicated no relevant financial relationships. Don t Waste Time With No Chance to See
Don t Waste Time with No Chance to See Kathy P. Bull-Henry, MD, FACG Dr. Bull-Henry has indicated no relevant financial relationships. Don t Waste Time With No Chance to See Kathy Bull-Henry, MD, FACG
Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment)
Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Amid Keshavarzi, MD UCHSC Grand Round 3/20/2006 Department of Surgery Introduction Epidemiology Pathophysiology Clinical manifestation
Assessment of short term prognosis in patients with upper gastrointestinal bleeding
Medical Communication Biosci. Biotech. Res. Comm. 10(3): 341-345 (2017) Assessment of short term prognosis in patients with upper gastrointestinal bleeding Saeid Hashemieh (MD) 1, Ramtin Moradi (MD) 2,
Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage
ORIGINAL ARTICLE Clin Endosc 2015;48:380-384 http://dx.doi.org/10.5946/ce.2015.48.5.380 Print ISSN 2234-2400 On-line ISSN 2234-2443 Open Access Clinical Application of AIMS65 Scores to Predict Outcomes
Prasugrel vs. Ticagrelor in ACS/PCI Which one to choose? V. Voudris MD FESC FACC 2 nd Cardiology Division Onassis Cardiac Surgery Center
Prasugrel vs. Ticagrelor in ACS/PCI Which one to choose? V. Voudris MD FESC FACC 2 nd Cardiology Division Onassis Cardiac Surgery Center Hospitalizations in the U.S. Due to ACS Acute Coronary Syndromes
Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding
ORIGINAL ARTICLE Korean J Intern Med 2016;31:54-64 Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding Yoo Jin Lee 1,*, Bo Ram Min 1,*, Eun Soo Kim
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding (Review)
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding (Review) Sreedharan A, Martin J, Leontiadis GI, Dorward S, Howden CW, Forman D, Moayyedi P This
When to Refer for OGD and the Work Up of Upper GI Malignancies
When to Refer for OGD and the Work Up of Upper GI Malignancies Dr Hong Qiantai Registrar, Department of Surgery GP Forum 27 May 2017 38 year old female, non-smoker, BMI 29 Works as investment banker Presents
ACG Clinical Guideline: Management of Patients with Ulcer Bleeding
ACG Clinical Guideline: Management of Patients with Ulcer Bleeding Loren Laine, MD 1,2 and Dennis M. Jensen, MD 3 5 1 Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut,
Management of acute upper gastrointestinal bleeding
1 Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 OSF, UK 2 Section of Digestive Diseases, Yale School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Connecticut,
Supplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Oakland K, Jairath V, Uberoi R, et al. Derivation
T he aim of a scheduled second endoscopy is to detect and
1403 STOMACH Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial P W Y Chiu, C Y W Lam, S W Lee, K H Kwong, S H Lam, D T Y Lee, S P Y Kwok... See
Update on the Management of Anticoagulants and Endoscopy. ACG Eastern Postgraduate Course, Washington, DC June 25, 2016
Update on the Management of Anticoagulants and Endoscopy ACG Eastern Postgraduate Course, Washington, DC June 25, 2016 Vivek Kaul, MD, FACG Segal-Watson Professor of Medicine Chief of Gastroenterology
The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department
-8/5/7/5/6-67 Revista Española de Enfermedades Digestivas Copyright 5 Arán Ediciones, S. L. Rev Esp Enferm Dig (Madrid Vol. 7, N.º 5, pp. 6-67, 5 ORIGINAL PAPERS The predictive capacity of the Glasgow-Blatchford
Surveying the Landscape of Oral Antiplatelet Therapy in Acute Coronary Syndrome Management
Surveying the Landscape of Oral Antiplatelet Therapy in Acute Coronary Syndrome Management Jeffrey S Berger, MD, MS Assistant Professor of Medicine and Surgery Director of Cardiovascular Thrombosis Disclosures
CrackCast Episode 30 GI Bleeding
CrackCast Episode 30 GI Bleeding Episode overview: 1) List 5 causes of UGIB in adults and pediatrics 2) List 5 causes of LGIB in adults and pediatrics 3) Describe your management approach for severe UGIB
Spectrum of upper gastrointestinal bleed in patients with cirrhosis of liver
Journal of College of Medical Sciences-Nepal, Vol-13, No 3, July-Sept 017 ISSN: 2091-0657 (Print); 2091-0673 (Online) Open Access Spectrum of upper gastrointestinal bleed in patients with cirrhosis of
haemorrhage Risk assessment after acute upper gastrointestinal important factors influencing the outcome of shock, diagnosis, admission haemoglobin
316 Gut 1996; 38: 316-321 Risk assessment after acute upper gastrointestinal haemorrhage Correspondence to: Mr T Rockall, The Surgical Epidemiology and Audit Unit, The Royal College of Surgeons of England,
Efficacy of dual therapy (APC & Adrenaline) in high risk peptic ulcer bleeding
ISSN: 2347-3215 Volume 2 Number 7 (July-2014) pp. 203-208 www.ijcrar.com Efficacy of dual therapy (APC & Adrenaline) in high risk peptic ulcer bleeding Saleh Azad Bakht*, Manouchehr Khoshbaten, Kamal Bostani,
Dr Ben Edwards Consultant Anaesthetist Sheffield Teaching Hospitals
Dr Ben Edwards Consultant Anaesthetist Sheffield Teaching Hospitals 70-75,000 #NOF per annum (costs 2 billion) 10% die within 1 month 33% die within 1 year Operative delays >48hs more than doubles risk
Clinical Endoscopic Parameters of Upper Gastrointestinal Bleeding Hemal Shah, 1 T. P. Manohar 2
Original Article Clinical Endoscopic Parameters of Upper Gastrointestinal Bleeding Hemal Shah, 1 T. P. Manohar 2 1 Junior Resident 2 Associate Professor,Department of Medicine, N.K.P. Salve Institute Of
Management of Dyspepsia
MPharm Programme Management of Dyspepsia Slide 1 of 28 Learning Objectives Understand the principles and wider implications underpinning evidence based therapeutics in the key clinical specialities Objectively
Acute Upper Gastrointestinal Hemorrhage Surgical Perspective. Dr.J.H.Barnard Dept. of Surgery PAH
Acute Upper Gastrointestinal Hemorrhage Surgical Perspective Dr.J.H.Barnard Dept. of Surgery PAH Introduction: AGH is a leading cause of admissions into ICU. Overall mortality 5-12%, but increases to 40%
Patients on anticoagulant or antiplatelet therapy undergoing elective endoscopic procedures
This is an official Northern Trust policy and should not be edited in any way Patients on anticoagulant or antiplatelet therapy undergoing elective endoscopic procedures Reference Number: NHSCT/11/454
Alister Jones Patient Blood Management Practitioner NHS Blood and Transplant. Lab Matters study day Oake Manor, Taunton, 8 th July 2015
Alister Jones Patient Blood Management Practitioner NHS Blood and Transplant Lab Matters study day Oake Manor, Taunton, 8 th July 2015 NPSA Rapid Response Report 2010 Transfusion of blood and blood components
Proton Pump Inhibitors- Questions & Controversies. Farah Kablaoui, PharmD, BCPS, BCCCP
Proton Pump Inhibitors- Questions & Controversies Farah Kablaoui, PharmD, BCPS, BCCCP Disclosure Information Proton Pump Inhibitors: Questions & Controversies Farah Kablaoui I have no financial relationship
GASTROINESTINAL BLEEDING. Dr.Ammar I. Abdul-Latif
GASTROINESTINAL BLEEDING Dr.Ammar I. Abdul-Latif CLASSIFICATION OF G.I.BLEEDING GIB Appearance Acuity Site Apparent Acute Upper Obscure Chronic Lower UPPER&LOWER G.I.BLEEDING CAUSES OF UPPER G.I. BLEEDING
Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy
ORIGINAL ARTICLE Korean J Intern Med 2016;31:470-478 Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy Dong-Won Ahn 1,2,*, Young Soo Park 1,3,*,
SECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION
SECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION DEMOGRAPHIC INFORMATION Given name Family name Date of birth Consent date Gender Female Male Date of surgery INCLUSION & EXCLUSION CRITERIA YES
Introduction. Methods. Introduction. Methods. Methods. Journal reading Transfusion Strategies for Acute Upper Gastrointestinal Bleeding
Journal reading Transfusion Strategies for Acute Upper Gastrointestinal Bleeding N Engl J Med 2013;368:11-21. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Càndid Villanueva, M.D., Alan Colomo,
Peri-Endoscopic Period. Neena S. Abraham MD, MSCE, FACG
How to Manage Antiplatelet Therapy in the Peri-Endoscopic Period Neena S. Abraham MD, MSCE, FACG Michael E. DeBakey Veterans Affairs Medical Center Sections of Gastroenterology & Health Services Research
The Bleeding Jehovah s Witness: A Nightmare Scenario?
The Bleeding Jehovah s Witness: A Nightmare Scenario? David Smith, Bristol Hospital Liaison Committee for Jehovah s Witnesses SW RTC: Bleeding in the Medical Patient - 21 February 2018 Jehovah s Witnesses
Sheffield guidelines for the use of antiplatelets in the prevention and treatment of cardiovascular disease (October 2017)
Sheffield guidelines f the use of antiplatelets in the prevention and treatment of cardiovascular disease (October 2017) Approved by Sheffield Area Prescribing Committee and Sheffield Teaching Hospitals
The Challenge. Warfarin or Novel Oral Anti-Coagulants in the PCI patient? Anticoagulation/Stroke
Anticoagulation/Stroke Warfarin v new oral anticoagulants post PCI Warfarin or Novel Oral Anti-Coagulants in the PCI patient? Gerry Devlin Chairs: Phillip Matsis & Tony Scott Gerry Devlin Honorary Associate