Talk:Upper gastrointestinal bleeding

Latest comment: 10 years ago by Jfdwolff in topic Updating

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Dear User:195.92.198.72, you inserted:

Usualy a 'bleed' can be controlled with the use of [infused] China [Tea]. Unfortunatly this sometimes causes' [chaffing] to the [inner thigh].

Firstly, you didn't wikify the links properly (double bracket). Secondly, it sounds rather remote and I've personally never heard of this remarkable treatment. When you reinsert it, would you please provide a reference? Jfdwolff 19:30, 21 Mar 2004 (UTC)

Rockall score

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PMID 8675081 - Rockall score. 62.6.139.11 15:18, 29 June 2006 (UTC)Reply

Some needs (limited)

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  • Literature (Laine et al, Lau et al)
  • Laine classification of PUD
  • Frequency of causes
  • Definitions of GI hemorrhage (Obscure occult vs Obscure overt)
  • Epidemiology/outcomes data
  • History of therapy

-- Samir धर्म 06:07, 4 September 2006 (UTC)Reply

Clipping/thermocoagulation vs injection

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Non-variceal bleeders do better after clipping or thermocoagulation than injection, but there is no mortality difference - doi:10.1136/gut.2007.123976 JFW | T@lk 23:43, 15 September 2007 (UTC)Reply

Review

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Tranexamic acid is often used in severe bleeding. Out of the castle of EBM in Denmark comes this review doi:10.1111/j.1365-2036.2008.03638.x - basically the studies show benefit but the methodology is weak. Great. What else is new in gastro trials? JFW | T@lk 23:47, 4 February 2008 (UTC)Reply

HALT-IT is going to look at tranexamic acid properly. JFW | T@lk 12:19, 24 December 2013 (UTC)Reply

IV PPI

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Many emergency departments (especially here in the UK) commence upper GI bleeders on IV PPI by boluses. Has no evidence behind it. Only an IV bolus 80 mg followed by 8 mg/h as an infusion has been shown to reduce the need for endoscopic therapy, but without reducing the rebleeding risk or mortality. Only studied in people not taking aspirin. Quite expensive - is it cost-effective?http://content.nejm.org/cgi/content/full/356/16/1631 JFW | T@lk 05:39, 23 May 2008 (UTC)Reply

doi:10.1111/j.1572-0241.2008.01865.x large observationsal study from Italy. Mortality is low, mainly in the elderly with comorbidities (we know, Rockall showed us that) and in those who failed endoscopic treatment. Only 10% who died seem to have died directly as a result of bleeding. JFW | T@lk 21:47, 18 June 2008 (UTC)Reply

Updating

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At the risk of starting something I won't be able to finish, this article needs a lot of improvement. There's been a lot of change in recent years with regards to risk stratification. doi:10.1001/jama.2012.253 looks like a great source. We need to provide more Cochrane-authored reviews, knowing how poor the evidence base is in many GI disorders.

For now I've just updated the introduction (with slightly outdated epidemiology figures until I can find something better), but the other sections need excellent sourcing. Certainly not instructions for readers to look up an article in some web archive. JFW | T@lk 08:40, 25 December 2013 (UTC)Reply

We also have National Institute for Health and Clinical Excellence. Clinical guideline 141: Acute upper GI bleeding. London, 2012.
ASGE doi:10.1016/j.gie.2009.11.026 and doi:10.1016/j.gie.2012.02.033
We might need to spare a thought for bleeding of obscure origin (iron deficiency anaemia without an obvious bleeding source or haematemesis and/or melaena with normal endoscopy). After all, bleeding is bleeding even if occult. JFW | T@lk 08:55, 25 December 2013 (UTC)Reply