Talk:Upper gastrointestinal bleeding

note

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

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

Some needs (limited)

• 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)

Clipping/thermocoagulation vs injection

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)

Review

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)

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

IV PPI

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)

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)

Updating

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)

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)