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Bleeding in any segment of the gastrointestinal tract.

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Antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease

We reviewed antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Existing trials, of poor quality, indicate that antibiotic prophylaxis reduces spontaneous bacterial peritonitis among cirrhotic patients with ascites and no gastrointestinal bleeding

Spontaneous bacterial peritonitis (infection and inflammation of the membrane lining the abdominal cavity) is a frequent complication among cirrhotic patients (patients with end‐stage liver disease marked by irreversible scarring of liver tissue) and is associated with significant morbidity and mortality. Selective intestinal decontamination, employing antibiotics, is a proposed prophylactic (preventive) measure. This systematic review of randomised clinical trials assesses whether antibiotic prophylaxis prevents spontaneous bacterial peritonitis and mortality among cirrhotic patients with ascites (excess fluid in the abdominal cavity) and no gastrointestinal bleeding. Nine trials are included in the review. The pooled rates of spontaneous bacterial peritonitis and mortality indicate that antibiotic prophylaxis reduces both. There are very few reports of adverse events. Reviewing these trials, we found poor methodology, evidence suggesting publication bias, and limited follow‐up periods. Thus, the recommendation to prescribe prophylactic antibiotics to cirrhotic patients without gastrointestinal bleeding is hampered by quality of the trials that generated the data. Due to potential hazards, both to society as a whole and the patients, as individuals, before antibiotic prophylaxis can be confidently recommended, trials of better design, well reported, and of longer follow‐up are required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Vitamin K for upper gastrointestinal bleeding in people with acute or chronic liver diseases

We reviewed vitamin K for upper gastrointestinal bleeding in people with acute liver disease (that is, loss of normal liver functions which occurs in days or weeks; most often, people do not have a pre‐existing liver disease) or chronic liver disease (that is, progressive destruction of normal liver functions, usually associated with fibrotic regeneration of the liver tissue).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding

Bleeding from lesions in the oesophagus, stomach or duodenum is a common medical emergency. Research has suggested that reducing the amount of acid in the stomach may help to control the bleeding, but it is unknown if early initiation of such treatment (that is, before endoscopic diagnosis) is beneficial for patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Recombinant human activated factor VII for upper gastrointestinal bleeding in patients with liver diseases

People with liver disease have an increased risk of upper gastrointestinal bleeding. Upper gastrointestinal bleeding is a frequent cause of morbidity and mortality in this population group. Due to severe liver damage, these people acquire coagulopathy (a bleeding disorder). Therefore, one of the approaches used for treating upper gastrointestinal bleeding is recombinant human activated factor VII, which is identical in structure and activity to human factor VII. The review includes two randomised clinical trials with 493 participants. The risk of bias was low. Both trials compared recombinant human activated factor VII with placebo. The meta‐analysis showed that the recombinant human activated factor VII does not seem to reduce mortality in patients with liver disease and suffering from upper gastrointestinal bleeding, irrespective of the grade of liver damage. The current evidence is insufficient to support or reject recombinant human activated factor VII for these patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antibiotic prophylaxis for prevention of bacterial infections and death in cirrhotic patients with upper gastrointestinal bleeding

Patients with liver cirrhosis have an impaired immune response. Often, liver cirrhosis patients experience complications from portal hypertension, such as gastroesophageal varices. These varices can bleed, increasing the risk of infection and death in a short period of time, despite proper endoscopic management. Patients who develop bacterial infections during hospitalisation for gastroesophageal haemorrhage are at increased risk of dying. Twelve trials (1241 patients) assessing several antibiotic prophylaxis regimens versus no intervention or placebo were analysed, showing that antibiotic prophylaxis successfully reduced the incidence of bacterial infections. Antibiotic prophylaxis was also associated with a reduction in mortality, mortality from bacterial infections, rebleeding rate, and days of hospitalisation. The prophylactic treatment was not associated with important adverse effects. Five trials (650 patients) assessed one antibiotic regimen compared with another. All antibiotic regimens provided similar benefits and none seemed superior. Thus, to this point there is no evidence to recommend one specific antibiotic regimen over the other. All trials analysed were subject to bias; thus, results should be interpreted carefully.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Red blood cell transfusion for the management of severe upper gastrointestinal bleeding

Bleeding in the upper gastrointestinal tract is common, affecting up to 1 in 1000 adults per year. It leads to death in 10% to 30% of cases, depending on whether patients are admitted with bleeding or bleed whilst in hospital with something else. Patients present with vomiting of fresh or partially digested blood, or with the passage of digested blood from the bowel (melaena). They may also present with symptoms associated with low blood pressure (which can occur secondary to rapid haemorrhage), or with symptoms of anaemia. Red blood cells may be transfused to patients to improve the blood pressure, haemoglobin concentration, or both, before the cause of the bleeding is identified and treated, usually with upper gastrointestinal endoscopy. Patients may also receive a transfusion after endoscopy to correct the haemoglobin concentration once the haemorrhage has been controlled. It is possible that blood transfusion (which has some serious potential adverse effects) may not always improve the patients' condition and may even make the bleeding worse.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Tranexamic acid, an agent that promotes blood clotting, for serious or uncontrolled upper gastrointestinal bleeding

Upper gastrointestinal bleeding is a common reason for emergency hospital admission. The prognosis is serious. Some patients may die as the result of uncontrolled bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Continuous versus Intermittent Intravenous Pantoprazole for Acute Gastrointestinal Bleeding: A Review of the Clinical Effectiveness and Guidelines [Internet]

The gastrointestinal (GI) tract stretches from the mouth to the anus and gastrointestinal bleeding describes any bleeding that starts in the GI tract. Acute GI bleeding refers to the passage of a clinically significant amount of blood (i.e., the passage of more than a scant amount of blood) Acute bleeding in the upper part of the GI tract often presents with hematemesis (i.e., vomiting of blood or coffee-ground-like material) and/or melena (i.e., black, tarry stools). Patients with acute bleeding in the lower part of the GI tract often present with hematochezia (i.e., bright red blood in the stool). Acute GI bleeding represents a serious medical emergency that can result in death. For example, the mortality rate associated with acute lower GI bleeding is two to four percent.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: May 1, 2015
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Fasting for haemostasis in children with gastrointestinal bleeding

To determine the effects and safety of fasting for haemostasis in children with gastrointestinal bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Acute Upper Gastrointestinal Bleeding: Management

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.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2012
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Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding

Upper gastrointestinal (UGI) haemorrhage is a major cause of morbidity, mortality and medical care costs, with peptic ulcer (PU) being the most frequent source of bleeding.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2007

Double balloon enteroscopy vs capsule endoscopy for obscure gastrointestinal bleeding: a meta-analysis

Bibliographic details: Wang BQ, Sun GB, Lou WH, Nan SS, Zhang BQ.  Double balloon enteroscopy vs capsule endoscopy for obscure gastrointestinal bleeding: a meta-analysis. World Chinese Journal of Digestology 2013; 21(35): 4060-4065

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Cirrhosis in Over 16s: Assessment and Management

The guideline covers the identification and assessment of suspected cirrhosis, monitoring to detect complications and management of complications such as ascites and hepatorenal syndrome and referral for tertiary care.

NICE Guideline - National Guideline Centre (UK).

Version: July 2016
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Erythromycin infusion prior to emergency endoscopy for acute upper gastrointestinal bleeding: a systematic review

Bibliographic details: Zhou J, He JD, Ouyang XB, Wang YP.  Erythromycin infusion prior to emergency endoscopy for acute upper gastrointestinal bleeding: a systematic review. World Chinese Journal of Digestology 2009; 17(31): 3273-3277

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Evidence to establish the beneficial and harmful effects of antacids for preventing oesophagogastric variceal bleeding and bleeding in cirrhotic patients is lacking

Randomised trials with antacids for preventing oesophagogastric variceal bleeding and bleeding in cirrhotic patients could not be found. Valid evidence for or against the use of antacids for preventing oesophagogastric variceal bleeding and bleeding in cirrhotic patients is lacking.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities [Internet]

The purpose of this project was to provide national guidance on the optimal use of 99mTc during a situation of reduced supply. To accomplish this, our objective at CADTH was:

Optimal Use Report - Canadian Agency for Drugs and Technologies in Health.

Version: 2012
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Pre-Endoscopic Intravenous Proton Pump Inhibitors for Emergency Department Patients with Upper Gastrointestinal Bleeds: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines [Internet]

The purpose of this report is to review the clinical efficacy of pre-endoscopic intravenous proton pump inhibitors (PPI) for patients with upper gastrointestinal bleeding (UGIB) and to review the evidence-based guidelines regarding the use of proton pump inhibitors before endoscopy in patients with UGIB.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: February 5, 2016
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High‐dose corticosteroids in heart surgery

During heart surgery, high doses of corticosteroids aiming to reduce inflammation are often administered. This practice, however, is controversial since there is no evidence available to show clear benefits. Moreover, corticosteroids have the potential of important side‐effects. The aim of this meta‐analysis was to summarize (pool) data from studies on this subject and to estimate the effect of corticosteroid administration on the risk of major complications (death, heart infarction, lung problems) following heart surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Cilostazol versus aspirin for secondary prevention of vascular events after a stroke of arterial origin

Stroke is a public health problem. As lower and middle income countries make rapid economic progress they face the additional health burden of diseases of affluence like stroke and heart attacks. Unlike heart attack, stroke is a disease caused by more than one mechanism. In Asians, a larger proportion of ischaemic stroke is due to narrowing of the arteries at the base of the brain. Compared to Caucasians, Asians are more likely to have bleeds into their brain matter causing stroke, because of uncontrolled high blood pressure. The medication cilostazol thins the blood by blocking platelet accumulation and appears, from early reports, to be more effective than aspirin in the prevention of stroke, heart attacks and death from vascular causes in patients with stroke. This may be due to its inherent effectiveness, as well as chances of fewer brain bleeds. In this review of two randomised trials involving 3477 participants, we found that cilostazol was more effective for the prevention of stroke, heart attack and death from vascular causes in Asian patients with stroke. In terms of safety, it causes more side effects than aspirin but less serious bleeding in the brain and the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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