Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding
Authors: Alan Barkun, Marc Bardou, John K. Marshall
Journal: Annals of Internal Medicine (2004)

Letters6 July 2004Managing Patients with Nonvariceal Upper Gastrointestinal BleedingAlan Barkun, MD, MSc, Marc Bardou, MD, PhD, and John K. Marshall, MD, MScAlan Barkun, MD, MScFrom McGill University, Montreal, Quebec H3G 1A4, Canada; Faculté de Médecine, 21079 Dijon Cedex, France; and McMaster University, Hamilton, Ontario L8N 3Z5, Canada.Search for more papers by this author, Marc Bardou, MD, PhDFrom McGill University, Montreal, Quebec H3G 1A4, Canada; Faculté de Médecine, 21079 Dijon Cedex, France; and McMaster University, Hamilton, Ontario L8N 3Z5, Canada.Search for more papers by this author, and John K. Marshall, MD, MScFrom McGill University, Montreal, Quebec H3G 1A4, Canada; Faculté de Médecine, 21079 Dijon Cedex, France; and McMaster University, Hamilton, Ontario L8N 3Z5, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-1-200407060-00030 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:In response to Dr. Andriulli and colleagues, the efficacy of high-dose intravenous proton-pump inhibition after successful endoscopic hemostasis has been clearly established by randomized trials in Scandinavia and Asia; recent meta-analyses discussed in the Conference's recommendations; and, in subgroup analysis, another more recent international trial (1). We cited the study by Udd and colleagues (2) but did not consider it further because it included patients with low-risk endoscopic lesions, a subgroup at low risk for rebleeding that was not targeted by that recommendation. We purposefully excluded studies not published in full (except for meta-analyses performed for the Conference) ...References1. van Rensburg CJ, Racz I, Bailey RJ, Barkun A, Feu F, Ahrens H, et al. Prevention of peptic ulcer rebleeding using continuous infusion of pantoprazole vs ranitidine: a multicenter, multinational, randomized, double-blind, parallel-group comparison [Abstract]. Can J Gastroenterol. 2004 [In press]. Google Scholar2. Udd M, Miettinen P, Palmu A, Heikkinen M, Janatuinen E, Pasanen P, et al . Regular-dose versus high-dose omeprazole in peptic ulcer bleeding: a prospective randomized double-blind study. Scand J Gastroenterol. 2001;36:1332-8. [PMID: 11761026] CrossrefMedlineGoogle Scholar3. Barkun AN, Sabbah S, Enns R, Armstrong, D, Gregor J, Fedorak RN, et al. The Canadian registry on non-variceal upper gastrointestinal bleeding and endoscopy (RUGBE): endoscopic hemostasis and proton-pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol. 2004 [In press]. Google Scholar4. Hasselgren G, Lind T, Lundell L, Aadland E, Efskind P, Falk A, et al . Continuous intravenous infusion of omeprazole in elderly patients with peptic ulcer bleeding. Results of a placebo-controlled multicenter study. Scand J Gastroenterol. 1997;32:328-33. [PMID: 9140154] CrossrefMedlineGoogle Scholar5. Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, et al . Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000;343:310-6. [PMID: 10922420] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From McGill University, Montreal, Quebec H3G 1A4, Canada; Faculté de Médecine, 21079 Dijon Cedex, France; and McMaster University, Hamilton, Ontario L8N 3Z5, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoConsensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Alan Barkun , Marc Bardou , John K. Marshall , and Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Angelo Andriulli , Vito Annese , and Gioacchino Leandro Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Kenneth M. Kessler Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Mohammed S. Khuroo and Mehnaaz S. Khuroo Metrics 6 July 2004Volume 141, Issue 1Page: 80-81KeywordsDeath ratesEffective doseEndoscopyExerciseHemorrhageHemostasisLesionsMortalityRandomized trialsSafety ePublished: 6 July 2004 Issue Published: 6 July 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...