Management of Nonvariceal Upper Gastrointestinal Bleeding
Authors: Stamatis Karakonstantis
Journal: Annals of Internal Medicine (2020)

Letters21 April 2020Management of Nonvariceal Upper Gastrointestinal BleedingStamatis Karakonstantis, MD, MResStamatis Karakonstantis, MD, MResGeneral Hospital of Heraklion Venizeleio-Pananeio, Heraklion, Greece (S.K.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-0013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read Barkun and colleagues' (1) updated guideline on the management of patients with nonvariceal upper gastrointestinal bleeding with interest. Their recommendation to consider nasogastric tube placement for prognostic purposes has remained unchanged since the first guideline was published in 2003 (2) and is not discussed at all in this update. However, several additional studies on this subject, including a recent systematic review, have been published since 2003 (3). Nasogastric intubation is uncomfortable and painful for patients (4); in the absence of evidence showing any benefit in terms of patient outcomes, the practice of placing a nasogastric ...References1. Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019;171:805-22. [PMID: 31634917] LinkGoogle Scholar2. Barkun A, Bardou M, Marshall JK; Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003;139:843-57. [PMID: 14623622] LinkGoogle Scholar3. Karakonstantis S, Tzagkarakis E, Kalemaki D, et al. Ntiogastric aspiration/lavage in patients with gastrointestinal bleeding: a review of the evidence. Expert Rev Gastroenterol Hepatol. 2018;12:63-72. [PMID: 29098897] CrossrefMedlineGoogle Scholar4. Singer AJ, Richman PB, Kowalska A, et al. Ctiparison of patient and practitioner assessments of pain from commonly performed emergency department procedures. Ann Emerg Med. 1999;33:652-8. [PMID: 10339680] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: General Hospital of Heraklion Venizeleio-Pananeio, Heraklion, Greece (S.K.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-0013. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoManagement of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group Alan N. Barkun , Majid Almadi , Ernst J. Kuipers , Loren Laine , Joseph Sung , Frances Tse , Grigorios I. Leontiadis , Neena S. Abraham , Xavier Calvet , Francis K.L. Chan , James Douketis , Robert Enns , Ian M. Gralnek , Vipul Jairath , Dennis Jensen , James Lau , Gregory Y.H. Lip , Romaric Loffroy , Fauze Maluf-Filho , Andrew C. Meltzer , Nageshwar Reddy , John R. Saltzman , John K. Marshall , and Marc Bardou Management of Nonvariceal Upper Gastrointestinal Bleeding Alan N. Barkun , Loren Laine , Grigorios I. Leontiadis , and Marc Bardou Metrics Cited byStudy on the preventive effect of intravenous esomeprazole in the management of nonvarices upper gastrointestinal bleeding 21 April 2020Volume 172, Issue 8Page: 572-573KeywordsConflicts of interestDisclosureHemorrhageIntubationLesionsMortalityNegative predictive valueSystematic reviewsUlcers ePublished: 21 April 2020 Issue Published: 21 April 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...