Effective treatment of gastrointestinal bleeding: A Synthesis of Findings from 30 Studies

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Original Abstract of the Article

Major Research Findings

Gastrointestinal bleeding is a common medical emergency with high mortality rates. Various treatments are used for gastrointestinal bleeding; however, evidence regarding their effectiveness and safety is inadequate. These studies provide diverse insights into treatment methods for gastrointestinal bleeding and their effects.

For example, the study in 5 investigated whether routine early endoscopy benefits patients with upper gastrointestinal tract bleeding that stops during hospitalization. The results showed no significant differences in overall hospital deaths, recurrence of bleeding, number of transfusions required to treat recurrent bleeding, deaths after recurrent bleeding, or length of hospital stay between the groups who underwent routine endoscopy and those who did not. This research suggests that early endoscopy may not be essential for patients whose gastrointestinal bleeding has stopped.

The study in 25 suggested that a history of gastrointestinal bleeding in patients with atrial fibrillation taking anticoagulants is associated with an increased risk of subsequent major gastrointestinal bleeding, but not stroke, intracranial bleeding, or all-cause mortality.

The study in 13 concluded that it is unclear whether vitamin K administration for gastrointestinal bleeding in patients with liver disease brings benefits or harms. Additionally, it mentioned that patients with liver disease may require additional interventions to stop bleeding.

The study in 4 indicated that the value of early endoscopy in managing acute upper gastrointestinal bleeding is limited. This study found no significant differences in any aspect of patient management or outcome between the groups who received the results of their endoscopy immediately and those who received them after 4 days. Therefore, acute upper gastrointestinal bleeding may naturally resolve without the influence of endoscopy.

The study in 10 explored the potential benefits of administering antifibrinolytic amino acids to patients with liver disease. Patients with liver disease often experience hemostatic abnormalities, such as accelerated fibrinolysis. Therefore, antifibrinolytic amino acids may offer a means to control bleeding.

A network meta-analysis in 21 assessed the value of oral proton pump inhibitors for acute non-variceal upper gastrointestinal bleeding. The study suggested that oral proton pump inhibitors are as effective as intravenous proton pump inhibitors, with a lower risk of re-operation. Therefore, oral proton pump inhibitors may be an effective option for treating acute non-variceal upper gastrointestinal bleeding.

The study in 22 evaluated the efficacy and safety of misoprostol for treating small bowel ulcers and erosions in patients taking low-dose aspirin or NSAIDs who experience obscure gastrointestinal bleeding. The study indicated that misoprostol is effective in treating small bowel ulcers and safe. Therefore, misoprostol may be an effective treatment for patients taking aspirin or NSAIDs who are suspected of having small bowel ulcers causing obscure gastrointestinal bleeding.

The study in 29 discussed the effectiveness of proton pump inhibitors administered before endoscopy in patients with upper gastrointestinal bleeding. The study concluded that the clinical efficacy of proton pump inhibitors administered before endoscopy is inconsistent.

A meta-analysis in 11 compared endoscopic clipping with injection therapy and thermocoagulation for treating non-variceal upper gastrointestinal bleeding. The study suggested that endoscopic clipping reduces the risk of re-bleeding compared to injection therapy alone and decreases the likelihood of requiring surgery. However, there was no significant difference in re-bleeding or the need for surgery when compared to thermocoagulation.

The study in 19 detailed a planned randomized controlled trial to assess the efficacy and safety of tranexamic acid in treating gastrointestinal bleeding. The study highlighted that tranexamic acid might reduce the need for blood transfusions in surgical patients and lower mortality in bleeding trauma patients.

A systematic review in 12 explored the effectiveness of tranexamic acid for upper gastrointestinal bleeding. The review suggested that tranexamic acid might reduce all-cause mortality. However, due to limitations in the internal and external validity of included trials, additional evidence is necessary before treatment recommendations can be made.

The study in 15 compared the effects of an H2-receptor antagonist (famotidine) and a proton pump inhibitor (omeprazole) administered after endoscopic treatment for bleeding gastroduodenal ulcers. The study suggested that administering either famotidine or omeprazole in the early phase (the first 3 days) is effective in stopping bleeding and preventing its recurrence.

The study in 23 provided guidelines for managing acute upper gastrointestinal bleeding. These guidelines suggest that patients identified as very low risk of needing an intervention or death can be managed as outpatients. Furthermore, they outline specific management strategies, such as transfusion criteria, use of medications like proton pump inhibitors and erythromycin, timing of endoscopy, and endoscopic treatment techniques.

The study in 16 investigated the effectiveness of vitamin K administration for upper gastrointestinal bleeding in patients with acute or chronic liver disease. The study concluded that it is unclear whether vitamin K administration benefits or harms patients with acute or chronic liver disease experiencing upper gastrointestinal bleeding.

The study in 2 compared the effectiveness of ranitidine with standard treatment for acute gastrointestinal bleeding. The study suggested that ranitidine might be superior to standard treatment, particularly for patients with gastric ulcers.

A double-blind controlled trial in 3 evaluated whether cimetidine reduces the severity of bleeding and/or the incidence of re-bleeding in patients with acute upper gastrointestinal bleeding. The study failed to demonstrate any significant advantage of using cimetidine routinely in treating acute upper gastrointestinal bleeding.

The study in 8 examined the effectiveness of vitamin K administration for upper gastrointestinal bleeding in patients with liver disease. The study concluded that it is unknown whether vitamin K administration benefits or harms patients with liver disease experiencing upper gastrointestinal bleeding. Additionally, the study suggested that patients with liver disease may require additional interventions to stop bleeding.

A systematic review and meta-analysis in 26 found that resuming anticoagulation after hospitalization for gastrointestinal bleeding is associated with reduced thromboembolic events and improved mortality.

The study in 14 reviewed the efficacy of argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding compared to other endoscopic therapies. The review concluded that there is no evidence suggesting that argon plasma coagulation is superior to other endoscopic therapies. More randomized controlled trials are needed to confirm the effectiveness of this treatment.

The study in 17 explored the effectiveness of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver disease. The study mentioned that patients with liver disease often experience hemostatic abnormalities, such as hyperfibrinolysis. Therefore, antifibrinolytic amino acids may offer a means to control bleeding.

The study in 24 discussed pharmacological interventions for the prevention and treatment of upper gastrointestinal bleeding in newborn infants. The study suggested that pharmacological interventions with a proton pump inhibitor (PPI), H2 receptor antagonist (H2RA), antacid, bismuth, and sucralfate might have effects on both the prevention and treatment of upper gastrointestinal bleeding in infants.

A systematic review and meta-analysis in 27 assessed the effectiveness of tranexamic acid for gastrointestinal bleeding. The review concluded that extended-use high-dose intravenous tranexamic acid does not improve mortality or bleeding outcomes and increases adverse events. Low-dose intravenous/enteral tranexamic acid might be effective in reducing hemorrhage, but more evidence is needed to demonstrate its safety.

The study in 6 evaluated the effectiveness of drug treatment for upper gastrointestinal bleeding. The study found that the amount of blood in the stomach reflects the initial risk, predicts clinical outcomes, and can be reduced by treatment with lansoprazole and tranexamic acid.

A multicenter, non-inferiority, randomized trial in 28 compared a hemostatic powder (TC-325) with standard endoscopic hemostatic treatments for controlling active bleeding from non-variceal upper gastrointestinal causes. The study concluded that TC-325 is not inferior to standard treatment for controlling bleeding from non-variceal upper gastrointestinal causes.

The study in 9 assessed the beneficial and harmful effects of human recombinant activated factor VIIa in patients with liver disease and upper gastrointestinal bleeding. The study found no evidence suggesting that human recombinant activated factor VII reduces the risk of death in patients with liver disease and upper gastrointestinal bleeding. However, the study’s conclusion was based on a single randomized clinical trial. More randomized clinical trials with a low risk of bias are necessary to determine the role of human recombinant activated factor VIIa in clinical practice.

The study in 30 investigated the efficacy and safety of thalidomide for treating recurrent bleeding due to small-intestinal angiodysplasia. The study found that thalidomide reduced bleeding in patients with recurrent bleeding due to small-intestinal angiodysplasia. However, it is important to note that thalidomide can cause adverse events, including constipation, somnolence, limb numbness, peripheral edema, dizziness, and elevated liver enzyme levels.

The study in 20 examined the effectiveness of vitamin K administration for upper gastrointestinal bleeding in patients with acute or chronic liver disease. The study concluded that it is unknown whether vitamin K administration benefits or harms patients with acute or chronic liver disease experiencing upper gastrointestinal bleeding.

The study in 18 provided an overview of endoscopic hemostasis techniques and clinical scenarios. The study highlighted the importance of endoscopy in diagnosing and treating acute gastrointestinal bleeding. Endoscopic hemostasis is a critical technical skill for gastroenterologists, essential for managing acute gastrointestinal hemorrhage and preventing bleeding during high-risk endoscopic procedures. The study emphasized that while there is a lack of strong evidence-based information on endoscopic hemostasis procedures, doctors must be aware of all available devices to choose the most effective option for managing gastrointestinal bleeding.

The study in 7 reviewed the efficacy of argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding compared to other endoscopic therapies. The review concluded that there is no evidence suggesting that argon plasma coagulation is superior to other endoscopic therapies. More randomized controlled trials are needed to confirm the effectiveness of this treatment.

The study in 1 conducted a randomized controlled trial to evaluate the effectiveness of a small bipolar probe for treating bleeding peptic ulcers. The study suggested that the small bipolar probe could stop bleeding or re-bleeding. However, the study also mentioned that the technique is still under development, and further improvements in technology and technique may lead to significant reductions in mortality.

Treatment Summary

The study in 5 concluded that routine early endoscopy may not be necessary for patients whose gastrointestinal bleeding has stopped. If early endoscopy is performed, it should only be done for patients at high risk of re-bleeding or if X-ray films reveal a gastric ulcer or suggest a tumor.

The study in 21 suggested that oral proton pump inhibitors may be an effective option for treating acute non-variceal upper gastrointestinal bleeding.

The study in 22 suggested that misoprostol may be an effective treatment for patients taking aspirin or NSAIDs who are suspected of having small bowel ulcers causing obscure gastrointestinal bleeding.

The study in 11 suggested that endoscopic clipping is an effective treatment for non-variceal upper gastrointestinal bleeding. It appears to reduce the risk of re-bleeding and the likelihood of requiring surgery.

Benefits and Risks

Benefits Summary

These studies highlight the effectiveness of various pharmacological and endoscopic treatment methods for gastrointestinal bleeding. Specifically, proton pump inhibitors, misoprostol, and endoscopic clipping show promise in lowering the risk of re-bleeding and reducing the need for surgery. Tranexamic acid is also indicated to potentially reduce mortality.

Risks Summary

Treating gastrointestinal bleeding carries various risks. Endoscopic treatment methods, in particular, have a potential for complications, including perforation and bleeding. Additionally, pharmacological treatments can cause side effects. Therefore, it is essential to carefully consider the risks and benefits before initiating any treatment.

Comparison Between Studies

Commonalities

These studies employ research methods such as randomized controlled trials and systematic reviews to evaluate the effectiveness and safety of treatments for gastrointestinal bleeding. They all focus on assessing the effectiveness and safety of pharmacological and endoscopic treatment methods for gastrointestinal bleeding.

Differences

These studies differ in their target patient populations, research designs, and evaluation criteria. Direct comparison of research findings is therefore challenging. However, a comprehensive evaluation of these results can lead to a deeper understanding of the effectiveness and safety of treatment methods for gastrointestinal bleeding.

Consistency and Discrepancies in Results

The results of these studies are not always consistent. For example, the effectiveness of tranexamic acid varies across studies. While some studies suggest that tranexamic acid may reduce mortality, others do not confirm this effect. Inconsistencies like this highlight the need for further research.

Application in Real-World Practice

The findings of these studies provide valuable information for selecting treatment options for gastrointestinal bleeding, but they may not be universally applicable to all patients. Various factors must be considered when choosing a treatment method, such as the patient's age, gender, medical condition, drug history, and previous treatment history. Furthermore, making self-treatment decisions or stopping treatment based solely on these research findings is dangerous. Following the guidance of a physician is crucial when treating gastrointestinal bleeding.

Limitations of Current Research

Several limitations exist in these studies, including small sample sizes, design flaws, and insufficient evaluation criteria. When interpreting these results, it is important to consider these limitations.

Future Research Directions

Further research is needed to gain a deeper understanding of the effectiveness and safety of treatment methods for gastrointestinal bleeding. Specifically, randomized controlled trials are needed to confirm the effectiveness of newer treatments, such as tranexamic acid and argon plasma coagulation therapy. Basic research focused on clarifying the causes and mechanisms of gastrointestinal bleeding is also important.

Conclusion

Gastrointestinal bleeding is a serious medical emergency with high mortality rates. Various treatments are available, but evidence for their effectiveness and safety is insufficient. These studies offer valuable insights into treatment methods for gastrointestinal bleeding and their effects. However, it is important to acknowledge limitations in these studies. Following the guidance of a physician is essential for treating gastrointestinal bleeding.

List of Treatments

Endoscopic clipping, proton pump inhibitors, misoprostol, tranexamic acid, argon plasma coagulation therapy, human recombinant activated factor VII (rFVIIa), thalidomide, vitamin K, ranitidine, cimetidine, antifibrinolytic amino acids

Literature analysis of 30 papers
Positive Content
24
Neutral Content
4
Negative Content
2
Article Type
12
7
16
14
30
1.

Controlled trial of small bipolar probe in bleeding peptic ulcers.

Author: O'BrienJ D, DayS J, BurnhamW R

Bleeding control
Mortality
Rebleeding

This study investigated the effectiveness of electrocoagulation using a small bipolar probe in 204 patients with upper gastrointestinal bleeding. Patients were randomly assigned to receive either electrocoagulation or no electrocoagulation. Fewer patients in the treated group experienced continued or recurrent bleeding compared to those who didn't receive electrocoagulation. However, rebleeding and mortality rates were higher in the treated group early in the trial, suggesting that experience with the probe is important. The study suggests that future improvements in technology and technique may further reduce mortality.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Ranitidine in the treatment of acute upper gastrointestinal haemorrhage--a comparative study. Preliminary report.

Author: NowakA, SadlińskiC, GórkaZ, NowakowskaE, RudzkiJ, GibińskiK

Superior to standard treatment

A study of 50 patients with acute gastrointestinal bleeding found that ranitidine treatment was more effective than standard conservative therapy, particularly in patients with gastric ulcers. Ranitidine reduced the need for blood transfusions and led to better endoscopic findings after treatment. The study suggests that ranitidine may be a beneficial addition to the management of acute gastrointestinal bleeding, especially in patients with gastric ulcers.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

3.

Cimetidine and acute upper gastrointestinal bleeding: a double-blind controlled trial.

Author: MeredithC G, KennedyM C, WadeD N, SweetenM V, ByrnesD J, FrommerD J, HennessyW B

No benefit from cimetidine

This study of 88 patients with acute upper gastrointestinal bleeding found that cimetidine did not improve the severity of bleeding or the risk of rebleeding. In fact, more patients in the cimetidine group required surgery for life-threatening bleeding and had rebleeding.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

4.

Limited value of early endoscopy in the management of acute upper gastrointestinal bleeding. Prospective controlled trial.

Author: GrahamD Y

The study found that immediate disclosure of endoscopy results in patients with acute upper gastrointestinal hemorrhage did not significantly affect patient management or outcome.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

5.

Routine early endoscopy in upper-gastrointestinal-tract bleeding: a randomized, controlled trial.

Author: PetersonW L, BarnettC C, SmithH J, AllenM H, CorbettD B

Routine early endoscopy for patients with upper gastrointestinal bleeding that stops during hospitalization did not improve outcomes. There were no significant differences in death rates, recurrence of bleeding, number of blood transfusions, deaths after recurrent bleeding, or length of hospital stay between patients who received routine endoscopy and those who did not. There were also no significant differences in readmission rates, further bleeding, hemorrhage-related deaths, or the need for gastrointestinal surgery during the year after discharge.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

6.

Drug treatments in upper gastrointestinal bleeding: value of endoscopic findings as surrogate end points.

Author: HawkeyG M, ColeA T, McIntyreA S, LongR G, HawkeyC J

Bleeding reduction

Blood in the stomach at endoscopy reflected the severity of upper gastrointestinal bleeding and predicted clinical outcomes like rebleeding and surgery. Lansoprazole and tranexamic acid significantly reduced the amount of blood in the stomach.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding.

Author: HavanondC, HavanondP

There is no evidence to suggest that argon plasma coagulation (APC) is superior to other endoscopic therapies for non-variceal upper gastrointestinal bleeding. Further randomized controlled trials are needed.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

Vitamin K for upper gastrointestinal bleeding in patients with liver diseases.

Author: Martí-CarvajalA J, Martí-PeñaA J

Improved treatment for upper gastrointestinal bleeding
Liver disease
Upper gastrointestinal bleeding

Upper gastrointestinal bleeding is a major cause of illness and death in people with liver cirrhosis. While various treatments exist, vitamin K is often given in addition. However, it's unclear whether vitamin K helps or harms patients with liver disease and upper gastrointestinal bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

9.

Human recombinant activated factor VII for upper gastrointestinal bleeding in patients with liver diseases.

Author: Marti-CarvajalA J, SalantiG, Marti-CarvajalP I

Gastrointestinal bleeding treatment
No evidence of benefit

This review assessed the beneficial and harmful effects of human recombinant factor VIIa in patients with liver disease and upper gastrointestinal bleeding. The review found no evidence that human recombinant activated factor VII reduces the risk of death in patients with liver disease and upper gastrointestinal bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

Antifibrinolytic amino acids for acquired coagulation disorders in patients with liver disease.

Author: Marti-CarvajalA J, Pérez-RequejoJ L

Improved upper gastrointestinal bleeding treatment
Upper gastrointestinal bleeding

Upper gastrointestinal bleeding is a major cause of illness and death in people with liver disease. People with liver disease often have problems with blood clotting, including increased breakdown of blood clots. While several treatments are used for upper gastrointestinal bleeding, some additional therapies are also used. One such therapy is giving medications that prevent the breakdown of blood clots.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis.

Author: SungJoseph J Y, TsoiKelvin K F, LaiLarry H, WuJustin C Y, LauJames Y W

Reduced recurrent bleeding
Failed application

Hemoclips are superior to injection alone but comparable to thermocoagulation in producing definitive hemostasis for non-variceal gastrointestinal bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

12.

Systematic review: tranexamic acid for upper gastrointestinal bleeding.

Author: GluudL L, KlingenbergS L, LangholzS E

Reduced mortality
Increased thromboembolic disease

Tranexamic acid may reduce all-cause mortality in patients with upper gastrointestinal bleeding, but additional evidence is needed before treatment recommendations can be made.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

Vitamin K for upper gastrointestinal bleeding in patients with liver diseases.

Author: Martí-CarvajalArturo J, Cortés-JofréMarcela, Martí-PeñaArturo J

Improved upper gastrointestinal bleeding treatment
Upper gastrointestinal bleeding

Upper gastrointestinal bleeding is a major cause of illness and death in people with liver disease. While various treatments exist, vitamin K is often given in addition. However, it's unclear whether vitamin K helps or harms patients with liver disease and upper gastrointestinal bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

14.

WITHDRAWN: Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding.

Author: HavanondChittinad, HavanondPiyalamporn

There is no evidence to suggest that Argon Plasma Coagulation (APC) is superior to other endoscopic therapies in the treatment of non-variceal upper gastrointestinal bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

15.

Comparison of adjuvant therapies by an H2-receptor antagonist and a proton pump inhibitor after endoscopic treatment in hemostatic management of bleeding gastroduodenal ulcers.

Author: SakuradaTomoya, KawashimaJunichi, AriyamaShigekazu, KaniKazuhito, TakabayashiHidehiko, OhnoShino, KatoShingo, YakabiKoji

Bleeding control
Bleeding prevention

Famotidine, an H2-receptor antagonist, was found to be as effective as omeprazole, a proton pump inhibitor, in stopping bleeding and preventing recurrence in patients who underwent endoscopic therapy for gastroduodenal ulcer bleeding.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

16.

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

Author: Martí-CarvajalArturo J, SolàIvan

Treatment of upper gastrointestinal bleeding

Bleeding in the upper digestive tract is a common and serious problem for people with liver cirrhosis. While vitamin K is sometimes given to treat this bleeding, it is unclear whether it helps or harms people with acute or chronic liver disease.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

17.

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

Author: Martí-CarvajalArturo J, SolàIvan, Martí-CarvajalPedro I

Reduce upper GI bleeding

Antifibrinolytic amino acids are proposed as supplementary interventions for upper gastrointestinal bleeding in patients with liver cirrhosis. This is because patients with liver disease often have hemostatic abnormalities, including hyperfibrinolysis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

18.

Endoscopic haemostasis: an overview of procedures and clinical scenarios.

Author: JacquesJérémie, LegrosRomain, ChaussadeStanislas, SautereauDenis

Gastrointestinal bleeding treatment

Bleeding in the digestive tract is a common and urgent medical issue. Endoscopy is crucial for diagnosing and treating this condition. Doctors need to be skilled in stopping bleeding during endoscopy, which is essential for treating acute bleeding and preventing it during procedures. While many new techniques and devices are available, there's a lack of strong evidence to support their use due to the difficulty of conducting large research studies. This review aims to provide an overview of techniques and clinical situations to help doctors best manage gastrointestinal bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

19.

HALT-IT--tranexamic acid for the treatment of gastrointestinal bleeding: study protocol for a randomised controlled trial.

Author: RobertsIan, CoatsTimothy, EdwardsPhil, GilmoreIan, JairathVipul, KerKatharine, MannoDaniela, ShakurHaleema, StanworthSimon, VeitchAndrew

Tranexamic acid
Gastrointestinal bleeding

Gastrointestinal bleeding is a serious medical emergency that causes many deaths. While tranexamic acid has been shown to reduce the need for blood transfusions in surgical patients and deaths in trauma patients, there is limited research on its effects for upper gastrointestinal bleeding. While some studies suggest it can reduce the risk of death, the quality of this research is poor and more research is needed to determine its effectiveness and safety.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Pragmatic Clinical TrialA trial conducted in a real-world clinical setting. It evaluates the effectiveness of interventions in everyday healthcare environments.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

20.

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

Author: Martí-CarvajalArturo J, SolàIvan

Vitamin K for bleeding

This updated Cochrane review examines the effectiveness of vitamin K administration for managing upper gastrointestinal bleeding in people with liver diseases. The study investigates whether vitamin K benefits or harms patients with acute or chronic liver disease and upper gastrointestinal bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

21.

Value of Oral Proton Pump Inhibitors in Acute, Nonvariceal Upper Gastrointestinal Bleeding: A Network Meta-Analysis.

Author: RodriguezEduardo A, DonathElie, WaljeeAkbar K, SussmanDaniel A

Reduced LOS
Reduced blood transfusion
Reduced rebleeding

This systematic review and network meta-analysis of 39 studies found that scheduled intravenous (IV) proton pump inhibitors (PPIs) were as effective as IV PPI drip for most outcomes in acute nonvariceal upper gastrointestinal bleeding (ANVGIB). Oral PPIs were comparable to scheduled IV for length of stay and total units of blood transfused, and superior to IV PPI drip for surgery.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

22.

Misoprostol for small bowel ulcers in patients with obscure bleeding taking aspirin and non-steroidal anti-inflammatory drugs (MASTERS): a randomised, double-blind, placebo-controlled, phase 3 trial.

Author: TahaAli S, McCloskeyCaroline, McSkimmingPaula, McConnachieAlex

Small bowel erosion treatment
Small bowel ulcer treatment

A study of patients taking low-dose aspirin or NSAIDs with obscure gastrointestinal bleeding found that misoprostol was effective and safe for the treatment of small bowel ulcers and erosions.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

24.

Pharmacological interventions for prevention and treatment of upper gastrointestinal bleeding in newborn infants.

Author: GreenDaniel Stephen, Abdel-LatifMohamed E, JonesLisa J, LuiKei, OsbornDavid A

Pharmacological interventions
Upper gastrointestinal bleeding treatment

Bleeding in the upper digestive system is a common problem in both premature and full-term babies, but can be more serious in those with other health problems. Medications like proton pump inhibitors (PPIs), H2 receptor antagonists (H2RAs), antacids, bismuth, and sucralfate may help prevent and treat this type of bleeding in infants.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

25.

Gastrointestinal bleeding in patients with atrial fibrillation treated with Apixaban or warfarin: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial.

Author: GarciaDavid A, FisherDeborah A, MulderHillary, WruckLisa, De CaterinaRaffele, HalvorsenSigrun, GrangerChristopher B, HeldClaes, WallentinLars, AlexanderJohn H, LopesRenato D

Stroke prevention
GIB risk

Patients with atrial fibrillation (AF) who have had a history of gastrointestinal bleeding (GIB) have an increased risk of subsequent major GIB. However, this history is not associated with an increased risk of stroke, intracranial bleeding, or all-cause mortality. The use of apixaban versus warfarin in patients with AF was not modified by a history of GIB.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

26.

Resuming Anticoagulation Following Hospitalization for Gastrointestinal Bleeding Is Associated with Reduced Thromboembolic Events and Improved Mortality: Results from a Systematic Review and Meta-Analysis.

Author: TapaskarNatalie, PangAlice, WernerDebra A, SenguptaNeil

Thromboembolism prevention
Thromboembolism treatment
GIB

Blood thinners are commonly used to prevent and treat blood clots, but they can cause bleeding in the digestive system. There's not enough information about how to best manage blood thinners after a patient has been hospitalized for this kind of bleeding. We need to better understand the risks of further bleeding, blood clots, and death after these events.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

27.

Tranexamic Acid in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis.

Author: DionneJoanna C, OczkowskiSimon J W, HuntBeverley J, AntonelliMassimo, WijnbergeMarije, RaasveldSenta Jorinde, VlaarAlexander P J,

Reduced bleeding
Increased risk of pulmonary embolism
Increased risk of seizures
Increased risk of thrombosis

Extended-use high-dose IV tranexamic acid does not improve mortality or bleeding outcomes and increases adverse events. Low-dose/enteral tranexamic acid may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

28.

Comparison of a Hemostatic Powder and Standard Treatment in the Control of Active Bleeding From Upper Nonvariceal Lesions : A Multicenter, Noninferiority, Randomized Trial.

Author: LauJames Y W, PittayanonRapat, KwekAndrew, TangRaymond S, ChanHeyson, RerknimitrRungsun, LeeJune, AngTiing Leong, SuenBing-Yee, YuYuan-Yuan, ChanFrancis K L, SungJoseph J Y

Bleeding control
Death
Further interventions

TC-325 was not inferior to standard endoscopic hemostatic treatments in controlling acute nonvariceal upper gastrointestinal bleeding. TC-325 was associated with fewer failures of hemostasis during index endoscopy but had similar rates of recurrent bleeding and further interventions. Further research is needed to confirm the findings.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

29.

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

Author: KannoTakeshi, YuanYuhong, TseFrances, HowdenColin W, MoayyediPaul, LeontiadisGrigorios I

PPIs for upper GI bleeding
Conflicting evidence

This study reviews the evidence regarding the clinical efficacy of proton pump inhibitors (PPIs) for managing upper gastrointestinal (GI) bleeding. PPIs reduce gastric acid production and are commonly used for upper GI bleeding, but their effectiveness before endoscopy remains unclear.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

30.

Thalidomide for Recurrent Bleeding Due to Small-Intestinal Angiodysplasia.

Author: ChenHuimin, WuShan, TangMingyu, ZhaoRan, ZhangQingwei, DaiZihao, GaoYunjie, YangShiming, LiZhaoshen, DuYiqi, YangAiming, ZhongLiang, LuLungen, XuLeiming, ShenXizhong, LiuSide, ZhongJie, LiXiaobo, LuHong, XiongHua, ShenYufeng, ChenHaiying, GongShuai, XueHanbing, GeZhizheng

Recurrent bleeding treatment
Thalidomide side effects

Thalidomide was effective in reducing bleeding in patients with recurrent bleeding due to small-intestinal angiodysplasia (SIA). Treatment with thalidomide at a daily dose of 100 mg resulted in a 68.6% effective response, compared to 51.0% for 50 mg thalidomide and 16.0% for placebo.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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