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Cited by 261Gastrointestinal Bleeding Diagnosis and TreatmentHelicobacter pylori-related gastroenterology studiesLiver Disease and Transplantation

Non-variceal upper gastrointestinal haemorrhage: guidelines

Open access
Kelvin R. Palmer·2002·Gut
DOI 10.1136/gut.51.suppl_4.iv1PMC PMC1867732
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Abstract

Acute upper gastrointestinal bleeding is the commonest emergency managed by gastroenterologists. It has an incidence ranging from approximately 50 to 150 per 100 000 of the population each year, the incidence being highest in areas of the lowest socioeconomic status. An audit of patients admitted to hospital in the UK published in 1995 reported 11% mortality in patients admitted to hospital because of bleeding and 33% mortality in those who developed gastrointestinal bleeding while hospitalised for other reasons.1 Most deaths occur in elderly patients who have significant comorbidity and the majority are inevitable, despite improvements in medical and surgical expertise. Mortality is reported to be lower in specialist units2,3 and this is probably not related to technical developments but because of adherence to protocols and guidelines. Thus guidelines do have the potential to improve prognosis and in addition may be of value in making the best use of resources by fast tracking low risk patients, thereby optimising duration of hospital stay. “Medline” and “EMBASE” were searched to identify the evidence used in formulating these guidelines. The term “gastrointestinal hemorrhage” was used to identify general reviews, leading articles, meta-analyses, and randomised clinical trials. Not all of the recommendations have been subjected to clinical trial but represent what, in the view of the British Society of Gastroenterology (BSG) endoscopy committee, defines best clinical practice. Guidelines cannot replace clinical judgment in the management of any specific patient. Best management depends on close cooperation between medical and surgical gastroenterologists and “combined care” is essential in managing the critically ill bleeding patient. The specific management of acute variceal haemorrhage is a special subject and is not considered in detail. ### 1.1 Grading of recommendations #### Grade A #### Grade B #### Grade C

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  • That RCT showed early feeding provides better nutrition compared to delayed feeding.

    “provides better nutrition”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [225]

    Section 4.0 (Management Following Endoscopy; page unavailable) recommends allowing haemodynamically stable patients to drink and start a light diet 4–6 hours after endoscopy. But this source is a guideline, not the RCT described in the claim, and the passage reports neither a comparison with delayed feeding nor a nutritional benefit. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • An RCT showed that early feeding with a regular solid diet in patients after successful variceal ligation for esophageal varices is safe compared to delayed feeding.

    “An RCT showed that early feeding with a regular solid diet in patients after successful variceal 1656 ligation for esophageal varices is safe”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [225]

    Section 4.0 (page unavailable) recommends a light diet for patients who are haemodynamically stable 4–6 hours after endoscopy and says prolonged fasting is unnecessary. It does not report an RCT comparing early regular solid food with delayed feeding after variceal ligation; section 3.4.1 says variceal banding is described elsewhere. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The RCT of early feeding after variceal ligation included only patients with low-risk varices.

    “however, they included only patients with low-risk varices.”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [225]

    The Introduction says acute variceal haemorrhage is not considered in detail, and §3.4.1 refers readers elsewhere for variceal banding. A search for early feeding, variceal ligation, and low-risk varices found no account of the claimed RCT or its eligibility criteria in our copy. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • That RCT showed early feeding results in a lower incidence of infections in bleeders compared to delayed feeding.

    “and results in a lower incidence 1657 of infections in bleeders compared to delayed feeding [225].”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [225]

    Section 4.0 (page unavailable) recommends allowing haemodynamically stable patients to drink and start a light diet 4–6 hours after endoscopy, but reports no trial comparing early with delayed feeding or their infection rates. Searches for feeding, infection, and randomized trials found no passage addressing the claimed outcome. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 42

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Authors
Palmer, K. R.
Affiliations
Western General Hospital (GB)
Corresponding author
Kelvin R. Palmer
Venue
Gut
Publisher
BMJ
Published
2002-10
Volume
51
Issue
suppl 4
Pages
iv1-iv6
ISSN
  • 0017-5749 (ISSN-L)
  • 1468-3288
DOI
10.1136/gut.51.suppl_4.iv1
PMC
PMC1867732
OpenAlex
W2126673014
Cited by
261
References
1
Citations by year
2025: 8 · 2024: 5 · 2023: 3 · 2022: 5 · 2021: 9 · 2020: 10 · 2019: 8 · 2018: 9 · 2017: 9 · 2016: 5 · 2015: 7 · 2014: 18 · 2013: 13 · 2012: 14
FWCI
6.06
Type
journal article
Language
en
Open access
Locations
  • Gut (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Keywords
non-variceal upper gastrointestinal bleeding, bleeding mortality, hospitalization, resource utilization (health care), length of hospital stay
MeSH terms
Fluid Therapy, Follow-Up Studies, Gastrointestinal Hemorrhage, Hospitalization, Humans, Infusions, Intravenous, Postoperative Care, Recurrence, Referral and Consultation, Reoperation, Endoscopy, Gastrointestinal

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