Abstract：
Acute upper gastrointestinal bleeding (UGIB) is a common emergency requiring hospital-based care. Advances in care across pre-endoscopic, endoscopic and post-endoscopic phases have led to improvements in clinical outcomes.
To provide a detailed, evidence-based update on major aspects of care across pre-endoscopic, endoscopic and post-endoscopic phases.
We performed a structured bibliographic database search for each topic. If a recent high-quality meta-analysis was not available, we performed a meta-analysis with random effects methods and odds ratios with 95% confidence intervals.
Pre-endoscopic management of UGIB includes risk stratification, a restrictive red blood cell transfusion policy unless the patient has cardiovascular disease, and pharmacologic therapy with erythromycin and a proton pump inhibitor. Patients with cirrhosis should be treated with prophylactic antibiotics and vasoactive medications. Tranexamic acid should not be used. Endoscopic management of UGIB depends on the aetiology. For peptic ulcer disease (PUD) with high-risk stigmata, endoscopic therapy, including over-the-scope clips (OTSCs) and TC-325 powder spray, should be performed. For variceal bleeding, treatment should be customised by severity and anatomic location. Post-endoscopic management includes early enteral feeding for all UGIB patients. For high-risk PUD, PPI should be continued for 72 h, and rebleeding should initially be evaluated with a repeat endoscopy. For variceal bleeding, high-risk patients or those with further bleeding, a transjugular intrahepatic portosystemic shunt can be considered.
Management of acute UGIB should include treatment plans for pre-endoscopic, endoscopic and post-endoscopic phases of care, and customise treatment decisions based on aetiology and severity of bleeding.
To provide a detailed, evidence-based update on major aspects of care across pre-endoscopic, endoscopic and post-endoscopic phases.
We performed a structured bibliographic database search for each topic. If a recent high-quality meta-analysis was not available, we performed a meta-analysis with random effects methods and odds ratios with 95% confidence intervals.
Pre-endoscopic management of UGIB includes risk stratification, a restrictive red blood cell transfusion policy unless the patient has cardiovascular disease, and pharmacologic therapy with erythromycin and a proton pump inhibitor. Patients with cirrhosis should be treated with prophylactic antibiotics and vasoactive medications. Tranexamic acid should not be used. Endoscopic management of UGIB depends on the aetiology. For peptic ulcer disease (PUD) with high-risk stigmata, endoscopic therapy, including over-the-scope clips (OTSCs) and TC-325 powder spray, should be performed. For variceal bleeding, treatment should be customised by severity and anatomic location. Post-endoscopic management includes early enteral feeding for all UGIB patients. For high-risk PUD, PPI should be continued for 72 h, and rebleeding should initially be evaluated with a repeat endoscopy. For variceal bleeding, high-risk patients or those with further bleeding, a transjugular intrahepatic portosystemic shunt can be considered.
Management of acute UGIB should include treatment plans for pre-endoscopic, endoscopic and post-endoscopic phases of care, and customise treatment decisions based on aetiology and severity of bleeding.
摘要：
背景：急性上消化道出血（UGIB）是需要医院护理的常见紧急情况。内镜前护理的进展，内镜和内镜后阶段改善了临床结局.
目的：提供详细的，关于内镜前护理主要方面的循证更新，内镜和内镜后阶段。
方法：我们对每个主题进行了结构化的书目数据库搜索。如果最近没有高质量的荟萃分析，我们采用随机效应法和比值比进行了meta分析,95%置信区间.
结果：UGIB的内镜前管理包括风险分层，限制性红细胞输血政策，除非患者有心血管疾病，以及红霉素和质子泵抑制剂的药物治疗。肝硬化患者应使用预防性抗生素和血管活性药物治疗。不应使用氨甲环酸。UGIB的内镜治疗取决于病因。对于具有高风险污名的消化性溃疡（PUD），内镜治疗,包括超镜夹（OTSC）和TC-325粉末喷雾，应该执行。静脉曲张出血,治疗应根据严重程度和解剖位置定制。内镜后管理包括对所有UGIB患者进行早期肠内喂养。对于高风险的PUD，PPI应持续72小时，和再出血最初应通过重复内镜检查进行评估.静脉曲张出血,高危患者或进一步出血的患者，可以考虑经颈静脉肝内门体分流术。
结论：急性UGIB的治疗应包括内镜前的治疗计划，内镜和内镜后护理阶段，并根据病因和出血严重程度定制治疗决策。
目的：提供详细的，关于内镜前护理主要方面的循证更新，内镜和内镜后阶段。
方法：我们对每个主题进行了结构化的书目数据库搜索。如果最近没有高质量的荟萃分析，我们采用随机效应法和比值比进行了meta分析,95%置信区间.
结果：UGIB的内镜前管理包括风险分层，限制性红细胞输血政策，除非患者有心血管疾病，以及红霉素和质子泵抑制剂的药物治疗。肝硬化患者应使用预防性抗生素和血管活性药物治疗。不应使用氨甲环酸。UGIB的内镜治疗取决于病因。对于具有高风险污名的消化性溃疡（PUD），内镜治疗,包括超镜夹（OTSC）和TC-325粉末喷雾，应该执行。静脉曲张出血,治疗应根据严重程度和解剖位置定制。内镜后管理包括对所有UGIB患者进行早期肠内喂养。对于高风险的PUD，PPI应持续72小时，和再出血最初应通过重复内镜检查进行评估.静脉曲张出血,高危患者或进一步出血的患者，可以考虑经颈静脉肝内门体分流术。
结论：急性UGIB的治疗应包括内镜前的治疗计划，内镜和内镜后护理阶段，并根据病因和出血严重程度定制治疗决策。
