• 1 Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
  • 2 Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 4 University of Ulsan College of Medicine, Ulsan, South Korea
  • 5 UST Hospital, University of Santo Tomas, Manila, Philippines
  • 6 Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
  • 7 Asian Institute of Gastroenterology, Asian Healthcare Foundation, Hyderabad, India
  • 8 Department of Medicine, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia, Australia
  • 9 Department of Medicine, Jichi Medical School, Shimotsuke, Japan
  • 10 State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Xi'an, China
  • 11 China Medical University, Taichung, Taiwan
  • 12 University of Utah College of Health, Salt Lake City, Utah, USA
  • 13 University of California, Los Angeles, California, USA
  • 14 Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
  • 15 Department of Gastroenterology, University Hospital, Zaragoza, Spain
Gut, 2018 10;67(10):1757-1768.
PMID: 29691276 DOI: 10.1136/gutjnl-2018-316276


Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the 'gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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