title: Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding.
abstract: Upper gastrointestinal bleeding (UGIB), especially peptic ulcer bleeding, remains one of the most important cause of hospitalisation and mortality world wide. In Asia, with a high prevalence of Helicobacter pylori infection, a potential difference in drug metabolism, and a difference in clinical management of UGIB due to variable socioeconomic environments, it is considered necessary to re-examine the International Consensus of Non-variceal Upper Gastrointestinal Bleeding with emphasis on data generated from the region. The working group, which comprised experts from 12 countries from Asia, recommended the use of the Blatchford score for selection of patients who require endoscopic intervention and which would allow early discharge of patients at low risk. Patients' comorbid conditions should be included in risk assessment. A pre-endoscopy proton pump inhibitor (PPI) is recommended as a stop-gap treatment when endoscopy within 24 h is not available. An adherent clot on a peptic ulcer should be treated with endoscopy combined with a PPI if the clot cannot be removed. Routine repeated endoscopy is not recommended. High-dose intravenous and oral PPIs are recommended but low-dose intravenous PPIs should be avoided. COX-2 selective non-steroidal anti-inflammatory drugs combined with a PPI are recommended for patients with very high risk of UGIB. Aspirin should be resumed soon after stabilisation and clopidogrel alone is no safer than aspirin plus a PPI. When dual antiplatelet agents are used, prophylactic use of a PPI reduces the risk of adverse gastrointestinal events.
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong. joesung@cuhk.edu.hk
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
authors.forename: Francis K L
authors.initials: FK
authors.lastname: Chan
authors.forename: Minhu
authors.initials: M
authors.lastname: Chen
authors.forename: Jessica Y L
authors.initials: JY
authors.lastname: Ching
authors.forename: K Y
authors.initials: KY
authors.lastname: Ho
authors.forename: Udom
authors.initials: U
authors.lastname: Kachintorn
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: James Y W
authors.initials: JY
authors.lastname: Lau
authors.forename: Jayaram
authors.initials: J
authors.lastname: Menon
authors.forename: Abdul Aziz
authors.initials: AA
authors.lastname: Rani
authors.forename: Nageshwar
authors.initials: N
authors.lastname: Reddy
authors.forename: Jose
authors.initials: J
authors.lastname: Sollano
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
authors.forename: Kelvin K F
authors.initials: KK
authors.lastname: Tsoi
authors.forename: Chun Ying
authors.initials: CY
authors.lastname: Wu
authors.forename: Neville
authors.initials: N
authors.lastname: Yeomans
authors.forename: Namish
authors.initials: N
authors.lastname: Vakil
authors.forename: K L
authors.initials: KL
authors.lastname: Goh
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004621:Embolization, Therapeutic; D016099:Endoscopy, Gastrointestinal; D019317:Evidence-Based Medicine / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D001241:Aspirin