title: Variability in the management of nonvariceal upper gastrointestinal bleeding in Europe: an observational study.
abstract: BACKGROUND
  Despite recent advances in endoscopic and pharmacological management, nonvariceal upper gastrointestinal bleeding (NVUGIB) is still associated with considerable mortality and morbidity that vary between countries. The European Survey of Nonvariceal Upper Gastrointestinal Bleeding (ENERGiB) reported clinical outcomes across Europe (Belgium, Greece, Italy, Norway, Portugal, Spain, and Turkey) and evaluated management strategies in a "real-world" European setting. This article presents the differences in clinical management strategies among countries participating in ENERGiB.
  
  
  METHODS
  Adult patients consecutively presenting with overt NVUGIB at 123 participating hospitals over a 2-month period were included. Data relevant to the initial NVUGIB episode and for up to 30 days afterwards were collected retrospectively from patient medical records.
  
  
  RESULTS
  The number of evaluable patients was 2,660; patient demographics and clinical characteristics were similar across countries. There was wide between-country variability in the area and speciality of the NVUGIB management team and unit transfer rates after the initial hospital assessment. The mean time from admission to endoscopy was <1 day only in Italy and Spain. Wide variation in the use of preendoscopy (35.0-88.7%) and relatively consistent (86.5-96.0%) postendoscopic pharmacological therapy rates were observed. There was substantial by-country variability in the rate of therapeutic procedures performed during endoscopy (24.9-47.6%). NVUGIB-related healthcare resource consumption was high and variable (days hospitalized, mean 5.4-8.7 days; number of endoscopies during hospitalization, mean 1.1-1.7).
  
  
  CONCLUSIONS
  ENERGiB demonstrates that there are substantial differences in the management of patients with acute NVUGIB episodes across Europe, and that in many cases the guideline recommendations for the management of NVUGIB are not being followed.
authors.affiliation: Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain. angel.lanas@gmail.com
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
authors.forename: Lars
authors.initials: L
authors.lastname: Aabakken
authors.forename: Jorge
authors.initials: J
authors.lastname: Fonseca
authors.forename: Zeynel
authors.initials: Z
authors.lastname: Mungan
authors.forename: George
authors.initials: G
authors.lastname: Papatheodoridis
authors.forename: Hubert
authors.initials: H
authors.lastname: Piessevaux
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rotondano
authors.forename: Javier
authors.initials: J
authors.lastname: Nuevo
authors.forename: Monica
authors.initials: M
authors.lastname: Tafalla
mesh_terms: D000328:Adult; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000453:epidemiology*; D006115:Greece / Q000453:epidemiology; D019983:Guideline Adherence; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011174:Portugal / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014421:Turkey / Q000453:epidemiology