title: Consensus on control of risky nonvariceal upper gastrointestinal bleeding in Taiwan with National Health Insurance.
abstract: OBJECTIVE
  To compose upper gastrointestinal bleeding (UGIB) consensus from a nationwide scale to improve the control of UGIB, especially for the high-risk comorbidity group.
  
  
  METHODS
  The steering committee defined the consensus scope to cover preendoscopy, endoscopy, postendoscopy, and overview from Taiwan National Health Insurance Research Database (NHIRD) assessments for UGIB. The expert group comprised thirty-two Taiwan experts of UGIB to conduct the consensus conference by a modified Delphi process through two separate iterations to modify the draft statements and to vote anonymously to reach consensus with an agreement ≥80% for each statement and to set the recommendation grade.
  
  
  RESULTS
  The consensus included 17 statements to highlight that patients with comorbidities, including liver cirrhosis, end-stage renal disease, probable chronic obstructive pulmonary disease, and diabetes, are at high risk of peptic ulcer bleeding and rebleeding. Special considerations are recommended for such risky patients, including raising hematocrit to 30% in uremia or acute myocardial infarction, aggressive acid secretory control in high Rockall scores, monitoring delayed rebleeding in uremia or cirrhosis, considering cycloxygenase-2 inhibitors plus PPI for pain control, and early resumption of antiplatelets plus PPI in coronary artery disease or stroke.
  
  
  CONCLUSIONS
  The consensus comprises recommendations to improve care of UGIB, especially for high-risk comorbidities.
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan ; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Bor-Shyang
authors.initials: BS
authors.lastname: Sheu
authors.affiliation: Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chun-Ying
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.affiliation: Gastroenterology Endoscopy Center, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: Cheng-Tang
authors.initials: CT
authors.lastname: Chiu
authors.affiliation: Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Chun-Che
authors.identifier: 0000-0002-2474-6734
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan ; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Hsiu-Chi
authors.initials: HC
authors.lastname: Cheng
authors.affiliation: Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Teng-Yu
authors.identifier: 0000-0002-4097-4315
authors.initials: TY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.affiliation: School of Medicine, Fu Jen Catholic University, No. 510 Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan.
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
mesh_terms: D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000628:therapy*; D006801:Humans; D009313:National Health Programs; D012307:Risk Factors; D013624:Taiwan