Haematemesis – Related resources

Cochrane reviews

• High dose and medium to low dose proton pump inhibitors may be equally effective in the treatment of acute peptic ulcer bleeding.
• Proton pump inhibitor treatment prior to endoscopic diagnosis may have no effect on clinically important outcomes (mortality, re-bleeding, or need for surgery or blood transfusions) compared to placebo or histamine-2-receptor antagonists in patients with acute upper GI-bleeding .
• Tranexamic acid may reduce all-cause mortality compared to placebo in patients with upper gastrointestinal bleeding but not the incidence of re-bleeding or need for surgery or transfusions
• Antifibrinolytics might possibly reduce the duration of bleeding (but not the rate of remission) in haemoptysis from any cause, although the evidence is insufficient.
• Terlipressin is more effective than placebo in reducing mortality in oesophageal variceal bleeding .
• There is no convincing evidence of the effectiveness of emergency sclerotherapy as the first, single treatment compared with vasoactive drugs .
• Additional endoscopic treatment after epinephrine injection reduces further bleeding and the need for surgery in patients with bleeding peptic ulcer .
• There is insufficient evidence on the benefits and harms of red blood cell transfusion in acute upper gastrointestinal haemorrhage .

Other evidence summaries

• Beta-adrenergic-antagonist drugs appear to be effective in reducing fatal and nonfatal first-time gastrointestinal bleeding in patients with cirrhosis and esophageal varices but not improve total 2-year mortality .
• Isosorbide-5-mononitrate appears to be as effective as propranolol in the prevention of first bleeding in cirrhosis .

Literature

• Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med 2008 Aug 28;359(9):928-37.
• Pagliaro L, D'Amico G, Sörensen TI, Lebrec D, Burroughs AK, Morabito A, Tiné F, Politi F, Traina M. Prevention of first bleeding in cirrhosis. A meta-analysis of randomized trials of nonsurgical treatment. Ann Intern Med 1992 Jul 1;117(1):59-70.
• Teran JC, Imperiale TF, Mullen KD, Tavill AS, McCullough AJ. Primary prophylaxis of variceal bleeding in cirrhosis: a cost-effectiveness analysis. Gastroenterology 1997 Feb;112(2):473-82.
• Hayes PC, Davis JM, Lewis JA, Bouchier IA. Meta-analysis of value of propranolol in prevention of variceal haemorrhage. Lancet 1990 Jul 21;336(8708):153-6.
• Merkel C, Marin R, Enzo E, Donada C, Cavallarin G, Torboli P, Amodio P, Sebastianelli G, Sacerdoti D, Felder M, Mazzaro C, Beltrame P, Gatta A. Randomised trial of nadolol alone or with isosorbide mononitrate for primary prophylaxis of variceal bleeding in cirrhosis. Gruppo-Triveneto per L'ipertensione portale (GTIP) Lancet 1996 Dec 21-28;348(9043):1677-81.