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[APPROACH TO PATIENTS WITH GASTROINTESTINAL BLEEDING].

M Nikolić, M Hanževački, P Jurčić

    Acta Medica Croatica : Casopis Hravatske Akademije Medicinskih Znanosti
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    Summary
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    Gastrointestinal bleeding hospitalizations and mortality remain high due to aging populations and increased risk factors. This review details current management strategies for upper and lower gastrointestinal bleeding.

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    Area of Science:

    • Gastroenterology
    • Internal Medicine

    Background:

    • Despite advances in endoscopic techniques and knowledge, hospitalizations and mortality from gastrointestinal bleeding (GIB) have not decreased as anticipated in developed nations.
    • Key contributing factors include an aging population, rising prevalence of alcoholic liver cirrhosis, gastroesophageal reflux disease, obesity, antibiotic resistance in Helicobacter pylori, and increased use of anti-aggregation therapies, anticoagulants, and NSAIDs.

    Purpose of the Study:

    • To present the incidence, signs, and symptoms of GIB.
    • To outline initial clinical evaluation, diagnostic methods, common causes, and endoscopic hemostatic treatments for upper and lower GIB.

    Main Methods:

    • Systematic review of meta-analyses and systematic reviews published in English from 2005-2015, sourced from MEDLINE and Ovid databases.
    • Inclusion of randomized, double-blind studies on adults with GIB, guidelines from the European and American Societies of Gastroenterological Endoscopy, and recent expert literature.

    Main Results:

    • The review covers the current state of GIB management, including new classifications, controversies in nasogastric tube use, prokinetic agents, and proton pump inhibitors for upper GIB.
    • It addresses restrictive transfusion strategies, clinical stratification of bleeding severity, hospitalization criteria, use of clinical bleeding scores, gastroprotection for high-risk patients, and the role of initial endoscopy.
    • Management of variceal bleeding (assessment, prophylaxis) and novel endoscopic, radiological, and surgical treatments are also discussed.

    Conclusions:

    • This comprehensive review provides an up-to-date overview of gastrointestinal bleeding management.
    • The educational content can inform the development of national guidelines for GIB management.