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Towards personalised management for non-variceal upper gastrointestinal bleeding
Joseph J Y Sung1, Loren Laine2, Ernst J Kuipers3
1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore josephsung@ntu.edu.sg.
Insights
Optimal upper gastrointestinal bleeding management requires personalized strategies. This approach integrates patient needs, lesion characteristics, and available resources across all treatment stages for better outcomes.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Existing guidelines for upper gastrointestinal bleeding (UGIB) lack individualized patient management strategies.
- Optimal UGIB treatment necessitates consideration of patient-specific factors and healthcare setting resources.
Purpose of the Study:
- To integrate international guidelines and consensus for a personalized, staged approach to UGIB management.
- To provide a framework for decision-making in pre-endoscopic, endoscopic, and post-endoscopic phases of UGIB care.
Main Methods:
- Systematic integration of international professional society guidelines and expert consensus on UGIB.
- Development of a three-stage management framework: pre-endoscopic, endoscopic, and post-endoscopic.
- Emphasis on tailoring strategies based on patient characteristics, bleeding lesion type, and clinical environment.
Main Results:
- A comprehensive, three-stage management model for upper gastrointestinal bleeding.
- Identification of key factors for personalized treatment: patient status, bleeding source, and resource availability.
- Integration of current evidence into actionable clinical pathways.
Conclusions:
- Personalized management strategies are crucial for optimizing upper gastrointestinal bleeding treatment.
- A staged approach considering individual patient needs and resources improves clinical decision-making.
- This framework facilitates tailored care for diverse UGIB scenarios.
Abstract:
Guidelines from national and international professional societies on upper gastrointestinal bleeding highlight the important clinical issues but do not always identify specific management strategies pertaining to individual patients. Optimal treatment should consider the personal needs of an individual patient and the pertinent resources and experience available at the point of care. This article integrates international guidelines and consensus into three stages of management: pre-endoscopic assessment and treatment, endoscopic evaluation and haemostasis and postendoscopic management. We emphasise the need for personalised management strategies based on patient characteristics, nature of bleeding lesions and the clinical setting including available resources.
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