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Upper gastrointestinal bleeding erythromycin

Ian Beales
Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been published, but advances as well as controversies continue to evolve. Important recent advances include the evidence supporting a more restrictive transfusion strategy aiming for a target haemoglobin of 70-90 g/l...
2017: F1000Research
Hee Kyong Na, Hwoon-Yong Jung, Dong Woo Seo, Hyun Lim, Ji Yong Ahn, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim
BACKGROUND/AIMS: The aim of this study was to compare the effects of erythromycin infusion and gastric lavage in order to improve the quality of visualization during emergency upper endoscopy. METHODS: We performed a prospective randomized pilot study. Patients presented with hematemesis or melena within 12 hours and were randomly assigned to the erythromycin group (intravenous infusion of erythromycin), gastric lavage group (nasogastric tube placement with gastric lavage), or erythromycin + gastric lavage group (both erythromycin infusion and gastric lavage)...
November 2017: Korean Journal of Internal Medicine
Rubayat Rahman, Douglas L Nguyen, Umair Sohail, Ashraf A Almashhrawi, Imran Ashraf, Srinivas R Puli, Matthew L Bechtold
BACKGROUND: In patients suffering from upper gastrointestinal bleeding (UGIB), adequate visualization is essential during endoscopy. Prior to endoscopy, erythromycin administration has been shown to enhance visualization in these patients; however, guidelines have not fully adopted this practice. Thus, we performed a comprehensive, up-to-date meta-analysis on the issue of erythromycin administration in this patient population. METHODS: After searching multiple databases (November 2015), randomized controlled trials on adult subjects comparing administration of erythromycin before endoscopy in UGIB patients to no erythromycin or placebo were included...
July 2016: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
Ian M Gralnek, Jean-Marc Dumonceau, Ernst J Kuipers, Angel Lanas, David S Sanders, Matthew Kurien, Gianluca Rotondano, Tomas Hucl, Mario Dinis-Ribeiro, Riccardo Marmo, Istvan Racz, Alberto Arezzo, Ralf-Thorsten Hoffmann, Gilles Lesur, Roberto de Franchis, Lars Aabakken, Andrew Veitch, Franco Radaelli, Paulo Salgueiro, Ricardo Cardoso, Luís Maia, Angelo Zullo, Livio Cipolletta, Cesare Hassan
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists (strong recommendation, moderate quality evidence)...
October 2015: Endoscopy
Kyle J Fortinsky, Marc Bardou, Alan N Barkun
Nonvariceal upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality worldwide. Mortality from UGIB has remained 5-10% over the past decade. This article presents current evidence-based recommendations for the medical management of UGIB. Preendoscopic management includes initial resuscitation, risk stratification, appropriate use of blood products, and consideration of nasogastric tube insertion, erythromycin, and proton pump inhibitor therapy. The use of postendoscopic intravenous proton pump inhibitors is strongly recommended for certain patient populations...
July 2015: Gastrointestinal Endoscopy Clinics of North America
Iyad Khamaysi, Ian M Gralnek
Upper gastrointestinal (UGI) endoscopy is the cornerstone of diagnosis and management of patients presenting with acute UGI bleeding. Once hemodynamically resuscitated, early endoscopy (performed within 24 hours of patient presentation) ensures accurate identification of the bleeding source, facilitates risk stratification based on endoscopic stigmata, and allows endotherapy to be delivered where indicated. Moreover, the preendoscopy use of a prokinetic agent (eg, i.v. erythromycin), especially in patients with a suspected high probability of having blood or clots in the stomach before undergoing endoscopy, may result in improved endoscopic visualization, a higher diagnostic yield, and less need for repeat endoscopy...
July 2015: Gastrointestinal Endoscopy Clinics of North America
Mohammad Javad Ehsani Ardakani, Ehsan Zare, Maryam Basiri, Hamid Mohaghegh Shalmani
AIM: To evaluate the efficacy of erythromycin to decrease the time and improves the quality of EGD in patients with acute upper GI bleeding. BACKGROUND: The diagnostic and therapeutic value of esophagogastroduodenoscopy (EGD) in patients with upper GI bleeding is often limited by the presence of residual blood or clots. Infused erythromycin (3 mg/kg) before EGD, a potent gastro kinetic drug, might improve the quality of EGD in patients with upper GI bleeding and decrease the time of EGD and second- look EGD...
2013: Gastroenterology and Hepatology From Bed to Bench
Shoba Theivanayagam, Roxanne G Lim, William J Cobell, Jayashree T Gowda, Michelle L Matteson, Abhishek Choudhary, Matthew L Bechtold
BACKGROUND/AIM: Erythromycin infusion before endoscopy in upper gastrointestinal bleeding (UGIB) has been hypothesized to aid in visualization and reduce the need for second-look endoscopy; however, the results have been controversial. To evaluate further, we performed a meta-analysis comparing the efficacy of erythromycin infusion before endoscopy in acute UGIB. METHODS: Multiple databases were searched (March 2013). Only randomized controlled trials were included in the analysis...
September 2013: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
Stephen Kim, V Raman Muthusamy
No abstract text is available yet for this article.
September 2013: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
Loren Laine, Dennis M Jensen
This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes...
March 2012: American Journal of Gastroenterology
Thomas O G Kovacs, Dennis M Jensen
Upper gastrointestinal (UGI) bleeding secondary to ulcer disease occurs commonly and results in significant patient morbidity and medical expense. After initial resuscitation, carefully performed endoscopy provides an accurate diagnosis of the source of the UGI hemorrhage and can reliably identify those high-risk subgroups that may benefit most from endoscopic hemostasis. Effective endoscopic hemostasis of ulcer bleeding can significantly improve outcomes by reducing rebleeding, transfusion requirement, and need for surgery, as well as reduce the cost of medical care...
October 2011: Gastrointestinal Endoscopy Clinics of North America
Justin C Y Wu, Joseph J Y Sung
There are many clinical outcome measures for evaluation of the effectiveness of a pharmacologic agent in the management of upper gastrointestinal bleeding (UGIB). As a preemptive treatment, it should reduce the need for emergency endoscopy and endoscopic intervention, facilitate the efficient identification of the bleeding source and, hence, shorten procedure time and reduce the risk of procedure-related complications. As an effective adjunctive therapy after endoscopic hemostasis, it should reduce the incidence of recurrent bleeding and the need to repeat endoscopic hemostasis...
October 2011: Gastrointestinal Endoscopy Clinics of North America
Y Bai, J-F Guo, Z-S Li
BACKGROUND: Studies evaluating the effect of erythromycin on patients with acute upper gastrointestinal bleeding (UGIB) had been reported, but the results were inconclusive. AIMS: To compare erythromycin with control in patients with acute UGIB by performing a meta-analysis. METHODS: Electronic databases including PubMed, EMBASE and the Cochrane Library, Science Citation Index, were searched to find relevant randomised controlled trials (RCTs)...
July 2011: Alimentary Pharmacology & Therapeutics
Nicholas M Szary, Ruchi Gupta, Abhishek Choudhary, Michelle L Matteson, Murtaza Arif, Hazem T Hammad, Matthew L Bechtold
OBJECTIVE: Upper gastrointestinal bleeding (UGIB) is a medical emergency requiring urgent endoscopy and diagnosis. However, adequate visualization is a necessity. Studies have been performed evaluating the efficacy of erythromycin infusion prior to endoscopy to improve visibility and therapeutic potential of esophagogastroduodenoscopy (EGD) with varied results. Therefore, a meta-analysis was performed comparing the efficacy of erythromycin infusion prior to endoscopy in acute UGIB. MATERIALS AND METHODS: Multiple databases were searched...
July 2011: Scandinavian Journal of Gastroenterology
Dominique Pateron, Eric Vicaut, Erwan Debuc, Karima Sahraoui, Nicolas Carbonell, Xavier Bobbia, Dominique Thabut, Frédéric Adnet, Pierre Nahon, Rolland Amathieu, Mounir Aout, Nicolas Javaud, Patrick Ray, Jean Claude Trinchet
STUDY OBJECTIVE: The quality of endoscopy depends on the quality of upper gastrointestinal tract preparation. We determine whether in acute upper gastrointestinal bleeding the frequency of satisfactory stomach visualization was different after intravenous erythromycin, a nasogastric tube with gastric lavage, or both. METHODS: We performed a prospective, randomized, multicenter (6 emergency departments) study in patients with acute upper gastrointestinal bleeding presenting with hematemesis or melena...
June 2011: Annals of Emergency Medicine
Alan N Barkun, Marc Bardou, Myriam Martel, Ian M Gralnek, Joseph J Y Sung
BACKGROUND: Recent data suggest that administration of prokinetics before gastroscopy may be useful in patients with acute upper GI bleeding (UGIB). Published studies are limited in the number of subjects evaluated, and the conclusions are disparate. OBJECTIVE: To assess the evidence of administering prokinetic agents before EGD in acute UGIB. DESIGN AND SETTING: Comprehensive literature searches from 1990 to January 2010 were performed. We selected for meta-analysis randomized trials assessing prokinetic agents in acute UGIB...
December 2010: Gastrointestinal Endoscopy
Joshua Greenspoon, Alan Barkun
Recommendations in managing patients with nonvariceal upper gastrointestinal bleeding were recently updated, addressing resuscitation, risk assessment and pre-endoscopic care, endoscopy, pharmacotherapy, and secondary prophylaxis. Initial adequate resuscitation and risk stratification using validated scales remain critical. Intravenous erythromycin improves visualization when likely to find blood in the stomach. Pre-endoscopic proton pump inhibition (PPI) does not improve outcomes, but downstages high-risk endoscopic lesions and may be considered...
September 2010: Polskie Archiwum Medycyny Wewnętrznej
Sawomir Rudzki, Sławomir Czekalowski, Krzysztof Michalak, Wojciech Kusz, Andrzej Fularz
Twenty four patients with acute upper gastrointestinal bleeding undergoing endoscopy were assessed. Thirteen received erythromycin before the examination and 11 did not. The cleansing effect was bad in 2/6, satisfactory in 4/3 and good in 7/2 patients (erythromycin/non erythromycin group respectively). The need for repeat endoscopy was in 3 and 8 patients respectively. In conclusion erythromycin given before endoscopy improves quality of endoscopic examination in patients with upper gastrointestinal bleeding...
2006: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Nicholas Carbonell, Arnaud Pauwels, Lawrence Serfaty, Pierre-Yves Boelle, Laurent Becquemont, Raoul Poupon
BACKGROUND/AIM: Presence of clots in the stomach makes emergency endoscopy difficult in patients with upper gastrointestinal bleeding. We investigated whether the association of erythromycin infusion to gastric lavage could improve stomach cleansing before endoscopy. PATIENTS AND METHODS: One hundred patients admitted for upper gastrointestinal bleeding were randomly assigned to receive either gastric lavage plus intravenous erythromycin (250 mg) or gastric lavage plus placebo before endoscopy in a double-blind study...
June 2006: American Journal of Gastroenterology
H Nietsch, E Lotterer, W E Fleig
Upper gastrointestinal hemorrhage calls for a team approach. Early endotracheal intubation of unconscious patients helps to prevent aspiration. Erythromycin i.v. 20 min. before emergency endoscopy improves the diagnostic yield. Patients without increased risk of rebleeding may be treated on an outpatient basis. Band ligation is the gold standard for acute variceal bleeding. Terlipressin, somatostatin and octreotide are equally effective but require additional measures for prevention of late recurrence. Somatostatin and analogues used as adjunct to ligation slightly reduce the risk of rebleeding but not of death...
May 2003: Der Internist
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