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87 MANAGEMENT OF NONVARICEAL UPPER GI BLEEDING (NVUGIB) AFTER GUIDELINE PUBLICATION: THE REASON STUDY AN Barkun1, A Gasco2, D Jewell2, K Nevin2; the REASON Study Investigators AIM: The present study aimed to identify the current management patterns of NVUGIB in 21 Canadian hospitals to determine the adherence to guidelines published in 20031.
1Division of Gastroenterology, McGill University, Montreal, Quebec; 2AstraZeneca Canada, Mississauga, Ontario
METHODS: Patients admitted for NVUGIB between January 2004 and May 2005 were identified using ICD-9/10 codes. Consecutive patient charts were retrospectively reviewed in chronological order of admission date. A Web-based case report form using standardized definitions for variables was used, with validation of all entered data by two independent nurses in addition to a centralized data validation process previously described in the literature. The study is ongoing and we expect to conclude with approximately 2000 patients.
RESULTS: Data from 1450 patients admitted for NVUGIB are presented (67±17 yrs, 41% female, 3.7±2.9 comorbid conditions). Medication use included antithrombotics (47%), NSAIDS (27%), corticosteroids (7%) and SSRIs (4%). Upper endoscopy was performed in 88% of patients; of these, 64% had endoscopy within 24 h of initial presentation of UGIB. Ulcers were reported in 61% of patients. High-risk endoscopic stigmata (HRS) were reported in 36%, low-risk endoscopic stigmata (LRS) in 17% and 47% of patients who underwent endoscopy had no classification of stigmata. Endoscopic therapy was reported in only 62% (20% injection, 9% thermal, 3% other, 30% combination thereof) of patients with HRS, despite guideline recommendations; also 16% of patients with LRS received endoscopic therapy. Of the total 1450 patients, 84% received an IV PPI to treat NVUGIB and 12% received an oral PPI only. PPI treatment was initiated before endoscopy in 75% of patients; of these 36% received the 80 mg bolus + 8 mg/h continuous infusion regimen. Less than 4% of patients received H2RA treatment for NVUGIB. Although 91% of patients with HRS received an IV PPI, only 50% received the guideline recommended dose (IV PPI 80 mg bolus + 8 mg/h continuous infusion). Furthermore, only 36% of patients with HRS received both endoscopic therapy and the recommended dosing regimen of IV PPI treatment. An oral PPI was the only medication used in 7% of patients with HRS. 24% of patients with LRS received the 80 mg bolus + 8 mg/h infusion regimen, which is not recommended according to the management guidelines.
CONCLUSION: These data suggest that there is a need at the national level for improved adherence to published recommendations on the management of NVUGIB.
1Barkun et al. Ann Intern Med 2003;139:843-57.
This research was funded by AstraZeneca