A new international consensus guideline has been published on the management of non-variceal upper GI bleeding (guidelines). Among the highlights, the guidelines stress the use of prognostic staging and early endoscopy. Post endoscopy, low risk patients should be candidates for early discharge, while high risk patients should be observed for re-bleeding on high-dose IV PPIs for 72 hours. ASA should be restarted within 7 days for those who require it (and ASA+PPI is preferred over clopidogrel). For those requiring NSAIDs, a PPI with a COX-2 inhibitor is preferred. In peptic ulcers, test (and treat) for Hpylori
This large systematic review found rectal NSAIDs significantly reduced the risk of post-ERCP pancreatitis compared to pancreatic duct stents (abstract).
This large population-based cohort found the most common causes of drug induced liver injury to be augmentin and diclofenac, followed by herbal and nutritional supplements (abstract).
This large trial of patients with a relative contraindication for enteral feeds were randomized to early TPN or usual care. There were no differences in the groups in 60 day mortality or LOS, but those on TPN did have a shorter time ventilated and less muscle/fat loss. It is unclear based on this trial if […]