INTRODUCTION: Despite recent advances in endoscopic and pharmacological management, nonvariceal upper gastrointestinal bleeding (NVUGIB) is still associated with considerable mortality and morbidity that vary between countries. The European Survey of Nonvariceal Upper Gastrointestinal Bleeding (ENERGiB) reported clinical outcomes across Europe (Belgium, Greece, Italy, Norway, Portugal, Spain, and Turkey) and evaluated management strategies in a "real-world" European setting. This article presents the differences in clinical management strategies among countries participating in ENERGiB. METHODS: Adult patients consecutively presenting with overt NVUGIB at 123 participating hospitals over a 2-month period were included. Data relevant to the initial NVUGIB episode and for up to 30 days afterwards were collected retrospectively from patient medical records. RESULTS: The number of evaluable patients was 2,660; patient demographics and clinical characteristics were similar across countries. There was wide between-country variability in the area and speciality of the NVUGIB management team and unit transfer rates after the initial hospital assessment. The mean time from admission to endoscopy was <1 day only in Italy and Spain. Wide variation in the use of preendoscopy (35.0-88.7%) and relatively consistent (86.5-96.0%) postendoscopic pharmacological therapy rates were observed. There was substantial by-country variability in the rate of therapeutic procedures performed during endoscopy (24.9-47.6%). NVUGIB-related healthcare resource consumption was high and variable (days hospitalized, mean 5.4-8.7 days; number of endoscopies during hospitalization, mean 1.1-1.7). CONCLUSIONS: ENERGiB demonstrates that there are substantial differences in the management of patients with acute NVUGIB episodes across Europe, and that in many cases the guideline recommendations for the management of NVUGIB are not being followed.
INTRODUCTION: Despite recent advances in endoscopic and pharmacological management, nonvariceal upper gastrointestinal bleeding (NVUGIB) is still associated with considerable mortality and morbidity that vary between countries. The European Survey of Nonvariceal Upper Gastrointestinal Bleeding (ENERGiB) reported clinical outcomes across Europe (Belgium, Greece, Italy, Norway, Portugal, Spain, and Turkey) and evaluated management strategies in a "real-world" European setting. This article presents the differences in clinical management strategies among countries participating in ENERGiB. METHODS: Adult patients consecutively presenting with overt NVUGIB at 123 participating hospitals over a 2-month period were included. Data relevant to the initial NVUGIB episode and for up to 30 days afterwards were collected retrospectively from patient medical records. RESULTS: The number of evaluable patients was 2,660; patient demographics and clinical characteristics were similar across countries. There was wide between-country variability in the area and speciality of the NVUGIB management team and unit transfer rates after the initial hospital assessment. The mean time from admission to endoscopy was <1 day only in Italy and Spain. Wide variation in the use of preendoscopy (35.0-88.7%) and relatively consistent (86.5-96.0%) postendoscopic pharmacological therapy rates were observed. There was substantial by-country variability in the rate of therapeutic procedures performed during endoscopy (24.9-47.6%). NVUGIB-related healthcare resource consumption was high and variable (days hospitalized, mean 5.4-8.7 days; number of endoscopies during hospitalization, mean 1.1-1.7). CONCLUSIONS: ENERGiB demonstrates that there are substantial differences in the management of patients with acute NVUGIB episodes across Europe, and that in many cases the guideline recommendations for the management of NVUGIB are not being followed.
Authors: Keith Siau; James Hodson; Richard Ingram; Andrew Baxter; Monika M Widlak; Caroline Sharratt; Graham M Baker; Tom Troth; Ben Hicken; Faraz Tahir; Malik Magrabi; Nouman Yousaf; Claire Grant; Dennis Poon; Hesham Khalil; Hui Lin Lee; Jonathan R White; Huey Tan; Syazeddy Samani; Patricia Hooper; Saeed Ahmed; Muhammad Amin; Sara Mahgoub; Khayal Asghar; Farique Leet; Matthew J Harborne; Beata Polewiczowska; Sheeba Khan; Muhammad R Anjum; Michael McFarlane; Ella Mozdiak; Lauren D O'Flynn; Ilona C Blee; Rachel M Molyneux; Ashok Kurian; Syed N Abbas; Abdullah Abbasi; Aadil Karim; Asif Yasin; Fawad Khattak; Josephine White; Ruhina Ahmed; James A Morgan; Lance Alleyne; Mohamed A Alam; Naaventhan Palaniyappan; Victoria J Rodger; Paramvir Sawhney; Nasar Aslam; Theodore Okeke; Adam Lawson; Danny Cheung; Jeremy P Reid; Ashish Awasthi; Mark R Anderson; Joe R Timothy; Sanjeev Pattni; Saqib Ahmad; Gillian Townson; Jeremy Shearman; Vanja Giljaca; Matthew J Brookes; Ben R Disney; Neil Guha; Titus Thomas; Anthony Norman; Peter Wurm; Ashit Shah; Neil C Fisher; Sauid Ishaq; Giles Major Journal: United European Gastroenterol J Date: 2018-10-28 Impact factor: 4.623