Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain.
Adv Ther. 2012 Dec;29(12):1026-36. doi: 10.1007/s12325-012-0069-x. Epub 2012 Dec 6.
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.
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.
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).
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.
尽管内镜和药物治疗方面取得了进展，但非静脉曲张性上消化道出血（NVUGIB）仍然与相当高的死亡率和发病率相关，而这些死亡率和发病率在不同国家之间存在差异。欧洲非静脉曲张性上消化道出血调查（ENERGiB）报告了整个欧洲（比利时、希腊、意大利、挪威、葡萄牙、西班牙和土耳其）的临床结果，并在“真实世界”的欧洲环境中评估了管理策略。本文介绍了参与 ENERGiB 的国家之间临床管理策略的差异。
在为期两个月的时间里，123 家参与医院连续纳入出现显性 NVUGIB 的成年患者。从患者的病历中回顾性收集与初始 NVUGIB 发作相关的数据，以及最多 30 天后的数据。
共评估了 2660 例可评估患者；患者的人口统计学和临床特征在各国之间相似。NVUGIB 管理团队的区域和专业领域以及初始医院评估后的单位转院率在国家之间存在广泛的差异。仅在意大利和西班牙，从入院到内镜检查的平均时间<1 天。在接受内镜检查前的使用情况（35.0%-88.7%）存在广泛的差异，而在接受内镜检查后的药物治疗率（86.5%-96.0%）则相对一致。在接受内镜检查时进行治疗性操作的国家间差异很大（24.9%-47.6%）。NVUGIB 相关医疗资源的消耗很高且存在差异（住院天数，平均 5.4-8.7 天；住院期间的内镜检查次数，平均 1.1-1.7 次）。
ENERGiB 表明，欧洲各国在急性 NVUGIB 患者的管理方面存在很大差异，而且在许多情况下，NVUGIB 管理指南推荐的治疗方法并未得到遵循。
