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Expanding the Scope of High-Value Practice Beyond Guideline-Based Care—Reply
JAMA Internal Medicine ( IF 22.5 ) Pub Date : 2018-03-01 , DOI: 10.1001/jamainternmed.2017.8517
Emmanuel Coronel 1 , Vineet M. Arora 2 , K. Gautham Reddy 3
Affiliation  

In Reply We want to thank Gupta et al for the letter written with regard to our manuscript. The work by Gupta and colleagues reviewing the outcomes of their practice change to use intermittent dosing of proton pump infusion (PPIs) in nonvariceal upper gastrointestinal bleeding (UGIB) at their institution is laudable. Even though PPI therapy administered as intermittent intravenous bolus dosing has shown to be equivalent to PPI administered as a continued infusion in a meta-analysis,1 continuous infusion continues to be the standard of care in patients with UGIB who have ulcers with high-risk stigmata per guidelines published by the European Society of Gastrointestinal Endoscopy2 and the American College of Gastroenterology.3 The consensus from both of these societies made the strong recommendation for continuous infusion based on high-quality evidence. There is a recommendation in the European guidelines suggesting intermittent PPI can be considered after endoscopic hemostasis, but this is based on low-quality evidence and is not as strong of a recommendation as previously mentioned.2



中文翻译:

扩大基于指南的护理之外的高价值实践的范围-答复

在答复中,我们要感谢Gupta等人写的关于我们手稿的信。Gupta及其同事回顾了他们机构改变使用非连续性上消化道出血(UGIB)的质子泵输注(PPIs)间歇给药的实践成果的工作。即使在荟萃分析中以间歇静脉推注方式进行的PPI治疗与通过持续输注进行的PPI等效,但对于患有高风险柱头溃疡的UGIB患者,连续1输注仍然是治疗的标准根据欧洲胃肠内窥镜学会2和美国胃肠病学院发布的指南。3这两个社会的共识为基于高质量证据的持续输注提出了强烈建议。欧洲指南中有一项建议,建议在内窥镜止血后可以考虑间歇性PPI,但这是基于低质量的证据,并不像前面提到的那样强烈。2个

更新日期:2018-03-06
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