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Kola G, Sureshkumar S, Mohsina S, Sreenath GS, Kate V. Restrictive versus liberal transfusion strategy in upper gastrointestinal bleeding: A randomized controlled trial. Saudi J Gastroenterol 2020; 27:13-19. [PMID: 32801255 PMCID: PMC8083250 DOI: 10.4103/sjg.sjg_152_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The study aimed at comparing restrictive and liberal transfusion strategy in reducing mortality in patients with upper gastrointestinal bleeding (UGIB). METHODS This was a single-center, prospective, open-label, non-inferiority, randomized controlled trial conducted over two years. Patients presenting with UGIB were randomized into restrictive (hemoglobin (Hb) <7 g/dl) or liberal (Hb <8 g/dl) transfusion strategy groups. Transfusion was given till patients achieved target Hb of 9 g/dl in restrictive and 10 g/dl in the liberal arms. Patients with exsanguinating bleeding, transfusion within 90 days, recent history of trauma or surgery were excluded. Primary outcome was mortality rate and the secondary outcomes were morbidity, re-bleeding episodes and the need for intervention. RESULTS A total of 224 patients were randomized to 112 patients in each group. Demographic characteristics were comparable. 45-day mortality was similar between the two groups (restrictive vs. liberal; 10/112 vs. 12/112; P = 0.65). The number of in-hospital bleeding episodes (12 vs. 9; P = 0.25), incidence of re-bleeding during the 45-day follow-up (13 vs. 14; P = 0.84), need for endoscopic banding for varices (37/112 vs. 39/112, P = 0.99), mean hospital stay (days) (3.21 ± 2.78 vs. 2.73 ± 1.29; P = 0.10) were similar between the two groups. CONCLUSION Restrictive transfusion strategy is non-inferior to liberal transfusion strategy in patients with UGIB.
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Affiliation(s)
- Gautham Kola
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Sathasivam Sureshkumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Subair Mohsina
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - GS Sreenath
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India,Address for correspondence: Dr. Vikram Kate, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry - 605 006, India. E-mail:
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Manko M, Bello AK, Mohammed MF, Egbegbedia PO, Daniyan M, Jabir AM, Mustapaha SK, Dauda MM. Demographic profile and endoscopic findings among patients with upper gastrointestinal bleeding in Ahmadu Bello University Teaching Hospital, Zaria, North-Western Nigeria. Niger J Clin Pract 2020; 23:1163-1166. [PMID: 32788496 DOI: 10.4103/njcp.njcp_69_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency that can result in significant morbidity and mortality. Aim The aim of this study was to determine the demographic profile and etiology of UGIB in patients seen at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, North-Western Nigeria. Subjects and Methods This descriptive retrospective study was carried out at the Gastroenterology Unit of ABUTH Zaria. Data of patients referred for upper gastrointestinal endoscopy with UGIB from June 2017 to December 2019 were extracted from the endoscopy register and analyzed. Results One hundred and forty-four patients had upper gastrointestinal (UGI) endoscopy done for UGIB during the period under review. Of these, 105 (72.9%) were males while 39 (27.1%) were females with male-to-female ratio of 2.7:1. The mean age of the patients was 43.5 ± 17.3 and their age ranges from 11 to 89 years. The modal age group was 40-49 years. The most common cause of UGIB was esophageal varices (67 [46.5%]) followed by erosive mucosal diseases: gastritis/duodenitis 43 (29.9%), esophagitis 12 (8.3%). Less common causes were peptic ulcer disease (PUD) in five (3.5%) patients, gastric tumor in two (1.4%), hiatus hernia in one (0.7%), and portal hypertensive gastropathy in one (0.7%). Thirteen patients (9.0%) had normal findings. Conclusion Esophageal varices are the most common cause of UGIB among our patients and middle-aged male patients were the most commonly affected group.
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Affiliation(s)
- M Manko
- Department of Medicine, ABU/ABUTH, Zaria, Nigeria
| | - A K Bello
- Department of Medicine, ABU/ABUTH, Zaria, Nigeria
| | - M F Mohammed
- Department of Specialty Medicine, Worcestershire Royal Hospital, Worcester, UK
| | | | - M Daniyan
- Department of Surgery, ABU/ABUTH, Zaria, Nigeria
| | - A M Jabir
- Department of Medicine, ABUTH, Zaria, Nigeria
| | | | - M M Dauda
- Department of Surgery, ABU/ABUTH, Zaria, Nigeria
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Seo DW, Yi H, Park B, Kim YJ, Jung DH, Woo I, Sohn CH, Ko BS, Kim N, Kim WY. Prediction of Adverse Events in Stable Non-Variceal Gastrointestinal Bleeding Using Machine Learning. J Clin Med 2020; 9:jcm9082603. [PMID: 32796647 PMCID: PMC7464777 DOI: 10.3390/jcm9082603] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 11/16/2022] Open
Abstract
Clinical risk-scoring systems are important for identifying patients with upper gastrointestinal bleeding (UGIB) who are at a high risk of hemodynamic instability. We developed an algorithm that predicts adverse events in patients with initially stable non-variceal UGIB using machine learning (ML). Using prospective observational registry, 1439 out of 3363 consecutive patients were enrolled. Primary outcomes included adverse events such as mortality, hypotension, and rebleeding within 7 days. Four machine learning algorithms, namely, logistic regression with regularization (LR), random forest classifier (RF), gradient boosting classifier (GB), and voting classifier (VC), were compared with the Glasgow-Blatchford score (GBS) and Rockall scores. The RF model showed the highest accuracies and significant improvement over conventional methods for predicting mortality (area under the curve: RF 0.917 vs. GBS 0.710), but the performance of the VC model was best in hypotension (VC 0.757 vs. GBS 0.668) and rebleeding within 7 days (VC 0.733 vs. GBS 0.694). Clinically significant variables including blood urea nitrogen, albumin, hemoglobin, platelet, prothrombin time, age, and lactate were identified by the global feature importance analysis. These results suggest that ML models will be useful early predictive tools for identifying high-risk patients with initially stable non-variceal UGIB admitted at an emergency department.
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Affiliation(s)
- Dong-Woo Seo
- Department of Emergency Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Korea; (D.-W.S.); (Y.-J.K.); (D.H.J.); (C.H.S.)
- Department of Information Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Korea
| | - Hahn Yi
- Asan Institute for Life Sciences, Asan Medical Center, Seoul 05505, Korea;
| | - Beomhee Park
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea; (B.P.); (I.W.)
| | - Youn-Jung Kim
- Department of Emergency Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Korea; (D.-W.S.); (Y.-J.K.); (D.H.J.); (C.H.S.)
| | - Dae Ho Jung
- Department of Emergency Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Korea; (D.-W.S.); (Y.-J.K.); (D.H.J.); (C.H.S.)
| | - Ilsang Woo
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea; (B.P.); (I.W.)
| | - Chang Hwan Sohn
- Department of Emergency Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Korea; (D.-W.S.); (Y.-J.K.); (D.H.J.); (C.H.S.)
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea;
| | - Namkug Kim
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea; (B.P.); (I.W.)
- Correspondence: (N.K.); (W.Y.K.); Tel.: +822-3010-6573 (N.K.); +822-3010-5670 (W.Y.K.)
| | - Won Young Kim
- Department of Emergency Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Korea; (D.-W.S.); (Y.-J.K.); (D.H.J.); (C.H.S.)
- Correspondence: (N.K.); (W.Y.K.); Tel.: +822-3010-6573 (N.K.); +822-3010-5670 (W.Y.K.)
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Robertson M, Ng J, Abu Shawish W, Swaine A, Skardoon G, Huynh A, Deshpande S, Low ZY, Sievert W, Angus P. Risk stratification in acute variceal bleeding: Comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding. Dig Endosc 2020; 32:761-768. [PMID: 31863515 DOI: 10.1111/den.13577] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Risk stratification is recommended in all patients with acute variceal bleeding (AVB). It remains unclear whether liver disease severity or upper gastrointestinal bleeding (UGIB) scoring algorithms offer superior predictive ability. We aimed to validate the AIMS65 score as a predictor of mortality in AVB, and to compare AIMS65 with established UGIB and liver disease severity risk stratification scores. METHODS International Classification of Diseases, Tenth Revision codes identified patients presenting with AVB to three tertiary centers over a 48-month period. Patients were risk-stratified using AIMS65, Rockall, pre-endoscopy Rockall, Child-Pugh, Model for End-stage Liver Disease (MELD) and United Kingdom MELD (UKELD) scores. Primary outcomes were inpatient and 6-week mortality and inpatient rebleeding. RESULTS Two hundred and twenty-three patients were included. Inpatient and 6-week mortality were 13.9% and 15.5% respectively. Prediction of inpatient mortality by AIMS65 (area under the receiver-operating characteristic curve [AUROC: 0.84]) was equivalent to UGIB (Rockall: 0.79, pre-Rockall: 0.78) and liver risk scores (MELD: 0.81, UKELD: 0.79, Child-Pugh: 0.78). AIMS65 score ≥3 best defined high- and low-risk groups for inpatient mortality (mortality 37.7% vs 4.9%). AIMS65 (AUROC: 0.62) was equivalent to UGIB risk scores (pre-Rockall: 0.64, Rockall: 0.70) in predicting inpatient rebleeding and superior to liver risk scores (MELD: 0.56, UKELD: 0.57, Child-Pugh: 0.60). CONCLUSIONS AIMS65 is equivalent to established UGIB and liver disease severity risk stratification scores in predicting mortality, and superior to liver scores in predicting rebleeding.
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Affiliation(s)
- Marcus Robertson
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Australia.,Department of Gastroenterology, Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Jonathan Ng
- Department of Gastroenterology, Monash Health, Clayton, Australia
| | | | - Adrian Swaine
- Department of Gastroenterology, Monash Health, Clayton, Australia
| | - Gillian Skardoon
- Department of Gastroenterology, Monash Health, Clayton, Australia
| | - Andrew Huynh
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Australia
| | | | - Zi Yi Low
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Australia
| | - William Sievert
- Department of Gastroenterology, Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Peter Angus
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
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Abstract
Hyperplastic polyps are the second most common type of gastric polyp in the United States with equal incidence in both genders, usually found incidentally during endoscopic examinations. It is a well-known fact that they are associated with iron-deficiency anemia due to chronic blood loss. We present a case of a 69-year-old man with a relatively small hyperplastic gastric polyp with acute upper gastrointestinal bleeding, presenting with melena and acute blood loss anemia requiring admission to intensive care unit and urgent endoscopic intervention with hot snare removal of the polyp and cautery of surrounding area with excellent hemostasis. The pathology revealed focal intestinal metaplasia and low-grade dysplasia with no evidence of malignancy. He was subsequently discharged with outpatient follow-up with gastroenterology.
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Affiliation(s)
- Aimen Farooq
- Internal Medicine, AdventHealth Orlando, Orlando, USA
| | | | - James Wert
- Internal Medicine, AdventHealth Orlando, Orlando, USA
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106
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Abstract
Background and Aim The aim of this study was to evaluate the impact of a change in our institute's protocol from continuous intravenous (IV) proton pump inhibitor (PPI) therapy to bolus IV PPI therapy for the treatment of peptic ulcer-related bleeding on patient outcomes. Current guidelines recommend PPI therapy through high-dose IV bolus followed by continuous infusion for bleeding ulcers. Conflicting data have been reported regarding the practice shift to intermittent IV PPI therapy. Methods A retrospective record review was conducted of patients treated at West Virginia University between 2017 and 2018 for peptic ulcer related bleeding who underwent endoscopy and had high-risk stigmata. Relevant variables were identified. Outcomes were compared between groups based on PPI strategy. The primary endpoint was any poor outcome defined as rebleeding, need for embolization or surgery, or mortality during hospital stay. Results A total of 130 patients were included, with a mean age of 62.18 years. Continuous PPI infusion was used in 39.23%, whereas bolus IV PPI was used 60.76%. Poor outcome was encountered in 11 (21.57%) patients in the continuous and 33 (41.77%) patients in the bolus group (p = 0.028). On multivariable analyses, bolus PPI strategy was independently linked to poor outcome (Wald's odds ratio: 2.8; 95% CI: 1.21-6.84; p = 0.019) and an increased need for embolization/surgery (OR: 4.12, 95% CI: 1.14-19.99; p = 0.046). Conclusions IV bolus therapy showed worse outcomes compared with continuous IV PPI therapy for patients with peptic ulcer bleeding with high-risk features. More robust data are needed before a practice shift to bolus PPI may be appropriate.
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Affiliation(s)
- Raja Samir Khan
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Yousaf B Hadi
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA.,Internal Medicine, J.W. Ruby Memorial Hospital, Morgantown, USA
| | - Noor Chima
- Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Justin Kupec
- Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, USA
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Wu CK, Yang SC, Liang CM, Li YC, Yeh WS, Tai WC, Lee CH, Yang YH, Hsu CN, Tsai TH, Chuah SK. The role of antibiotics in upper gastrointestinal bleeding among cirrhotic patients without major complications after endoscopic hemostasis. J Gastroenterol Hepatol 2020; 35:777-787. [PMID: 31674688 DOI: 10.1111/jgh.14873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Antibiotic prophylaxis should be instituted for cirrhotic patients with upper gastrointestinal bleeding (UGIB), but the benefit on compensated patients remains undetermined. We aimed to compare the clinical outcomes between cirrhotic patients without major complications with UGIB with and without antibiotic prophylaxis. METHODS We conducted this population-based cohort study by using Taiwanese Longitudinal Health Insurance Database 2000 (LHID2000, between 1997 to 2013), aged 18 years or older with a hospital discharge diagnosis of cirrhosis (n = 64,506), UGIB (n = 7,784), and endoscopic therapy (n = 2,292). After strict exclusions, 1205 patients were enrolled and were divided into antibiotic exposure (n = 558) and non-exposure (n = 647) groups. The outcomes were rebleeding and mortality. RESULTS After completing the analysis adjusted by death, the rebleeding rates within 4 weeks were significantly lower in patients with antibiotic prophylaxis (3.05% versus 6.03%, P = 0.0142) and those with endoscopic therapy (0.72% vs 3.09%, P = 0.0033) but not significant after 3 months and onwards. Male patients aged > 55, high CCI score ≧ 4, and UGIB of variceal etiologies were benefited from rebleeding. The use of antibiotics did not significantly impact 6-week mortality (adjusted hazard ratio: 1.07, 95%CI: 0.41~2.75; P = 0.8943). Old age, multiple comorbidities, and UGIB of variceal etiologies were risk factors of all-cause mortality. CONCLUSIONS The current study suggested that cirrhotic patients without major complications who suffered from UGIB were benefited by the use of antibiotics to prevent rebleeding within 4 weeks after endoscopic treatment of UGIB especially for those with age > 55, high CCI score ≧ 4, and UGIB of variceal etiologies.
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Affiliation(s)
- Cheng-Kun Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Li
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Shuo Yeh
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Shafaghi A, Gharibpoor F, Mahdipour Z, Samadani AA. Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin. ACTA ACUST UNITED AC. 2019;57:322-333. [PMID: 31268861 DOI: 10.2478/rjim-2019-0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Management of upper gastrointestinal bleeding (UGIB) is of great importance. In this way, we aimed to evaluate the performance of three well known scoring systems of AIMS65, Glasgow-Blatchford Score (GBS) and Full Rockall Score (FRS) in predicting adverse outcomes in patients with UGIB as well as their ability in identifying low risk patients for outpatient management. We also aimed to assess whether changing albumin cutoff in AIMS65 and addition of albumin to GBS add predictive value to these scores. METHODS This was a retrospective study on adult patients who were admitted to Razi hospital (Rasht, Iran) with diagnosis of upper gastrointestinal bleeding between March 21, 2013 and March 21, 2017. Patients who didn't undergo endoscopy or had incomplete medical data were excluded. Initially, we calculated three score systems of AIMS65, GBS and FRS for each patient by using initial Vital signs and lab data. Secondary, we modified AIMS65 and GBS by changing albumin threshold from <3.5 to <3.0 in AIMS65 and addition of albumin to GBS, respectively. Primary outcomes were defined as in hospital mortality, 30-day rebleeding, need for blood transfusion and endoscopic therapy. Secondary outcome was defined as composition of primary outcomes excluding need for blood transfusion. We used AUROC to assess predictive accuracy of risk scores in primary and secondary outcomes. For albumin-GBS model, the AUROC was only calculated for predicting mortality and secondary outcome. The negative predictive value for AIMS65, GBS and modified AIMS65 was then calculated. RESULT Of 563 patients, 3% died in hospital, 69.4% needed blood transfusion, 13.1% needed endoscopic therapy and 3% had 30-day rebleeding. The leading cause of UGIB was erosive disease. In predicting composite of adverse outcomes all scores had statistically significant accuracy with highest AUROC for albumin-GBS. However, in predicting in hospital mortality, only albumin-GBS, modified AIMS65 and AIMS65 had acceptable accuracy. Interestingly, albumin, alone, had higher predictive accuracy than other original risk scores. None of the four scores could predict 30-day rebleeding accurately; on the contrary, their accuracy in predicting need for blood transfusion was high enough. The negative predictive value for GBS was 96.6% in score of ≤2 and 85.7% and 90.2% in score of zero in AIMS65 and modified AIMS65, respectively. CONCLUSION Neither of risk scores was highly accurate as a prognostic factor in our population; however, modified AIMS65 and albumin-GBS may be optimal choice in evaluating risk of mortality and general assessment. In identifying patient for safe discharge, GBS ≤ 2 seemed to be advisable choice.
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Abstract
<b>Introduction: </b>Gastrointestinal bleeding is a common disease that surgeons encounter in everyday clinical practice. It is most often easy to diagnose and treat. However, rare causes of bleeding can lead to delayed diagnosis and ineffective treatment. Dysfibrinogenemia is a qualitative fibrinogen disorder in which functional fibrinogen level is reduced with normal antigenic level. <br><b> Case report:</b> Herein we present the case of a 59-year-old female with recurrent gastrointestinal bleeds, that turned out to be an unusual manifestation of congenital dysfibrinogenemia. Detailed imaging and endoscopic diagnostics revealed portal hypertension with a non-bleeding 1-cm gastrointestinal stromal tumor and multiple angiodysplastic lesions in close proximity.
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Affiliation(s)
- Weronika Lebowa
- Klinika Chirurgii Ogólnej, Onkologicznej i Geriatrycznej, Collegium Medicum Uniwersytetu Jagiellońskiego, Kraków, Polska
| | - Jakub Kenig
- Klinika Chirurgii Ogólnej, Onkologicznej i Geriatrycznej, Collegium Medicum Uniwersytetu Jagiellońskiego, Kraków, Polska
| | - Joanna Zdziarska
- Katedra Hematologii, Collegium Medicum Uniwersytetu Jagiellońskiego, Kraków, Polska
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Tang B, Xiao S. Logistic regression analysis of risk factors for upper gastrointestinal bleeding induced by PCI in combination with double antiplatelet therapy for STEMI patients. Acta Gastroenterol Belg 2020; 83:245-248. [PMID: 32603042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To analyze the risk factors for upper gastrointestinal bleeding (UGIB) in patients with ST-segment elevation myocardial infarction (STEMI) during double antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). METHODS A total of 388 patients treated from January 2015 to September 2017 due to STEMI were selected. Thirty-two cases of UGIB occurring during DAPT after PCI were included as a UGIB group, and another 356 cases without UGIB were set as a control group. Age, gender, body mass index, smoking, drinking, history of previous diseases (hypertension, diabetes and digestive tract diseases), infection of Helicobacter pylori (Hp), combined use of other drugs (statins, NSAIDs, β receptor blockers, PPI, H2RA and dabigatran etexilate), as well as serum levels of creatinine (Cr), alanine transaminase (ALT) and C-reactive protein (CRP) were compared. The risk factors for UGIB were subjected to univariate and logistic regression analyses. RESULTS Compared with the control group, the UGIB group had significantly longer hospital stay, and higher proportion of discontinuation of antithrombotic drugs and mortality rate (P<0.05). Logistic regression analysis showed that age (P=0.002), smoking (P=0.000), Hp infection (P=0.020), history of digestive tract diseases (P=0.030) and renal insufficiency (P=0.041) were independent risk factors for UGIB, and use of PPI (P=0.028) was a protective factor for UGIB. CONCLUSIONS Old age, smoking, Hp infection, history of digestive tract diseases and renal insufficiency are risk factors for UGIB caused by PCI combined with DAPT in patients with STEMI. Proper use of PPI thereafter can reduce the incidence rate of UGIB.
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Affiliation(s)
- B Tang
- Department of Cardiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | - S Xiao
- Department of Cardiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
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111
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Rao VL, Gupta N, Swei E, Wagner T, Aronsohn A, Reddy KG, Sengupta N. Predictors of mortality and endoscopic intervention in patients with upper gastrointestinal bleeding in the intensive care unit. Gastroenterol Rep (Oxf) 2020; 8:299-305. [PMID: 32843977 PMCID: PMC7434581 DOI: 10.1093/gastro/goaa009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/15/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background The outcomes of patients undergoing esophagogastroduodenoscopy (EGD) in the intensive care unit (ICU) for upper gastrointestinal bleeding (UGIB) are not well described. Our aims were to determine predictors of 30-day mortality and endoscopic intervention, and assess the utility of existing clinical-prediction tools for UGIB in this population. Methods Patients hospitalized in an ICU between 2008 and 2015 who underwent EGD were identified using a validated, machine-learning algorithm. Logistic regression was used to determine factors associated with 30-day mortality and endoscopic intervention. Area under receiver-operating characteristics (AUROC) analysis was used to evaluate established UGIB scoring systems in predicting mortality and endoscopic intervention in patients who presented to the hospital with UGIB. Results A total of 606 patients underwent EGD for UGIB while admitted to an ICU. The median age of the cohort was 62 years and 55.9% were male. Multivariate analysis revealed that predictors associated with 30-day mortality included American Society of Anesthesiologists (ASA) class (odds ratio [OR] 4.1, 95% confidence interval [CI] 2.2-7.9), Charlson score (OR 1.2, 95% CI 1.0-1.3), and duration from hospital admission to EGD (OR 1.04, 95% CI 1.01-1.07). Rockall, Glasgow-Blatchford, and AIMS65 scores were poorly predictive of endoscopic intervention (AUROC: 0.521, 0.514, and 0.540, respectively) and in-hospital mortality (AUROC: 0.510, 0.568, and 0.506, respectively). Conclusions Predictors associated with 30-day mortality include ASA classification, Charlson score, and duration in the hospital prior to EGD. Existing risk tools are poorly predictive of clinical outcomes, which highlights the need for a more accurate risk-stratification tool to predict the benefit of intervention within the ICU population.
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Affiliation(s)
- Vijaya L Rao
- Section of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Nina Gupta
- Section of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Eric Swei
- Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Thomas Wagner
- Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Andrew Aronsohn
- Section of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - K Gautham Reddy
- Section of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Neil Sengupta
- Section of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
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García Rodríguez LA, Lanas A, Soriano-Gabarró M, Vora P, Cea Soriano L. Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational Study. J Clin Med 2020; 9:jcm9040928. [PMID: 32231106 PMCID: PMC7230296 DOI: 10.3390/jcm9040928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 12/14/2022] Open
Abstract
Estimates of the effect of proton pump inhibitors (PPIs) on risks of upper and lower gastrointestinal bleeding (UGIB and LGIB) among low-dose aspirin users in routine clinical practice are variable (UGIB) or lacking (LGIB). We aimed to establish these risks in the same observational study population. Using UK primary care data, we followed 199,049 new users of low-dose aspirin (75–300 mg/day) and matched non-users at start of follow-up to identify incident UGIB/LGIB cases. In nested case–control analyses, adjusted odds ratios (ORs) were calculated for concomitant PPI use vs. past (discontinued) PPI use among current low-dose aspirin users. For UGIB (n = 987), ORs (95% CIs) were 0.69 (0.54–0.88) for >1 month PPI use and 2.65 (1.62–4.3) for ≤1 month PPI use. Among the latter group, ORs (95% CIs) were 3.05 (1.75–5.33) for PPI initiation after start of aspirin therapy, and 1.66 (0.63–4.36) for PPI initiation on/before start of aspirin therapy. For LGIB (n = 1428), ORs (95% CIs) were 0.98 (0.81–1.17) for >1 month PPI use and 1.12 (0.73–1.71) for ≤1 month PPI use. Among low-dose aspirin users, maintaining PPI use (>1 month) was associated with a significantly reduced UGIB risk. Neither short nor long-term PPI use affected LGIB risk.
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Affiliation(s)
- Luis A. García Rodríguez
- Spanish Centre for Pharmacoepidemiologic Research (CEIFE), 28004 Madrid, Spain;
- Correspondence: ; Tel.: +34-91-531-3404
| | - Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico, University of Zaragoza, 50009 IIS Aragón, Zaragoza, Spain;
- CIBERehd, Av. Monforte de Lemos 3–5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | | | - Pareen Vora
- Epidemiology, Bayer AG, 13353 Berlin, Germany; (M.S.-G.) (P.V.)
| | - Lucía Cea Soriano
- Spanish Centre for Pharmacoepidemiologic Research (CEIFE), 28004 Madrid, Spain;
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
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113
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Saleem SA, Kudaravalli P, Riaz S, Pendela VS, Wang D, Lowe D, Manocha D. Outcomes of Upper Gastrointestinal Bleeding Based on Time to Endoscopy: A Retrospective Study. Cureus 2020; 12:e7325. [PMID: 32313766 PMCID: PMC7164718 DOI: 10.7759/cureus.7325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Non-variceal upper gastrointestinal bleeding (UGIB) is a major burden on the health care system. The timing of endoscopy has been an ongoing debate and data on the association of early endoscopy with a better or worse clinical outcome are conflicting. In our study, we aimed to identify the benefits versus the risks of performing an urgent endoscopy in regards to the number of endoscopic interventions, length of hospital stay, number of packed red blood cells (PRBCs) transfused, and mortality. Methodology This is a retrospective record-based study. A total of 806 charts were reviewed and 251 patients with the signs and symptoms of UGIB on presentation were included in the study. Patients with variceal bleeding, lower gastrointestinal bleeding, insignificant bleeds with no drop in H/H, GI bleed not being the presenting complaint on admission, and patients on anticoagulation were excluded. Results Out of the patients who underwent an urgent esophagogastroduodenoscopy (EGD), 26.2% needed a second-look EGD 48 hours after the first EGD when compared to 4% and 2% in the early (12-24 hours) and late (>24 hours) endoscopy groups, respectively. In patients who underwent urgent EGD, 23% had active bleeding and it was statistically significant when compared to the other groups. The active bleeding limited the visualization during the endoscopy, which led to a repeat EGD in the urgent EGD group. If an endoscopic intervention was received, patients having EGD >24 hours received a smaller number of interventions. There was no statistical difference in the Blatchford scores between the three groups, indicating that the groups were similar in morbidity. No difference in mortality, hospital length of stay, or number of blood transfusions received, surgical or interventional radiology-guided interventions was found between the three groups. Conclusion Patients who underwent urgent endoscopy had more procedures, with no difference in mortality, number of units of blood transfused, or length of hospitalization when compared to the early or late endoscopy groups.
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Affiliation(s)
- Sheikh A Saleem
- Gastroenterology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Pujitha Kudaravalli
- Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Sana Riaz
- Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | | | - Dongliang Wang
- Public Health and Preventive Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Dhruv Lowe
- Gastroenterology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Divey Manocha
- Gastroenterology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
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Aziz M, Weissman S, Mehta TI, Hassan S, Khan Z, Fatima R, Tsirlin Y, Hassan A, Sciarra M, Nawras A, Rastogi A. Efficacy of Hemospray in non-variceal upper gastrointestinal bleeding: a systematic review with meta-analysis. Ann Gastroenterol 2020; 33:145-154. [PMID: 32127735 PMCID: PMC7049242 DOI: 10.20524/aog.2020.0448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/20/2019] [Indexed: 12/16/2022] Open
Abstract
Background Recently, amongst other hemostatic modalities, Hemospray (TC-325) has emerged as an effective method for managing patients with non-variceal upper gastrointestinal bleeding (GIB). We conducted this systematic review and meta-analysis to assess the efficacy of Hemospray in patients with non-variceal upper GIB. Methods Our primary outcomes were clinical and technical success; secondary outcomes were aggregate rebleeding, early rebleeding, delayed rebleeding, refractory bleeding, mortality, and treatment failure. A meta-analysis of proportions was conducted for all reported primary and secondary outcomes. A relative risk meta-analysis was conducted for studies reporting direct comparisons between Hemospray and other hemostatic measures. Results A total of 20 studies with 1280 patients were included in the final analysis. Technical success of Hemospray was seen in 97% of cases (95% confidence interval [CI] 94-98%, I2=52.89%) and a significant trend towards increasing technical success was seen during publication years 2011-2019. Clinical success of Hemospray was seen in 91% of cases (95%CI 88-94%, I2=47.72%), compared to 87% (95%CI 75-94%, I2=0.00%) for other hemostatic measures. The secondary outcomes of aggregate rebleeding, early rebleeding, delayed rebleeding, refractory rebleeding, mortality and treatment failure following the use of Hemospray were seen in 27%, 20%, 9%, 8%, 8%, and 31% of cases, respectively. Conclusion Hemospray is safe, effective and non-inferior to traditional hemostatic measures for the management of non-variceal upper GIB, and can thus be used as an alternative option.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Zubair Khan, Rawish Fatima)
| | - Simcha Weissman
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, New Jersey (Simcha Weissman)
| | - Tej I Mehta
- Department of Medicine, University of South Dakota Sanford school of Medicine, Sioux Falls, South Dakota (Tej I. Mehta)
| | - Shafae Hassan
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio (Shafae Hassan, Ali Nawras)
| | - Zubair Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Zubair Khan, Rawish Fatima)
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Zubair Khan, Rawish Fatima)
| | - Yuriy Tsirlin
- Department of Gastroenterology, Maimonides Medical Center, Brooklyn, New York (Yuriy Tsirlin)
| | - Ammar Hassan
- Division of Gastroenterology and Hepatology, Hackensack University-Palisades Medical Center, North Bergen, New Jersey (Ammar Hassan, Michael Sciarra)
| | - Michael Sciarra
- Division of Gastroenterology and Hepatology, Hackensack University-Palisades Medical Center, North Bergen, New Jersey (Ammar Hassan, Michael Sciarra)
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio (Shafae Hassan, Ali Nawras)
| | - Amit Rastogi
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas (Amit Rastogi), USA
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Lu Z, Sun X, Zhang W, Jin B, Han J, Wang Y, Han J, Ma X, Liu B, Wu L, Wu Q, Yu X, Li H. Second urgent endoscopy within 48-hour benefits cirrhosis patients with acute esophageal variceal bleeding. Medicine (Baltimore) 2020; 99:e19485. [PMID: 32176084 PMCID: PMC7440074 DOI: 10.1097/md.0000000000019485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Urgent endoscopy (UE) is important to the diagnosis and treatment of liver cirrhosis patients with esophageal variceal bleeding (EVB). It was reported that a second-look endoscopy may benefit acute upper gastrointestinal bleeding (UGIB) caused by peptic ulcer, while whether it could improve UGIB caused by liver cirrhosis associated EVB remains unclear. This study aimed to investigate the characteristics of second UE for liver cirrhosis with EVB and further examined the potential prognostic factors.Patients aged ≥18 years who underwent UE for EVB within 2 hours after the admission were included and divided into scheduled second-look group (n = 245) and uncontrolled bleeding group (n = 352) based on the indications for second UE within 48 hours after initial endoscopy. Demographic and clinical data were collected and analyzed. Univariate and multivariate analysis were used to identify the risk factors for prognosis. The value of different scoring system was compared.Statistical differences were found on history of bleeding and hepatocellular carcinoma, ascites, endoscopic type of bleeding, between scheduled second-look group and uncontrolled bleeding group. Univariate and multivariate logistic regression analysis confirmed that ascites, hemoglobin <60 g/L, AIMS65 score and failure to identify in initial UE were independent risk factors for bleeding uncontrolled after initial UE, and age, bilirubin level, initial unsatisfactory UE hemostasis, failure to identify bleeding on initial UE and tube/urgent TIPS suggested in initial UE were independent risk factors for 42-day mortality.A second-look UE could bring benefit for liver cirrhosis patients with EVB without increasing the complication rate.
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Affiliation(s)
- Zheng Lu
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | - Xiaotian Sun
- Department of Internal Medicine, Clinic of August First Film Studio, Beijing South Medical District, Chinese PLA General Hospital, Beijing, China
| | - Wenhui Zhang
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | - Bo Jin
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | | | - Yanling Wang
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | - Jun Han
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | - Xuemei Ma
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | - Bo Liu
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | - Libing Wu
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | - Qin Wu
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | - Xiaoli Yu
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
| | - Hanwei Li
- Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital
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116
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Abstract
Glanzmann’s thrombasthenia (GT) is a rare bleeding disorder inherited in an autosomal recessive manner. The pathogenesis of GT mainly involves structural abnormalities and dysfunction of platelet membrane glycoprotein IIb/IIIa (integrin αIIbβ3). The most common symptoms of GT are various types of bleeding, including recurrent nasal bleeding, mucocutaneous bleeding, unremitting bleeding after injury or operation, and menorrhea in women. Such hemorrhage may be fatal in some patients. GT with spontaneous upper gastrointestinal bleeding is relatively rare. In the present report, we describe a middle-aged man who was hospitalized with spontaneous upper gastrointestinal bleeding. His main symptom was recurrent chronic and intermittent melena. Gastroscopy revealed oozing of blood in the gastric antrum wall. However, no obvious lesions such as erosion or ulceration were found. Upon further inspection, we found that the patient’s platelet aggregation was poor, and flow cytometry assay revealed low expression of platelet membrane integrin αIIbβ3. The patient was eventually diagnosed with GT and exhibited clinical improvement after active treatment.
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Affiliation(s)
- Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital (Affiliated Wujiang Hospital of Nantong University), Suzhou, China
| | - Yi Chen
- Department of Gastroenterology, Suzhou Ninth People's Hospital (Affiliated Wujiang Hospital of Nantong University), Suzhou, China
| | - Wangtianyi Shi
- Department of Hematology, Suzhou Ninth People's Hospital (Affiliated Wujiang Hospital of Nantong University), Suzhou, China
| | - Jun Yang
- Department of Gastroenterology, Suzhou Ninth People's Hospital (Affiliated Wujiang Hospital of Nantong University), Suzhou, China
| | - Yi Song
- Department of Gastroenterology, Suzhou Ninth People's Hospital (Affiliated Wujiang Hospital of Nantong University), Suzhou, China
| | - Jiaqing Shen
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University, Suzhou, China
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117
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Abstract
Although its incidence is decreasing, upper gastrointestinal bleeding represents a significant cause of morbidity and mortality. We present the most common sources of upper gastrointestinal bleeding and treatments.
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Affiliation(s)
- Vihas Patel
- Department of Surgery, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY
| | - Jeffrey Nicastro
- Department of Surgery, Western Connecticut Health Network, Connecticut
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Ramadani A, Jovanovska RP, Trajkovska M, Andreevski V, Calovska V, Serafimoski V, Bojadzieva S. Comparison of Argon Plasma Coagulation and Injection Therapy with Adrenalin and Polidocanol in the Management of Bleeding Angiodysplasia in Upper Gastrointestinal Tract. ACTA ACUST UNITED AC 2018; 39:63-8. [PMID: 30864370 DOI: 10.2478/prilozi-2018-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The term angiodysplasia (AD) refers to acquired malformation of the blood vessels (communications between veins and capillaries), frequently found within the gastrointestinal mucosa and submucosa. AD of stomach and duodenum are cause of upper gastrointestinal bleeding in 4%-7% of patients. The means of treatment are usually endoscopic, including argon plasma coagulation (APC), electrocoagulation, mechanical hemostasis by clippsing, laser photo-coagulation and injection therapy. AIM To compare the success rate, and adverse events (ulcer lesions, perforations) of APC and injection therapy in the treatment of bleeding angiodysplasia in the upper gastrointestinal tract (GIT). MATERIAL AND METHODS In a prospective study including 50 patients with bleeding angiodysplasia of the upper GIT, 35 patients were treated with APC, and remaining 15 with injection therapy using adrenaline and 1.5% solution of polidocanol. Follow-up period was 6 months. RESULTS A total of 50 patients aged 18 to 64 years, 64% male and 36% female, have been treated during 2 years period. The rate of recurrent bleeding and side effects was significantly higher in the adrenaline group (p <0.01). Blood transfusion was required in 68% during the first hospital admission. Angiodysplasia of the stomach was present in 66%, versus 34% in duodenum. CONCLUSION Endoscopy is "gold standard" for diagnosis and treatment of AD in the gastrointestinal tract. The study unveiled APC as more effective treatment option with lower degree of complications and adverse events in comparison to injection therapy in patients with bleeding AD.
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Fouad TR, Abdelsameea E, Abdel-Razek W, Attia A, Mohamed A, Metwally K, Naguib M, Waked I. Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post-therapeutic outcome and prognostic indicators. J Gastroenterol Hepatol 2019; 34:1604-1610. [PMID: 30937995 DOI: 10.1111/jgh.14659] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/26/2019] [Accepted: 03/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Upper gastrointestinal bleeding (UGIB) is a serious complication of portal hypertension in cirrhotic patients. The objective of this study is to identify the risk factors for morbidity and mortality occurring after an UGIB attack. METHODS A total of 1097 UGIB attacks in 690 patients with liver cirrhosis were studied. Their clinical, laboratory, and endoscopic data were reviewed. RESULTS Mean age 53.2 ± 10.6 (20-90) years, 78% men and the main cause of liver disease was hepatitis C (94.9%). Complications occurred after 467 attacks (42.6%): hepatic encephalopathy 31.4%, spontaneous bacterial peritonitis 18%, renal impairment 13.2%, and re-bleeding in 7.8%, while 199 patients (18.1%) died. Complications followed 78.4% of bleeding from gastric varices, 75% of post-interventional ulcers, 10.8% of peptic ulcers, and 5.9% of telangiectasias. By univariate analysis: packed red blood cells units transfused, transaminases, Child-Pugh (CP), model of end-stage liver disease (MELD), and albumin-bilirubin (ALBI) scores, beside the presence of hepatocellular carcinoma (HCC), previous hemorrhage in the previous 6 months, and the source of bleeding, were associated with occurrence of complications. By multivariate analysis, independent predictors of complications were CP, MELD, and ALBI scores (odds ratio, 95% confidence interval: 5.63, 3.55-8.93; 1.15, 1.11-1.19; and 2.11, 1.4-3.19, respectively) beside the presence of HCC (4.89, 2.48-9.64). Mortality predictors were packed red blood cells units transfused (1.11, 1.01-1.24), CP (5.1, 1.42-18.25) MELD (1.27, 1.21-1.32) scores, and presence of HCC (6.62, 2.93-14.95). CONCLUSION High CP, MELD, and ALBI scores beside the presence of HCC could predict poor outcome of UGIB. In the absence of these risk factors, early discharge could be considered if the source of bleeding is peptic ulcer or telangiectasia.
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Affiliation(s)
- Tamer R Fouad
- Hepatology Department, National Liver Institute, University of Menoufia, Shebeen El-Kom, Egypt
| | - Eman Abdelsameea
- Hepatology Department, National Liver Institute, University of Menoufia, Shebeen El-Kom, Egypt
| | - Wael Abdel-Razek
- Hepatology Department, National Liver Institute, University of Menoufia, Shebeen El-Kom, Egypt
| | - Ahmed Attia
- Hepatology Department, National Liver Institute, University of Menoufia, Shebeen El-Kom, Egypt
| | - Anwar Mohamed
- Hepatology Department, National Liver Institute, University of Menoufia, Shebeen El-Kom, Egypt
| | - Khaled Metwally
- Hepatology Department, National Liver Institute, University of Menoufia, Shebeen El-Kom, Egypt
| | - Mary Naguib
- Clinical Biochemistry Department, National Liver Institute, University of Menoufia, Shebeen El-Kom, Egypt
| | - Imam Waked
- Hepatology Department, National Liver Institute, University of Menoufia, Shebeen El-Kom, Egypt
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Argueta EA, Zhang AY, Rossi A, Jain S, Farrell R, Newton E. A Case of Acute Esophageal Necrosis. R I Med J (2013) 2019; 102:41-43. [PMID: 31398968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Acute esophageal necrosis (AEN) is a rare condition that impacts the distal esophagus after a vascular insult. In this case report, we describe a patient with multiple comorbid conditions presenting with shock from gastroenteritis who subsequently developed AEN complicated by refractory strictures.
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Affiliation(s)
- Erick A Argueta
- Internal Medicine Resident, Rhode Island Hospital/Brown University
| | | | | | - Sukrit Jain
- Warren Alpert Medical School of Brown University
| | - Ronan Farrell
- Gastroetnerology Fellow, Rhode Island Hospital/Brown University
| | - Eric Newton
- Clinical Associate Professor, Department of Gastroenterology, Warren Alpert Medical School of Brown University
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Siau K, Chapman W, Sharma N, Tripathi D, Iqbal T, Bhala N. Management of acute upper gastrointestinal bleeding: an update for the general physician. J R Coll Physicians Edinb 2019; 47:218-230. [PMID: 29465096 DOI: 10.4997/jrcpe.2017.303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute upper gastrointestinal bleed (AUGIB) is one of the most common medical emergencies in the UK, with roughly one presentation every 6 min. Despite advances in therapeutics and endoscopy provision, mortality following AUGIB over the last two decades has remained high, with over 9,000 deaths annually in the UK; consequently, several national bodies have published UK-relevant guidelines. Despite this, the 2015 UK National Confidential Enquiry into Patient Outcome and Death in AUGIB highlighted variations in practice, raised concerns regarding suboptimal patient care and released a series of recommendations. This review paper incorporates the latest available evidence and UK-relevant guidelines to summarise the optimal pre-endoscopic, endoscopic, and post-endoscopic approach to and management of non-variceal and variceal AUGIB that will be of practical value to both general physicians and gastroenterologists.
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Affiliation(s)
- K Siau
- N Bhala, Department of Gastroenterology, University Hospital, Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.
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Abstract
RATIONALE Esophageal hemorrhage may occasionally develop subsequent to esophagitis and stasis ulcer, but potentially fatal esophageal bleeding is very uncommon in primary achalasia. PATIENT CONCERNS We describe a case of a 64-year-old man with long-standing achalasia and megaesophagus who presented acute episodes of life-threatening upper gastrointestinal bleeding. DIAGNOSES AND INTERVENTIONS Five esophagogastroduodenoscopies (EGD) were conducted and during each large amount of static food, bloody material, and clots should be removed from the esophagus because of impaired esophageal transit. Eventually, diffuse multiple irregular ulcers were observed in the middle and lower portions of the esophagus that were presumed to have been caused by aspirin stasis based on considerations of previous drug use. EGD also revealed a 2.0 × 2.5 cm flat nodular lesion with central ulceration at the mid-to-lower esophagus and adherent blood clots suggestive of bleeding stigma. The biopsy specimen demonstrated esophageal cancer. Accordingly, a diagnosis of massive esophageal hemorrhage in long-standing achalasia complicated by squamous cell carcinoma, possibly triggered by acute mucosal irritation and ulcer caused by aspirin stasis, was made. The patient then successfully underwent the Ivor-Lewis operation. Resultantly, the tumor was diagnosed as moderately differentiated squamous cell carcinoma stage IIA (T2N0M0). OUTCOMES The patient's postoperative course was uneventful, and no evidence of tumor recurrence or metastasis has been found during the 6 months of follow-up examination. He was tolerating normal food with only minimal reflux symptoms. LESSONS Although, fortunately in the described case, esophageal cancer was diagnosed at a relatively early stage because it is the acute presentation of life-threatening upper gastrointestinal bleeding, this report cautions that when symptoms of dysphagia are aggravated, taking drugs capable of acting as local irritants, such as aspirin, could cause fatal esophageal hemorrhage in achalasia.
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Bonnet N, Paul J, Helleputte T, Veyckemans F, Pirotte T, Prégardien C, Eeckhoudt S, Hermans C, Detaille T, Clapuyt P, Menten R, Dumitriu D, Reding R, Scheers I, Varma S, Smets F, Sokal E, Stéphenne X. Novel insights into the assessment of risk of upper gastrointestinal bleeding in decompensated cirrhotic children. Pediatr Transplant 2019; 23:e13390. [PMID: 30888111 DOI: 10.1111/petr.13390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/16/2019] [Accepted: 02/10/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Cirrhotic children wait-listed for liver transplant are prone to bleeding from gastrointestinal varices. Grade 2-3 esophageal varices, red signs, and gastric varices are well-known risk factors. However, the involvement of hemostatic factors remains controversial because of the rebalanced state of coagulation during cirrhosis. METHODS Children suffering from decompensated cirrhosis were prospectively included while being on waitlist. Portal hypertension was assessed by ultrasound and endoscopy. Coagulopathy was evaluated through conventional tests, thromboelastometry, and platelet function testing. The included children were followed up until liver transplantation, and all bleeding episodes were recorded. Children with or without bleeding were compared according to clinical, radiological, endoscopic, and biological parameters. In addition, validation of a predictive model for risk of variceal bleeding comprising of grade 2-3 esophageal varices, red spots, and fibrinogen level <150 mg/dL was applied on this cohort. RESULTS Of 20 enrolled children, 6 had upper gastrointestinal bleeding. Significant differences were observed in fibrinogen level, adenosine diphosphate, and thrombin-dependent platelet aggregation. The model used to compute the upper gastrointestinal bleeding risk had an estimated predictive performance of 81.0%. Platelet aggregation analysis addition improved the estimated predictive performance up to 89.0%. CONCLUSIONS We demonstrated an association between hemostatic factors and the upper gastrointestinal bleeding risk. A low fibrinogen level and platelet aggregation dysfunction may predict the risk of bleeding in children with decompensated cirrhosis. A predictive model is available to assess the upper gastrointestinal bleeding risk but needs further investigations. Clinicaltrials.gov number: NCT03244332.
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Affiliation(s)
- Nicolas Bonnet
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | | | | | - Francis Veyckemans
- Service d'anesthésiologie pédiatrique, Département de médecine aigue, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Thierry Pirotte
- Service d'anesthésiologie, Département de médecine aigue, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Caroline Prégardien
- Service d'anesthésiologie, Département de médecine aigue, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Stéphane Eeckhoudt
- Service de biologie hématologique, Département de biologie clinique, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Cédric Hermans
- Service d'hématologie, Département de médecine interne, Cliniques Universitaires Saint-Luc, Unité d'hémostase, Bruxelles, Belgique
| | - Thierry Detaille
- Service des soins intensifs pédiatriques, Département de médecine aigue, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Philippe Clapuyt
- Service de radiologie pédiatrique, Département de radiologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Renaud Menten
- Service de radiologie pédiatrique, Département de radiologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Dana Dumitriu
- Service de radiologie pédiatrique, Département de radiologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Raymond Reding
- Service de chirurgie pédiatrique, Département de chirurgie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Isabelle Scheers
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Sharat Varma
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Françoise Smets
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Etienne Sokal
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Xavier Stéphenne
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
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Zheng W, Jiang L, Jia X, Long G, Shu X, Jiang M. Analysis of risk factors and development of scoring system to predict severity of upper gastrointestinal bleeding in children. J Gastroenterol Hepatol 2019; 34:1035-1041. [PMID: 30462839 DOI: 10.1111/jgh.14548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/29/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Upper gastrointestinal bleeding is a rare and potentially life-threatening condition in children. Herein, clinical features and risk factors in children with upper gastrointestinal bleeding were analyzed, and a clinical scoring system was constructed to assess severity. METHODS This retrospective cohort study involved 224 children hospitalized with upper gastrointestinal bleeding between January 2012 and April 2018. Demographic data, clinical information, and laboratory test results on admission were statistically examined. RESULTS Out of 224 upper gastrointestinal bleeding cases, 76 were diagnosed as severe and 148 as mild cases according to the rate of blood loss and severity. Severe group was significantly different from mild group in 23 items including age, number of patients aged more than 7 years, and so forth (P < 0.01 or P < 0.05). Positive detection rate of bleeding etiology was gradually decreased (P < 0.01) in relation to delay in timing of endoscopy. Analysis of logistic regression evinced five independent risk factors for severe cases to be associated with poor consciousness, hemoglobin < 80 g/L, hemoglobin drop of > 20 g/L, hematochezia, and anemic appearance (P < 0.01 or P < 0.05). Using these five parameters, a number of scoring models were tested. The most predictive resulted in a scoring system constructed with a total of 16 and a cutoff for intervention of 8. CONCLUSIONS Amalgamation of risk factors with the scoring system plays an important role in assessing upper gastrointestinal bleeding severity in children.
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Affiliation(s)
- Wei Zheng
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Linmei Jiang
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinyi Jia
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Gao Long
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoli Shu
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mizu Jiang
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Chen YC, Chuang CJ, Hsiao KY, Lin LC, Hung MS, Chen HW, Lee SC. Massive transfusion in upper gastrointestinal bleeding: a new scoring system. Ann Med 2019; 51:224-231. [PMID: 31050553 PMCID: PMC7877879 DOI: 10.1080/07853890.2019.1615122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Massive transfusion in patients with upper gastrointestinal bleeding (UGIB) was not investigated. We developed a new scoring system to predict massive transfusion and to enhance care and early resource mobilization. Methods: Massive transfusion was defined as transfusion with ≥10 units of red blood cells within the first 24 h. Data were extracted from a 10-year, six-hospital database. Logistic regression was applied to derive a risk score for massive transfusion using data from 2006 to 2010, in 24,736 patients (developmental cohort). The score was then validated using data from 2011 to 2015 in 27,449 patients (validation cohort). Area under the receiver operating characteristic (AUROC) curve was performed to assess prediction accuracy. Results: Five characteristics were independently associated (p < .001) with massive transfusion: presence of band-form cells among white blood cells (band form >0), international normalized ratio (INR) >1.5, pulse >100 beats per minute or systolic blood pressure <100 mmHg (shock), haemoglobin <8.0 g/dL and endoscopic therapy. The new scoring system successfully discriminated well between UGIB patients requiring massive transfusion and those who did not in both cohorts (AUROC: 0.831, 95%CI: 0.827-0.836; AUROC: 0.822, 95% CI: 0.817-0.826, respectively). Conclusions: The new scoring system predicts massive transfusion requirement in patients with UGIB well. Key messages Massive transfusion is a life-saving management in massive upper gastrointestinal bleeding. How to identify patients requiring massive transfusion in upper gastrointestinal bleeding is poorly documented. Approximately 3.9% of upper gastrointestinal bleeding patients require massive transfusion. A new scoring system is developed to identify patients requiring massive transfusion with high accuracy.
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Affiliation(s)
- Yi-Chuan Chen
- a Department of Emergency Medicine , Chang Gung Memorial Hospital , Chiayi , Taiwan.,b Department of Nursing , Chang Gung University of Science and Technology, Chiayi Campus , Chiayi , Taiwan
| | - Chen-Ju Chuang
- a Department of Emergency Medicine , Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Kuang-Yu Hsiao
- a Department of Emergency Medicine , Chang Gung Memorial Hospital , Chiayi , Taiwan.,b Department of Nursing , Chang Gung University of Science and Technology, Chiayi Campus , Chiayi , Taiwan
| | - Leng-Chieh Lin
- a Department of Emergency Medicine , Chang Gung Memorial Hospital , Chiayi , Taiwan.,b Department of Nursing , Chang Gung University of Science and Technology, Chiayi Campus , Chiayi , Taiwan
| | - Ming-Szu Hung
- c Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine , Chang Gung Memorial Hospital , Chiayi , Taiwan.,d College of Medicine, Chang Gung University , Taoyuan , Taiwan
| | - Huan-Wen Chen
- a Department of Emergency Medicine , Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Shung-Chieh Lee
- a Department of Emergency Medicine , Chang Gung Memorial Hospital , Chiayi , Taiwan
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126
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Lee DH, Lee KM, Lee SM, Lee BK, Cho YS, Choi G, Yun SW. Performance of Three Scoring Systems in Predicting Massive Transfusion in Patients with Unstable Upper Gastrointestinal Hemorrhage. Yonsei Med J 2019; 60:368-374. [PMID: 30900423 PMCID: PMC6433562 DOI: 10.3349/ymj.2019.60.4.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/29/2019] [Accepted: 02/20/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE After trauma and surgery, upper gastrointestinal bleeding (UGIB) is the most common condition that can require massive transfusion (MT). The present study aimed to analyze and compare the prognostic performance of the Glasgow-Blatchford (GB), pre-endoscopy Rockall (PER), and modified early warning (MEW) scores for predicting MT in patients with unstable UGIB. MATERIALS AND METHODS This retrospective observational study included patients with UGIB from March 2016 to February 2018. Receiver operating characteristics analysis was performed to examine the prognostic performance of the GB, PER, and MEW scoring systems. Logistic regression analysis was used to identify independent risk factors for MT, after adjusting for relevant covariates. The primary outcome was MT. RESULTS Of the 484 included patients with unstable UGIB, 19 (3.9%) received an MT. The areas under the curves (AUCs) of the GB, PER, and MEW scores for MT were 0.577 [95% confidence interval (CI), 0.531-0.621], 0.570 (95% CI, 0.525-0.615), and 0.767 (95% CI, 0.727-0.804), respectively. The AUC of the MEW score was significantly different from those of the GB and PER scores. In multivariate analysis, MEW score was independently associated with MT in patients with unstable UGIB (odds ratio, 1.495; 95% CI, 1.100-2.033; p=0.010). CONCLUSION In unstable UGIB patients, MEW score had the best prognostic performance for MT among three scoring systems.
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Affiliation(s)
- Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kyeung Mi Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Min Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yong Soo Cho
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Goeun Choi
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seong Woo Yun
- Department of Emergency Medical Technology, Namseoul University, Cheonan, Korea
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He E, Alison R, Blanks R, Pirie K, Reeves G, Ward RL, Steele R, Patnick J, Canfell K, Beral V, Green J. Association of ten gastrointestinal and other medical conditions with positivity to faecal occult blood testing in routine screening: a large prospective study of women in England. Int J Epidemiol 2019; 48:549-558. [PMID: 30668711 PMCID: PMC6469304 DOI: 10.1093/ije/dyy271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding. METHODS By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders. RESULTS RRs in FOBt-positive versus FOBt-negative women were 201.3 (95% CI 173.8-233.2) for colorectal cancer and 197.9 (95% CI 180.6-216.8) for adenoma within 12 months after screening and 3.49 (95% CI 2.31-5.26) and 4.88 (95% CI 3.80-6.26), respectively, 12-24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95% CI 19.9-34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12-24 months after screening, were 1.81 (95% CI 1.81-2.01) and 1.92 (95% CI 1.66-2.13), respectively. CONCLUSIONS Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.
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Affiliation(s)
- Emily He
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Prince of Wales Clinical School, University of New South Wales Sydney, NSW, Australia
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia
| | - Rupert Alison
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Roger Blanks
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kirstin Pirie
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gillian Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robyn L Ward
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Robert Steele
- Department of Surgery, Ninewells Hospital, Dundee, UK
| | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Karen Canfell
- Prince of Wales Clinical School, University of New South Wales Sydney, NSW, Australia
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Valerie Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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128
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Mohammad S, Chandio B, Shaikh A, Soomro AA, Rizwan A. Endoscopic Findings in Patients Presenting with Upper Gastrointestinal Bleeding. Cureus 2019; 11:e4280. [PMID: 31157141 PMCID: PMC6529045 DOI: 10.7759/cureus.4280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Upper gastrointestinal bleeding (UGIB) is one of the most common and grave emergencies encountered by the emergency medicine doctors. The aim of this study is to assess the endoscopic findings in patients presenting with acute UGIB. Methods: This is a retrospective study which included all endoscopy records of the Department of Gastroenterology, Ghulam Mohammad Maher Hospital, Sukkur from 1st January 2017 till 30th June 2018. Results: There were 100 males (49.3%) and 103 females (50.7%) who underwent endoscopy in the study duration. The mean ± standard deviation (SD) age of the participants was 41.03 ± 14.94 years. Esophageal varices were found in 65% cases. There were more men (68%) with varices than women (32%). Almost 10% patients were with gastric erosions, 9% had antral gastritis, 6.4% had pangastritis, and peptic ulcer disease was found in 5.8% cases. Conclusion: Variceal bleeding is the most common endoscopic finding in the patients with UGIB. Other lesser common causes include erosions of the gastric and esophageal mucosa.
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Affiliation(s)
- Saleh Mohammad
- Internal Medicine, Ghulam Muhammad Meher Medical Hospital, Sukkur, PAK
| | - Bashir Chandio
- Internal Medicine, Ghulam Muhammad Meher Medical Hospital, Sukkur, PAK
| | - Abrar Shaikh
- Internal Medicine, Ghulam Muhammad Meher Medical Hospital, Sukkur, PAK
| | - Aftab A Soomro
- Pathology, Ghulam Muhammad Meher Medical Hospital, Sukkur, PAK
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Wei J, Jiang R, Li L, Kang D, Gao G, You C, Zhang J, Gao L, Huang Q, Luo D, Zhao G, Zhang H, Wang S, Wang R. Stress-related upper gastrointestinal bleeding in adult neurocritical care patients: a Chinese multicenter, retrospective study. Curr Med Res Opin 2019; 35:181-187. [PMID: 29499622 DOI: 10.1080/03007995.2018.1448261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE China has limited data on stress-related gastrointestinal ulcers in patients admitted for neurosurgical care. This study evaluated the incidence of upper gastrointestinal bleeding (UGIB) and use of stress ulcer prophylaxis (SUP) in Chinese neurocritical care patients (Glasgow Coma Scale [GCS] score ≤10). METHODS This multicenter, retrospective study was performed from January 2015 to July 2015. Medical records of 1468 patients hospitalized during 2014 were reviewed. An estimated UGIB incidence rate of 4.4% was considered for precision of 1.3% for estimation of UGIB. The primary endpoint was evaluation of overall incidence of any overt UGIB in ≤14 days after cerebral lesion. Secondary endpoints included incidence of UGIB with or and without clinically significant complications, time to UGIB, associated risk factors and SUP used. RESULTS We analyzed 1416 patients (mean age: 53.7 ± 14.00 years; males: 62.4%) with cerebral lesions. Overall incidence rate of UGIB ≤14 days was 12.9% (95% CI: 11.2%-14.7%), 0.76% with and 12.1% without significant clinical complications. Average time and duration of bleeding were 2.9 ± 3.37 days and 4.2 ± 8.4 days, respectively. The most significant risk factors for UGIB were mechanical ventilation for >48 hours (p < .0001), UGIB history (p = .0026) and use of anticoagulants (p < .0001). Acid-suppression drugs were administered for SUP in 79.0% of the patients, whereas 40.5% received hemostatic drugs. CONCLUSIONS The rate of UGIB incidence was higher than the estimated rate in neurocritical care patients in China, suggesting the need for better management and treatment for stress-related mucosal disease in China. History of UGIB, mechanical ventilation and/or anticoagulants significantly affected UGIB. ClinicalTrials registry number: NCT02316990.
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Affiliation(s)
- Junji Wei
- a Department of Neurosurgery , Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College , Beijing , China
| | - Rongcai Jiang
- b Department of Neurosurgery , Tianjin Medical University General Hospital , Tianjin , China
| | - Lihong Li
- c Department of Neurosurgery , Tangdu Hospital of the Fourth Military Medical University , Xi'an , China
| | - Dezhi Kang
- d Department of Neurosurgery , the First Affiliated Hospital of Fujian Medical University , Fuzhou , China
| | - Guodong Gao
- c Department of Neurosurgery , Tangdu Hospital of the Fourth Military Medical University , Xi'an , China
| | - Chao You
- e Department of Neurosurgery, West China School of Medicine/West China Hospital , Sichuan University , Chengdu , China
| | - Jianmin Zhang
- f Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou , China
| | - Liang Gao
- g Department of Neurosurgery , Shanghai Tenth People's Hospital/Tenth People's Hospital of Tongji University , Shanghai , China
| | - Qibing Huang
- h Department of Neurosurgery , Qilu Hospital of Shandong University , Jinan , China
| | - Duanwu Luo
- i Department of Neurosurgery , Xiangya Hospital Central South University , Changsha , China
| | - Gang Zhao
- j Department of Neurosurgery , the First Hospital of Jilin University , Changchun , China
| | - Hongyi Zhang
- k Department of Neurosurgery , Tangshan Gongren Hospital , Tangshan , China
| | - Shuo Wang
- l Department of Neurosurgery , Beijing Tian Tan Hospital, Capital Medical University , Beijing , China
| | - Renzhi Wang
- a Department of Neurosurgery , Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College , Beijing , China
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Perisetti A, Kopel J, Shredi A, Raghavapuram S, Tharian B, Nugent K. Prophylactic pre-esophagogastroduodenoscopy tracheal intubation in patients with upper gastrointestinal bleeding. Proc (Bayl Univ Med Cent) 2019; 32:22-25. [PMID: 30956574 DOI: 10.1080/08998280.2018.1530007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 12/25/2022] Open
Abstract
The indications for endotracheal intubation (ETI) during an esophagogastroduodenoscopy (EGD) procedure remain unclear. This study performed a descriptive analysis of patients who underwent prophylactic tracheal intubation during or before an EGD to prevent pulmonary aspiration. We selected patients with an upper gastrointestinal bleed in an intensive care unit who underwent EGD between 2000 and 2013. Eighty-nine patients who underwent pre-EGD tracheal intubation were analyzed. The main outcomes in this study were pulmonary aspiration, length of stay, and mortality. The average age of patients undergoing pre-EGD intubation was 61 years. The incidence of pulmonary aspiration was 38% in patients who underwent pre-EGD tracheal intubation. The patients requiring tracheal intubation had a mortality rate of 22% during hospitalization. Other complications in pre-EGD ETI patients included myocardial infarction (9%), acute respiratory distress syndrome (10%), and pulmonary edema (7%). In conclusion, the incidence of pulmonary aspiration with pre-EGD tracheal intubation in our patients was high (38%). Cardiopulmonary complications including myocardial infarction, acute respiratory distress syndrome, and pulmonary edema were high in intubated patients.
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Affiliation(s)
- Abhilash Perisetti
- Department of Internal Medicine, Division of Gastroenterology, University of Arkansas for Medical SciencesLittle RockArkansas
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Abdussalam Shredi
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Saikiran Raghavapuram
- Department of Internal Medicine, Division of Gastroenterology, University of Arkansas for Medical SciencesLittle RockArkansas
| | - Benjamin Tharian
- Department of Internal Medicine, Division of Gastroenterology, University of Arkansas for Medical SciencesLittle RockArkansas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
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Mărginean MO, Meliț LE, Mocanu S, Săsăran V. Ibuprofen, a Potential Cause of Acute Hemorrhagic Gastritis in Children - A Case Report. ACTA ACUST UNITED AC 2018; 4:143-6. [PMID: 30574567 DOI: 10.2478/jccm-2018-0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/03/2018] [Indexed: 12/16/2022]
Abstract
Introduction Upper gastrointestinal bleeding is an uncommon but possible life-threatening entity in children, frequently caused by erosive gastritis. Non-steroidal anti-inflammatory drugs are one of the most common class of drugs which can cause gastrointestinal complications, including hemorrhagic gastritis. Case report The case of a 6-year-old male, admitted for hematemesis, abdominal pain and loss of appetite. It was ascertained at the time of admission, that ibuprofen had been prescribed as the patient had a fever. This was inappropriately administered as the mother did not respect the intervals between the doses. Initial laboratory tests revealed neutrophilia, leukopenia, high levels of lactate dehydrogenase and urea. An upper digestive endoscopy revealed an increased friability of the mucosa, digested blood in the gastric corpus and fornix. No active bleeding site was detected. The histopathological examination described a reactive modification of the corporeal gastric mucosa. Intravenous treatment with proton pump inhibitors and fluid replacement were initiated, with favorable results. Conclusion Ibuprofen can lead to upper digestive hemorrhage independently of the administered dose. Parents should avoid administering Ibuprofen for fever suppression without consulting their pediatrician.
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Abstract
Endoscopic intervention is well validated for the control of upper gastrointestinal bleeding (UGIB). In cases of refractory bleeding, transarterial embolization is a safe and effective alternative. Ethylene vinyl alcohol (EVOH) commonly known as Onyx® is an inherently black liquid embolic approved for use in cerebrovascular arteriovenous malformations and is increasingly used as an embolic agent in multiple peripheral and visceral territories. Onyx® has a uniquely undesirable property of causing black color discoloration when used in peripheral applications adjacent to the skin akin to a "tattoo effect." Knowledge of the agents used by the interventional radiologist, clinical correlation, and close follow-up can be of paramount importance to avoid unnecessary surgical intervention. Here, we report a case demonstrating this "tattoo effect" on the gastric mucosa following UGIB embolization.
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Affiliation(s)
- Driss Raissi
- Division of Vascular and Interventional Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Qian Yu
- Division of Vascular and Interventional Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - S Houssam Mardini
- Division of Gastroenterology and Hepatology, University of Kentucky, College of Medicine, Lexington, Kentucky, USA
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Wang TP. Association between TNF-α polymorphisms and the risk of upper gastrointestinal bleeding induced by aspirin in patients with coronary heart disease. Ann Hum Genet 2018; 83:124-133. [PMID: 30506894 DOI: 10.1111/ahg.12295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To investigate the correlation of tumor necrosis factor α (TNF-α) polymorphisms with upper gastrointestinal bleeding (UGIB) induced by enteric-coated aspirin in coronary heart disease (CHD) patients. METHODS In total, 154 CHD patients taking enteric-coated aspirin were enrolled in this study. Patients were divided into the UGIB group (n = 57) and non-UGIB group (n = 97) based on the presence or absence of signs of UGIB, respectively. TNF-α polymorphism (-857C > T, -863C > A, and -1031T > C) genotyping was performed using polymerase chain reaction (PCR) amplification with sequence-specific primers (PCR-SSP). RESULTS Patients who had the CC genotype and C allele of -1031T > C exhibited a significantly increase risk of UGIB after receiving enteric-coated aspirin (CC vs. TT: odds (OR) (95% confidence interval (CI)): 7.568 (1.527-37.49), P = 0.005; C vs. T: OR (95% CI): 1.852 (1.036-3.312), P = 0.036). Patients who had CA and CA + AA genotypes and the A allele of -863C > A also exhibited an increased risk of aspirin-induced UGIB (CA vs. CC: OR (95% CI): 2.415 (1.143-5.101), P = 0.019: CA + AA vs. CC: OR (95% CI): 2.218 (1.123-4.381), P = 0.021; A vs. C: OR (95% CI): 1.788 (1.039-3.078), P = 0.035). However, the TNF-α -857 C > T polymorphism was unrelated to the induction of UGIB by enteric-coated aspirin in CHD patients (P > 0.05). In addition, the haplotypes of CCC (-1031T > C, -863C > A, and -857C > T) markedly reduced the risk of aspirin-induced UGIB in CHD patients. CONCLUSION TNF-α -863A and -1031C increased the risk of UGIB induction by enteric-coated aspirin in CHD patients, whereas TNF-α -857C > T was not correlated with the UGIB risk.
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Affiliation(s)
- Tai-Ping Wang
- Department of Gastroenterology, Rizhao People's Hospital of Shandong Province, Rizhao, 276800, China
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Youn SH, Lim H, Ju Y, Soh JS, Park JW, Kang HS, Kim SE, Moon SH, Kim JH, Park CK, Seo SI, Shin WG. Effect of gastroprotective agents on upper gastrointestinal bleeding in patients receiving direct oral anticoagulants. Scand J Gastroenterol 2018; 53:1490-1495. [PMID: 30509124 DOI: 10.1080/00365521.2018.1541478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Direct oral anticoagulants (DOACs) are effective in the prevention and treatment of thromboembolism; however, they are associated with upper gastrointestinal bleeding (UGIB). In this study, we evaluated the efficacy of gastroprotective agents (GPAs) in reducing the risk of UGIB in patients receiving DOACs. METHODS We retrospectively reviewed the medical records of 2076 patients who received DOACs for the prevention or treatment of thromboembolic events between January 2008 and July 2016. A cumulative incidence analysis using the Kaplan-Meier method was performed to determine the rate of UGIB and its association with GPAs administration. RESULTS Of the 2076 patients, 360 received GPAs. Over the follow-up period (1160 person-years), one patient in the GPA group (0.7 per 100 person-years) and 29 patients in the non-GPA group (2.8 per 100 person-years) developed UGIB (p = .189). In the multivariate analysis, UGIB was associated with older age (hazard ratio (HR), 1.041; p = .048), a history of peptic ulcer or UGIB (HR, 5.931; p < .001), and concomitant use of antiplatelet agents (HR, 3.121; p = .014). GPAs administration did not reduce the risk of UGIB (p = .289). However, based on the subgroup analysis of 225 patients with concomitant use of antiplatelet agents or a history of peptic ulcer or UGIB, the GPA group (0 per 100 person-years) showed reduced incidence of UGIB compared with the non-GPA group (11.3 per 100 person-years) (p = .065). CONCLUSIONS The prophylactic use of GPAs could reduce the risk of UGIB in patients receiving DOACs who have risk factors, such as concomitant use of antiplatelet agents or a history of peptic ulcer or UGIB.
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Affiliation(s)
- Sung Hee Youn
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Hyun Lim
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Yeonmi Ju
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Jae Seung Soh
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Ji Won Park
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Ho Suk Kang
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Sung Eun Kim
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Sung Hoon Moon
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Jong Hyeok Kim
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Choong Kee Park
- a Department of Internal Medicine, Hallym University Sacred Heart Hospital , University of Hallym College of Medicine , Anyang , Republic of Korea
| | - Seung In Seo
- b Department of Internal Medicine, Kangdong Sacred Heart Hospital , University of Hallym College of Medicine , Seoul , Republic of Korea
| | - Woon Geon Shin
- b Department of Internal Medicine, Kangdong Sacred Heart Hospital , University of Hallym College of Medicine , Seoul , Republic of Korea
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135
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Abstract
A 1-year-old female toddler who was under a great amount of psychological stress presented with acute hematemesis. She had no significant medical history; she displayed lethargy and was anemic. Although blood transfusion and famotidine were administered for upper gastrointestinal bleeding (UGIB), the anemia did not improve. Thus, early endoscopy was performed under general anesthesia, revealing a gastric ulcer with exposed vessels in the supra-angular region. Cauterization via bipolar hemostatic forceps was performed on the exposed vessels, and the bleeding was controlled successfully. We diagnosed the patient with hemorrhagic stress-induced gastric ulcer due to psychological stress. Three months later, endoscopy revealed that the gastric ulcer had healed.
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Affiliation(s)
- Katsunori Matsueda
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Japan
| | - Tatsuya Toyokawa
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Japan
| | - Masahiro Sakata
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Japan
| | - Isao Fujita
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Japan
| | - Jouichiro Horii
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Japan
| | - Yoshiko Abe
- Department of Pediatrics, National Hospital Organization Fukuyama Medical Center, Japan
| | - Toru Araki
- Department of Pediatrics, National Hospital Organization Fukuyama Medical Center, Japan
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136
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Zimmer V, Lammert F. GISToscopy. Clin Case Rep 2018; 6:1903-1904. [PMID: 30214792 PMCID: PMC6132131 DOI: 10.1002/ccr3.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/13/2018] [Indexed: 11/28/2022] Open
Abstract
Gastrointestinal stromal tumors (GIST) tumors are a rare, though typical cause for upper GI bleeding. Excavated ulcerated lesions are common; however, a clear-cut visualization of the tumor surface ("GISToscopy") itself has not yet been reported. In line, careful biopsy taking streamlines the diagnostic work-up by providing pathologic diagnosis.
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Affiliation(s)
- Vincent Zimmer
- Department of Medicine IISaarland University Medical CenterSaarland UniversityHomburgGermany
| | - Frank Lammert
- Department of Medicine IISaarland University Medical CenterSaarland UniversityHomburgGermany
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137
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Abstract
RATIONALE Ectopic variceal bleeding due to hepaticojejunostomy (HJ) is unusual and difficult to manage. Reports on the use of side-to-side splenorenal shunt for severe bleeding from varices at HJ anastomosis are lacking. PATIENT CONCERNS A 43-year-old man was admitted to our hospital with repeated episodes of hematemesis. He has a history of right hemihepatectomy with HJ reconstruction to the left hepatic duct for hilar cholangiocarcinoma. Two years after surgery, he presented with repeated episodes of hematemesis and underwent blood transfusion. DIAGNOSES Imaging tests and endoscopic investigation failed to identify the bleeding source. When conservative management failed to control his bleeding, he underwent emergency laparotomy, which revealed hemorrhage from ectopic varices at the HJ anastomosis. INTERVENTIONS To arrest the bleeding, a side-to-side venovenal anastomosis was created between the splenic and left renal veins to form a shunt for decompression of the varices at the HJ anastomosis. OUTCOMES After the surgery, the patient's symptoms ceased, and a no bleeding in the digestive tract was noted at 2-year follow-up. LESSONS The present patient is the first reported case of unusual bleeding from HJ controlled by a side-to-side splenorenal shunt. We believe this approach is a useful and effective surgical treatment for severe bleeding from varices at the HJ anastomosis.
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138
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Liu J, Gupta R, Hay K, Pulle C, Rahman T, Pandy S. Upper gastrointestinal bleeding in neck of femur fracture patients: a single tertiary centre experience. Intern Med J 2018; 48:731-735. [PMID: 29898280 DOI: 10.1111/imj.13809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 11/30/2022]
Abstract
This study aimed to identify the incidence of perioperative acute upper gastrointestinal bleeding (UGIB) in our hip fracture patients; to evaluate the characteristics, management and clinical outcomes of these patients; and to explore risk factors and protective factors. Of the 1691 consecutive patients admitted for surgical management of hip fractures, 11 (0.65%) had UGIB and a further four patients for each case were selected as controls for evaluation of risk factors and protective factors. Pre-existing peptic ulcer disease was identified as a risk factor for acute UGIB (odds ratio 7.9; 95% confidence interval: 1.1-54.9). This study reported a very low incidence of UGIB in hip fracture patients. Despite being a high-risk population, timely endoscopic evaluation can be safely undertaken to optimise patient outcome. When risk factors such as history of peptic ulcer disease are present, additional precaution including gastro-protective agent and nutritional support should be undertaken.
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Affiliation(s)
- Jessamine Liu
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rohit Gupta
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Chrys Pulle
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tony Rahman
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Shaun Pandy
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
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139
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Ramai D, Tan QT, Nigar S, Ofori E, Etienne D, Reddy M. Ulcerated gastric leiomyoma causing massive upper gastrointestinal bleeding: A case report. Mol Clin Oncol 2018; 8:671-674. [PMID: 29725533 DOI: 10.3892/mco.2018.1597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/07/2018] [Indexed: 11/05/2022] Open
Abstract
Leiomyomas are rare, benign submucosal tumors originating from smooth muscle cells. The clinical presentation is usually asymptomatic, with excellent prognosis. We herein report the case of a 68-year-old female with a solitary leiomyoma found during esophagogastroduodenoscopy for hematemesis. Histopathological examination revealed smooth muscle proliferation supported by positive staining for smooth muscle myosin heavy chain and negative staining for CD117 and S-100, consistent with the marker expression pattern of leiomyoma. We report on the clinical presentation of this case, and discuss the origin, epidemiology, treatment and management of leiomyomas.
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Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA.,Department of Anatomical Sciences, St. George's University School of Medicine, True Blue, Grenada, West Indies
| | - Qiuxue T Tan
- Department of Anatomical Sciences, St. George's University School of Medicine, True Blue, Grenada, West Indies
| | - Sofia Nigar
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA
| | - Emmanuel Ofori
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA
| | - Denzil Etienne
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA
| | - Madhavi Reddy
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA
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140
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Abstract
Background/Aims Patients with simultaneous upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) have higher mortality than patients with either GIB or AMI. We aimed to assess the incidence and risk factors of in-hospital mortality in patients with UGIB and AMI. Patients and Methods A total of 243 patients with UGIB and AMI were enrolled during 2012-2017. Clinical and laboratory data were collected and analyzed for clinical characteristics and potential risk factors of in-hospital mortality. Results Among the 243 patients, 60 in-hospital deaths were observed (in-hospital mortality rate of 24.7%). Patients who died were older than the survivors (78.7 ± 6.6 vs. 72.6 ± 10.5 years, P < 0.001). Compared with survivors, patients who died showed increased peak white blood cell (WBC) count (9.74 ± 4.72 vs. 7.60 ± 2.91 × 109/L, P= 0.002), serum creatinine levels [134 (106, 190) vs. 97 (79, 125) mmol/L, P= 0.014], peak blood urine nitrogen levels (16.31 ± 8.48 mmol/L vs. 9.86 ± 6.33 mmol/L, P < 0.001), and peak brain natriuretic peptide (BNP) amounts [13,250 (6071, 30,000) vs. 3598 (728, 12,842) pg/mL, P < 0.001]. Meanwhile, patients who died also displayed lower minimum hemoglobin levels (78.3 ± 21.1 vs. 86.3 ± 22.3 g/L, P= 0.018) and minimum platelet counts (184.3 ± 79.1 vs. 214.6 ± 80.1 × 109/L, P= 0.013). In multivariable logistic analysis, age [OR (95% CI) =1.118 (1.053-1.186), P < 0.001], peak WBC count [OR (95% CI) =1.252 (1.113-1.407), P < 0.001], minimum platelet count [OR (95% CI) = 0.994 (0.989-1.000), P= 0.032], and peak BNP levels [OR (95% CI) =3.880 (1.761-8.550), P= 0.001] were independent predictors of in-hospital mortality. Conclusions Patients with UGIB and AMI had a high in-hospital mortality, which was independently associated with age, peak WBC count, minimum platelet count, and peak BNP levels.
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Affiliation(s)
- Lingjie He
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
| | - Jianwei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
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141
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Iqbal U, Anwar H, Patel H, Chaudhary A, Raymond P. Does Early Endoscopy Improve Mortality in Patients with Acute Non-variceal Gastrointestinal Bleeding? A Retrospective review. Cureus 2018; 10:e2246. [PMID: 29719748 PMCID: PMC5922500 DOI: 10.7759/cureus.2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Initial management of acute upper gastrointestinal bleeding (UGIB) aims towards aggressive fluid resuscitation to maintain hemodynamic stability. Existing evidence regarding the benefit of early endoscopy is unclear with some studies suggesting mortality benefits and some suggesting otherwise. The purpose of this study is to evaluate if there is any mortality benefit of doing early endoscopy within 24 hours of presentation. Methods From July 2013 to July 2016, 179 patients admitted with a diagnosis of non-variceal UGIB were retrospectively reviewed. Clinical variables including 30-day mortality were then compared between the patients who had endoscopy within 24 hours with those who had endoscopy after greater than 24 hours. Results Out of 179 patients admitted for non-variceal UGIB, 146 underwent endoscopy within 24 hours of presentation and 33 underwent endoscopy after 24 hours. The overall mortality associated with UGIB was 6.7% (12/179). There was no statistically significant difference found in 30-day mortality between the two groups (6.8% within 24 hours vs 6.1% after 24 hours). There was also no difference in 30-day readmission or rates of rebleeding among the two groups. The length of stay was also similar in both groups (6.0 days vs 6.1 days). Conclusion This study did not find any advantage of endoscopy within 24 hours on length of stay, rate of complications, and 30-day mortality. As hemostasis is achieved in almost 90% of patients with supportive management without any endoscopic intervention, focus should be made on aggressive fluid resuscitation to achieve hemodynamic stability before endoscopy.
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Affiliation(s)
- Umair Iqbal
- Internal Medicine, Bassett Medical Center, Cooperstown, Ny
| | - Hafsa Anwar
- Jinnah Sindh Medical University, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Hunaiz Patel
- General Surgery, Bassett Medical Center, Cooperstown, Ny
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142
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Jayarajah U, Bulathsinghala RP, Handagala DMS, Samarasekera DN. Inflammatory myofibroblastic tumor of the esophagus presenting with hematemesis and melaena: a case report and review of literature. Clin Case Rep 2018; 6:82-85. [PMID: 29375843 PMCID: PMC5771923 DOI: 10.1002/ccr3.1296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/04/2017] [Accepted: 10/27/2017] [Indexed: 11/12/2022] Open
Abstract
Esophageal inflammatory myofibroblastic tumors (IMT) are extremely rare, and the understanding on the clinical presentation is limited. IMT of esophagus should be considered as a differential diagnosis in the context of unexplained upper gastrointestinal bleeding and rapidly progressing dysphagia in young patients.
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Affiliation(s)
- Umesh Jayarajah
- Department of Surgery Faculty of Medicine University of Colombo Colombo Sri Lanka
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143
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Reilev M, Damkier P, Rasmussen L, Olesen M, Thomsen Ernst M, Rishøj RM, Rix Hansen M, Broe A, Dastrup AS, Hellfritzsch M, Arnspang S, Pottegård A, Hallas J. Use of beta-blockers and risk of serious upper gastrointestinal bleeding: a population-based case-control study. Therap Adv Gastroenterol 2017; 10:919-929. [PMID: 29204187 PMCID: PMC5703107 DOI: 10.1177/1756283x17734116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/07/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Some studies indicate a reduced risk of serious upper gastrointestinal bleeding (UGIB) for users of beta-blockers, but the association remains to be confirmed in larger studies and characterized with respect to differences among beta-blockers. We aimed to assess whether beta-blocker use decreases the risk of UGIB. METHODS We conducted a register-based, population-based case-control study in Denmark. We identified cases with a first validated discharge diagnosis of UGIB during the period 1995-2006. Controls were selected by risk-set sampling in a ratio of 10:1. We estimated crude and adjusted odds ratios (ORs) of the association between current beta-blocker use and the risk of UGIB by using conditional logistic regression and further stratified by selective and non-selective beta-blockers, respectively. RESULTS We identified 3571 UGIB cases and 35,582 controls. Use of beta-blockers was not found to be associated with a decreased risk of UGIB (adjusted OR 1.10; 95% CI: 1.00-1.21). The association remained neutral after stratification by selective and non-selective beta-blockers, and by single beta-blocker substances. Similarly, we found no association between current beta-blocker use and the risk of UGIB within different subgroups. CONCLUSIONS We found no association between beta-blocker use and UGIB.
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Affiliation(s)
- Mette Reilev
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - Per Damkier
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark Department of Clinical Research, University of Southern Denmark, Denmark
| | - Lotte Rasmussen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Morten Olesen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Martin Thomsen Ernst
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Rikke Mie Rishøj
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Morten Rix Hansen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Anne Broe
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | | | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Sidsel Arnspang
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
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144
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Nasher O, Devadason D, Stewart RJ. Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children's Hospital Experience. Children (Basel) 2017; 4:children4110095. [PMID: 29099778 PMCID: PMC5704129 DOI: 10.3390/children4110095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/30/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Abstract
The aim of this study was to review the aetiology, presentation and management of these patients with upper gastrointestinal bleeding (UGIB) at a tertiary children’s unit in the United Kingdom. This was a retrospective single-institution study on children (<16 years) who presented with acute UGIB over a period of 5 years using known International Classification of Diseases (ICD) codes. A total of 32 children (17 males, 15 females) were identified with a total median age at presentation of 5.5 years. The majority (24/32) of patients presented as an emergency. A total of 19/32 presented with isolated haematemesis, 8/32 with isolated melaena and 5/32 with a combination of melaena and haematemesis. On admission, the mean haemoglobin of patients who presented with isolated haematemesis was 11 g/dL, those with isolated melaena 9.3 g/dL and those with a combination 7.8 g/dL. Blood transfusion was required in 3/19 with haematemesis and 3/5 with haematemesis and melaena. A total of 19/32 underwent upper gastrointestinal endoscopy. Endoscopic findings were oesophageal varices (5/19) of which 4 required banding; bleeding gastric ulcer (1/19) requiring clips, haemospray and adrenaline; gastric vascular malformation (1/19) treated with Argon plasma coagulation therapy; duodenal ulcer (3/19) which required surgery in two cases; oesophagitis (5/19); and gastritis +/− duodenitis (3/19). A total of 13/32 patients did not undergo endoscopy and the presumed aetiology was a Mallory–Weiss tear (4/13); ingestion of foreign body (2/13); gastritis (3/13); viral illness (1/13); unknown (2/13). While UGIB is uncommon in children, the morbidity associated with it is very significant. Melaena, dropping haemoglobin, and requirement for a blood transfusion appear to be significant markers of an underlying cause of UGIB that requires therapeutic intervention. A multi-disciplinary team comprising gastroenterologists and surgeons is essential.
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Affiliation(s)
- Omar Nasher
- Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK.
| | - David Devadason
- Department of Paediatric Gastroenterology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK.
| | - Richard J Stewart
- Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK.
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145
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Siau K, Hannah JL, Hodson J, Widlak M, Bhala N, Iqbal TH. Stopping antithrombotic therapy after acute upper gastrointestinal bleeding is associated with reduced survival. Postgrad Med J 2017; 94:137-142. [PMID: 29101296 DOI: 10.1136/postgradmedj-2017-135276] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/20/2017] [Accepted: 10/13/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Antithrombotic drugs are often stopped following acute upper gastrointestinal bleeding (AUGIB) and frequently not restarted. The practice of antithrombotic discontinuation on discharge and its impact on outcomes are unclear. OBJECTIVE To assess whether restarting antithrombotic therapy, prior to hospital discharge for AUGIB, affected clinical outcomes. DESIGN Retrospective cohort study. SETTING University hospital between May 2013 and November 2014, with median follow-up of 259 days. PATIENTS Patients who underwent gastroscopy for AUGIB while on antithrombotic therapy. INTERVENTIONS Continuation or cessation of antithrombotic(s) at discharge. MAIN OUTCOMES MEASURES Cause-specific mortality, thrombotic events, rebleeding and serious adverse events (any of the above). RESULTS Of 118 patients analysed, antithrombotic treatment was stopped in 58 (49.2%). Older age, aspirin monotherapy and peptic ulcer disease were significant predictors of antithrombotic discontinuation, whereas dual antiplatelet use predicted antithrombotic maintenance. The 1-year postdischarge mortality rate was 11.3%, with deaths mainly due to thrombotic causes. Stopping antithrombotic therapy at the time of discharge was associated with increased mortality (HR 3.32; 95% CI 1.07 to 10.31, P=0.027), thrombotic events (HR 5.77; 95% CI 1.26 to 26.35, P=0.010) and overall adverse events (HR 2.98; 95% CI 1.32 to 6.74, P=0.006), with effects persisting after multivariable adjustment for age and peptic ulcer disease. On subgroup analysis, the thromboprotective benefit remained significant with continuation of non-aspirin regimens (P=0.016). There were no significant differences in postdischarge bleeding rates between groups (HR 3.43, 0.36 to 33.04, P=0.255). CONCLUSION In this hospital-based study, discontinuation of antithrombotic therapy is associated with increased thrombotic events and reduced survival.
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Affiliation(s)
- Keith Siau
- Joint Advisory Group in Gastrointestinal Endoscopy, Royal College of Physicians, London.,Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley
| | - Jack L Hannah
- Department of Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - James Hodson
- Department of Medical Statistics, Institute of Translational Medicine, Queen Elizabeth Hospital, Birmingham, England
| | - Monika Widlak
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, England
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
| | - Tariq H Iqbal
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
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146
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Hallas J, Pottegård A, Støvring H. Using probability of drug use as independent variable in a register-based pharmacoepidemiological cause-effect study-An application of the reverse waiting time distribution. Pharmacoepidemiol Drug Saf 2017; 26:1520-1526. [PMID: 29024218 DOI: 10.1002/pds.4326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/21/2017] [Accepted: 09/03/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND In register-based pharmacoepidemiological studies, each day of follow-up is usually categorized either as exposed or unexposed. However, there is an underlying continuous probability of exposure, and by insisting on a dichotomy, researchers unwillingly force a nondifferential misclassification into their analyses. We have recently developed a model whereby probability of exposure can be modeled, and we tested this on an empirical case of nonsteroidal anti-inflammatory drug (NSAID)-induced upper gastrointestinal bleeding (UGIB). METHODS We used a case-controls data set, consisting of 3568 cases of severe UGIB and 35 552 matched controls. Exposure to NSAID was based on 3 different conventional dichotomous measures. In addition, we tested 3 probabilistic exposure measures, a simple univariate backward-recurrence model, a "full" multivariable model, and a "reduced" multivariable model. Odds ratios (ORs) and 95% confidence intervals for the association between NSAID use and UGIB were calculated by conditional logistic regression, while adjusting for preselected confounders. RESULTS Compared to the conventional dichotomous exposure measures, the probabilistic exposure measures generated adjusted ORs in the upper range (4.37-4.75) while at the same time having the most narrow confidence intervals (ratio between upper and lower confidence limit, 1.46-1.50). Some ORs generated by conventional measures were higher than the probabilistic ORs, but only when the assumed period of intake was unrealistically short. CONCLUSION The pattern of high ORs and narrow confidence intervals in probabilistic exposure measures is compatible with less nondifferential misclassification of exposure than in a dichotomous exposure model. Probabilistic exposure measures appear to be an attractive alternative to conventional exposure measures.
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Affiliation(s)
- Jesper Hallas
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.,Hospital Pharmacy, Odense University Hospital, Odense, Denmark
| | - Henrik Støvring
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
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147
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Huang X, Zhang W, Chen S, Liu C, Sheng R, Li F, Wang J, Luo J, Xu P. Therapeutic evaluation of arterio-portal fistula-related gastroesophageal variceal bleeding. Oncotarget 2017; 8:66584-66592. [PMID: 29029539 PMCID: PMC5630439 DOI: 10.18632/oncotarget.16579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/14/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND & AIMS Intrahepatic arterio-portal fistula is an uncommon etiology of portal hypertension, which presents diagnostic and therapeutic challenges. This study aimed to assess the efficacy and outcomes of gastroesophageal variceal bleeding caused by arterio-portal fistula using different therapeutic approaches. METHODS Medical records of 451 consecutive patients with arterio-portal fistula were reviewed from January 1, 2009, to July 15, 2016, and patients suffered variceal bleeding were eligible for the study. RESULTS Among 57 patients with arterio-portal fistula, hepatocellular carcinoma was existed in 61.4% patients. A combination of radiological intervention and endoscopic treatment was performed in 8 (14.0%) patients; the remainder were treated using radiological intervention alone (n = 20, 35.1%), endoscopic treatment alone (n = 18, 31.6%), or without any intervention (n = 11, 19.3%). No patient died in the combination group, while 20 patients in the single-treatment group and 6 in the untreated group died during follow-up. A significant difference in the survival rate was found between the combination group and the other two groups. Treatment selection between combination and untreated groups was the only parameter significantly associated with survival (p = 0.002). CONCLUSIONS For patients diagnosed with arterio-portal fistula, combination treatment is the most optimal strategy in managing variceal bleeding, especially in patient with severe type of fistula.
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Affiliation(s)
- Xiaoquan Huang
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shiyao Chen
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chengfeng Liu
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ruofan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feng Li
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pengju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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148
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Kawasaki K, Nakamura S, Kurahara K, Nagasue T, Yanai S, Harada A, Yaita H, Fuchigami T, Matsumoto T. Continuing use of antithrombotic medications for patients with bleeding gastroduodenal ulcer requiring endoscopic hemostasis: a case-control study. Scand J Gastroenterol 2017; 52:948-953. [PMID: 28532190 DOI: 10.1080/00365521.2017.1328989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to compare clinical characteristics and outcomes of bleeding gastroduodenal ulcer between patients taking antithrombotic medications and those not taking antithrombotic medications. METHODS We performed a case-control study of 346 patients with endoscopically verified bleeding gastroduodenal ulcer, which included 173 cases taking antithrombotic medications throughout peri-bleeding period and 173 age- and sex-matched controls not taking antithrombotic medications. RESULTS The cases showed less frequent Helicobacter pylori (H. pylori) infections (45.1% versus 60.7%, p = .005), more frequent duodenal location (31.8% versus 19.1%, p = .009), and more frequent rebleeding (13.9% versus 5.8%, p = .02) than the controls. Multivariate analysis revealed that duodenal location (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.37-6.65) and use of antithrombotic medications (OR 2.47, 95% CI 1.13-5.77) were independent factors for rebleeding. However, there were no differences in clinical outcomes, including final successful endoscopic hemostasis, need for surgical intervention, and mortality between cases and controls. Thromboembolic events did not occur in any cases and controls during the periendoscopic period. CONCLUSIONS Low prevalence of H. pylori infection, frequent duodenal location, and high rebleeding rate are characteristics of patients with bleeding gastroduodenal ulcer under antithrombotic medications. Continuation of antithrombotic medications can be accepted for bleeding gastroduodenal ulcer.
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Affiliation(s)
- Keisuke Kawasaki
- a Division of Gastroenterology, Department of Internal Medicine , Iwate Medical University , Morioka , Japan.,b Division of Gastroenterology , Matsuyama Red Cross Hospital , Matsuyama , Japan
| | - Shotaro Nakamura
- a Division of Gastroenterology, Department of Internal Medicine , Iwate Medical University , Morioka , Japan
| | - Koichi Kurahara
- b Division of Gastroenterology , Matsuyama Red Cross Hospital , Matsuyama , Japan
| | - Tomohiro Nagasue
- b Division of Gastroenterology , Matsuyama Red Cross Hospital , Matsuyama , Japan
| | - Shunichi Yanai
- a Division of Gastroenterology, Department of Internal Medicine , Iwate Medical University , Morioka , Japan
| | - Akira Harada
- b Division of Gastroenterology , Matsuyama Red Cross Hospital , Matsuyama , Japan
| | - Hiroki Yaita
- b Division of Gastroenterology , Matsuyama Red Cross Hospital , Matsuyama , Japan
| | - Tadahiko Fuchigami
- b Division of Gastroenterology , Matsuyama Red Cross Hospital , Matsuyama , Japan
| | - Takayuki Matsumoto
- a Division of Gastroenterology, Department of Internal Medicine , Iwate Medical University , Morioka , Japan
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149
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Alshamsi F, Jaeschke R, Baw B, Alhazzani W. Prophylactic Endotracheal Intubation in Patients with Upper Gastrointestinal Bleeding Undergoing Endoscopy: A Systematic Review and Meta-analysis. Saudi J Med Med Sci 2017; 5:201-209. [PMID: 30787790 PMCID: PMC6298294 DOI: 10.4103/sjmms.sjmms_95_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Patients with upper gastrointestinal bleeding (UGIB) often require urgent or emergent esophagogastroduodenoscopy (EGD) and are at risk of complications such as aspiration of gastric content or blood. The role of prophylactic endotracheal intubation (PEI) in the absence of usual respiratory status-related indications is not well established. Methods: We searched Medline, EMBASE, Cochrane Library's Central Register of Controlled Trials (CENTRAL) and SCOPUS from inception through July 2017 without date or language of publication restriction. We included studies that compared PEI with usual care (UC) in patients with acute UGIB, and reported any of the following outcomes: aspiration, pneumonia, mortality and length of stay. We excluded studies in which majority of included patients required intubation due to respiratory failure or decreased level of consciousness. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence for each outcome. Results: We did not identify any randomized trials on this topic. We included 10 observational studies (n = 6068). We were not able to perform any adjusted analyses. PEI was associated with a significant increase in aspiration (OR 3.85, 95% CI, 1.46, 10.25; P = 0.01; I2= 56%; low-quality evidence), pneumonia (OR 4.17, 95% CI, 1.82, 9.57; P = 0.0007; I2=52%; low-quality evidence) and hospital length of stay (mean difference 0.86 days, 95% CI 0.13, 1.59; P = 0.02; I2= 0; low-quality evidence), without clear effect on mortality (OR 1.92, 95% CI, 0.71, 5.23; P = 0.2; I2= 95%; very low-quality evidence). Conclusions: Low- to very low-quality evidence from observational studies suggests that PEI in the setting of UGIB may be associated with higher rates of respiratory complications and, less likely, with increased mortality. Although the results are alarming, the lack of higher quality evidence calls for randomized trials to inform practice.
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Affiliation(s)
- Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Roman Jaeschke
- Department of Medicine, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Bandar Baw
- Division of Emergency Medicine, McMaster University, Hamilton, Canada
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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150
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Obleagă CV, Vere CC, Mogoanţa SŞ, Firuţ C, Meșina C, Ciorbagiu MC, Mirea CS, Vîlcea ID. Upper Gastrointestinal Bleeding - Initial Manifestation of Pancreatic Head Carcinoma. Curr Health Sci J 2017; 43:236-240. [PMID: 30595882 PMCID: PMC6284840 DOI: 10.12865/chsj.43.03.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/16/2017] [Indexed: 12/17/2022]
Abstract
Pancreatic head carcinomas are a rare cause of upper digestive bleeding and the diagnosis and the treatment of these pose particular problems. We selected 6 cases from a number of 283 patients who were hospitalized for surgery between January 2014 and December 2016 with signs of upper digestive bleeding with no varicose origin who were subsequently diagnosed with pancreatic head carcinomas. The diagnosis was established by endoscopic and surgical methods. The evolution of these patients was influenced by whether there was active digestive bleeding or history of digestive bleeding and the possibility of tumor resection. Four patients needed emergency surgery due to continuous bleeding or rebleeding. The resectability of the cephalo-pancreatic tumor was determined and then subsequently performed in two patients who had a favorable postoperative outcome, while in two patients the tumor resection was impossible. The other two patients with upper digestive haemorrhage responded favorable to drug therapy, and digestive endoscopy and CT explorations were negative. After a 5-month interval they presented with clinical signs of a pancreatic neoplasm with invasion into the common bile duct, unwanted weight loss, abdominal pain, and icterus of the sclera and skin. The surgical intervention resulted in the confirmation of locally advanced pancreatic head carcinomas and the performing of bilio-digestive derivations. Pancreatic head carcinomas may be associated with upper digestive tract haemorrhage due to duodenal or bile duct invasion. The clinical picture of these patients can vary from occult haemorrhage to severe upper digestive tract haemorrhage accompanied by hypovolemic shock.
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Affiliation(s)
- C V Obleagă
- Department of Surgery, University of Medicine and Pharmacy Craiova, Romania
| | - C C Vere
- Department of Gastroenterology, University of Medicine and Pharmacy Craiova, Romania
| | - S Ş Mogoanţa
- Department of Surgery, University of Medicine and Pharmacy Craiova, Romania
| | - C Firuţ
- Department of Surgery, University of Medicine and Pharmacy Craiova, Romania
| | - C Meșina
- Department of Surgery, University of Medicine and Pharmacy Craiova, Romania
| | - M C Ciorbagiu
- Department of Surgery, University of Medicine and Pharmacy Craiova, Romania
| | - C S Mirea
- Department of Surgery, University of Medicine and Pharmacy Craiova, Romania
| | - I D Vîlcea
- Department of Surgery, University of Medicine and Pharmacy Craiova, Romania
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