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Chaudhary SM, Singh A, Chavan M, Das A, Bathvar PK. Uncommon, overlooked and underreported causes of upper gastrointestinal bleeding. Intractable Rare Dis Res 2023; 12:13-21. [PMID: 36873674 PMCID: PMC9976090 DOI: 10.5582/irdr.2022.01128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Upper gastrointestinal bleeding (UGB) is a potentially fatal consequence of digestive disorders. There is a wide range of rare causes for UGB that can lead to misdiagnosis and occasionally catastrophic outcomes. The lifestyles of those who are afflicted are mostly responsible for the underlying conditions that result in the hemorrhagic cases. The development of a novel approach targeted at raising public awareness of the issue and educating the public about it could significantly contribute to the elimination of gastrointestinal bleeding with no associated risks and to a nearly zero mortality rate. There are reports of UGB related to Sarcina ventriculi, gastric amyloidosis, jejunal lipoma, gastric schwannoma, hemobilia, esophageal varices, esophageal necrosis, aortoenteric fistula, homosuccus pancreaticus, and gastric trichbezoar in the literature. The common feature of these rare causes of UGB is that the diagnosis is difficult to establish before surgery. Fortunately, UGB with a clear lesion in the stomach itself is a clear sign for surgical intervention, and the diagnosis can only be verified by pathological examination with the help of immunohistochemical detection of a particular antigen for a specific condition. The clinical traits, diagnostic techniques, and the therapeutic, or surgical options of unusual causes of UGB reported in the literature are compiled in this review.
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Affiliation(s)
| | - Ajay Singh
- Department of General Surgery, Sri Ram MurtiSmarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
- Address correspondence to:Ajay Singh, Department of General Surgery, Sri Ram MurtiSmarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India. E-mail:
| | - Manisha Chavan
- Department of General Surgery, Kakatiya Medical College, RangamPeta, Warangal, Telangana, India
| | - Arghadip Das
- Department of General Surgery, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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Kuyumcu G, Latich I, Hardman RL, Fine GC, Oklu R, Quencer KB. Gastrodoudenal Embolization: Indications, Technical Pearls, and Outcomes. J Clin Med 2018; 7:jcm7050101. [PMID: 29724061 PMCID: PMC5977140 DOI: 10.3390/jcm7050101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 01/06/2023] Open
Abstract
The gastroduodenal artery (GDA) is frequently embolized in cases of upper GI bleed that has failed endoscopic therapy. Additionally, it may be done for GDA pseudoaneurysms or as an adjunctive procedure prior to Yttrim-90 (Y90) treatment of hepatic tumors. This clinical review will summarize anatomy and embryology of the GDA, indications, outcomes and complications of GDA embolization.
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Affiliation(s)
- Gokhan Kuyumcu
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale University School of Medicine, New Haven, CT 06519, USA.
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale University School of Medicine, New Haven, CT 06519, USA.
| | - Rulon L Hardman
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT 84108, USA.
| | - Gabriel C Fine
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT 84108, USA.
| | - Rahmi Oklu
- Department of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA.
| | - Keith B Quencer
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT 84108, USA.
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Abstract
Non-variceal upper gastrointestinal bleeding continues to be an important cause of morbidity and mortality. The most common causes include peptic ulcer disease, Mallory-Weiss syndrome, erosive gastritis, duodenitis, esophagitis, malignancy, angiodysplasias and Dieulafoy's lesion. Initial assessment and early aggressive resuscitation significantly improves outcomes. Upper gastrointestinal endoscopy continues to be the gold standard for diagnosis and treatment. We present a comprehensive review of literature for the evaluation and management of non-variceal upper gastrointestinal bleeding.
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Affiliation(s)
- Ronald Samuel
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, University of Texas Medical Branch, 7400 Jones Drive, Apt 724, Galveston, TX 77551.
| | - Obada Tayyem
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Praveen Guturu
- Division of Gastroenterology & Hepatology, University of Texas Medical Branch, 7400 Jones Drive, Apt 724, Galveston, TX 77551
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Tsukanov VV, Kasparov EV, Tonkikh JL, Shtygasheva OV, Butorin NN, Amelchugova OS, Vasyutin AV, Bronnikova EP, Fassan M, Rugge M. Peptic Ulcer Disease and Helicobacter pylori Infection in Different Siberian Ethnicities. Helicobacter 2017; 22. [PMID: 27265879 DOI: 10.1111/hel.12322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The high prevalence of Helicobacter pylori (H. pylori) infection in eastern Siberia is consistently established. In the same geographic area, however, fragmentary information is available on the epidemiology of the peptic ulcer disease (PUD). AIM To assess the prevalence of H. pylori infection (including CagA status) and PUD in different eastern Siberian ethnicities. PATIENTS AND METHODS An endoscopy population of 3149 eastern Siberian dyspeptic patients was considered [1727 Europoids and 1422 Mongoloids (Evenks = 792; Khakases = 630)]. H. pylori status was assessed by urease test and/or serum anti-H. pylori IgG and/or histology. CagA status was serologically assessed (anti-CagA antibodies). RESULTS All the Siberian ethnicities featured high rates of H. pylori infection (Europoids = 87.1%, Evenks = 88.6%, Khakases = 85.4%). Among the 1504 H. pylori-positive Europoids, the prevalence of CagA-positive status (68.7%) was significantly higher than that featured by the 1240 H. pylori-positive Mongoloid ethnicities (46.9%; p < .001 for both comparisons). Peptic ulcer disease significantly prevailed among Europoids (prevalence among Europoid Evenks and Khakases: 8.9% and 8.3%, respectively; prevalence among Mongoloid Evenks and Khakases = 1.0% and 4.4%, respectively). CONCLUSIONS eastern Siberian populations feature consistent high rates of H. pylori infection, but different prevalence of peptic ulcer disease. In particular, Europoids featured a prevalence of both CagA-positive status and peptic ulcer disease significantly higher than that of the Mongoloid ethnicities. These results suggest that both environmental factors (coexisting with the H. pylori infection) and host-related variables modulate the clinicopathological expression of the H. pylori -associated gastric diseases.
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Affiliation(s)
- Vladislav V Tsukanov
- Gastroenterology Department, Federal State Budgetary Scientific Institution "Scientific research institute of medical problems of the North", Krasnoyarsk, Russia
| | - Edward V Kasparov
- Gastroenterology Department, Federal State Budgetary Scientific Institution "Scientific research institute of medical problems of the North", Krasnoyarsk, Russia
| | - Julia L Tonkikh
- Gastroenterology Department, Federal State Budgetary Scientific Institution "Scientific research institute of medical problems of the North", Krasnoyarsk, Russia
| | - Olga V Shtygasheva
- Department of Internal Medicine, Khakass State University, Abakan, Russia
| | - Nikolay N Butorin
- Department of Internal Medicine, Khakass State University, Abakan, Russia.,Endoscopy Department, Khakass Republican Hospital, Abakan, Russia
| | - Olga S Amelchugova
- Gastroenterology Department, Federal State Budgetary Scientific Institution "Scientific research institute of medical problems of the North", Krasnoyarsk, Russia
| | - Alexander V Vasyutin
- Gastroenterology Department, Federal State Budgetary Scientific Institution "Scientific research institute of medical problems of the North", Krasnoyarsk, Russia
| | - Elena P Bronnikova
- Gastroenterology Department, Federal State Budgetary Scientific Institution "Scientific research institute of medical problems of the North", Krasnoyarsk, Russia
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - Massimo Rugge
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy.,Veneto Cancer Registry, Padua, Italy
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Chan FKL, Goto S, Wu MS, Abola MTB, Yeoh KG, Sutrisna B, Chua SS, Mahachai V, Turajane T, Wu B, Zeng QY, Sugano K. Burden of nonsteroidal anti-inflammatory and antiplatelet drug use in Asia: a multidisciplinary working party report. Clin Gastroenterol Hepatol 2012; 10:753-60. [PMID: 22504000 DOI: 10.1016/j.cgh.2012.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/08/2012] [Accepted: 03/10/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We established a working group to examine the burden of atherothrombotic and musculoskeletal diseases in Asia and made recommendations for safer prescribing of nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin. METHODS By using a modified Delphi process, consensus was reached among 12 multidisciplinary experts from Asia. Statements were developed by the steering committee after a literature review, modified, and then approved through 3 rounds of anonymous voting by using a 6-point scale from A+ (strongly agree) to D+ (strongly disagree). Agreement (A+/A) by ≥ 80% of panelists was defined a priori as consensus. RESULTS We identified unique aspects of atherothrombotic and musculoskeletal diseases in Asia. Asia has a lower prevalence of degenerative arthritis and coronary artery disease than Western countries. The age-adjusted mortality of coronary artery disease is lower in Asia; cerebrovascular accident has higher mortality than coronary artery disease. Ischemia has replaced hemorrhage as the predominant pattern of cerebrovascular accident. Low-dose aspirin use is less prevalent in Asia than in Western countries. Traditional Chinese medicine and mucoprotective agents are commonly used in Asia, but their efficacy is not established. For Asian populations, little is known about complications of the lower gastrointestinal tract from use of NSAIDs and underutilization of gastroprotective agents. Our recommendations for preventing ulcer bleeding among users of these drugs who are at high risk for these complications were largely derived from Asian studies and are similar to Western guidelines. CONCLUSIONS By using an evidence-based, multidisciplinary approach, we have identified unique aspects of musculoskeletal and atherothrombotic diseases and strategies for preventing NSAID-related and low-dose aspirin-related gastrointestinal toxicity in Asia.
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Amorena Muro E, Borda Celaya F, Martínez-Peñuela Virseda JM, Borobio Aguilar E, Oquiñena Legaz S, Jiménez Pérez FJ. [Analysis of the clinical benefits and cost-effectiveness of performing a systematic second-look gastroscopy in benign gastric ulcer]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 32:2-8. [PMID: 19174093 DOI: 10.1016/j.gastrohep.2008.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 07/30/2008] [Indexed: 01/14/2023]
Abstract
INTRODUCTION We analyzed the need to routinely perform a second gastroscopy after an initial diagnosis of benign gastric ulcer. METHOD A total of 226 consecutive cases of gastric ulcer were reviewed. Sensitivity (S), specificity (Sp), positive and negative predictive value (PPV and NPV) and the accuracy of the initial gastroscopy plus biopsy were analyzed, both overall and according to the initial endoscopist's experience (attending or resident physician). The diagnostic accuracy of the initial and second-look gastroscopies was compared. The number of second endoscopies required to diagnose a new case of malignant gastric ulcer and their cost was calculated, both overall and according to the endoscopist's experience. RESULTS There were 178 benign ulcers (79%) and 48 malignant ulcers (21%). The initial gastroscopy (S: 87.2%; Sp: 100%; PPV: 100%; PNV: 96.7%; accuracy: 96.7%) was performed by an attending physician in 74% of the patients and by a resident physician in the remaining 26%. Diagnostic accuracy was higher for attending physicians than for residents (98.2% vs. 94.8%; p=0.18). The accuracy of second-look endoscopy was 100%, with a significant improvement when compared with the initial procedure (p=0.035). Three new cases of MALT lymphoma and three new cases of gastric adenocarcinoma were diagnosed and could be treated with curative intent. The number of second gastroscopies required to diagnose a new case of malignant gastric ulcer and their economic cost was: 37.3 (4,675 Euros) for the whole group, 55.2 (6,845 Euros) for attending physicians and 19.3 (2,393 Euros) for residents. CONCLUSIONS Initial gastroscopy showed high diagnostic accuracy, which was slightly lower when performed by resident physicians. Second-look gastroscopy significantly improved the results, confirming the clinical benefit of this procedure in diagnosing potentially curable malignant lesions. The mean cost of each new diagnosis of malignancy was 4,675 Euros, which was three times lower if the initial gastroscopy was performed by a less experienced endoscopist.
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