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Lu MH, Chiang HC. Turn over the new leaf of the treatment in peptic ulcer bleeding: a review of the literature. Therap Adv Gastroenterol 2024; 17:17562848241275318. [PMID: 39253108 PMCID: PMC11382247 DOI: 10.1177/17562848241275318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/26/2024] [Indexed: 09/11/2024] Open
Abstract
Peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, which has a high mortality risk. The standard therapy for acute peptic ulcer bleeding combines medication administration and endoscopic therapies. Both pharmacologic and endoscopic therapies have developed continuously in the past few decades. Proton pump inhibitors (PPIs) already reached a high efficacy in ulcer healing and have been widely used in the past few decades. Endoscopic hemostasis, which includes local epinephrine injection, heater probe coagulation, use of hemostatic clips, and/or band ligation, is highly effective with an overall hemostatic success rate of 85%-90%. However, 10%-20% of patients could not be cured by the current standard combination treatment. Recurrent ulcer bleeding, despite an initial successful hemostasis, is also a big problem for longer hospitalization stays, higher mortality, and higher complication rates, especially for malignant ulcer bleeding. How to manage all types of peptic ulcer bleeding and how to prevent early recurrent peptic ulcer bleeding remain unresolved clinical problems. Recently, several novel medications and endoscopic methods have been developed. Potassium competitive acid blockers have shown a stronger and longer acid suppression than PPI. Hemostatic powder spray and hemostatic gel emulsion are novel hemostatic weapons with emerging evidence, which are potential missing pieces of the puzzle. This literature review will go through the development of endoscopic hemostasis to the prospects of novel endoscopic treatments.
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Affiliation(s)
- Meng-Hsuan Lu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsueh-Chien Chiang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 70428, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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2
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Peña Amaya RG, Figueredo Peña MDC. Variceal hemorrhage in a patient with cirrhosis and congenital hemophilia A: A therapeutic challenge. SAGE Open Med Case Rep 2024; 12:2050313X241255825. [PMID: 38800133 PMCID: PMC11119485 DOI: 10.1177/2050313x241255825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
We describe the case of a 61-year-old male patient with a history of hemophilia A and previous hepatitis C virus infection with sustained virological response and no previous documentation of cirrhosis, who was admitted for variceal bleeding. He was taken for endoscopic evaluation with evidence of active variceal hemorrhage requiring rubber band ligation. Patients with congenital coagulation disorders, such as hemophilia A, are excluded from international guidelines for gastrointestinal bleeding, making their management and counseling challenging. In this article, we describe the specific interventions to be performed in patients with hemophilia A and upper gastrointestinal tract bleeding, specifically variceal bleeding, focusing on pre-endoscopic and endoscopic management.
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Affiliation(s)
- Rafael Gregorio Peña Amaya
- Specialist in Internal Medicine, Fellow of Gastroenterology, University Hospital San Ignacio, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - María del Carmen Figueredo Peña
- Specialist in Internal Medicine and Gastroenterology, Gastroenterology and Digestive Endoscopy Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
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Ivashkin VТ, Mayev IV, Tsarkov РV, Korolev МР, Andreev DN, Baranskaya ЕК, Bordin DS, Burkov SG, Derinov АА, Efetov SК, Lapina ТL, Pavlov РV, Pirogov SS, Poluektova ЕА, Tkachev АV, Trukhmanov АS, Uljanin АI, Fedorov ЕD, Sheptulin АА. Diagnostics and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, the Russian Society of Colorectal Surgeons, the Russian Endoscopic Society and the Scientific Society for the Clinical Study of Human Microbiome). RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2024; 34:101-131. [DOI: 10.22416/1382-4376-2024-34-2-101-131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Aim. The guidelines set out the modern methods of diagnostics and treatment of peptic ulcer and are created for gastroenterologists, primary care physicians, general practitioners, surgeons, endoscopists.Key points. The clinical guidelines contain modern views on the etiology and pathogenesis of peptic ulcer, its clinical features, methods of laboratory and instrumental diagnostics, the main approaches to conservative and surgical treatment. They include the criteria for assessment of the quality of medical care, the algorithm of the doctor's actions, as well as information for the patient.Conclusion. Knowledge of modern methods of diagnostics and therapy of peptic ulcers will contribute to improving the results of its treatment.
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Affiliation(s)
- V. Т. Ivashkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - I. V. Mayev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - Р. V. Tsarkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - D. N. Andreev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - Е. К. Baranskaya
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - D. S. Bordin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry; A.S. Loginov Moscow Clinical Science Center
| | - S. G. Burkov
- Polyclinic No. 3 of Presidential Administration of Russian Federation
| | - А. А. Derinov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - S. К. Efetov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Т. L. Lapina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Р. V. Pavlov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - S. S. Pirogov
- P.A. Hertsen Moscow Oncology Research Center — Branch of “National Medical Research Radiological Center”
| | - Е. А. Poluektova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - А. S. Trukhmanov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - А. I. Uljanin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Е. D. Fedorov
- Pirogov Russian National Research Medical University
| | - А. А. Sheptulin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Al Hanaei A, AlKindi F, Alkhemeiri A, Nair SC. Gastrointestinal Bleeding in COVID-19 Infected Patients, and Management Outcomes. Int J Gen Med 2024; 17:1145-1153. [PMID: 38559591 PMCID: PMC10981877 DOI: 10.2147/ijgm.s454841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Gastrointestinal bleeding in COVID-19-infection poses unique challenges to patients owing to the high risk of concomitant respiratory failure. However, endoscopic care providers are prone to transmission. This study aimed to understand the risk and management outcomes of gastrointestinal bleeding in COVID-19-infected patients. Methods Data were abstracted from electronic patient medical records, using ICD 10 codes, and demographic and clinical data were collected, for COVID-19-infected patients who developed gastrointestinal (GI) bleeding. Complications related to COVID-19 infection and management outcomes of GI bleeding were studied. Statistically, descriptive analysis was used because of the small sample size. Results Eighteen COVID-19-infected patients developed episodes of GI bleeding, yielding a prevalence of 0.45%. Their mean age was 74.8 years, 55.5% were female, and 66.6% of patients (n=12) had upper GI bleeding symptoms, predominantly melena (55.5%), followed by coffee ground nasogastric aspirates (n=2). Only two patients (11.11%) had episodes of lower GI bleeding, and the remaining four patients (22.2%) had recurrent acute anemia requiring blood transfusion. The Glasgow-Blatchford score (GBS) at presentation ranged between 6 to 16 (mean 8.8) and seven patients (38.8%) underwent endoscopic evaluation for GI bleeding. The predominant comorbid conditions included hypertension (22.2%), diabetes mellitus (27.7%), chronic kidney disease (50%), ischemic heart disease (33%), atrial fibrillation (11.1%), and peripheral vascular disease (11.1%). The median hospitalization was 24.6 days (range: 3-54 days). The 30-day mortality rate in our cohort was 22.2%, (4/18) mainly noted in older patients aged> 60 years with comorbid conditions and severe COVID-19 infection. Conclusion The prevalence of GI bleeding observed in our cohort was approximately 0.45%, significantly lower than the global prevalence observed, majority (66%) had upper GI bleeding. The exact reasons for the observed low prevalence of GI bleeding cannot be explained and will be the subject of future research.
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Affiliation(s)
- Amnah Al Hanaei
- Division of Gastroenterology, Tawam Hospital, Al Ain, Emirate of Abu Dhabi, United Arab Emirates
| | - Fatima AlKindi
- Department of Internal Medicine, Tawam Hospital, Al Ain, Emirate of Abu Dhabi, United Arab Emirates
| | - Aysha Alkhemeiri
- Department of Internal Medicine, Tawam Hospital, Al Ain, Emirate of Abu Dhabi, United Arab Emirates
| | - Satish Chandrasekhar Nair
- Department of Academic Affairs, Tawam Hospital & the College of Medicine UAE University, Al Ain, Emirate of Abu Dhabi, United Arab Emirates
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Schuster KF, Thompson CC, Ryou M. Preclinical study of a novel ingestible bleeding sensor for upper gastrointestinal bleeding. Clin Endosc 2024; 57:73-81. [PMID: 37253640 PMCID: PMC10834283 DOI: 10.5946/ce.2022.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/14/2023] [Accepted: 03/06/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND/AIMS Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that necessitates early identification and intervention and is associated with substantial morbidity, mortality, and socioeconomic burden. However, several diagnostic challenges remain regarding risk stratification and the optimal timing of endoscopy. The PillSense System is a noninvasive device developed to detect blood in patients with UGIB in real time. This study aimed to assess the safety and performance characteristics of PillSense using a simulated bleeding model. METHODS A preclinical study was performed using an in vivo porcine model (14 animals). Fourteen PillSense capsules were endoscopically placed in the stomach and blood was injected into the stomach to simulate bleeding. The safety and sensitivity of blood detection and pill excretion were also investigated. RESULTS All the sensors successfully detected the presence or absence of blood. The minimum threshold was 9% blood concentration, with additional detection of increasing concentrations of up to 22.5% blood. All the sensors passed naturally through the gastrointestinal tract. CONCLUSION This study demonstrated the ability of the PillSense System sensor to detect UGIB across a wide range of blood concentrations. This ingestible device detects UGIB in real time and has the potential to be an effective tool to supplement the current standard of care. These favorable results will be further investigated in future clinical studies.
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Affiliation(s)
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Orpen-Palmer J, Stanley AJ. A Review of Risk Scores within Upper Gastrointestinal Bleeding. J Clin Med 2023; 12:jcm12113678. [PMID: 37297873 DOI: 10.3390/jcm12113678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Upper gastrointestinal bleeding is a common medical emergency. Thorough initial assessment and appropriate resuscitation are essential to stabilise the patient. Risk scores provide an important tool to discriminate between lower- and higher-risk patients. Very low-risk patients can be safely discharged for out-patient management, while higher-risk patients can receive appropriate in-patient care. The Glasgow Blatchford Score, with a score of 0-1, performs best in the identification of very low-risk patients who will not require hospital based intervention or die, and is recommended by most guidelines to facilitate safe out-patient management. The performance of risk scores in the identification of specific adverse events to define high-risk patients is less accurate, with no individual score performing consistently well. Ongoing developments in the use of machine learning models and artificial intelligence in predicting poor outcomes in UGIB appear promising and will likely form the basis of dynamic risk assessment in the future.
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Affiliation(s)
- Josh Orpen-Palmer
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - Adrian J Stanley
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
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Wakatsuki T, Mannami T, Furutachi S, Numoto H, Umekawa T, Mitsumune M, Sakaki T, Nagahara H, Fukumoto Y, Yorifuji T, Shimizu S. Glasgow‐Blatchford score combined with nasogastric aspirate as a new diagnostic algorithm for patients with nonvariceal upper gastrointestinal bleeding. DEN OPEN 2023; 3:e185. [PMCID: PMC9663679 DOI: 10.1002/deo2.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/15/2022] [Accepted: 10/22/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Toshiyuki Wakatsuki
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Tomohiko Mannami
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Shinichi Furutachi
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Hiroki Numoto
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Tsuyoshi Umekawa
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Mayu Mitsumune
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Tsukasa Sakaki
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Hanako Nagahara
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Yasushi Fukumoto
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Shin'ichi Shimizu
- Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan
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Muacevic A, Adler JR, Correia JF, Pereira AM, Nora M. The Predictive Value of Glasgow-Blatchford Score: The Experience of an Emergency Department. Cureus 2023; 15:e34205. [PMID: 36843719 PMCID: PMC9957609 DOI: 10.7759/cureus.34205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Upper gastrointestinal bleeding (UGB) is a common emergency and a major cause of morbidity and mortality worldwide. An early and accurate assessment at admission is essential to estimate the severity of each case, assisting in the management of patients. The Glasgow-Blatchford score (GBS) is currently recommended for risk stratification of UGB in the emergency department (ED), helping triage patients to in-hospital vs. ambulatory management. The aim of this study was to test the validity of the GBS in an ED. METHODS Patients who presented to the ED with a diagnosis of UGB between 2017 and 2018 were retrospectively analyzed. RESULTS The mean GBS value of the 149 patients included in the study was 10.3. Of the patients, 4.3% had values ≤1 and 8.7% had values ≤3. The sensitivity and negative predictive value for intervention needs (98.9% and 91.7%) and complications in 30 days (100% and 100%) remained high with a threshold ≤3. In the receiver operating characteristic curves, GBS presented an area under the curve of 0.883 and 0.625, regarding the need for intervention and complications in 30 days, respectively. CONCLUSIONS In our population, the threshold ≤2, and eventually ≤3, allows the identification of twice as many low-risk patients, manageable as outpatients, without significant increases in intervention needs or complications in 30 days.
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International Normalized Ratio-to-Albumin Ratio as a Novel Marker of Upper Gastrointestinal Bleeding Severity. Gastroenterol Res Pract 2022; 2022:1172540. [PMID: 36275426 PMCID: PMC9584709 DOI: 10.1155/2022/1172540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/15/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Upper gastrointestinal bleeding (UGIB) is a potentially life-threatening gastrointestinal emergency, and effective management depends on early risk stratification. The Glasgow–Blatchford and Rockall scores are commonly used prognostic measures for UGIB, although these scoring systems are relatively difficult to apply in early emergency settings. AIMS65 with five items, albumin, international normalized ratio, mental status, systolic blood pressure, and age (>65 years), showed efficacy in predicting long-term hospitalization and mortality. This study aimed to investigate the usefulness of the prothrombin time-international normalized ratio-to-albumin ratio (PTAR) in the emergency room for early UGIB risk stratification. Methods We retrospectively examined patients who visited a tertiary academic hospital's emergency department (ED) with UGIB as the chief presentation between January 2019 and December 2020. The cutoff values and diagnostic accuracies of the PTAR, Glasgow–Blatchford score, AIMS65 score, pre-endoscopy, and complete Rockall score were analyzed, and the performance of the PTAR was compared with that of other risk stratification methods. In total, 519 patients were enrolled: 163 patients were admitted in the intensive care unit (ICU) and 35 died during admission. Multiple logistic regression analyses confirmed the association of the PTAR with ICU admission and mortality. The adjusted odd ratio (aOR) of the PTAR for ICU admission care was 8.376 (2.722–25.774), and the aOR of the PTAR for mortality was 27.846 (8.701–89.116). Conclusions The PTAR measured in the ED is an independent factor related to ICU admission and mortality in patients with UGIB. Using ED blood laboratory results, which are reported relatively quickly and are easy to acquire and calculate, the PTAR can be used as a risk stratification marker in the early emergency setting.
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Ryan K, Malacova E, Appleyard M, Brown AF, Song L, Grimpen F. Clinical utility of the Glasgow Blatchford Score in patients presenting to the emergency department with upper gastrointestinal bleeding: A retrospective cohort study. Emerg Med Australas 2021; 33:817-825. [PMID: 33543572 DOI: 10.1111/1742-6723.13737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Upper gastrointestinal bleeding (UGIB) is a common presentation to EDs. Limited Australian data are available. Study aims were to assess mortality and re-bleeding rates in patients presenting with UGIB as risk-stratified by the Glasgow Blatchford Score (GBS). METHODS We conducted a retrospective medical chart review of all patients presenting with UGIB to a Brisbane tertiary hospital ED over a 12-month period. This descriptive study summarised the medical characteristics related to UGIB as risk-stratified by the GBS. Non-variceal bleeding was categorised as low-risk (GBS 0-2) or high-risk (GBS 3+). Variceal bleeding was not risk stratified. RESULTS A total of 211 patients presented with UGIB to the ED. The median age was 57 years, 67% were male. Mortality rates at 30 days were: 0% for GBS 0-2, 3% (95% confidence interval [CI] 0-6) for GBS 3+ and 10% (95% CI 0-21) for variceal groups. The overall 30-day re-bleeding rate was 4.3% (95% CI 2-7). High-risk patients accessed endoscopy according to international best practice of less than 24 h (GBS 3+, 23.7 h; variceal bleeding, 7.3 h). CONCLUSIONS Mortality and re-bleeding outcomes are similar to other international UGIB cohorts. Patients with a low-risk bleed were appropriately identified and discharged home. Those at higher risk were correctly identified and accessed timely endoscopy. The GBS demonstrated clinical utility in an Australian ED cohort of UGIB bleeding patients.
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Affiliation(s)
- Kimberley Ryan
- Department of Gastroenterology and Hepatology/Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Eva Malacova
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Mark Appleyard
- Department of Gastroenterology and Hepatology/Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Anthony Ft Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Song
- Department of Gastroenterology and Hepatology/Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Florian Grimpen
- Department of Gastroenterology and Hepatology/Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Schembre DB, Ely RE, Connolly JM, Padhya KT, Sharda R, Brandabur JJ. Semiautomated Glasgow-Blatchford Bleeding Score helps direct bed placement for patients with upper gastrointestinal bleeding. BMJ Open Gastroenterol 2020; 7:bmjgast-2020-000479. [PMID: 33214231 PMCID: PMC7681917 DOI: 10.1136/bmjgast-2020-000479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care. DESIGN We reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator. Patients with a score ≤7 (low risk) were directed to an unmonitored bed (UMB), while those with a score of ≥8 (high risk) were considered for MB placement. Conformity with guidelines and subsequent transfers to MB were reviewed, along with transfusion requirement, rebleeding, length of stay, need for intervention and death. RESULTS Over 34 months, 1037 patients received a GBS in the ER. 745 had an UGIB. 235 (32%) of these patients had a GBS ≤7. 29 (12%) low-risk patients were admitted to MBs. Four low-risk patients admitted to UMB required transfer to MB within the first 48 hours. Low-risk patients admitted to UMBs were no more likely to die, rebleed, need transfusion or require more endoscopic, radiographic or surgical procedures than those admitted to MBs. No low-risk patient died from GIB. Patients with GBS ≥8 were more likely to rebleed, require transfusion and interventions to control bleeding but not to die. CONCLUSION A semiautomated GBS calculator can be incorporated into an ER workflow. Patients with a GBS ≤7 are unlikely to need MB care for UGIB. Further studies are warranted to determine an ideal scoring system for MB admission.
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Affiliation(s)
- Drew B Schembre
- Digestive Health, John Muir Health, Walnut Creek, California, USA
| | - Robson E Ely
- Clinical Transformation, Swedish Medical Center, Seattle, Washington, USA
| | | | - Kunjali T Padhya
- Gastroenterology, Swedish Medical Center, Seattle, Washington, USA
| | - Rohit Sharda
- Gastroenterology, Swedish Medical Center, Seattle, Washington, USA
| | - John J Brandabur
- Gastroenterology, Swedish Medical Center, Seattle, Washington, USA
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12
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Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin. ACTA ACUST UNITED AC 2020; 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] [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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Ivashkin VT, Maev IV, Tsar’kov PV, Korolev MP, Andreev DN, Baranskaya EK, Burkov SG, Derinov AA, Efetov SK, Lapina TL, Pavlov PV, Pirogov SS, Tkachev AV, Trukhmanov AS, Fedorov ED, Sheptulin AA. Diagnosis and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, Russian Society of Colorectal Surgeons and the Russian Endoscopic Society). RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2020; 30:49-70. [DOI: 10.22416/1382-4376-2020-30-1-49-70] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
| | - I. V. Maev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | | | - D. N. Andreev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | - S. G. Burkov
- Polyclinic No. 3 of the Administrative Department of the President of the Russian Federation
| | | | - S. K. Efetov
- I.M. Sechenov First Moscow State Medical University
| | - T. L. Lapina
- I.M. Sechenov First Moscow State Medical University
| | - P. V. Pavlov
- I.M. Sechenov First Moscow State Medical University
| | - S. S. Pirogov
- P.A. Gertsen National Medical Research Centre for Radiology, branch of the Moscow Research Institute of Oncology
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Bates D, Edwards J, Langevin A, Abu-Ulba A, Yallou F, Wilson B, Ghosh S. Rebleeding in Variceal and Nonvariceal Gastrointestinal Bleeds in Cirrhotic Patients Using Vitamin K 1: The LIVER-K Study. Can J Hosp Pharm 2020; 73:19-26. [PMID: 32109957 PMCID: PMC7023928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Gastroesophageal varices are the most common cause of upper gastrointestinal bleeding (UGIB) in patients with cirrhosis. Vitamin K1 is commonly administered to patients presenting with UGIB and elevated international normalized ratio, despite limited evidence to support this practice. OBJECTIVES The primary objective was to describe the incidence of rebleeding within 30 days after vitamin K1 administration in patients with cirrhosis and UGIB. The secondary objective was to describe prescribing patterns for vitamin K1. METHODS This retrospective, descriptive multicentre study involved patients with cirrhosis and UGIB who were admitted to any of the 4 adult acute care hospitals in Calgary, Alberta, from January 1, 2014, to December 31, 2016. Patients were divided into 2 groups: those who received vitamin K1 and those who did not. RESULTS A total of 370 patients met the inclusion criteria, of whom 243 received vitamin K1 and 127 did not. Baseline characteristics were similar between the groups. Greater proportions of patients in the vitamin K1 group received transfusions of packed red blood cells, fresh frozen plasma, platelets, cryoprecipitate, or prothrombin concentrate during their admissions. There was no significant difference in the duration of octreotide and pantoprazole infusions. Among patients in the vitamin K1 group, there were more admissions to the intensive care unit and longer lengths of stay. More patients in the no vitamin K1 group had esophageal varices evident on endoscopy that required endoscopic treatment. Forty of the patients (16.5%) in the vitamin K1 group and 7 (5.5%) in the no vitamin K1 group had rebleeding within 30 days of the initial bleed. The median total vitamin K1 dose administered was 25 mg. CONCLUSIONS The study results suggest that vitamin K1 does not reduce the incidence of rebleeding within 30 days of the initial bleed in patients with cirrhosis and UGIB.
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Affiliation(s)
- Duane Bates
- , BScPharm, ACPR, is a Clinical Pharmacist at the Peter Lougheed Centre, Calgary Zone, Alberta Health Services, Calgary, Alberta
| | - Jenny Edwards
- , BScPharm, ACPR, PharmD, is a Clinical Pharmacist at the Peter Lougheed Centre, Calgary Zone, Alberta Health Services, Calgary, Alberta
| | - Ashten Langevin
- , BSc, BScPharm, PharmD, is a Clinical Pharmacist at the Foothills Medical Centre, Calgary Zone, Alberta Health Services, Calgary, Alberta
| | - Adrian Abu-Ulba
- , BScPharm, PharmD, was, at the time of this study, a PharmD candidate with the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta. He is a Clinical Pharmacist at the Peter Lougheed Centre, Calgary Zone, Alberta Health Services, Calgary, Alberta
| | - Faizath Yallou
- , BScPharm, ACPR, is a Clinical Pharmacist at the Foothills Medical Centre, Calgary Zone, Alberta Health Services, Calgary, Alberta
| | - Ben Wilson
- , MD, FRCPC, is a Clinical Assistant Professor with the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Sunita Ghosh
- , PhD, PStat, is a Research Scientist with the Department of Experimental Oncology, Alberta Health Services-Cancer Control Alberta, Edmonton, Alberta
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Abstract
PURPOSE OF REVIEW To review new advances in managing nonvariceal upper gastrointestinal hemorrhage. RECENT FINDINGS Implementation of various scoring systems in combination with video capsule endoscopy assists in stratifying and managing nonvariceal upper gastrointestinal bleeding. New techniques such as thermocoagulation and hemoclips are useful to treat bleeding. SUMMARY The advancement of methods and procedures in managing nonvariceal upper gastrointestinal bleeding has decreased mortality of patients presenting with this type of hemorrhage. In this chapter, we will be discussing various scores to stratify nonvariceal upper gastrointestinal bleeding and techniques to stop bleeding.
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Banister T, Spiking J, Ayaru L. Discharge of patients with an acute upper gastrointestinal bleed from the emergency department using an extended Glasgow-Blatchford Score. BMJ Open Gastroenterol 2018; 5:e000225. [PMID: 30233807 PMCID: PMC6135483 DOI: 10.1136/bmjgast-2018-000225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To use an extended Glasgow-Blatchford Score (GBS) cut-off of ≤1 to aid discharge of patients presenting with acute upper gastrointestinal bleeding (AUGIB) from emergency departments. BACKGROUND The GBS accurately predicts the need for intervention and death in AUGIB, and a cut-off of 0 is recommended to identify patients for discharge without endoscopy. However, this cut-off is limited by identifying a low percentage of low-risk patients. Extension of the cut-off to ≤1 or ≤2 has been proposed to increase this proportion, but there is controversy as to the optimal cut-off and little data on performance in routine clinical practice. METHODS Dual-centre study in which patients with AUGIB and GBS ≤1 were discharged from the emergency department without endoscopy unless there was another reason for admission. Retrospective analysis of associated adverse outcome defined as a 30-day combined endpoint of blood transfusion, intervention or death. RESULTS 569 patients presented with AUGIB from 2015 to 2018. 146 (25.7%) had a GBS ≤1 (70, GBS=0; 76, GBS=1). Of these, 103 (70.5%) were managed as outpatients, and none had an adverse outcome. GBS ≤1 had a negative predictive value=100% and the GBS had an area under receiver operator characteristic (AUROC)=0.89 (95% CI 0.86 to 0.91) in predicting adverse outcomes. In 2008-2009, prior to risk scoring (n=432), 6.5% of patients presenting with AUGIB were discharged safely from the emergency department in comparison with 18.1% (p<0.001) in this cohort. A GBS cut-off ≤2 was associated with an adverse outcome in 8% of cases. CONCLUSION GBS of ≤1 is the optimal cut-off for the discharge of patients with an AUGIB from the emergency department.
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Affiliation(s)
- Thomas Banister
- Department of Gastroenterology, Imperial College Healthcare and Imperial College London, London, UK
| | - Josesph Spiking
- Department of Gastroenterology, Imperial College Healthcare and Imperial College London, London, UK
| | - Lakshmana Ayaru
- Department of Gastroenterology, Imperial College Healthcare and Imperial College London, London, UK
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Nicol E. Maintaining optimism in adversity: physicians leading innovation, education and responsible care delivery. Clin Med (Lond) 2018; 18:113. [PMID: 29626012 PMCID: PMC6303446 DOI: 10.7861/clinmedicine.18-2-113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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