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Non-variceal upper gi bleeding

Mohammad Minakari, Shervin Badihian, Pooyan Jalalpour, Vahid Sebghatollahi
BACKGROUND AND AIM: Upper gastrointestinal bleeding (UGIB) is a threatening condition leading to urgent hospitalization. This study aims to investigate etiology and outcome in UGIB patients in Iran. METHODS: Medical records of GIB patients admitted to Alzahra referral hospital (in Isfahan) during 2010-2015 were retrospectively reviewed for demographic data, comorbidities, history of smoking and taking non-steroidal anti-inflammatory drugs (NSAIDs), presenting symptoms, endoscopic findings, therapeutic endoscopy, blood products' infusion, surgical intervention and mortality...
October 17, 2016: Journal of Gastroenterology and Hepatology
Peter Witters, Dominic Hughes, Palaniswamy Karthikeyan, Somashekara Ramakrishna, Mark Davenport, Anil Dhawan, Tassos Grammatikopoulos
BACKGROUND AND AIMS: Variceal haemorrhage can be a life-threatening complication of chronic liver disease in children. There is limited evidence about the optimal prophylactic management and selection criteria of children who will benefit from upper gastrointestinal endoscopy. METHODS: Children presenting in our centre with suspected portal hypertension or gastrointestinal bleeding and undergoing their first oesophagogastroduodenoscopy between 2005-2012 were included...
October 4, 2016: Journal of Pediatric Gastroenterology and Nutrition
Ari Garber, Sunguk Jang
Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application...
September 2016: Clinical Endoscopy
Václav Hejda
Cirrhosis is the end stage of progressive development of different liver diseases and is associated with significant morbidity and mortality rates. Cirrhosis is associated with a number of potential complications, in particular with development of portal hypertension. Portal hypertension with the production of ascites, hepatic and gastric varices bleeding in the upper part of the gastrointestinal tract, presents the breakpoint in the natural course of cirrhosis, and it is associated with a considerably worse prognosis of patients, with a dramatically increased risk of mortality...
2016: Vnitr̆ní Lékar̆ství
J A González-González, G Vázquez-Elizondo, R Monreal-Robles, D García-Compean, O D Borjas-Almaguer, B Hernández-Velázquez, H J Maldonado-Garza
INTRODUCTION AND AIM: The role of serum albumin level in patients with non-variceal upper gastrointestinal bleeding (NVUGB) has not been extensively studied. Our aim was to evaluate the role of serum albumin on admission in terms of in-hospital mortality in patients with NVUGB. MATERIALS AND METHODS: Patients admitted with NVUGB during a 4-year period were prospectively included. Demographic, clinical, and laboratory data were collected. ROC curve analysis was used to determine the cutoff value for serum albumin on admission that made a distinction between deceased patients and survivors with respect to serum albumin on admission, as well as its overall performance compared with the Rockall score...
August 25, 2016: Revista de Gastroenterología de México
Júlio Rocha Pimenta, Alexandre Rodrigues Ferreira, Eleonora Druve Tavares Fagundes, Thaís Costa Nascentes Queiroz, Regiane Aparecida Nascimento Baptista, Eduardo Guimarães de Araújo Moreira, Camilo Brandão de Resende, Paulo Fernando Souto Bittencourt, Simone Diniz Carvalho, José Andrade Franco Neto, Francisco José Penna
OBJECTIVE: Bleeding of esophageal varices is the main cause of morbidity and mortality in children with portal hypertension. It is important to understand the factors related with a bleeding episode to evaluate more effective primary prophylaxis. This study aims to describe the endoscopic and laboratory findings associated with upper gastrointestinal bleeding (UGIB) secondary to esophageal varices. METHOD: A cross-sectional study with 103 children and adolescents with cirrhosis, divided into a group that had experienced an episode of upper UGIB (35 patients) and a group without a history of UGIB (68 patients), was carried out...
August 4, 2016: Journal of Pediatric Gastroenterology and Nutrition
Liam Zakko, Tarun Rustagi, Maura Douglas, Loren Laine
BACKGROUND & AIMS: Antiplatelet agents decrease cardiovascular events but increase gastrointestinal bleeding (GIB). Guidelines propose platelet transfusion for patients who take antiplatelet agents and have serious GIB. We investigated whether such patients are at decreased risk for rebleeding or increased risk for cardiovascular events after platelet transfusion. METHODS: We performed a retrospective cohort study of patients with GIB admitted to Yale-New Haven Hospital from 2008 to 2013 who were taking antiplatelet agents and had platelet counts higher than 100 × 10(9)/L...
July 25, 2016: Clinical Gastroenterology and Hepatology
Karina M Souk, Hani M Tamim, Hussein A Abu Daya, Don C Rockey, Kassem A Barada
AIM: To compare outcomes of patients with non-variceal upper gastrointestinal bleeding (NVUGIB) taking aspirin for primary prophylaxis to those not taking it. METHODS: Patients not known to have any vascular disease (coronary artery or cerebrovascular disease) who were admitted to the American University of Beirut Medical Center between 1993 and 2010 with NVUGIB were included. The frequencies of in-hospital mortality, re-bleeding, severe bleeding, need for surgery or embolization, and of a composite outcome defined as the occurrence of any of the 4 bleeding related adverse outcomes were compared between patients receiving aspirin and those on no antithrombotics...
July 27, 2016: World Journal of Gastrointestinal Surgery
James Maurice, Edgar Brodkin, Frances Arnold, Annalan Navaratnam, Heidi Paine, Sabrina Khawar, Ameet Dhar, David Patch, James O'Beirne, Raj Mookerjee, Massimo Pinzani, Emmanouil Tsochatzis, Rachel H Westbrook
BACKGROUND: The Baveno VI guidelines propose that cirrhotic patients with a liver stiffness measurement (LSM) <20kPa and a platelet count >150000/μL can avoid screening endoscopy as their combination is highly specific for excluding clinically significant varices. The aim of the study was to validate these criteria. METHODS: Transient elastography data was collected from two institutions from 2006-2015. Inclusion criteria were a LSM ⩾10kPa and an upper gastrointestinal endoscopy within 12 months, with a diagnosis of compensated chronic liver disease...
July 4, 2016: Journal of Hepatology
Andrew M Moon, Jason A Dominitz, George N Ioannou, Elliott Lowy, Lauren A Beste
BACKGROUND & AIMS: Prophylactic antibiotics are recommended for all patients with cirrhosis hospitalized for upper gastrointestinal bleeding (UGIB). We evaluated the association between use of antibiotics, outcomes of re-admissions, and mortality in these patients. METHODS: We performed a retrospective study of 6451 patients with cirrhosis (mean age, 60.6 y) in the Veterans Affairs health care system hospitalized for UGIB from January 1, 2005, through December 31, 2013 (8655 hospitalizations)...
June 14, 2016: Clinical Gastroenterology and Hepatology
H Bart van der Worp
Guidelines for the management of non-variceal upper gastrointestinal haemorrhage recommend restarting anticoagulant therapy after treatment of the haemorrhage in patients with an indication for anticoagulation, such as atrial fibrillation. This recommendation is based on findings in retrospective observational studies, and probably also on common sense: if the cause of the haemorrhage has been treated, the chance of a life-threatening second gastrointestinal haemorrhage when anticoagulation is restarted is likely to be smaller than the chance of a serious thromboembolic complication if anticoagulation is stopped indefinitely...
2016: Nederlands Tijdschrift Voor Geneeskunde
Yidan Lu, Viviane Adam, Vanessa Teich, Alan Barkun
OBJECTIVES: High-dose intravenous proton pump inhibitors (PPIs) post endoscopy are recommended in non-variceal upper gastrointestinal bleeding (UGIB), as they improve outcomes of patients with high-risk lesions. Determine the budget impact of using different PPI regimens in treating non-variceal UGIB, including pre- and post-endoscopic use, continuous infusion (high dose), and intermittent bolus (twice daily) dosing. METHODS: A budget impact analysis using a decision model informed with data from the literature adopting a US third party payer's perspective with a 30-day time horizon was used to determine the total cost per patient (US$2014) presenting with acute UGIB...
May 3, 2016: American Journal of Gastroenterology
Carla Senosiain Lalastra, Julia Arribas Anta, Víctor Moreira Vicente, Javier Martínez González, Maite Maroto Castellanos, María Concepción García Sánchez, Celia Zaera de la Fuente, Sergio López Durán, Ángel Cañete Ruiz, Agustín Albillos Martínez
INTRODUCTION: Variceal upper gastrointestinal bleeding (UGIB) can trigger acute hypoxic hepatitis (AHH). The aim of this study was to analyse the incidence, associated risk factors and mortality of AHH after variceal UGIB. PATIENTS AND METHODS: Retrospective study of cirrhotic patients with variceal UGIB, classified into 2 groups according to the development of AHH. AHH was diagnosed when AST and ALT reached levels 10 times above the upper limit of normal, after ruling out other causes of hepatitis...
November 2016: Gastroenterología y Hepatología
V Mukta, Lakshmi C Panicker, Kalaimani Sivamani, Amit Goel, Debdutta Basu, Halnayak Dhanapathi
BACKGROUND: Non-cirrhotic portal fibrosis (NCPF) is one of the important causes of upper gastrointestinal haemorrhage in patients in tropical countries. The aim of this study was to describe the clinical and laboratory profile of 68 patients with NCPF. MATERIAL AND METHODS: NCPF is defined as liver disease with: (1) evidence of portal hypertension; (2) a liver biopsy showing no cirrhosis or a Tc-labelled sulphur colloid scan showing a pattern suggestive of NCPF; and (3) a patent splenoportal axis...
March 16, 2016: Tropical Doctor
Sejin Hwang, Seong Woo Jeon, Joong Goo Kwon, Dong Wook Lee, Chang Yoon Ha, Kwang Bum Cho, ByungIk Jang, Jung Bae Park, Youn Sun Park
BACKGROUND: Although the mortality rates for non-variceal upper gastrointestinal bleeding (NVUGIB) have recently decreased, it remains a significant medical problem. AIM: The main aim of this prospective multicenter database study was to construct a clinically useful predictive scoring system by using our predictors and compare its prognostic accuracy with that of the Rockall scoring system. METHODS: Data were collected from consecutive patients with NVUGIB...
July 2016: Digestive Diseases and Sciences
Don C Rockey, Alan Elliott, Thomas Lyles
In patients with upper gastrointestinal bleeding (UGIB), identifying those with esophageal variceal hemorrhage prior to endoscopy would be clinically useful. This retrospective study of a large cohort of patients with UGIB used logistic regression analyses to evaluate the platelet count, aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) and Lok index (all non-invasive blood markers) as predictors of variceal bleeding in (1) all patients with UGIB and (2) patients with cirrhosis and UGIB...
March 2016: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
Mitsuhiro Fujishiro, Mikitaka Iguchi, Naomi Kakushima, Motohiko Kato, Yasuhisa Sakata, Shu Hoteya, Mikinori Kataoka, Shunji Shimaoka, Naohisa Yahagi, Kazuma Fujimoto
Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance...
May 2016: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Mamdouh Ahmed Gabr, Mohamed Abd El-Raouf Tawfik, Abd Allah Ahmed El-Sawy
BACKGROUND AND STUDY AIMS: Acute upper gastrointestinal bleeding (AUGIB) in cirrhotic patients occurs mainly from esophageal and gastric varices; however, quite a large number of cirrhotic patients bleed from other sources as well. The aim of the present work is to determine the prevalence of non-variceal UGIB as well as its different causes among the cirrhotic portal hypertensive patients in Nile Delta. METHODS: Emergency upper gastrointestinal (UGI) endoscopy for AUGIB was done in 650 patients...
January 2016: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Yu Bai, Zhao Shen Li
Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common medical emergencies in China and worldwide. In 2009, we published the "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding" for the patients in China; however, during the past years numerous studies on the diagnosis and treatment of ANVUGIB have been conducted, and the management of ANVUGIB needs to be updated. The guidelines were updated after the databases including PubMed, Embase and CNKI were searched to retrieve the clinical trials on the management of ANVUGIB...
February 2016: Journal of Digestive Diseases
June Sung Kim, Byuk Sung Ko, Chang Hwan Son, Shin Ahn, Dong Woo Seo, Yoon Seon Lee, Jae Ho Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim
BACKGROUND/AIMS: The aim of this study was to identify the ability of Glasgow-Blatchford score (GBS) and pre-endoscopic Rockall score (pre-E RS) to predict the occurrence of hypotension in patients with non-variceal upper gastrointestinal bleeding who are initially normotensive at emergency department. METHODS: Retrospective observational study was conducted at Asan Medical Center emergency department (ED) in patients who presented with non-variceal upper gastrointestinal bleeding from January 1, 2011 to December 31, 2013...
January 25, 2016: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
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