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Non Variceal Bleed

Jeong-Ju Yoo, Young Chang, Eun Ju Cho, Ji Eun Moon, Sang Gyune Kim, Young Seok Kim, Yun Bin Lee, Jeong-Hoon Lee, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon
AIM: To examine the association between the timing of endoscopy and the short-term outcomes of acute variceal bleeding in cirrhotic patients. METHODS: This retrospective study included 274 consecutive patients admitted with acute esophageal variceal bleeding of two tertiary hospitals in Korea. We adjusted confounding factors using the Cox proportional hazards model and the inverse probability weighting (IPW) method. The primary outcome was the mortality of patients within 6 wk...
November 28, 2018: World Journal of Gastroenterology: WJG
Jitrapa Kerdsuknirun, Virunpat Vilaichone, Ratha-Korn Vilaichone
Objective: Hepatocellular carcinoma (HCC) is common cancer in ASEAN. Variceal bleeding (VB) is considered to be fatal complication of cirrhosis with HCC. However, limited studies were reported in ASEAN. Aim of this study was to evaluate overall survival rate and predictors of VB in HCC patients. Methods: We conducted a retrospective cohort study of HCC patients aged ≥15 years between January 2012-January 2016 and follow up through June 2016 at Thammasat University Hospital, Thailand. Clinical information and radiologic findings were collected from reviewing computer database of medical records...
November 29, 2018: Asian Pacific Journal of Cancer Prevention: APJCP
Asmaa Elzeftawy, Loai Mansour, Abdelrahman Kobtan, Heba Mourad, Ferial El-Kalla
BACKGROUND/AIMS: The development of esophageal varices (EV) and resultant bleeding are the most critical complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV. To find a non-invasive method for diagnosis of EV and to predict the bleeding risk is appealing and would decrease the cost and discomfort of upper endoscopy. The aim of our study was to evaluate the blood ammonia level as a predictor of the presence of EV and of a high risk of bleeding...
November 21, 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Driss Raissi, Elizabeth A Roney, Mohamed M Issa, Sreeja Sanampudi, Michael A Winkler
Transjugular intrahepatic portosystemic shunt (TIPS) periprocedural thrombosis rates have fallen significantly since the introduction of polytetrafluoroethylene-covered stent grafts. We present a case of a cirrhotic patient with portal hypertension presenting with early TIPS thrombosis in association with an underlying competing spontaneous left mesenterico-gonadal venous shunt, an uncommon variant of spontaneous portal systemic shunt (SPSS). The patient presented with bleeding distal duodenal varices refractory to endovascular therapy, and although a successful TIPS procedure was performed for this indication, early thrombosis was determined by follow-up abdominopelvic computed tomographic angiography (CTA) scan...
October 27, 2018: Clinical Imaging
Andrew Ofosu, Daryl Ramai, Febin John, Mohammed Barakat, Tagore Sunkara, Santosh Sharma, Vinaya Gaduputi, Douglas Adler, Madhavi Reddy
INTRODUCTION: Endoscopic hemostasis in patients with non-variceal bleeding (NVGIB) with standard therapy has improved outcomes. However, persistent bleeding and re-bleeding continues to drive morbidity and mortality. Use of Over-the-scope clips (OTSC) is an emerging treatment modality for managing gastrointestinal bleeding. We performed a systematic review and meta-analysis to evaluate the ability of OTSC to achieve primary hemostasis and re-bleeding rates as primary therapy and rescue endoscopic interventions in patients with NVGIB...
November 7, 2018: Minerva Gastroenterologica e Dietologica
Antony P Zacharias, Rebecca Jeyaraj, Lise Hobolth, Flemming Bendtsen, Lise Lotte Gluud, Marsha Y Morgan
BACKGROUND: Non-selective beta-blockers are recommended for the prevention of bleeding in people with cirrhosis, portal hypertension and gastroesophageal varices. Carvedilol is a non-selective beta-blocker with additional intrinsic alpha1 -blocking effects, which may be superior to traditional, non-selective beta-blockers in reducing portal pressure and, therefore, in reducing the risk of upper gastrointestinal bleeding. OBJECTIVES: To assess the beneficial and harmful effects of carvedilol compared with traditional, non-selective beta-blockers for adults with cirrhosis and gastroesophageal varices...
October 29, 2018: Cochrane Database of Systematic Reviews
Pei-Jui Luo, Xi-Hsuan Lin, Chung-Chi Lin, Jiing-Chyuan Luo, Hsiao-Yun Hu, Po-Hsiang Ting, Ming-Chih Hou
BACKGROUND/PURPOSE: We aimed to identify the risk factors of first-time occurrence of non-variceal upper gastrointestinal bleeding (UGIB) among aspirin users after adjusting for confounding factors like age, gender, underlying co-morbidities, and medications. METHODS: Using the National Health Insurance Research Database of Taiwan and matching age, gender, underlying co-morbidities and enrollment time by propensity score, 11105 aspirin users and 11105 controls were identified for comparison from a cohort dataset of 1,000,000 randomly sampled subjects...
October 23, 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Jia Lin Ng, Musfirah Marican, Ronnie Mathew
BACKGROUND: Although most diverticular bleeding resolve spontaneously, up to 30% can bleed torrentially, necessitating angioembolization, endoscopic or surgical intervention. Non-contact endoscopic therapies, such as topical haemostatic powders, do not require precise targeting and are attractive because identification of specific culprit diverticulum is difficult. While their use in non-variceal upper gastrointestinal bleeding is well established, its role in lower gastrointestinal bleeding remains unclear...
October 10, 2018: ANZ Journal of Surgery
Elaine Tang, Sharon Torres, Benny Liu, Rachel Baden, Taft Bhuket, Robert J Wong
Background and aims: Delays in diagnosis of chronic hepatitis B virus infection (HBV) may be more common among underserved safety-net populations, contributing to more advanced disease at presentation. We aim to evaluate rates of and predictors of cirrhosis and cirrhosis-related complications among adults with chronic HBV. Methods: We retrospectively evaluated consecutive chronic HBV adults from gastroenterology clinics from July 2014 to May 2016 at a community-based safety-net hospital...
September 2018: Journal of Clinical and Experimental Hepatology
Mahesh Kumar Goenka, Bhavik Bharat Shah, Vijay Kumar Rai, Surabhi Jajodia, Usha Goenka
Background/Aims: To evaluate patients with portal hypertension (PH) of varied etiologies for portal hypertensive enteropathy (PHE) using the PillCam SB3 capsule endoscopy (CE) system. Methods: Consecutive patients with PH presenting with unexplained anemia and/or occult gastrointestinal bleeding were evaluated using the PillCam SB3 CE system. Abnormal findings were categorized as vascular or non-vascular. The patients with ongoing bleeding caused by PHE were treated...
October 5, 2018: Clinical Endoscopy
Mingliang Lu, Gang Sun, Xiao-Mei Zhang, You-Qing Xv, Shi-Yao Chen, Ying Song, Xue-Liang Li, Bin Lv, Jian-Lin Ren, Xue-Qing Chen, Hui Zhang, Chen Mo, Yan-Zhi Wang, Yun-Sheng Yang
BACKGROUND This study aimed to discover the common cause of non-variceal upper-gastrointestinal bleeding (NVUGIB) by conducting a multi-center retrospective study from 2008 to 2012. MATERIAL AND METHODS Hospitalized patients ages ≥18 years old, from 8 hospitals in China, diagnosed with NVUGIB by endoscopy from 1 January 2008 to 31 December 2012 were enrolled. Questionnaires were developed and a data-entry graphical user interface was designed by using EpiData software. RESULTS Total of 2977 hospitalized patients from 8 medical centers were included...
October 6, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Peter Lykke Eriksen, Anne Luise Hartkopf-Mikkelsen, Peter Ott, Hendrik Vilstrup, Niels Kristian Aagaard
Background: Terlipressin is used as pharmacological treatment for variceal bleeding. The drug's physiological effect favours hyponatremia, and rapid changes in plasma sodium (PNa) may cause brain injury. Cirrhosis patients seem to be largely protected against this effect but patients without cirrhosis may not be so. Objective: The objective of this study was to examine whether terlipressin treatment of patients without cirrhosis leads to more serious fluctuations in PNa than in cirrhosis...
October 2018: United European Gastroenterology Journal
Sagarika Satyavada, Perica Davitkov, Meer Akbar Ali, Gregory Cooper, Richard C K Wong, Amitabh Chak
Through-the-scope (TTS) endoscopic Doppler ultrasound probe technology is a tool that has garnered interest for the evaluation of variceal and non-variceal bleeding. In previous studies, this technology has been proposed as a more objective method of identifying the bleeding subsurface blood vessel in peptic ulcer hemorrhage. We describe 3 cases where the use of an endoscopic Doppler probe guided the diagnosis and management of upper gastrointestinal (GI) hemorrhage due to causes other than peptic ulcer disease...
2018: ACG Case Reports Journal
Maya Frank Wolf, Reut Elon, Dunia Hassan, Doron Zarfati, Benjamin Diker, Oleg Shnaider, Jacob Bornstein
BACKGROUND: The etiology of vaginal bleeding during pregnancy may be obstetric or non-obstetric. Though colposcopy is generally not part of the routine evaluation of 2nd- or 3rd-trimester vaginal bleeding without obvious obstetrical cause, our department does perform colposcopy and cervical cytology testing in these patients. This study assessed the need and possible contribution of colposcopy in diagnosing the etiology of 2nd- and 3rd-trimester bleeding. METHODS: Retrospective analysis of colposcopy findings from 2012-2015 in patients with 2nd- or 3rd-trimester bleeding where an obstetrical cause was not found...
September 28, 2018: Gynecologic and Obstetric Investigation
Kara Wegermann, Ricardo Henao, Anna Mae Diehl, Susan K Murphy, Manal F Abdelmalek, Cynthia A Moylan
BACKGROUND AND OBJECTIVES: Although the burden of non-alcoholic fatty liver disease (NAFLD) continues to increase worldwide, genetic factors predicting progression to cirrhosis and decompensation in NAFLD remain poorly understood. We sought to determine whether gene expression profiling was associated with clinical decompensation and death in patients with NAFLD, and to assess whether altered DNA methylation contributes to these changes in gene expression. METHODS: We performed a retrospective analysis of 86 patients in the Duke NAFLD Clinical Database and Biorepository with biopsy-proven NAFLD whose liver tissue was previously evaluated for gene expression and DNA methylation using array based technologies...
2018: PloS One
Benjamin L Bick, Mohammad Al-Haddad, Suthat Liangpunsakul, Marwan S Ghabril, John M DeWitt
BACKGROUND: Endoscopic injection of cyanoacrylate into gastric varices may be performed by EUS-guided fine needle injection (EUS-FNI) or direct endoscopic injection (DEI). The aim of this study is to compare the rate of recurrent GV bleeding and adverse events between DEI and EUS-FNI for treatment of GV. METHODS: In a single-center study, a retrospective cohort of patients with actively/recently bleeding or high-risk GV treated with DEI were compared with a prospective cohort of similar patients treated with EUS-FNI...
September 26, 2018: Surgical Endoscopy
Hee Bum Jo, Jun Kyu Lee, Dong Kee Jang, Hyoun Woo Kang, Jae Hak Kim, Yun Jeong Lim, Moon-Soo Koh, Jin Ho Lee
BACKGROUND/AIMS: Endoscopic variceal ligation (EVL) is an established treatment for esophageal variceal bleeding. Midazolam (MDZ) is most commonly used for sedation during endoscopic procedures. However, adverse events (AEs) may occur more frequently in patients with cirrhosis due to altered MDZ metabolism. MATERIALS AND METHODS: We retrospectively reviewed the records of 325 patients with cirrhosis who received EVL. RESULTS: No significant differences were found in treatment outcome and procedure time among 151 patients in the MDZ group and 169 patients in the non-MDZ group...
July 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Harry Sutton, Emer Fitzpatrick, Mark Davenport, Charlotte Burford, Emma Alexander, Anil Dhawan, Tassos Grammatikopoulos
OBJECTIVES: Investigate the use of spleen stiffness measurements (SSMs), measured by transient elastography (TE), for the prediction of clinically significant varices (CSV) in children with portal hypertension. METHODS: This observational cohort study included children selected for endoscopy, as per department protocol, between September 2015 and June 2016. Those included underwent single TE FibroScan for liver stiffness measurements and SSM. Clinical and laboratory data were collected and variceal prediction scores were calculated at time of elastography...
October 2018: Journal of Pediatric Gastroenterology and Nutrition
Livio Cipolletta, Fabio Cipolletta, Antonino Granata, Dario Ligresti, Luca Barresi, Ilaria Tarantino, Mario Traina
OPINION STATEMENT: PURPOSE OF REVIEW: Upper non-variceal gastrointestinal bleeding (UNVGIB) remains an important clinical challenge for endoscopists, requiring skill and expertise for correct management. In this paper, we suggest the best strategy for an effective treatment of this complex category of patients. RECENT FINDINGS: Early endoscopic examination, the increasingly widespread use of endoscopic hemostasis methods, and the most powerful antisecretory agents that induce clot stabilization have radically modified the clinical scenario for treating this pathology...
December 2018: Current Treatment Options in Gastroenterology
Khalid Mumtaz, Abdulfatah Issak, Kyle Porter, Sean Kelly, James Hanje, Anthony J Michaels, Lanla F Conteh, Ashraf El-Hinnawi, Sylvester M Black, Marwan S Abougergi
INTRODUCTION: The early readmission in patients with decompensated liver cirrhosis leads to enormous burden on healthcare utilization. METHODS: Retrospective cohort study using the 2013 and 2014 Nationwide Readmission Database (NRD) was conducted. Patients with diagnoses of cirrhosis and at least one feature of decompensation were included. The primary outcome was to develop a validated risk model for early readmission. Secondary outcomes were to study 30-day all cause-readmission rate and most common reasons for readmission...
September 15, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
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