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Gastrointestinal bleeds

Natália Noronha, Pedro Ramalho, Rogério Barreira, Juliana Roda, Teresa Reis Silva, Miguel Félix
Idiopathic pulmonary hemosiderosis is a potentially fatal disease that results from episodes of alveolar hemorrhage of unknown origin. The clinical spectrum is varied, and anemia may constitute the only manifestation of illness, preceding other signs and symptoms by several months. We present the case of a 4 year-old child presenting with fever, vomiting and prostration, associated with pallor. He had microcytic and hypochromic anemia refractory to iron therapy. Gastrointestinal bleeding was ruled out after negative extensive etiological investigation...
November 29, 2018: Einstein
Deepa R J Arachchillage, Sharon Alavian, Jessica Griffin, Kamala Gurung, Richard Szydlo, Nilanthi Karawitage, Mike Laffan
This retrospective study investigated the efficacy and safety of prothrombin complex concentrates (PCCs) for management of major bleeding events (MBE) in 344 patients receiving the anticoagulants rivaroxaban, apixaban or warfarin during the period January 2016 to April 2018. Median (range) PCC dose was 2000 units (1000-4500). Intracranial haemorrhage (ICH) was the most common indication (137/344, 39·8%) for PCC use followed by gastrointestinal bleeding (93/344, 27%). ICH patients more frequently received rivaroxaban (62·5%) or apixaban (52·5%) compared to warfarin (34·5%), P = 0·002; and visceral bleeding patients received warfarin more frequently (24·2%) than rivaroxaban (5%) or apixaban (10%), P = 0·003...
December 4, 2018: British Journal of Haematology
Manish P Shrestha, Sasha Taleban
The incidence rate of ulcerative colitis (UC) in older patients is rising. Diagnosis of UC may be difficult in older patients as several common gastrointestinal disorders can mimic UC in these patients. Compared with younger adults, left-sided colitis is more common in older-onset UC, while rectal bleeding, abdominal pain, and extraintestinal manifestations are less common. The disease course of older-onset UC may be similar to that of adult-onset UC. The management of UC in older patients includes medical and surgical options...
December 4, 2018: Drugs & Aging
Wayne A Ray, Cecilia P Chung, Katherine T Murray, Walter E Smalley, James R Daugherty, William D Dupont, C Michael Stein
Importance: Anticoagulant choice and proton pump inhibitor (PPI) cotherapy could affect the risk of upper gastrointestinal tract bleeding, a frequent and potentially serious complication of oral anticoagulant treatment. Objectives: To compare the incidence of hospitalization for upper gastrointestinal tract bleeding in patients using individual anticoagulants with and without PPI cotherapy, and to determine variation according to underlying gastrointestinal bleeding risk...
December 4, 2018: JAMA: the Journal of the American Medical Association
Atli Steinn Valgardsson, Sigurbergur Karason, Elin Laxdal, Kristin Huld Haraldsdottir
Arterial cannulation is a common procedure in critically ill patients, as it facilitates continuous monitoring of blood pressure, titration of inotropes, vasopressors and fluids and is also used for blood sampling. Serious complications from arterial lines are very rare, permanent ischemic damage occurs in less than 0,1% of patients. We report the case of a 60-year-old woman in septic shock caused by a perforated duodenal ulcer which was treated with emergent laparoscopic repair. She required high doses of vasopressors and received several arterial lines, including lines in both the ulnar and the radial arteries of the left arm...
December 2018: Læknablađiđ
Brian W Powers, Jiali Yan, Jingsan Zhu, Kristin A Linn, Sachin H Jain, Jennifer L Kowalski, Amol S Navathe
BACKGROUND: There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations. OBJECTIVE: To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients. DESIGN: We used a density-based clustering algorithm to group high-cost patients (top 10% of spending) according to 161 distinct demographic, clinical, and claims-based variables...
December 3, 2018: Journal of General Internal Medicine
Diego García-Compeán, Alan R Jiménez-Rodríguez, Ángel N Del Cueto-Aguilera, Gilberto Herrera-Quiñones, José A González-González, Héctor J Maldonado-Garza
BACKGROUND: Meckel's diverticulum (MD) occurs predominantly in children and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is difficult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy (VCE) in the diagnosis of MD is unknown, and the endoscopic patterns are not defined. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic characteristics. CASE SUMMARY: We present four cases of MD confirmed by surgery...
November 26, 2018: World Journal of Clinical Cases
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
Chayanit Jumniensuk, Mongkon Charoenpitakchai
OBJECTIVE: This study aimed to understand clinicopathological characteristics of gastrointestinal stromal tumors (GISTs) and correlation between pathologic features and clinical outcome. METHODS: We used 76 cases diagnosed as primary GISTs during January 2007 to July 2017 at Army Institute of Pathology, Thailand. Clinical, survival, and pathological data were collected and analyzed. RESULTS: Ages of the patients ranged from 15 to 88 years (M:F = 1:1)...
December 3, 2018: World Journal of Surgical Oncology
Sung Hee Youn, Hyun Lim, Yeonmi Ju, Jae Seung Soh, Ji Won Park, Ho Suk Kang, Sung Eun Kim, Sung Hoon Moon, Jong Hyeok Kim, Choong Kee Park, Seung In Seo, Woon Geon Shin
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...
December 3, 2018: Scandinavian Journal of Gastroenterology
Jinfeng Lin, Xiaoying Huang, Weihua Zhou, Suyan Zhang, Weiwei Sun, Yadong Wang, Ke Ren, Lijun Tian, Junxian Xu, Zhilong Cao, Zunguo Pu, Xudong Han
RATIONALE: Extensive thrombosis in the portal venous system caused by hypereosinophilic syndrome (HES) is rare, and there is no consensus on anticoagulant and thrombolytic treatments for arteriovenous thrombosis caused by HES. PATIENT CONCERNS: The clinical data of a patient with extensive thrombosis in his portal venous system (superior mesenteric, splenic, hepatic, and portal veins), renal artery thrombosis, and mesenteric thrombosis caused by HES with secondary gastrointestinal bleeding and intestinal necrosis were retrospectively analyzed...
November 2018: Medicine (Baltimore)
Chuan-Guo Guo, Lijia Chen, Esther W Chan, Ka Shing Cheung, Takaaki Isshiki, Ian C K Wong, Wai K Leung
BACKGROUND: Ticagrelor and prasugrel are third-generation oral P2Y12 receptor antagonists with rapid onset and pronounced platelet inhibition. However, higher overall bleeding rates have been reported for these agents when compared with clopidogrel. AIM: To compare the risk of gastrointestinal bleeding (GIB) among users of third-generation P2Y12 inhibitors with clopidogrel. METHODS: We systematically searched for published randomised controlled trials of ticagrelor or prasugrel versus clopidogrel until September 2018...
December 2, 2018: Alimentary Pharmacology & Therapeutics
Tai-Ping Wang
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)...
December 2, 2018: Annals of Human Genetics
Lele Zhang, Haiyi Wang
Both malignant tumors derived from gastrointestinal tract and metastasis from peritoneal spread, hematogenous dissemination and lymph node can lead to acute abdomen. Such acute abdomen patients have poor prognosis, high mortality, and complex clinical manifestations. It is difficult to make a correct diagnosis in clinical practice. Recent studies show that gastrointestinal tumors are associated with clinical emergency. Malignant gastrointestinal tumors mostly result in obstruction, so upper gastrointestinal contrast for gastric cancer and post-enhanced CT for colon cancer are recommended; gastrointestinal stromal tumors usually cause bleeding, so computed tomography angiography (CTA) is the first choice for examination; primary gastrointestinal lymphoma tends to cause perforation and usually occurs in small intestine, so CT is the first examination for patients with ischemic acute abdomen, and post-enhanced CT is essential to exclude small intestine carcinoid because of its rising incidence in recent years...
November 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Yuhong Dai, Hong Qiu
Malignant acute abdomen is a emergency with abrupt onset, rapid progress and often a complex etiology, presenting difficulties for treatment and high mortality. Therefore, multidisciplinary team (MDT) treatment modality is required. Compared with single-discipline diagnosis and treatment modality, diagnosis made from MDT discussion is more accurate, where specialists can improve efficiency and quality of the treatment through better communication. A good MDT can cover all stages from the diagnosis to the assessment and treatment of the disease, and combine them into a more coherent process...
November 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Yilin Liu, Xiaotian Zhang
Acute abdomen in patients with malignant tumors is called malignant acute abdomen, often seen in the digestive system tumor or abdominal pelvic metastasis of the other primary tumors. Bleeding, perforation, gastrointestinal obstruction, biliary obstruction with infection, acute peritonitis are acute and severe, however, prevention is more important than treatment. For high-risk patients, even if acute abdomen does not occur when the disease is diagnosed, we should make precautions, including actively local treatment of local lymph nodes or primary lesions and careful choice of drugs...
November 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
P Kasper, U Janssens, G Michels
No abstract text is available yet for this article.
November 30, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Tanyaporn Chantarojanasiri, Natsuyo Yamamoto, Yousuke Nakai, Tomotaka Saito, Kei Saito, Ryunosuke Hakuta, Kazunaga Ishigaki, Tsuyoshi Takeda, Rie Uchino, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Saburo Matsubara, Minoru Tada, Hiroyuki Isayama, Kazuhiko Koike
Background and study aims  While endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collection (PFC) is recommended to be performed ≥ 4 weeks after onset of acute pancreatitis (AP), early (< 4 weeks) interventions are needed in some symptomatic cases. Despite feasibility of early percutaneous drainage, there have been few studies about early EUS-guided drainage of PFC. Patients and methods  Consecutive patients who received EUS-guided drainage (EUS-PCD) of infected or symptomatic PFC at the University of Tokyo were retrospectively studied...
December 2018: Endoscopy International Open
Burton I Korelitz, Bernard Partiula, Kelly Teagle, Arun Swaminath, Judy Schneider, Martin Ellington, Guillaume Stoffels
Objective: To seek the habits of pediatricians by which anorectal skin tags (AST) of Crohn's disease might be overlooked. Methods: Questionnaires were sent to pediatricians affiliated with the Northwell Health System. Results: Based on the responses, the majority of pediatricians did feel the abdomen of children presenting with abdominal pain or diarrhea but did not spread the buttocks to seek the presence of AST unless there was rectal pain, rectal bleeding, or, in some cases, loose stools...
November 2018: Inflammatory Intestinal Diseases
Oğuzhan Çelik, Cem Çil, Bülent Özlek, Eda Özlek, Volkan Doğan, Özcan Başaran, Erkan Demirci, Lütfü Bekar, Macit Kalçık, Osman Karaarslan, Mücahit Yetim, Tolga Doğan, Vahit Demir, Sedat Kalkan, Buğra Özkan, Şıho Hidayet, Gökay Taylan, Zafer Küçüksu, Yunus Çelik, Süleyman Çağan Efe, Onur Aslan, Murat Biteker
OBJECTIVE: The aim of this study was to describe the current status of aspirin use and the demographic characteristics of patients on aspirin for primary and secondary prevention of cardiovascular diseases. METHODS: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) trial was a multicenter, cross-sectional, and observational study conducted in Turkey. The study was planned to include 5000 patients from 14 cities in Turkey...
December 2018: Anatolian Journal of Cardiology
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