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Martin Strömdahl, Johan Helgeson, Evangelos Kalaitzakis
OBJECTIVE: To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). PATIENTS AND METHODS: All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution in 2009-2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted...
September 30, 2016: European Journal of Gastroenterology & Hepatology
Deli Zou, Xingshun Qi, Cuihong Zhu, Zheng Ning, Feifei Hou, Jiancheng Zhao, Ying Peng, Jing Li, Han Deng, Xiaozhong Guo
BACKGROUND/AIMS: The albumin-bilirubin (ALBI) score is a new model for assessing the severity of liver dysfunction. In the present study, we aimed to retrospectively compare the performance of ALBI with Child-Pugh and the model for end-stage liver disease (MELD) scores for predicting the in-hospital mortality of acute gastrointestinal bleeding (AUGIB) in liver cirrhosis. MATERIALS AND METHODS: All cirrhotic patients with AUGIB were eligible, provided they had the data needed to determine the ALBI score...
March 2016: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
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
Matthew Kurien, Alan J Lobo
Acute upper gastrointestinal bleeding (AUGIB) is a frequently encountered medical emergency with an incidence of 84-160/100000 and associated with mortality of approximately 10%. Guidelines from the National Institute for Care and Care Excellence outline key features in the management of AUGIB. Patients require prompt resuscitation and risk assessment using validated tools. Upper gastrointestinal endoscopy provides accurate diagnosis, aids in estimating prognosis and allows therapeutic intervention. Endoscopy should be undertaken immediately after resuscitation in unstable patients and within 24 hours in all other patients...
October 2015: Clinical Medicine: Journal of the Royal College of Physicians of London
Kelvin L Y Lam, John C T Wong, James Y W Lau
Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency. Bleeding peptic ulcers account for the majority of causes in patients presenting with AUGIB, whereas variceal bleeding in cirrhotic patients represents a more severe form of bleeding. Endoscopic therapy is the mainstay of treatment in patients with active bleeding, as it achieves hemostasis and improves patient outcomes. Pharmacotherapy is an important adjunct to endoscopic hemostasis. In the management of patients with bleeding peptic ulcers, acid suppression after endoscopic hemostasis reduces rates of further bleeding and interventions...
December 2015: Current Treatment Options in Gastroenterology
H E Campbell, E A Stokes, D Bargo, R F Logan, A Mora, R Hodge, A Gray, M W James, A J Stanley, S M Everett, A A Bailey, H Dallal, J Greenaway, C Dyer, C Llewelyn, T S Walsh, S P L Travis, M F Murphy, V Jairath
OBJECTIVES: Data on costs associated with acute upper gastrointestinal bleeding (AUGIB) are scarce. We provide estimates of UK healthcare costs, indirect costs and health-related quality of life (HRQoL) for patients presenting to hospital with AUGIB. SETTING: Six UK university hospitals with >20 AUGIB admissions per month, >400 adult beds, 24 h endoscopy, and on-site access to intensive care and surgery. PARTICIPANTS: 936 patients aged ≥18 years, admitted with AUGIB, and enrolled between August 2012 and March 2013 in the TRIGGER trial of AUGIB comparing restrictive versus liberal red blood cell (RBC) transfusion thresholds...
2015: BMJ Open
Vipul Jairath, J Thompson, B C Kahan, R Daniel, S A Hearnshaw, S P L Travis, M F Murphy, K R Palmer, R F A Logan
OBJECTIVES: Previous studies have found higher mortality rates among inpatients (IPs) compared with new admissions (outpatients, OPs) with acute upper gastrointestinal bleeding (AUGIB), but no studies have investigated the cause for this. The objective of this study was to determine whether the difference in outcomes between IPs and OPs with AUGIB can be explained by differences in baseline characteristics, bleeding severity, or processes of care. METHODS: Data were collected from 6,657 presentations with all-cause AUGIB from 212 UK hospitals as part of a nationwide audit...
October 2014: American Journal of Gastroenterology
A Gray, V Jairath, B Kahan, C Dore, K Palmer, S Travis, R Logan, T Walsh, M Murphy
OBJECTIVES & BACKGROUND: Transfusion thresholds for upper gastrointestinal bleeding (UGIB) are controversial. Observational studies suggest associations between liberal red blood cell (RBC) transfusion and adverse outcome. A recent trial reported increased mortality following liberal transfusion. We delivered a cluster randomised trial to evaluate the feasibility and safety of implementing a restrictive (transfusion when haemoglobin (Hb) <8 g dL) vs liberal (transfusion when Hb <10 g/dL) RBC transfusion policy for UGIB...
September 2014: Emergency Medicine Journal: EMJ
M Harrington, S Subramaniam, V Mathew, S Gupta
INTRODUCTION: Acute upper gastrointestinal bleeding (AUGIB) is still a medical emergency with a hospital mortality rate of 10%([1]). NICE guidelines recommend that endoscopy is offered to all patients presenting with AUGIB within 24 h([1]). In order to improve our waiting times, a week day dedicated Inpatient Bleeders (IB) list was introduced from October 2012 and its impact on time to endoscopy and length of hospital stay monitored through audit. METHODS: A retrospective audit of all AUGIB in Princess Alexandra Hospital (a district general hospital in Essex) was conducted from April-September 2012 (prior to the introduction of the IB list) and from January-April 2013 (once IB list established)...
June 2014: Gut
I Al Bakir, S Oke, T Rashid, Sm Greenfield
INTRODUCTION: The management of acute upper GI bleeds (AUGIB) comes under greatest stress at weekends; this is a topical concern given the national drive towards a 7 day working week. We previously described the development of a centralised cross-county out of hours endoscopy service.(1) We aim to critically appraise this service against NICE guidelines (CG141) and quality standards (QS38) for the management of AUGIB. METHODS: Our computer-based endoscopy database was retrospectively analysed to identify patients undergoing gastroscopy (OGD) for AUGIB during the weekend in 2012...
June 2014: Gut
E Stokes, H Campbell, D Bargo, M Murphy, R Logan, V Jairath
INTRODUCTION: Acute upper gastrointestinal bleeding (AUGIB) accounts for over 70,000 hospital admissions in the UK annually. Its incidence is likely to rise due to an ageing population and increasing burden of liver disease. Data on the healthcare costs and health-related quality of life (HRQoL) associated with this condition are sparse. METHODS: The TRIGGER trial is a cluster randomised feasibility trial evaluating restrictive versus liberal red cell transfusion for patients with AUGIB...
June 2014: Gut
Palle Bager, Jens F Dahlerup
OBJECTIVE: Nonvariceal acute upper gastrointestinal bleeding (AUGIB) is often associated with significant blood loss and anemia. Both the bleeding episode itself and the subsequent anemia are likely to significantly impact a patient's health-related quality of life (HRQoL). Treating the anemia is essential to increase the hemoglobin levels. The HRQoL impact has not been investigated. This longitudinal study aimed to determine the relationship between anemia, HRQoL, and fatigue in patients after nonvariceal AUGIB...
August 2014: Scandinavian Journal of Gastroenterology
Palle Bager
UNLABELLED: Fatigue in patients with gastrointestinal (GI) diseases can be caused by several conditions and anaemia is one of them. Anaemia can be caused by acute GI bleeding, or it can appear in relation to more chronic conditions: iron deficiency anaemia (IDA) and/or anaemia of chronic disease (ACD). Acute anaemia due to acute upper GI bleedings (AUGIB) is often treated with blood transfusions and/or oral iron supplementations. The need for blood transfusions prior to endoscopic intervention has been well described in guidelines...
April 2014: Danish Medical Journal
P Bager, J F Dahlerup
BACKGROUND: Nonvariceal acute upper gastrointestinal bleeding (AUGIB) is often accompanied by post-discharge anaemia. AIM: To investigate whether iron treatment can effectively treat anaemia and to compare a 3-month regimen of oral iron treatment with a single administration of intravenous iron prior to discharge. METHODS: Ninety-seven patients with nonvariceal AUGIB and anaemia were enrolled in a double-blind, placebo-controlled, randomised study...
January 2014: Alimentary Pharmacology & Therapeutics
Marinos Pericleous, Charles Murray, Mark Hamilton, Owen Epstein, Rupert Negus, Tim Peachey, Arvind Kaul, James O'Beirne
BACKGROUND: We studied the management of patients with acute upper gastrointestinal (GI) bleeding (AUGIB) at the Royal Free Hospital. The aim was to compare our performance with the national standard and determine ways of improving the delivery of care in accordance with the recently published 'Scope for improvement' report. METHODS: We randomly selected patients who presented with haematemesis, melaena, or both, and had an oesophageogastroduodenoscopy (OGD) between April and October 2009...
November 2013: Therapeutic Advances in Gastroenterology
El Mekkaoui Amine, Saâda Kaoutar, Mellouki Ihssane, Ibrahimi Adil, Benajah Dafr-Allah
BACKGROUND: Prolonged fasting may precipitate or exacerbate gastrointestinal complaints. The aim of this study was to evaluate the relation between Ramadan fasting and acute upper gastrointestinal bleeding (AUGIB), and to assess characteristics of those occurred in the holly month. MATERIALS AND METHODS: Retrospective analysis was conducted for all patients, who underwent endoscopy for AUGIB in Ramadan (R) and the month before Ramadan (BR). Epidemiological, clinical and etiological characteristics and outcome of patients having AUGIB were compared between the two periods from 2001 to 2010...
March 2013: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
Vinod S Hegade, Ruchit Sood, Noor Mohammed, Sulleman Moreea
An acute upper gastrointestinal bleed (AUGIB) often represents a life-threatening event and is recognised universally as a common cause of emergency hospitalisation. Large observational studies have improved our understanding of the disease characteristics and its impact on mortality but despite significant advancement in endoscopic management, mortality remains high, particularly in elderly patients and those with multiple comorbidities. Skilled assessment, risk stratification and prompt resuscitation are essential parts of patient care, with endoscopy playing a key role in the definitive management...
October 2013: Postgraduate Medical Journal
Brennan C Kahan, Vipul Jairath, Michael F Murphy, Caroline J Doré
BACKGROUND: Previous research has suggested an association between more liberal red blood cell (RBC) transfusion and greater risk of further bleeding and mortality following acute upper gastrointestinal bleeding (AUGIB). METHODS AND DESIGN: The Transfusion in Gastrointestinal Bleeding (TRIGGER) trial is a pragmatic cluster-randomised feasibility trial which aims to evaluate the feasibility of implementing a restrictive vs. liberal RBC transfusion policy for adult patients admitted to hospital with AUGIB in the UK...
2013: Trials
Chang-Yuan Wang, Jian Qin, Jing Wang, Chang-Yi Sun, Tao Cao, Dan-Dan Zhu
AIM: To validate the clinical Rockall score in predicting outcomes (rebleeding, surgery and mortality) in elderly patients with acute upper gastrointestinal bleeding (AUGIB). METHODS: A retrospective analysis was undertaken in 341 patients admitted to the emergency room and Intensive Care Unit of Xuanwu Hospital of Capital Medical University with non-variceal upper gastrointestinal bleeding. The Rockall scores were calculated, and the association between clinical Rockall scores and patient outcomes (rebleeding, surgery and mortality) was assessed...
June 14, 2013: World Journal of Gastroenterology: WJG
Vipul Jairath, Brennan C Kahan, Alasdair Gray, Caroline J Doré, Ana Mora, Claire Dyer, Elizabeth A Stokes, Charlotte Llewelyn, Adam A Bailey, Helen Dallal, Simon M Everett, Martin W James, Adrian J Stanley, Nicholas Church, Melanie Darwent, John Greenaway, Ivan Le Jeune, Ian Reckless, Helen E Campbell, Sarah Meredith, Kelvin R Palmer, Richard F A Logan, Simon P L Travis, Timothy S Walsh, Michael F Murphy
Acute upper gastrointestinal bleeding (AUGIB) is the commonest reason for hospitalization with hemorrhage in the UK and the leading indication for transfusion of red blood cells (RBCs). Observational studies suggest an association between more liberal RBC transfusion and adverse patient outcomes, and a recent randomised trial reported increased further bleeding and mortality with a liberal transfusion policy. TRIGGER (Transfusion in Gastrointestinal Bleeding) is a pragmatic, cluster randomized trial which aims to evaluate the feasibility and safety of implementing a restrictive versus liberal RBC transfusion policy in adult patients admitted with AUGIB...
July 2013: Transfusion Medicine Reviews
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