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Mike Thomson, Arun Urs, Priya Narula, Prithviraj Rao, Dalia Belsha
AIMS AND BACKGROUND: Advanced endo-haemostatic technique performance and experience is extremely variable in distribution amongst pediatric endoscopists. Haemostatic spray (Hemospray®), a novel endo-haemostatic topically applied powder has the advantage of extreme ease of use and; hence may lower the threshold of competency required by the endoscopist thereby potentially reducing mortality. The aim of the study is to prospectively evaluate the efficacy and the safety of haemostatic spray in paediatric patients with AUGIB...
March 22, 2018: Journal of Pediatric Gastroenterology and Nutrition
K Siau, W Chapman, N Sharma, D Tripathi, T Iqbal, N Bhala
Acute upper gastrointestinal bleed (AUGIB) is one of the most common medical emergencies in the UK, with roughly one presentation every 6 min. Despite advances in therapeutics and endoscopy provision, mortality following AUGIB over the last two decades has remained high, with over 9,000 deaths annually in the UK; consequently, several national bodies have published UK-relevant guidelines. Despite this, the 2015 UK National Confidential Enquiry into Patient Outcome and Death in AUGIB highlighted variations in practice, raised concerns regarding suboptimal patient care and released a series of recommendations...
September 2017: Journal of the Royal College of Physicians of Edinburgh
Kanthi Rekha Badipatla, Preeti Jadhav, Sushma Vaddigiri, Bharat Bajantri, Amandeep Singh, Chaitanya Chandrala, Vijay S Are, Suresh Kumar Nayudu
Background: Diabetic ketoacidosis (DKA) is a common acute complication of diabetes mellitus requiring aggressive medical management. We attempted to study the incidence and various clinical and laboratory variables associated with acute gastrointestinal bleeding (AGIB) and acute upper AGIB (AUGIB) in patients with DKA. Methods: We conducted a retrospective chart review of all the patients admitted to our hospital with DKA between January 2010 and December 2015. We collected demographic, clinical, laboratory, endoscopy and hospitalization details using an electronic medical-record database...
November 2017: Gastroenterology Report
Keith Siau, Jack L Hannah, James Hodson, Monika Widlak, Neeraj Bhala, Tariq H Iqbal
INTRODUCTION: Antithrombotic drugs are often stopped following acute upper gastrointestinal bleeding (AUGIB) and frequently not restarted. The practice of antithrombotic discontinuation on discharge and its impact on outcomes are unclear. OBJECTIVE: To assess whether restarting antithrombotic therapy, prior to hospital discharge for AUGIB, affected clinical outcomes. DESIGN: Retrospective cohort study. SETTING: University hospital between May 2013 and November 2014, with median follow-up of 259 days...
March 2018: Postgraduate Medical Journal
Bahman Nedjat-Shokouhi, Michael Glynn, Erika R E Denton, Simon M Greenfield
BACKGROUND: There has been a drive to raise the standard of management of acute upper gastrointestinal bleeding (AUGIB) in the UK, including three previous audits, sponsored by the British Society of Gastroenterology (BSG). OBJECTIVE: To review the results of the latest BSG/National Health Service (NHS) England national survey of endoscopy services in England between 2014 and 2015. METHOD: All NHS hospitals accepting acute admissions in England (168) were invited to respond to the survey...
January 2017: Frontline Gastroenterology
M S Paudel, S Kc, A K Mandal, N S Poudyal, R Shrestha, B N Paudel, S Chaudhary
INTRODUCTION: AUGIB is characterized by hematemesis or melena or both. Peptic ulcers and variceal bleed account for majority of cases. Use of proton pump inhibitors in current era is associated with a gradual reduction in burden of peptic ulcer disease. We conducted this study to look into the cause of AUGIB in our community. METHODS: We studied 100 patients in one year period who presented to us with hematemesis or melena. The study was conducted in department of Gastroenterology, Bir hospital, Kathmandu...
April 2017: JNMA; Journal of the Nepal Medical Association
Min Zhong, Wan Jun Chen, Xiao Ye Lu, Jie Qian, Chang Qing Zhu
OBJECTIVE: To compare the performances of the Glasgow-Blatchford score (GBS), modified GBS (mGBS) and AIMS65 in predicting clinical outcomes in patients with acute upper gastrointestinal bleeding (AUGIB). METHODS: This study enrolled 320 consecutive patients with AUGIB. Patients at high and low risks of developing adverse clinical outcomes (rebleeding, the need of clinical intervention and death) were categorized according to the GBS, mGBS and AIMS65 scoring systems...
December 2016: Journal of Digestive Diseases
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...
January 2017: 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...
April 29, 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
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