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upper gastrointestinal bleed

Lucía Cea Soriano, Angel Lanas, Montse Soriano-Gabarró, Luis A García Rodríguez
BACKGROUND & AIMS: There are few data on the incidence of upper and lower gastrointestinal bleeding (UGIB and LGIB) from observational studies of low-dose aspirin users. We aimed to estimate incidence rates of UGIB and LGIB in a large cohort of new users of low-dose aspirin in the United Kingdom, with sub-analyses of hospitalization status and fatalities. METHODS: We performed a population-based study of 199,079 new users of low-dose aspirin (median age, 64...
June 13, 2018: Clinical Gastroenterology and Hepatology
James H Tabibian, Daniel P Rhoades, Kimberly A Forde, Rhondalyn C McLean, Vinay Chandrasekhara
BACKGROUND & AIMS: Continuous-flow left ventricular assist devices (LVADs) for advanced heart failure have been associated with gastrointestinal bleeding (GIB). We examined the association between time of GIB after LVAD implantation and bleeding location (determined by endoscopy), etiology, and patient outcomes. METHODS: We performed a retrospective study of consecutive patients who underwent implantation of continuous-flow LVADs from 2008 through 2015. We analyzed data on anatomic location of GIB, etiology, length of hospital stay, transfusion requirement, time to endoscopy, and rate of readmission within 30 days...
June 12, 2018: Clinical Gastroenterology and Hepatology
Mayank Jain, Mahadevan Balkrishanan, Chenduran Snk, Sridhar Cgs, Ravi Ramakrishnan, Jayanthi Venkataraman
We report our experience of three cases of decompensated cirrhosis with massive upper gastrointestinal bleeding, which required insertion of an SX-Ella Danis stent for hemostasis. The procedure is safe and effective.
June 2018: Clinical and Experimental Hepatology
P J Devereaux, Emmanuelle Duceppe, Gordon Guyatt, Vikas Tandon, Reitze Rodseth, Bruce M Biccard, Denis Xavier, Wojciech Szczeklik, Christian S Meyhoff, Jessica Vincent, Maria Grazia Franzosi, Sadeesh K Srinathan, Jason Erb, Patrick Magloire, John Neary, Mangala Rao, Prashant V Rahate, Navneet K Chaudhry, Bongani Mayosi, Miriam de Nadal, Pilar Paniagua Iglesias, Otavio Berwanger, Juan Carlos Villar, Fernando Botto, John W Eikelboom, Daniel I Sessler, Clive Kearon, Shirley Pettit, Mukul Sharma, Stuart J Connolly, Shrikant I Bangdiwala, Purnima Rao-Melacini, Andreas Hoeft, Salim Yusuf
BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events and deaths, which anticoagulation therapy could prevent. Dabigatran prevents perioperative venous thromboembolism, but whether this drug can prevent a broader range of vascular complications in patients with MINS is unknown. The MANAGE trial assessed the potential of dabigatran to prevent major vascular complications among such patients. METHODS: In this international, randomised, placebo-controlled trial, we recruited patients from 84 hospitals in 19 countries...
June 9, 2018: Lancet
Jessamine Liu, Rohit Gupta, Karen Hay, Chrys Pulle, Tony Rahman, Shaun Pandy
This study aimed to identify the incidence of perioperative acute upper gastrointestinal bleeding (UGIB) in our hip fracture patients; to evaluate the characteristics, management and clinical outcomes of these patients; and to explore risk factors and protective factors. Of the 1691 consecutive patients admitted for surgical management of hip fractures, 11 (0.65%) had UGIB and a further four patients for each case were selected as controls for evaluation of risk factors and protective factors. Pre-existing peptic ulcer disease was identified as a risk factor for acute UGIB (odds ratio 7...
June 2018: Internal Medicine Journal
Kyohei Maruyama, Takatsugu Yamamoto, Hitoshi Aoyagi, Akari Isono, Koichiro Abe, Shinya Kodashima, Hiroto Kita, Yuji Watari, Ken Kozuma
Nonvitamin K oral anticoagulants (NOACs) sometimes cause hemorrhage, and the gastrointestinal tract is a common site of involvement. However, clinical characteristics of gastrointestinal bleeding (GIB) during NOAC therapy have not been fully elucidated. We studied 658 patients who were prescribed dabigatran, rivaroxaban, or apixaban between April 2011 and November 2015. Medical charts were reviewed to examine whether clinically relevant bleeding (Bleeding Academic Research Consortium criteria type 2 or greater) developed...
2018: BioMed Research International
R Z Qi, X Zhao, S Z Wang, K Zhang, Z Y Chang, X L Hu, M L Wu, P R Zhang, L X Yu, C H Xiao, X J Shi, Z W Li
Objective: To analyze the recent postoperative and long-term postoperative complications of open-splenectomy and disconnection in patients with portal hypertension. Methods: There were 1 118 cases with portal hypertension who underwent open splenectomy and azygoportal disconnection from April 2010 to September 2015 at Department of Surgery, People's Liberation Army 302 Hospital. Retrospective case investigation and telephone follow-up were conducted in October 2016. All patients had history of upper gastrointestinal bleeding before operation...
June 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Nassir Alhaboob Arabi, Abdulmagid Mohammed Musaad, Fatima Abbas Habiballah Mohammed, Elsaggad Eltayeb Ahmed, Muataz Salah Eldin Abdelaziz
BACKGROUND AND STUDY AIMS: Lower gastrointestinal bleeding originates from a site distal to the ligament of Treitz. It can present as an acute life-threatening or chronicbleeding. It is common among older patients and those with comorbidity. The common causes are diverticular disease, angiodysplasias, neoplasms, colitis, ischaemia and anorectal disorders. The aim of this study is to determine the prevalence and causes of acute lower gastrointestinal bleeding among Sudanese patients. PATIENTS AND METHODS: In a period of 2 years we studied 301 patients with fresh rectal bleeding out of 5625 patients with gastrointestinal bleeding in Ibn Sina Specialized Hospital, Khartoum, Sudan, This is a cross sectional observational hospital based study...
June 6, 2018: Arab Journal of Gastroenterology: the Official Publication of the Pan-Arab Association of Gastroenterology
Michael L Wells, Stephanie L Hansel, David H Bruining, Joel G Fletcher, Adam T Froemming, John M Barlow, Jeff L Fidler
Acute gastrointestinal (GI) bleeding is common and necessitates rapid diagnosis and treatment. Bleeding can occur anywhere throughout the GI tract and may be caused by many types of disease. The variety of enteric diseases that cause bleeding and the tendency for bleeding to be intermittent may make it difficult to render a diagnosis. The workup of GI bleeding is frequently prolonged and expensive, with examinations commonly needing to be repeated. The use of computed tomography (CT) for evaluation of acute GI bleeding is gaining popularity because it can be used to rapidly diagnose active bleeding and nonbleeding bowel disease...
June 8, 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Tzu-Chieh Lin, Chung-Lin Tsai, Yao-Tien Chang, Sung-Yuan Hu
BACKGROUND: Primary aortoduodenal fistula (ADF) is a rare cause of gastrointestinal (GI) bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA) can be used to detect primary ADF. Open surgery or endovascular aortic repair (EVAR) for ADF with bleeding will improve the survival rate...
June 7, 2018: BMC Cardiovascular Disorders
Manish P Shrestha, Mark Borgstrom, Eugene Abraham Trowers
Background and aims: Initial clinical management decision in patients with acute gastrointestinal bleeding (GIB) is often based on identifying high- and low-risk patients. Little is known about the role of lactate measurement in the triage of patients with acute GIB. We intended to assess if lactate on presentation is predictive of need for intervention in patients with acute GIB. Patients and methods: We performed a single-center, retrospective, cross-sectional study including patients ≥18 years old presenting to emergency with acute GIB between January 2014 and December 2014...
2018: Clinical and Experimental Gastroenterology
Yeong Jin Kim, Jun Chul Park, Eun Hye Kim, Sung Kwan Shin, Sang Kil Lee, Young Chan Lee
Background and study aims : Despite use of various endoscopic therapies in patients with tumor-related bleeding, various rates of successful immediate hemostasis and short-term rebleeding have been reported. We aimed to evaluate preliminary results of use of the EndoClot polysaccharide hemostatic system (PHS) in patients with acute upper gastrointestinal bleeding (UGIB) from a gastric malignancy. Patients and methods : We retrospectively analyzed data from a prospectively collected database of 12 patients with acute UGIB from a gastric malignancy who had been treated with EndoClot PHS...
June 2018: Endoscopy International Open
Jian-Yuan Gao, Jin-Feng Chen, Hui Su, Hai-Ying Fang, Li-Ping Wu, Ya-Jun Han, Xiao-Ming Wang
An 82-year patient presented with nausea, coffee-ground emesis, melena and hematochezia on July 10, 2011. The patient received blood transfusion on July 11, and continued to bleed from July 12 to 17. The patient underwent upper gastrointestinal endoscopy on July 16. There were no abnormalities in the esophagus, stomach and duodenum. Then the patient presented with shortness of breath, extreme fear, fatigue, hypotension, sweating, and cold limbs. Dopamine, as well as pressurised infusion of packed red blood cells and fresh frozen plasma were given to the patient to maintain blood pressure...
June 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Ingrid Toews, Aneesh Thomas George, John V Peter, Richard Kirubakaran, Luís Eduardo S Fontes, Jabez Paul Barnabas Ezekiel, Joerg J Meerpohl
BACKGROUND: Upper gastrointestinal (GI) bleeding due to stress ulcers contributes to increased morbidity and mortality in people admitted to intensive care units (ICUs). Stress ulceration refers to GI mucosal injury related to the stress of being critically ill. ICU patients with major bleeding as a result of stress ulceration might have mortality rates approaching 48.5% to 65%. However, the incidence of stress-induced GI bleeding in ICUs has decreased, and not all critically ill patients need prophylaxis...
June 4, 2018: Cochrane Database of Systematic Reviews
Kyoung Sun Park, Seung-Woo Lee, Junguee Lee, Moon Sung Kim, Pyung Hwa Park, Sung Jin Moon, Sang-Bum Kang, Dong Soo Lee
RATIONALE: Gastric hyperplastic polyps are frequently found on upper gastrointestinal endoscopy and usually asymptomatic. PATIENTS CONCERNS: A 65-year-old man visited the emergency department due to melena. Emergency upper endoscopy revealed a semi-pedunculated polyp measuring 1.2 cm in diameter with blood oozing. We resected the polyp using snare polypectomy. Ulceration was noted on the polypectomy specimen and was thought to be a bleeding focus. DIAGNOSES: Histopathologic findings revealed hyperplastic polyp with focal well-differentiated adenocarcinoma in the ulcerated area and involvement of the lateral resection margin by carcinoma...
June 2018: Medicine (Baltimore)
Marta Carneiro de Moura, Shiyi Chen, Binita M Kamath, Vicky Lee Ng, Simon C Ling
BACKGROUND AND AIMS: The need for primary prophylaxis of variceal bleeding in children is unclear due to insufficient evidence of the efficacy of prophylactic therapy and the mortality and morbidity associated with the first bleeding event. Previous studies have provided estimates of mortality. We aimed to investigate the morbidity associated with acute variceal bleeding (AVB) in children and to identify contributing factors. METHODS: We retrospectively reviewed children with chronic liver disease or portal vein thrombosis admitted with acute upper gastrointestinal bleeding between 2000 and 2015...
May 30, 2018: Journal of Pediatric Gastroenterology and Nutrition
Zahraa Abdul Sater, Smita Jha, Raven McGlotten, Iris Hartley, Mustapha El Lakis, Katherine Araque Triana, Lynnette K Nieman
Context: Patients taking exogenous glucocorticoids are at risk of gastrointestinal (GI) complications including peptic ulcer disease with perforation, and gastric bleeding. However, little is known about the GI co-morbidity in patients with endogenous hypercortisolemia. Case descriptions: We describe six patients with endogenous Cushing's Syndrome (CS) who developed sudden perforation of colonic diverticula requiring urgent exploratory laparotomy. Most of these patients shared the following features of Cushing's syndrome: significant skin thinning, severe hypercortisolemia (24-hour urine free cortisol ≥10X the upper limit of normal), ectopic secretion of ACTH, and severe hypokalemia...
May 28, 2018: Journal of Clinical Endocrinology and Metabolism
Yi-Heng Li, Chih-Yuan Fang, I-Chang Hsieh, Wei-Chun Huang, Tsung-Hsien Lin, Shih-Hsien Sung, Chiung-Zuan Chiu, Chiung-Jen Wu, Kou-Gi Shyu, Po-Yuan Chang, Ching-Chang Fang, Tse-Min Lu, Ching-Pei Chen, Wei-Chen Tai, Chau-Chyun Sheu, Kai-Che Wei, Yi-Hsiu Huang, Hsing-Mei Wu, Juey-Jen Hwang Hwang
Antiplatelet therapy is a key component in the treatment of acute coronary syndrome (ACS). The management of ACS has evolved considerably over recent years with the development of new and more potent antiplatelet agents. Clinical trials on ACS have demonstrated that potent antiplatelet agents can more effectively reduce cardiovascular events. However, there is a tipping point between safety and efficacy, beyond which the risk of bleeding and other adverse effects can outweigh the benefits of antiplatelet therapy...
May 2018: Acta Cardiologica Sinica
Kensuke Daida, Nobukazu Miyamoto, Hiromi Takagi, Yuji Ueno, Kazuo Yamashiro, Ryota Tanaka, Nobutaka Hattori
A 75-year-old woman presented with consciousness disturbance accompanied by hematemesis. Brain imaging revealed ischemia in the bilateral caudate nuclei and right cerebral watershed area due to stenosis of the right anterior cerebral artery (ACA) and bilateral internal carotid arteries (ICA), and hypoperfusion in the right caudate nucleus. The patient's only symptom was abulia, which gradually resolved. Further brain scans showed that the ICA stenosis had improved, although the right ACA stenosis persisted...
May 24, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Arthur Schmidt, Stefan Gölder, Martin Goetz, Alexander Meining, James Lau, Stefan von Delius, Markus Escher, Arthur Hoffmann, Reiner Wiest, Helmut Messmann, Thomas Kratt, Benjamin Walter, Dominik Bettinger, Karel Caca
BACKGROUND & AIMS: Endoscopic hemostasis is effective in treatment of bleeding peptic ulcers. However, re-bleeding is difficult to treat and associated with substantial morbidity and mortality. We performed a prospective randomized trial to determine whether over the scope clips (OTSC) are more effective that standard treatment of severe recurrent upper gastrointestinal bleeding. METHODS: We performed our study at 9 academic referral centers (in Germany, Switzerland, and Hong Kong) from March 2013 through September 2016...
May 24, 2018: Gastroenterology
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