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acute upper gastrointestinal bleeding

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
Mircea Beuran, Ionut Negoi, Ruxandra Irina Negoi, Sorin Hostiuc, Sorin Paun
A 59 year-old patient was admitted with upper gastrointestinal bleeding. The clinical exam showed mild hypotension and blood samples revealed acute anemia (hemoglobin = 7.5 g/dl). Emergency computed tomography showed an infrarenal abdominal aortic aneurysm and extravasation of the arterial contrast material toward the digestive tract. The patient was transported to the operating room for emergency laparotomy, which showed an aortoduodenal fistula. After proximal and distal aortic vascular control, the two anatomical structures were dissected with duodenorrhaphy, patch repair of the aortic tear and omentum interposition...
May 2016: Brazilian Journal of Cardiovascular Surgery
Beatriz Deoti E Silva Rodrigues, Raniere Dos Santos, Magda Maria Profeta da Luz, Flávia Chaves E Silva, Igor Guedes Nogueira Reis
Acute esophageal necrosis (AEN) or "black esophagus" is a rare condition presented by patients with critical state of health and characterized by a darkened esophagus, usually the distal third, in upper digestive endoscopy. The main clinical manifestation is upper gastrointestinal bleeding and there may be abdominal pain, dysphagia, nausea, vomiting, fever and syncope associated. The diagnosis depends on clinical suspicion and performing endoscopy, the biopsy not being required. In this article we present a case of a patient who had lots of comorbidities and developed AEN during a post-operative period, and discuss the importance of AEN in an increasingly ageing population...
October 11, 2016: Clinical Journal of Gastroenterology
Václav Hejda
Cirrhosis is the end stage of progressive development of different liver diseases and is associated with significant morbidity and mortality rates. Cirrhosis is associated with a number of potential complications, in particular with development of portal hypertension. Portal hypertension with the production of ascites, hepatic and gastric varices bleeding in the upper part of the gastrointestinal tract, presents the breakpoint in the natural course of cirrhosis, and it is associated with a considerably worse prognosis of patients, with a dramatically increased risk of mortality...
2016: Vnitr̆ní Lékar̆ství
Fatemeh Baradaran, Alireza Norouzi, Samaneh Tavassoli, Abdolvahab Baradaran, Gholamreza Roshandel
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a major healthcare problem and is the most frequent gastrointestinal reason for admission to hospital. We aimed to investigate the prognosis of patients with UGIB referred to a referral hospital in northern Iran in 2013. METHODS All patients with UGIB who admitted to Sayyad Shirazi Hospital, in Gorgan, northern Iran, in 2013 were enrolled. The patients' demographic data as well as data about admission, diseases, drug history, and patients' prognosis were collected by structured questionnaire using information in hospital files...
July 2016: Middle East Journal of Digestive Diseases
Navin L Kumar, Aaron J Cohen, Jennifer Nayor, Brian L Claggett, John R Saltzman
BACKGROUND: Current guidelines advise that upper endoscopy be performed within 24 hours of presentation in patients with acute nonvariceal upper gastrointestinal bleeding (UGIB). However, the role of urgent endoscopy (< 12 hours) is controversial. AIM: Our aim was to assess whether patients admitted with acute nonvariceal UGIB with lower-risk versus high-risk bleeding have different outcomes with urgent compared with non-urgent endoscopy. METHODS: A retrospective cohort study was conducted of patients admitted to an academic hospital with nonvariceal UGIB...
September 29, 2016: Gastrointestinal Endoscopy
Henrike Lenzen, Eliane Musmann, Martina Kottas, Bastian Schönemeier, Thomas Köhnlein, Michael P Manns, Tim O Lankisch
BACKGROUND: Gastrointestinal bleeding (GIB) is one of the most common emergencies in gastroenterology. The aim of this study was to investigate the association between the incidence of GIB and seasonal, circadian and meteorological patterns in the emergency department (ED) of a tertiary hospital. PATIENTS AND METHODS: From January 2007 until December 2012, we retrospectively evaluated patients presenting to the ED with respect to the number and location of GIB, season, time of day and weather...
September 22, 2016: European Journal of Gastroenterology & Hepatology
Jiancheng Zhao, Xingshun Qi, Feifei Hou, Zheng Ning, Xintong Zhang, Han Deng, Ying Peng, Jing Li, Xiaoxi Wang, Hongyu Li, Xiaozhong Guo
BACKGROUND: QTc interval prolongation is an electrocardiographic abnormality in liver cirrhosis. The objective of this study was to evaluate the prevalence, risk factors and in-hospital outcomes of QTc interval prolongation in Chinese patients with liver cirrhosis. METHODS: This was a retrospective analysis of a total of 1,268 patients with liver cirrhosis who were consecutively admitted to our hospital between January 2011 and June 2014. QTc interval data were collected from the medical records...
September 2016: American Journal of the Medical Sciences
Wesley D Kufel, Adam S Zayac, David F Lehmann, Christopher D Miller
Despite prescribing guidance, limited data exist to describe the use of apixaban in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD). Current apixaban dosing recommendations for this patient population are based largely on a single-dose pharmacokinetic study of eight patients. We describe the clinical application and pharmacodynamic monitoring of apixaban in a 62-year-old 156-kg African-American woman with nonvalvular atrial fibrillation and ESRD requiring hemodialysis who developed calciphylaxis while receiving warfarin therapy...
September 19, 2016: Pharmacotherapy
Nikhil R Kalva, Madhusudhan R Tokala, Sonu Dhillon, Watcoun-Nchinda Pisoh, Saqib Walayat, Vishwas Vanar, Srinivas R Puli
Acute esophageal necrosis (AEN), also called "black esophagus," is a condition characterized by circumferential necrosis of the esophagus with universal distal involvement and variable proximal extension with clear demarcation at the gastroesophageal junction. It is an unusual cause of upper gastrointestinal bleeding and is recognized with distinct and striking mucosal findings on endoscopy. The patients are usually older and are critically ill with shared comorbidities, which include atherosclerotic cardiovascular disease, diabetes mellitus, hypertension, chronic renal insufficiency, and malnutrition...
2016: Case Reports in Gastrointestinal Medicine
Dan Xie, Kunpeng Hu, Ying Xian, Ying Wang, Xiaofeng Yuan, Mingliang Li, Xiaogang Bi, Kouxing Zhang
Peptic ulcer bleeding due to primary hyperparathyroidism is extremely rare. We report a case of a 42-year-old male with life-threatening acute upper gastrointestinal bleeding secondary to a duodenal ulcer and a history of kidney stones. Gastroscopic therapy, Billroth II gastrointestinal anastomosis and angiographic embolization were sequentially conducted to arrest the hemorrhage. A complete investigative work-up revealed that the duodenal ulcer bleeding was due to primary hyperparathyroidism coexisting with a parathyroid adenoma...
September 10, 2016: Gastroenterology Report
K Sunil Raviraj, P Miglani, A Garg, P K Agarwal
Mucormycosis, is an emerging fungal infection in immunocompromised and diabetic individuals, usually affects rhino-orbito-cerebral, cutaneous and pulmonary regions. But mucormycosis in immunocompetent environment is rare and occurrence of gastric mucormycosis is unusual. We report a case of 19 year old female, with no pre-existing co-morbidities, presented with fever, dysentery, vomiting, and melena for 4 days. On evaluation she was found to have pancytopenia, acute kidney injury, hemolytic anemia, coagulopathy and hepatic derangement and treated with hemodialysis, plasmapheresis along with antibiotics and packed cell RBC transfusion...
October 2015: Journal of the Association of Physicians of India
Evren Ozcinar, Nur Dikmen Yaman, Mehmet Cakici, Cagdas Baran, Mustafa B Inan, Serkan Durdu, Ahmet R Akar, Mustafa Sirlak
BACKGROUND: This study aims to evaluate the efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the treatment of upper extremity deep vein thrombosis (UEDVT). METHODS: We conducted a prospective, observational cohort study of consecutive patients with acute UEDVT with low-dose UACDT using the Ekosonic® Endovascular System, EKOS Corporation, Bothell, WA, USA at a single center from September 2012 until October 2014. Overall, sixteen patients(11 males and 6 females, age range 18 to 70 years, mean age, 45...
September 7, 2016: International Angiology: a Journal of the International Union of Angiology
Soon Chul Kim, Jung Won Hwang, Min Kyung Lee, Pyoung Han Hwang
Primary gastric tumors are very rare in children. Burkitt lymphoma is a common type of non-Hodgkin's lymphoma, and gastric Burkitt lymphoma usually occurs in the aged. When involving the gastrointestinal tract, primary gastric Burkitt lymphoma is very rare in younger childhood. Many gastric lymphomas including mucosa-associated lymphoid tissue lymphoma are associated with Helicobacter pylori infection or acute bleeding symptom. We report a seven-year-old boy who presented with only some vomiting and postprandial pain...
August 25, 2016: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
Jan C Prei, Christian Barmeyer, Nataly Bürgel, Severin Daum, Hans-Jörg Epple, Ute Günther, Jochen Maul, Britta Siegmund, Michael Schumann, Hanno Tröger, Andrea Stroux, Andreas Adler, Winfried Veltzke-Schlieker, Christian Jürgensen, Robert Wentrup, Bertram Wiedenmann, Jana Binkau, Dirk Hartmann, Ellen Nötzel, Dirk Domagk, Wolfram Wacke, Ulrich Wahnschaffe, Christian Bojarski
BACKGROUND AND STUDY AIMS: Hemostatic powders have been introduced to improve the management of gastrointestinal (GI) bleeding and to extend the variety of tools available for emergency endoscopy. The aim of the present pilot study was to evaluate the indication profiles and the short-term outcome of EndoClot. PATIENTS, MATERIALS AND METHODS: In a prospective observational pilot study patients with acute nonvariceal GI bleeding were included. Primary or secondary application of EndoClot was assessed...
November 2016: Journal of Clinical Gastroenterology
Jae Min Lee, Eun Sun Kim, Hoon Jai Chun, Young-Jae Hwang, Jae Hyung Lee, Seung Hun Kang, In Kyung Yoo, Seung Han Kim, Hyuk Soon Choi, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim
BACKGROUND AND STUDY AIMS: Many patients with acute gastrointestinal bleeding present with anemia and frequently require red blood cell (RBC) transfusion. A restrictive transfusion strategy and a low hemoglobin (Hb) threshold for transfusion had been shown to produce acceptable outcomes in patients with acute upper gastrointestinal bleeding. However, most patients are discharged with mild anemia owing to the restricted volume of packed RBCs (pRBCs). We investigated whether discharge Hb influences the outcome in patients with acute nonvariceal upper gastrointestinal bleeding...
August 2016: Endoscopy International Open
Dong W Chang, Martin F Shapiro
Importance: Maximizing the value of critical care services requires understanding the relationship between intensive care unit (ICU) utilization, clinical outcomes, and costs. Objective: To examine whether hospitals had consistent patterns of ICU utilization across 4 common medical conditions and the association between higher use of the ICU and hospital costs, use of invasive procedures, and mortality. Design, Setting, and Participants: Retrospective cohort study of 156 842 hospitalizations in 94 acute-care nonfederal hospitals for diabetic ketoacidosis (DKA), pulmonary embolism (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF) in Washington state and Maryland from 2010 to 2012...
October 1, 2016: JAMA Internal Medicine
Eduardo A Rodriguez, Elie Donath, Akbar K Waljee, Daniel A Sussman
BACKGROUND: Intravenous (IV) proton pump inhibitors (PPI) are the standard medical treatment in acute nonvariceal upper gastrointestinal bleeding (ANVGIB). Optimal route of PPI delivery has been questioned. AIM: The aim was to perform a systematic review and network meta-analysis for the endpoints of risk of rebleeding, length of stay (LOS), surgery (ROS), mortality, and total units of blood transfused (UBT) among trials evaluating acid suppressive medications in ANVGIB...
August 8, 2016: Journal of Clinical Gastroenterology
Kathryn Oakland, Richard Guy, Raman Uberoi, Frances Seeney, Gary Collins, John Grant-Casey, Neil Mortensen, Mike Murphy, Vipul Jairath
INTRODUCTION: Acute lower gastrointestinal bleeding (LGIB) is a common indication for emergency hospitalisation worldwide. In contrast to upper GIB, patient characteristics, modes of investigation, transfusion, treatment and outcomes are poorly described. There are minimal clinical guidelines to inform care pathways and the use of endoscopy, including (diagnostic and therapeutic yields), interventional radiology and surgery are poorly defined. As a result, there is potential for wide variation in practice and clinical outcomes...
August 4, 2016: BMJ Open
Samantha Forder, Michael Voelker, Angel Lanas
BACKGROUND AND AIM: Aspirin is a commonly used over-the-counter (OTC) agent for the symptomatic treatment of acute pain, fever, or the common cold, but data regarding safety in this context are limited. In order to characterize the safety of aspirin beyond single-dose or long-term use data, we conducted a meta-analysis of multiple-dose, multiple-day studies of OTC aspirin at a label-approved dosage. METHODS: We conducted a meta-analysis of individual patient data from three Bayer-sponsored studies...
September 2016: Drugs in R&D
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