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variceal gastrointestinal bleeding

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https://www.readbyqxmd.com/read/28994870/predictive-scores-of-early-mortality-from-variceal-gastrointestinal-bleeding-in-cirrhotic-patients
#1
Leila Mouelhi, Hend Ayadi, Yosra Zaimi, Oussama Daboussi, Mohamed Salem, Radhouane Debbech, Fatma Houissa, Taoufik Najjar
INTRODUCTION: The variceal bleeding, main complication of portal hypertension during cirrhosis, is associated with high early mortality riskestimated between 15 and 20%. This highlights the necessity of predictive models that allow identifying high-risk patients raising the issue of amore aggressive therapeutic care. OBJECTIVE: To assess the performance of four scores for the prediction of cirrhotic patients' high early mortality risk due to digestive hemorrhageand to compare them to the Child-Pugh reference score...
November 2016: La Tunisie Médicale
https://www.readbyqxmd.com/read/28983161/etiological-and-endoscopic-profile-of-middle-aged-and-elderly-patients-with-upper-gastrointestinal-bleeding-in-a-tertiary-care-hospital-in-north-india-a-retrospective-analysis
#2
Pranav Mahajan, Vijant Singh Chandail
BACKGROUND: Upper gastrointestinal (GI) bleeding is a common medical emergency associated with significant morbidity and mortality. The clinical presentation depends on the amount and location of hemorrhage and the endoscopic profile varies according to different etiology. At present, there are limited epidemiological data on upper GI bleed and associated mortality from India, especially in the middle and elderly age group, which has a higher incidence and mortality from this disease...
July 2017: Journal of Mid-life Health
https://www.readbyqxmd.com/read/28971259/efficacy-and-safety-of-superselective-trans-catheter-arterial-embolization-of-upper-and-lower-gastrointestinal-bleeding-using-n-butyl-2-cyanoacrylate
#3
Jae Hyun Kwon, Yoon Hee Han
PURPOSE: To evaluate the efficacy and safety of superselective trans-catheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA) for patients with acute non-variceal upper and lower gastrointestinal (GI) bleeding. METHODS: TAE using NBCA was performed in 21 patients (13 males, 8 females, mean age 60.9 years) with acute non-variceal upper (n = 15) and lower (n = 6) GI bleeding. TAE using other embolic agents was performed in 25 patients (13 males, 12 females, mean age 69...
October 2, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28953556/uncontrolled-bleeding-of-the-gastrointestinal-tract
#4
Alain D'Hondt, Lionel Haentjens, Nicolas Brassart, Frédéric Flamme, Jean-Charles Preiser
PURPOSE OF REVIEW: Acute gastrointestinal bleeding is a frequent emergency situation, whose incidence will likely rise as a result of the increasing use of direct anticoagulants and of the medical progresses resulting in longer life expectancy with underlying comorbidities. Updated guidelines and improvements in the diagnostic and therapeutic tools are now available and will likely improve the management of massive gastrointestinal bleeding in the near future. RECENT FINDINGS: The assessment of severity has been improved by validated scores useable upon admission...
September 26, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28924594/can-we-now-recommend-otsc-as-first-line-therapy-in-case-of-non-variceal-upper-gastrointestinal-bleeding
#5
EDITORIAL
Shannon Melissa Chan, James Yw Lau
No abstract text is available yet for this article.
September 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28924593/use-of-the-over-the-scope-clip-otsc-in-non-variceal-upper-gastrointestinal-bleeding-in-patients-with-severe-cardiovascular-comorbidities-a-retrospective-study
#6
Edris Wedi, Daniel von Renteln, Susana Gonzalez, Olena Tkachenko, Carlo Jung, Sinan Orkut, Victor Roth, Selin Tumay, Juergen Hochberger
INTRODUCTION:  The over-the-scope-clip (OTSC) can potentially overcome limitations of standard clips and achieve more efficient and reliable hemostasis. Data on OTSC use for non-variceal upper gastrointestinal bleeding (NVUGIB) in patients with cardiovascular comorbidities are currently limited. PATIENTS AND METHODS:  We prospectively collected and retrospectively analyzed our database from February 2009 to September 2015 from all patients who underwent emergency endoscopy for high-risk NVUGIB in 2 academic centers and were treated with OTSC as first-line (n = 81) or second-line therapy (n = 19)...
September 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28923638/treatment-of-refractory-gastrointestinal-bleeding-in-patients-with-portal-hypertension-a-case-series-and-treatment-algorithm
#7
J Balogh, S Gordon-Burroughs, P Schwarz, J Galati, R A McFadden, M Cusick, M J Snyder, H R Bailey, M Weiner, A Wong, R A Ochoa, A Saharia, A O Gaber, R M Ghobrial
In patients with portal hypertension, ectopic varices can develop at any site along the gastrointestinal tract outside the classically described gastroesophageal location. Like esophageal variceal hemorrhage, bleeding from ectopic varices can be life-threatening. Diagnosis and treatment of ectopic varices can be challenging; to date, no effective treatment algorithm has been described. A systematic teamwork approach to diagnosing and treatment of ectopic varices is required to successfully manage hemorrhage from ectopic varices...
October 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28918809/endoscopic-ultrasonography-guided-hemostasis-techniques
#8
REVIEW
Everson Luiz de Almeida Artifon, Fernando Pavinato Marson, Muhammad Ali Khan
Endoscopic ultrasonography (EUS)-guided hemostasis is an evolving technique that has the potential to improve the care of patients with refractory variceal and nonvariceal gastrointestinal bleeding. EUS-guided treatment of fundal varices with coil and/or cyanoacrylate seems to be highly effective in active bleeding, as well as for primary and secondary bleeding prophylaxis. Reports of EUS-guided treatment of refractory nonvariceal sources of bleeding are more scarce, but show high success rates. The procedures involve a medium to high technical difficulty level, and this has been replicated worldwide...
October 2017: Gastrointestinal Endoscopy Clinics of North America
https://www.readbyqxmd.com/read/28918131/cirrhotic-patients-with-portal-hypertension-related-bleeding-and-an-indication-for-early-tips-a-large-multicentre-audit-with-real-life-results
#9
Dominique Thabut, Arnaud Pauwels, Nicolas Carbonell, Andre Jean Remy, Pierre Nahon, Xavier Causse, Jean-Paul Cervoni, Jean-François Cadranel, Isabelle Archambeaud, Slim Bramli, Florent Ehrhard, Philippe Ah-Soune, Florian Rostain, Alexandre Pariente, Julien Vergniol, Jean-Pierre Dupuychaffray, Anne-Laure Pelletier, Florence Skinazi, Anne Guillygomarc'h, René-Louis Vitte, Jean Henrion, Stéphanie Combet, Marika Rudler, Christophe Bureau
BACKGROUND: The Baveno VI consensus meeting concluded that an early TIPS must be considered in high-risk cirrhotic patients presenting with variceal bleeding (VB) (Child B + active bleeding at endoscopy or Child C10-13 patients). Whether this therapeutic approach is feasible in a real-life setting remains unclear. AIMS: To determine (1) the proportion of patients eligible for early-TIPS among cirrhotic patients with VB, (2) the proportion of these patients who underwent early-TIPS placement and the main reasons for discarding TIPS, and (3) the outcomes of patients who experienced early-TIPS placement in a large, national, prospective, multicentre audit including academic and non-academic centres...
September 13, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28839866/antithrombotic-drugs-and-non-variceal-bleeding-outcomes-and-risk-scoring-systems-comparison-of-glasgow-blatchford-rockall-and-charlson-scores
#10
Ali S Taha, Caroline McCloskey, Theresa Craigen, Wilson J Angerson
OBJECTIVES: Antithrombotic drugs (ATDs) cause non-variceal upper gastrointestinal bleeding (NVUGIB). Risk scoring systems have not been validated in ATD users. We compared Blatchford, Rockall and Charlson scores in predicting outcomes of NVUGIB in ATD users and controls. METHODS: A total of 2071 patients with NVUGIB were grouped into ATD users (n=851) and controls (n=1220) in a single-centre retrospective analysis. Outcomes included duration of hospital admission, the need for blood transfusion, rebleeding requiring surgery and 30-day mortality...
October 2016: Frontline Gastroenterology
https://www.readbyqxmd.com/read/28833912/identifying-emergency-department-patients-at-low-risk-for-a-variceal-source-of-upper-gastrointestinal-hemorrhage
#11
Lauren R Klein, Joel Money, Kaveesh Maharaj, Aaron Robinson, Tarissa Lai, Brian E Driver
BACKGROUND: Assessing the likelihood of a variceal versus nonvariceal source of upper gastrointestinal bleeding (UGIB) guides therapy, but can be difficult to determine on clinical grounds. The objective of this study was to determine if there are easily ascertainable clinical and laboratory findings that can identify a patient as low risk for a variceal source of hemorrhage. METHODS: This was a retrospective cohort study of adult ED patients with UGIB between January 2008 and December 2014 who had upper endoscopy performed during hospitalization...
August 22, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28814595/bleeding-ectopic-duodenal-varix-use-of-a-new-microvascular-plug-mvp-device-along-with-transjugular-intrahepatic-portosystemic-shunt-tipss
#12
Richa Bhardwaj, Gaurav Bhardwaj, Erik Bee, Raffi Karagozian
Ectopic varices (ECV) occur along the gastrointestinal (GI) tract outside the common variceal sites and represent 2%-5% of all GI variceal bleeds with mortality rates up to 40%. Management is challenging because of inaccessibility and increased risk of rebleeding. We report what is to our knowledge the first clinical use of a new microvascular plug (MVP) with transjugular intrahepatic portosystemic shunt (TIPSS) for a bleeding duodenal varix (DV). A 68-year-old man presented with melena. Endoscopy demonstrated a grade II varix in the second part of the duodenum with red wale sign...
August 16, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28814423/portal-hypertension-and-its-management-in-children
#13
REVIEW
Tassos Grammatikopoulos, Patrick James McKiernan, Anil Dhawan
Portal hypertension (PHT), defined as raised intravascular pressure in the portal system, is a complication of chronic liver disease or liver vascular occlusion. Advances in our ability to diagnose and monitor the condition but also predict the risk of gastrointestinal bleeding have enabled us to optimise the management of children with PHT either at a surveillance or at a postbleeding stage. A consensus among paediatric centres in the classification of varices can be beneficial in streamlining future paediatric studies...
August 16, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28798285/is-the-aims-65-score-useful-in-prepdicting-clinical-outcomes-in-korean-patients-with-variceal-and-nonvariceal-upper-gastrointestinal-bleeding
#14
Jung Wan Choe, Seung Young Kim, Jong Jin Hyun, Sung Woo Jung, Young Kul Jung, Ja Seol Koo, Hyung Joon Yim, Sang Woo Lee
Background/Aims: Various clinical scoring systems, including the Glasgow-Blatchford score (GBS), Rockall risk score (RS), and AIMS65 score (AIMS65), have been validated to predict the clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). We compared the performance of these three scoring systems in predicting clinical outcomes in patients with UGIB in Korea. Methods: We retrospectively evaluated 286 patients with UGIB who visited emergency department...
August 14, 2017: Gut and Liver
https://www.readbyqxmd.com/read/28780608/sx-ella-stent-danis-effectively-controls-refractory-variceal-bleed-in-patients-with-acute-on-chronic-liver-failure
#15
Rakhi Maiwall, Kapil Dev Jamwal, Ankit Bhardwaj, Ajeet Singh Bhadoria, Jaswinder Singh Maras, Guresh Kumar, Ankur Jindal, Ashok Choudhury, Lovkesh Anand, Amrish Sahney, Awinash Kumar, Manoj Kumar Sharma, Barjesh Chander Sharma, Shiv Kumar Sarin
BACKGROUND AND AIMS: Almost 10% of bleeding episodes are refractory to combination of vasoactive agent and endotherapy, and are associated with a mortality up to 50%. Severity of liver disease and high portal pressure are mainly responsible for it. TIPS cannot be used in these patients due to high MELD score. We aimed to evaluate the efficacy of self-expandable DE stents for control of refractory variceal bleeds in patients with ACLF. METHODS: Acute-on-chronic liver failure patients (n = 88, mean age 47...
August 5, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28756055/efficacy-of-over-the-scope-clips-in-management-of-high-risk-gastrointestinal-bleeding
#16
Justin Brandler, Navtej Buttar, Anushka Baruah, Muhammad Zeb, Ayesha Mehfooz, Prachi Pophali, Louis Wong Kee Song, Barham AbuDayyeh, Christopher Gostout, Kristin Mara, Ross Dierkhising
BACKGROUND & AIMS: Standard endoscopic therapies do not control bleeding or produce complications in as many as 20% of patients with non-variceal gastrointestinal bleeding. Most bleeding comes from ulcers with characteristics such as high-risk vascular territories and/or large vessels. We evaluated the efficacy of using over the scope clips (OTSCs) as primary or rescue therapy for patients with bleeding from lesions that have a high-risk for adverse outcomes. METHODS: We performed a retrospective analysis of data from 67 patients with gastrointestinal bleeding from high-risk lesions who were treated with OTSC as primary (n=49) or rescue therapy (n=18) at a quaternary center, from December 2011 through February 2015...
July 26, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28746317/acute-upper-gastrointestinal-bleeding-in-a-tertiary-care-centre-of-nepal
#17
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
https://www.readbyqxmd.com/read/28726433/gastric-antral-vascular-ectasia-and-solitary-rectal-ulcer-syndrome-two-rare-diagnoses-as-the-cause-of-anemia-in-a%C3%A2-single-patient-case-report
#18
Lumír Kunovský, Milan Dastych, Radek Kroupa, Beata Hemmelova, Katarina Muckova, Miroslava Chovancova, Lenka Kucerova, Jiri Dolina
Gastric antral vascular ectasia (GAVE) and solitary rectal ulcer syndrome (SRUS) are both mentioned in the literature as rare causes of iron deficiency anemia and gastrointestinal (GI) bleeding. GAVE accounts for up to 4 % of upper non-variceal GI bleeding; SRUS is a rare benign disorder that presents with rectal bleeding. We present the case of a 75-year-old patient who was admitted to our facility with anemia. In the same patient, we encountered chronic bleeding from GAVE and SRUS. Both diagnoses were treated endoscopically: GAVE by argon plasma coagulation and a subsequent treatment with proton pump inhibitors and SRUS by adrenaline injection and clipping, consecutively treated with mesalazine enemas...
2017: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28718261/modern-management-of-duodenal-variceal-bleeding
#19
Amer Rehman Farooqi, Lawrence Sunderraj
Duodenal variceal bleeding is an uncommon cause of gastrointestinal bleeding. Treatment strategies are reliant on case reports and case series with new developments in interventional treatment modalities including endoscopic therapy, radiological intervention, and surgery. Endoscopic treatment includes injection sclerotherapy using various agents, banding of varices and clipping of varices. Interventional radiological procedures include Transjugular Intrahepatic porto-systemic shunt (TIPSS), and Balloon- Occluded Retrograde Transvenous Obliteration (BRTO)...
April 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28714072/survival-of-patients-with-cirrhosis-and-acute-peptic-ulcer-bleeding-compared-with-variceal-bleeding-using-current-first-line-therapies
#20
Alba Ardevol, Gemma Ibañez-Sanz, Joaquim Profitos, Carles Aracil, Josep M Castellvi, Edilmar Alvarado, Alba Cachero, Diana Horta, Josep Miñana, Bárbara Gomez-Pastrana, Oana Pavel, Eva Dueñas, Meritxell Casas, Montserrat Planella, Jose Castellote J, Candid Villanueva
The presence of cirrhosis increases the mortality of patients with peptic ulcer bleeding (PUB). Both acute variceal bleeding (AVB) and PUB are associated with substantial mortality in cirrhosis. This multicenter cohort study was performed to assess whether the mortality of cirrhotic patients with PUB is different from that of those with AVB. Patients with cirrhosis and acute gastrointestinal bleeding were consecutively included and treated with somatostatin and PPI infusion from admission and with antibiotic prophylaxis...
July 17, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
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