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upper gastrointestinal bledding

Massimo Iavarone, Massimo Primignani, Sara Vavassori, Angelo Sangiovanni, Vincenzo La Mura, Raffaella Romeo, Massimo Colombo
BACKGROUND AND AIMS: Sorafenib is the standard of care for patients with advanced hepatocellular carcinoma (HCC), yet treatment safety may be challenged by portal hypertension. We therefore assessed the prevalence, risk factors and clinical consequences of esophageal varices (EVs) in sorafenib-treated patients with HCC. METHODS: Starting in 2008, all compensated patients with advanced or intermediate HCC not eligible for other therapies were consecutively enrolled in a prospective evaluation of sorafenib therapy, all with pretreatment by upper-gastrointestinal endoscopy (UGE)...
June 2016: United European Gastroenterology Journal
Shirley V Wang, Jessica M Franklin, Robert J Glynn, Sebastian Schneeweiss, Wesley Eddings, Joshua J Gagne
OBJECTIVES:  To compare stratified event rates from randomized controlled trials with predicted event rates from models developed in observational data, and assess their ability to accurately capture observed rates of thromboembolism and major bleeding for patients treated with dabigatran or warfarin as part of routine care. DESIGN:  New initiator cohort study. SETTING:  Data from United Health (October 2009 to June 2013), a commercial healthcare claims database in the United States...
2016: BMJ: British Medical Journal
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
Antonios Wehbeh, Hani M Tamim, Hussein Abu Daya, Rachel Abou Mrad, Rami J Badreddine, Mohamad A Eloubeidi, Don C Rockey, Kassem Barada
OBJECTIVE: To determine the effect of aspirin and anticoagulants on clinical outcomes and cause of in-hospital death in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). METHODS: Patients were identified from a tertiary center database that included all patients with UGIB. Clinical outcomes including (1) in-hospital mortality, (2) severe bleeding, (3) rebleeding, (4) in-hospital complications, and (5) length of hospital stay were examined in patients taking (a) aspirin only, (b) anticoagulants only, and (c) no antithrombotics...
July 2015: Digestive Diseases and Sciences
Patrick McKiernan, Mona Abdel-Hady
Portal hypertension is one of the most serious complications of childhood liver disease, and variceal bleeding is the most feared complication. Most portal hypertension results from cirrhosis but extra hepatic portal vein obstruction is the single commonest cause. Upper gastrointestinal endoscopy endoscopy remains necessary to diagnose gastro-esophageal varices. Families of children with portal hypertension should be provided with written instructions in case of gastrointestinal bleeding. Children with large varices should be considered for primary prophylaxis on a case-by-case basis...
May 2015: Expert Review of Gastroenterology & Hepatology
Mi Jin Hong, Sun-Young Lee, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park, Chan Sup Shim, Choon Jo Jin
Endoscopic hemostasis is the first-line treatment for upper gastrointestinal bleeding (UGIB). Although several factors are known to be risk factors for rebleeding, little is known about the use of antithrombotics. We tried to verify whether the use of antithrombotics affects rebleeding rate after a successful endoscopic hemostasis for peptic ulcer disease (PUD). UGIB patients who underwent successful endoscopic hemostasis were included. Rebleeding was diagnosed when the previously treated lesion bled again within 30 days of the initial episode...
October 2014: Journal of Korean Medical Science
A Giese, C Grunwald, J Zieren, N J Büchner, B F Henning
OBJECTIVES: To evaluate the usefulness of the Forrest classification and the complete Rockall score with customary cut-off values for assessing the risk of adverse events in patients with upper gastrointestinal bleeding (UGI-B) subject to after-hours emergency oesophago-gastro-duodenoscopy (E-EGD) within six hours after admission. METHODS: The medical records of patients with non-variceal UGI-B proven by after-hours endoscopy were analysed. For 'high risk' situations (Forrest stage Ia-IIb/complete Rockall score > 2), univariate analysis was conducted to evaluate odds ratio for reaching the study endpoints (30-day and one-year mortality, re-bleeding, hospital stay ≥ 3 days)...
January 2014: West Indian Medical Journal
Lise Lotte Gluud, Aleksander Krag
BACKGROUND: Non-selective beta-blockers are used as a first-line treatment for primary prevention in patients with medium- to high-risk oesophageal varices. The effect of non-selective beta-blockers on mortality is debated and many patients experience adverse events. Trials on banding ligation versus non-selective beta-blockers for patients with oesophageal varices and no history of bleeding have reached equivocal results. OBJECTIVES: To compare the benefits and harms of banding ligation versus non-selective beta-blockers as primary prevention in adult patients with endoscopically verified oesophageal varices that have never bled, irrespective of the underlying liver disease (cirrhosis or other cause)...
2012: Cochrane Database of Systematic Reviews
Hanna Lampela, Silja Kosola, Antti Koivusalo, Jouni Lauronen, Hannu Jalanko, Risto Rintala, Mikko P Pakarinen
OBJECTIVES: Evidence-based recommendations on endoscopic screening and prophylactic treatment of esophageal varices in patients with biliary atresia (BA) are scarce. We assessed the efficiency of endoscopic surveillance and risk factors of esophageal varices and associated upper gastrointestinal bleeding. METHODS: A total of 47 consecutive children with BA and portoenterostomy underwent yearly endoscopies and prophylactic injection sclerotherapy of esophageal varices between 1987 and 2009...
November 2012: Journal of Pediatric Gastroenterology and Nutrition
E Fattahi, M H Somi, M R Moosapour, R F Fouladi
Prediction of outcome is difficult in patients with acute upper gastrointestinal bleeding (AUGIB). Some factors have been proposed in this regard with varying accuracy. This study aimed to investigate probable predictors of in-hospital outcome in patients with AUGIB. One hundred sixty four patients with AUGIB were studied prospectively in Tabriz Imam Reza Teaching Centre. All these patients were evaluated endoscopically by an expert. Patients' age, gender, presenting complains, transfusion, clinical findings and previous medical history were compared between survived vs...
September 1, 2011: Pakistan Journal of Biological Sciences: PJBS
S A Musa, S J Brecker, T M Rahman, J Y Kang
Upper gastrointestinal haemorrhage (UGIH) in cardiac patients receiving antiplatelets presents a difficult management problem. The aim of this study was to describe a series of cardiac inpatients receiving antiplatelets who underwent endoscopy for an acute UGIH. Cardiac inpatients receiving antiplatelets and requiring endoscopy for UGIH over an 18-month period were followed up. Forty-one patients were studied. Most patients (25 [61%]) presented with melaena. Antiplatelets were withheld in 34 (83%) patients; predominantly in those with higher pre-endoscopy Rockall scores (median, 4; interquartile range [IQR], 3-5 versus median, 3; IQR, 2-4; P < 0...
May 2012: Scottish Medical Journal
Ashim Aggarwal, Rojina Pant, Shivani Kumar, Priya Sharma, Colleen Gallagher, Antone J Tatooles, Pat S Pappas, Geetha Bhat
BACKGROUND: Continuous flow left ventricular assist devices (CF-LVADs) have emerged as the standard of care for patients in advanced heart failure (HF) requiring long-term mechanical circulatory support. Gastrointestinal (GI) bleeding has been frequently reported within this population. METHODS: A retrospective analysis of 101 patients implanted with the Heart Mate II from January 2005 to August 2011 was performed to identify incidence, etiology, and management of GI bleeding...
May 2012: Annals of Thoracic Surgery
Zeljka Savić, Vladimir Vracarić, Ljiljana Hadnadjev, Zora Petrović, Dragomir Damjanov
BACKGROUND/AIM: Portal hypertension (PH) is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC): ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC). METHODS: A total of 237 patients with ALC were observed in a 3-year period. RESULTS: A total of 161 patients (68%) were hospitalized because of PH elements: 86 (36...
November 2011: Vojnosanitetski Pregled. Military-medical and Pharmaceutical Review
Joshua Greenspoon, Alan Barkun
Recommendations in managing patients with nonvariceal upper gastrointestinal bleeding were recently updated, addressing resuscitation, risk assessment and pre-endoscopic care, endoscopy, pharmacotherapy, and secondary prophylaxis. Initial adequate resuscitation and risk stratification using validated scales remain critical. Intravenous erythromycin improves visualization when likely to find blood in the stomach. Pre-endoscopic proton pump inhibition (PPI) does not improve outcomes, but downstages high-risk endoscopic lesions and may be considered...
September 2010: Polskie Archiwum Medycyny Wewnętrznej
Smruti Ranjan Mishra, Barjesh Chander Sharma, Ashish Kumar, Shiv Kumar Sarin
BACKGROUND AND AIMS: Bleeding from gastric varices is often severe and difficult to manage. Endoscopic injection of gastric varices with cyanoacrylate is effective in prevention of rebleeding. The efficacy of beta-blockers in secondary prophylaxis of gastric variceal bleed has not been well studied. A comparison of the efficacy of beta-blocker treatment and cyanoacrylate injection for the prevention of gastric variceal rebleeding was carried out. METHODS: Patients with gastro-oesophageal varices type 2 (GOV2) with eradicated oesophageal varices or isolated gastric varices type 1 (IGV1) who had bled from gastric varices were randomised to cyanoacrylate injection (n=33) or beta-blocker treatment (n=34)...
June 2010: Gut
R Srirajaskanthan, R Conn, C Bulwer, P Irving
BACKGROUND: Upper gastrointestinal (UGI) haemorrhage is a frequent cause of hospital admission. Scoring systems have been devised to identify those at risk of adverse outcomes. We evaluated the Glasgow Blatchford score's (GBS) ability to identify the need for clinical and endoscopic intervention in patients with UGI haemorrhage. METHODS: A retrospective observational study was performed in all patients who attended the A&E department with UGI haemorrhage during a 12-month period...
June 2010: International Journal of Clinical Practice
Jorge Vásquez, Edgar Alva, Oscar Frisancho, Max Yoza, Eduardo Zumaeta, José Watanabe, Américo Palomino
We report the case of a 35-year-old male patient, with a history of six months of pallor and dyspnea associated with severe iron deficiency anemia and positive fecal occult blood tests. Endoscopy of the lower and upper gastrointestinal tract, and a small bowel follow-through were performed, but did not reveal the origin of the bledding. Later, a capsule endoscopy study were performed and detected an elevated area - not well defined - with active bleeding in the jejunal portion of the small bowel, for that reason we decided to complement the study with a double balloon enteroscopy, that allowed us to see more clearly the jejunal lesion: an elevated and ulcerated lesion; the area was marked with India ink to guide the surgeon...
April 2009: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
Yasuhiro Onozato, Satoru Kakizaki, Hiroshi Ishihara, Haruhisa Iizuka, Naondo Sohara, Shinichi Okamura, Masatomo Mori, Hideaki Itoh
BACKGROUND: Although the presence of a duodenal diverticulum is usually asymptomatic, bleeding in this tissue is sometimes difficult to diagnose and treat. OBJECTIVE: To investigate the strategy for treatment, we reviewed the clinical data of patients diagnosed and treated for duodenal diverticular bleeding. DESIGN: Retrospective case series. SETTING: Single tertiary-referral center. PATIENTS: Seven consecutive patients with bleeding from a duodenal diverticulum (mean age, 73...
November 2007: Gastrointestinal Endoscopy
A K Setya, Y Mehta, M Kshatriya, N Trehan
One hundred and three patients (Group A), mean age 55.81 +/- 8.54 years, 94 males and 9 females, scheduled for coronary artery bypass graft (CABG) surgery were subjected to preoperative upper gastro-intestinal (UGI) endoscopy. 51.5% of these were found to have significant mucosal lesions in the UGI tract. Twenty one (20.4%) had severe lesions which could have bled, warranting postponement of their surgery. All of these 21 were treated with Omeprezole 20 mg / day for a mean of 35.87 +/- 4.64 days and subjected to check endoscopy after the treatment...
July 1998: Annals of Cardiac Anaesthesia
Hakan Yanar, Kemal Dolay, Cemalettin Ertekin, Korhan Taviloglu, Beyza Ozcinar, Recep Guloglu, Umut Barbaros
BACKGROUND/AIMS: Dieulafoy's lesions are uncommon sources of upper gastrointestinal tract bleeding. Endoscopists must be aware of these lesions when evaluating patients with upper gastrointestinal tract bleeding. METHODOLOGY: The aim of this study is to analyze the results of active bleeding or recurrently bleeding Dieulafoy's lesions treated either by endoscopic injection therapy (EIT) or endoscopic band ligation (EBL). Fifteen patients who had active bleeding due to Dieulafoy's lesions were evaluated retrospectively with respect to demographic properties, comorbidities, endoscopic therapy procedures, and the success rate of the procedure...
June 2007: Hepato-gastroenterology
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