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Lower gi bleed

Young Hee Nam, Colleen M Brensinger, Warren B Bilker, Charles E Leonard, Scott E Kasner, Tilo Grosser, Xuanwen Li, Sean Hennessy
OBJECTIVE: To examine the comparative safety of individual NSAIDs when given concomitantly with clopidogrel. METHODS: We conducted a retrospective cohort study using Medicaid claims from five US states during 1999-2010, supplemented with Medicare claims for dual-enrollees. The exposure of interest was the first concomitant use of clopidogrel and one of the 10 selected NSAIDs after a 1-year baseline period. The outcomes were: all-cause mortality; acute myocardial infarction (AMI)/ischemic stroke; and gastrointestinal bleeding (GIB)/intracranial hemorrhage (ICH)...
2018: PloS One
Sajith C Senadeera, Simon V Vun, Nicholas Butterfield, Tim W Eglinton, Frank A Frizelle
BACKGROUND: Lower gastrointestinal bleeding (LGIB) is a common acute general surgical condition that is typically self-limiting; however in refractory cases it can necessitate life-saving intervention. When bleeding is refractory, super-selective embolization (SSE) becomes an important management strategy. This study aims to evaluate outcomes of this procedure at our institution and identify predictors of clinical success. METHODS: A retrospective analysis of patients with positive computed tomography angiograms for LGIB at a tertiary centre between December 2007 and May 2017...
March 14, 2018: ANZ Journal of Surgery
Aun Raza Shah, Vikram Jala, Hammad Arshad, Mohammad Bilal
Lower gastrointestinal bleeding (LGIB) is a common cause of presentation to the emergency department and hospital admissions. The incidence of LGIB increases with age and the most common etiologies are diverticulosis, angiodysplasia, malignancy and anorectal diseases. Foremost modality for evaluation and treatment of LGIB is colonosopy. Other diagnostic tools such as nuclear scintigraphy, computed tomography, angiography and capsule endoscopy are also frequently used in the workup of LGIB. Choice of treatment modality depends on the hemodynamic status of the patient, rate of bleeding, expertise and available resources...
March 7, 2018: Disease-a-month: DM
Cindy Ningfu Zhu, Joshua Friedland, Brian Yan, Aze Wilson, Jamie Gregor, Vipul Jairath, Michael Sey
BACKGROUND AND AIMS: Melena is a symptom of upper gastrointestinal bleeding and usually indicates bleeding proximal to the ligament of Treitz. However, whether melena predicts bleeding in the proximal small intestine in patients with obscure gastrointestinal bleeding (OGIB) is unknown and the objective of this study. METHODS: A retrospective cohort study of consecutive patients undergoing capsule endoscopy for OGIB between July 2009 and May 2016 was conducted. Subjects were categorized based on the presence of melena, and the primary outcome was identification of a bleeding source within the proximal 2/3 of the small intestine...
March 8, 2018: Digestive Diseases and Sciences
Cedric Van de Bruaene, Pieter Hindryckx, Laurens Van de Bruaene, Danny De Looze
PURPOSE OF REVIEW: Gastrointestinal bleeding originating from the small bowel (SB) poses a challenge to the treating gastroenterologist. Once diagnosed, management is not a walk in the park either. This review intends to summarize the current state-of-the-art evidence in a complete way with special attention for vascular and ulcerative lesions, to provide the reader with a clinical guide and flow chart towards SB bleeding. RECENT FINDINGS: Absence of SB bleeding lesions on CE does not directly yield better prognosis; although having a lower rebleeding rate the first 2 years, rebleeding in the long term is high...
March 7, 2018: Current Gastroenterology Reports
Carol Coupland, Trevor Hill, Richard Morriss, Michael Moore, Antony Arthur, Julia Hippisley-Cox
BACKGROUND: Antidepressants are one of the most commonly prescribed medications in young and middle-aged adults, but there is relatively little information on their safety across a range of adverse outcomes in this age group. This study aimed to assess associations between antidepressant treatment and several adverse outcomes in people aged 20-64 years diagnosed with depression. METHODS: We conducted a cohort study in 238,963 patients aged 20-64 years registered with practices across the UK contributing to the QResearch primary care database...
March 8, 2018: BMC Medicine
Andrew T Strong, Gautam Sharma, Zubaidah Nor Hanipah, Chao Tu, Stacy A Brethauer, Philip R Schauer, Derrick Cetin, Ali Aminian
BACKGROUND: Warfarin dosing after bariatric surgery may be influenced by alterations in gastrointestinal pH, transit time, absorptive surface area, gut microbiota, food intake, and adipose tissue. OBJECTIVES: The aim of this study was to describe trends in warfarin dosing after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). SETTING: Single academic center. METHODS: All patients chronically on warfarin anticoagulation before RYGB or SG were retrospectively identified...
January 2, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Yitao He, Zhili Cai, Siling Zeng, Siyan Chen, Bingshan Tang, Yubing Liang, Xin Chang, Yi Guo
OBJECTIVE: To evaluate the effect of fluoxetine on three-year recurrence rate of acute ischemic stroke. PATIENTS AND METHODS: 404 enrolled patients with acute ischemic stroke were randomly divided into control and treatment groups, and underwent conventional secondary preventive therapy for ischemic stroke. In addition, the treatment group was administered fluoxetine (20 mg daily for 90 days). A three-year follow-up was performed, and indicators related to risk factors of stroke were assessed at day 90 of follow-up...
February 26, 2018: Clinical Neurology and Neurosurgery
Adam L Edwards, Paul Fitzmorris, Salpy V Pamboukian, James F George, C M Wilcox, Shajan Peter
Gastrointestinal bleeding (GIB) is common in patients with continuous-flow left ventricular assist devices (CF-LVADs) possibly because of changes in blood flow. We aimed to test the hypothesis that a low pulsatility index (PI) is associated with an increased hazard of overt GIB in patients with CF-LVADs. We conducted a retrospective cohort study of patients who had a HeartMate II (HMII) CF-LVAD implanted at our center. The study end-point was the first overt GIB causing or occurring during a hospitalization between 6 days and 6 months after HMII implantation...
February 27, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ira Roshan Afshar, Mo Seyed Sadr, Lisa L Strate, Myriam Martel, Charles Menard, Alan N Barkun
Objective: The use of early colonoscopy in the management of acute lower gastrointestinal bleeding (LGIB) is controversial, with disparate evidence. We aim to formally characterize the utility of early colonoscopy (within 24 h) in managing acute LGIB. Design: A systematic literature search to August 2016 identified fully published and abstracts of randomized controlled trials (RCTs) and observational studies assessing early colonoscopy in acute LGIB. Single-arm studies were also included to define incidence...
2018: Therapeutic Advances in Gastroenterology
Anton R Lord, Lisa A Simms, Allison Brown, Katherine Hanigan, Krupa Krishnaprasad, Belinda Schouten, Anthony R Croft, Mark N Appleyard, Graham L Radford-Smith
BACKGROUND: Gastroenterology Departments at hospitals within Australia receive thousands of General Practitioner (GP)-referral letters for gastrointestinal investigations every month. Many of these requests are for colonoscopy. This study aims to evaluate the performance of the current symptoms-based triage system compared to a novel risk score using objective markers. METHODS: Patients with lower abdominal symptoms referred by their GPs and triaged by a Gastroenterology consultant to a colonoscopy consent clinic were recruited into the study...
February 27, 2018: BMC Cancer
Laura Filograna, Enrica Filograna, Adolfo D'Onofrio, Nicola Flor, Yusef Haddad, Roberto Floris
Gastrointestinal angiodysplasia represents the cause of 6% of lower gastrointestinal tract bleeding, particularly in the elderly. Because of the common presentation and age range of affected patients, often patients with occult or massive gastrointestinal bleedings are investigated with colonoscopy, in the suspect of colonic cancer. Other methods are capsule enteroscopy, angiography, double-contrast barium enema, computed tomography angiography, and radionuclide scanning. In this contribution, we describe a case of colonic angiodysplasia first suspected during computed tomography colonography performed after an incomplete colonoscopy in a patient with recent anemization...
December 2017: Radiology Case Reports
Erik N Sorensen, Hannah J Voorhees, Lynn M Dees, Si M Pham, Zachary N Kon, Bartley P Griffith, Erika D Feller
There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and PFA-100 guide antiplatelet titration. Goals are normal kaolin thrombelastography maximum amplitude and prolonged PFA-100. We analyzed incidence and rates of nonprocedural bleeding, stroke, and pump thrombosis for all 81 primary Heartware left ventricular assist devices implanted since 2011...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ian C Glenn, Ibrahim Abd El-Shafy, Nicholas E Bruns, E Pete Muenks, Yara K Duran, Joshua A Hill, Shawn D St Peter, Jose M Prince, Aaron M Lipskar, Todd A Ponsky
PURPOSE: It is unclear whether simple diverticulectomy, rather than segmental bowel resection (SBR), is adequate treatment for gastrointestinal bleeding (GIB) secondary to Meckel diverticulum (MD). There is concern that ulcers in the adjacent bowel may continue to bleed if only the diverticulum is removed. This study seeks to determine if diverticulectomy is satisfactory treatment for bleeding MD. METHODS: A multi-institution, retrospective review was performed for patients with a diagnosis of MD and GIB who underwent simple diverticulectomy or small bowel resection...
February 19, 2018: Pediatric Surgery International
Victoria K Baxter, Elizabeth M Troisi, Nathan M Pate, Julia N Zhao, Diane E Griffin
Central nervous system (CNS) infection of C57BL/6 mice with the TE strain of Sindbis virus (SINV) provides a valuable animal model for studying the pathogenesis of alphavirus encephalomyelitis. While SINV TE inoculated intracranially causes little mortality, 20-30 % of mice inoculated intranasally (IN) died 8 to 11 days after infection, the period during which immune cells typically infiltrate the brain and clear infectious virus. To examine the mechanism behind the mortality, mice infected IN with SINV TE were monitored for evidence of neurological disease, and those with signs of severe disease (moribund) were sacrificed and tissues collected...
February 1, 2018: Journal of General Virology
Chul-Gyu Kim, Kyun-Seop Bae
BACKGROUND: Nurse staffing level is an important factor on nursing sensitive outcome. The relationships of nurse staffing level with nursing sensitive outcomes such as mortality, upper gastrointestinal bleeding and pressure ulcer have been explored in the United States, Canada, Australia, and New Zealand. Lower level of hospital nurse staffing seems associated with more adverse outcomes, especially mortality. However, there is insufficient evidence of the nurse staffing level-outcome relationship in other indicators...
January 2, 2018: International Journal of Nursing Studies
N V Khatri, B Patel, D R Kohli, S S Solomon, K Bull-Henry, C M Kessler
INTRODUCTION: Lenalidomide is a thalidomide analog with anti-angiogenic properties. Previous case reports suggest its efficacy in preventing gastrointestinal bleeding (GIB) secondary to angiodysplasia (AD) in hereditary haemorrhagic telangiectasia and potentially in reversing AD. We present the first case series to explore lenalidomide as a treatment for AD-related GIB in patients with von Willebrand disease (VWD). METHODS: A retrospective chart review was conducted to include patients with VWD, who were evaluated from 2010 to 2013 and who had received lenalidomide to treat recurrent GIB secondary to AD...
February 15, 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
Sami Miilunpohja, Jussi Kärkkäinen, Juha Hartikainen, Johanna Jyrkkä, Tuomo Rantanen, Hannu Paajanen
BACKGROUND/AIMS: The role of emergency surgery is decreasing in the treatment of patients with upper gastrointestinal bleeding (UGIB). We investigated the need of urgent surgery and outcome of elderly UGIB patients who often have cardiovascular comorbidities with antithrombotic medication. METHODS: All consecutive adult patients who received emergency treatment for suspected gastrointestinal bleeding between January 2009 and December 2011 were registered in an electronic database (n = 1,643)...
February 13, 2018: Digestive Surgery
Shanglei Liu, Garth R Jacobsen, Bryan J Sandler, Thomas J Savides, Syed Fehmi, Hans Fuchs, Ran B Luo, Jonathan C Delong, Alisa M Coker, Caitlin Houghton, Santiago Horgan
AIM: Over-the-scope-clip (OTSC) System is a relatively new endoluminal intervention for gastrointestinal (GI) leaks, fistulas, and bleeding. Here, we present a single center experience with the device over the course of 4 years. METHODS: Retrospective chart review was conducted for patients who received endoscopic OTSC treatment. Primary outcome is the resolution of the original indication for clip placement. Secondary outcomes are complications and time to resolution...
February 12, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Ravi Maharaj, Barry Raghunanan, Wayne Mohammed, Rakesh Rambally, Vandana Devika Sookdeo, Dave Harnanan, Wayne A Warner
Splenic artery aneurysms (SAAs) are an extremely rare cause of asymptomatic massive lower gastrointestinal bleeding with less than a handful of patients surviving such a presentation. A 24-year-old female presented in shock after multiple episodes of massive rectal bleeding. Imaging revealed a heterogeneous mass arising from the tail of the pancreas eroding into the splenic flexure of the colon. Further episodes of bleeding led to an exploratory laparotomy. Intraoperatively, a suspected neoplastic process arising from the tail of the pancreas with contiguous involvement of the splenic flexure of the colon and the greater curvature of the stomach was noted...
February 2018: Journal of Surgical Case Reports
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