A cost effective strategy for managing GI bleeding secondary to peptic ulcer disease

Abstract Background: Helicobacter pylori is a major risk factor for gastric cancer. Screening and treatment of H. pylori may reduce the risk of gastric cancer and peptic ulcer disease. Polymerase chain reaction (PCR) of gastric biopsies provides superior sensitivity and specificity for the detection of H. pylori. This study explores whether population-based H. pylori screening with PCR is cost-effective in the US.Methods: A Markov cohort state-transition model was developed to compare three strategies: no screening with opportunistic eradication, 13C-UBT population screening and treating of H. pylori, and PCR population screening and treating of H. pylori. Estimates of risks and costs were obtained from published literature. Since the efficacy of H. pylori therapy in gastric cancer prevention is not certain, we broadly varied the benefit 30-100% in sensitivity analysis.Results: PCR screening was cost-effective and had an incremental-cost effectiveness ratio per quality adjusted life-year (QALY) of $38,591.89 when compared to 13C-UBT strategy with an ICER of $2373.43 per QALY. When compared to no screening, PCR population screening reduced cumulative gastric cancer incidence from 0.84% to 0.74% and reduced peptic ulcer disease risk from 14.8% to 6.0%. The cost-effectiveness of PCR screening was robust to most parameters in the model.Conclusion: Our modeling study finds PCR screening and treating of H. pylori to be cost-effective in the prevention of gastric cancer and peptic ulcer disease. However, the potential negative consequences of H. pylori eradication such as antibiotic resistance could change the balance of benefits of population screening.

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Nonvariceal Upper Gastrointestinal Bleeding

10.2310/im.5435 ◽

2020 ◽

Author(s):

John R. Saltzman ◽

Wasif Abidi

Keyword(s):

Differential Diagnosis ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Endoscopic Therapy ◽

Scoring Systems ◽

Gi Bleeding ◽

Ulcer Disease ◽

Treatment Regimens ◽

Consensus Statements ◽

Ligament Of Treitz

Gastrointestinal (GI) bleeding that is proximal to the ligament of Treitz is considered upper GI bleeding (UGIB). UGIB can be further divided into variceal and nonvariceal, differentiated by etiology, presentation, management, and mortality. This review of nonvariceal UGIB addresses the epidemiology, diagnosis, treatment (including endoscopic therapy), prognosis, and differential diagnosis. Recommendations presented are evidence based and consistent with consensus statements and society guidelines. Figures show stigmata of recent hemorrhage, endoscopic therapy, peptic ulcer disease, Mallory-Weiss syndrome, angiodysplasia, Dieulafoy lesion, and arterioenteric fistula. Tables list the manifestation of GI bleeding and the presumed source of the bleeding, clues in the symptom and presentation of the patient that may suggest the diagnosis, medical history and physical examination findings that can suggest a specific diagnosis, a comparison of different prognostic scoring systems, differential diagnosis of UGIB, various etiologies of peptic ulcer disease, and treatment regimens for Helicobacter pylori. This review contains 7 highly rendered figures, 10 tables, and 85 references

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Nonvariceal Upper Gastrointestinal Bleeding

10.2310/gastro.5435 ◽

2020 ◽

Author(s):

John R. Saltzman ◽

Wasif Abidi

Keyword(s):

Differential Diagnosis ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Endoscopic Therapy ◽

Scoring Systems ◽

Gi Bleeding ◽

Ulcer Disease ◽

Treatment Regimens ◽

Consensus Statements ◽

Ligament Of Treitz

Gastrointestinal (GI) bleeding that is proximal to the ligament of Treitz is considered upper GI bleeding (UGIB). UGIB can be further divided into variceal and nonvariceal, differentiated by etiology, presentation, management, and mortality. This review of nonvariceal UGIB addresses the epidemiology, diagnosis, treatment (including endoscopic therapy), prognosis, and differential diagnosis. Recommendations presented are evidence based and consistent with consensus statements and society guidelines. Figures show stigmata of recent hemorrhage, endoscopic therapy, peptic ulcer disease, Mallory-Weiss syndrome, angiodysplasia, Dieulafoy lesion, and arterioenteric fistula. Tables list the manifestation of GI bleeding and the presumed source of the bleeding, clues in the symptom and presentation of the patient that may suggest the diagnosis, medical history and physical examination findings that can suggest a specific diagnosis, a comparison of different prognostic scoring systems, differential diagnosis of UGIB, various etiologies of peptic ulcer disease, and treatment regimens for Helicobacter pylori. This review contains 7 highly rendered figures, 10 tables, and 85 references

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Gastrointestinal illness

Oxford Handbook of Humanitarian Medicine ◽

10.1093/med/9780199565276.003.0038 ◽

2019 ◽

pp. 647-668

Author(s):

Ingo Hartlapp

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Clinical Presentation ◽

Gastrointestinal Illness ◽

Gi Bleeding ◽

Gi Tract ◽

Specific Diagnosis ◽

Low Resource Settings ◽

Ulcer Disease ◽

Clinical Presentations

This chapter gives an overview of the most important clinical presentations involving the gastrointestinal (GI) tract commonly seen in the field, including hepatitis, cirrhosis, peptic ulcer disease, and GI bleeding, from typical clinical presentation to specific diagnosis and treatment. Recognizing the challenges with diagnosis and management of such conditions in humanitarian settings, this chapter provides doctors who practise in low-resource settings with the guidance to implement more specialized GI medicine

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Hemostatic spray powder TC-325 in the primary endoscopic treatment of peptic ulcer-related bleeding: multicenter international registry

Endoscopy ◽

10.1055/a-1186-5360 ◽

2020 ◽

Vol 53 (01) ◽

pp. 36-43

Author(s):

Mohamed Hussein ◽

Durayd Alzoubaidi ◽

Miguel-Fraile Lopez ◽

Michael Weaver ◽

Jacobo Ortiz-Fernandez-Sordo ◽

...

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Rescue Therapy ◽

Case Series ◽

Ulcer Bleeding ◽

Peptic Ulcers ◽

Gi Bleeding ◽

Ulcer Disease ◽

Bleeding Peptic Ulcers ◽

The Uk

Abstract Background Upper gastrointestinal bleeding (UGIB) is a leading cause of morbidity and is associated with a 2 % – 17 % mortality rate in the UK and USA. Bleeding peptic ulcers account for 50 % of UGIB cases. Endoscopic intervention in a timely manner can improve outcomes. Hemostatic spray is an endoscopic hemostatic powder for GI bleeding. This multicenter registry was created to collect data prospectively on the immediate endoscopic hemostasis of GI bleeding in patients with peptic ulcer disease when hemostatic spray is applied as endoscopic monotherapy, dual therapy, or rescue therapy. Methods Data were collected prospectively (January 2016 – March 2019) from 14 centers in the UK, France, Germany, and the USA. The application of hemostatic spray was decided upon at the endoscopist’s discretion. Results 202 patients with UGIB secondary to peptic ulcers were recruited. Immediate hemostasis was achieved in 178/202 patients (88 %), 26/154 (17 %) experienced rebleeding, 21/175 (12 %) died within 7 days, and 38/175 (22 %) died within 30 days (all-cause mortality). Combination therapy of hemostatic spray with other endoscopic modalities had an associated lower 30-day mortality (16 %, P < 0.05) compared with monotherapy or rescue therapy. There were high immediate hemostasis rates across all peptic ulcer disease Forrest classifications. Conclusions This is the largest case series of outcomes of peptic ulcer bleeding treated with hemostatic spray, with high immediate hemostasis rates for bleeding peptic ulcers.

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