Mo1390 ELECTIVE ENDOTRACHEAL INTUBATION PRIOR TO EGD FOR UPPER GASTROINTESTINAL BLEEDING INCREASED RISK OF CARDIOPULMONARY EVENTS

2020 ◽  
Vol 158 (6) ◽  
pp. S-872-S-873
Author(s):  
Sakolwan Suchartlikitwong ◽  
Rita Medrano Juarez ◽  
Sarah Jaroudi ◽  
Amr Ismail ◽  
Wasawat Vutthikraivit ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Endotracheal Intubation ◽  
Upper Gastrointestinal Bleeding ◽  
Increased Risk ◽  
Upper Gastrointestinal

scholarly journals Genetic Variants in PTGS1 and NOS3 Genes Increase the Risk of Upper Gastrointestinal Bleeding: A Case–Control Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Marcela Forgerini ◽  
Gustavo Urbano ◽  
Tales Rubens de Nadai ◽  
Sabrina Setembre Batah ◽  
Alexandre Todorovic Fabro ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Gastrointestinal Bleeding ◽  
Genetic Variants ◽  
Case Control Study ◽  
Upper Gastrointestinal Bleeding ◽  
Case Control ◽  
Gastrointestinal Disorders ◽  
Increased Risk ◽  
Upper Gastrointestinal ◽  
Control Study

Objective: To assess the association between PTGS1 and NOS3 variant alleles and the risk to develop upper gastrointestinal bleeding (UGIB) secondary to complicated peptic disease.Methods: A case–control study was conducted in a Brazilian complex hospital from July 2016 to March 2020. Case: Patients with UGIB diagnosis. Control: Patients admitted for surgery not related to gastrointestinal disorders. Variables: UGIB (outcome), genetic variants in PTGS1 and NOS3 genes (independent), and sex, age, schooling, ethnicity, previous history of gastrointestinal disorders, Helicobacter pylori serology, comorbidity, drug therapy, and lifestyle (confounding). The single-nucleotide polymorphisms (SNPs) of the PTSG1 gene (rs1330344, rs3842787, rs10306114, and rs5788) and NOS3 gene (rs2070744 and rs1799983) were determined using the real-time polymerase chain reaction. Helicobacter pylori serology was determined through the chemiluminescence technique. Logistic regression models were built and deviations of allelic frequencies from Hardy–Weinberg equilibrium were verified.Results: 200 cases and 706 controls were recruited. Carriers of the AG genotype of rs10306114 (OR: 2.55, CI 95%: 1.13–5.76) and CA + AA genotypes of rs5788 (OR: 2.53, CI 95%: 1.14–5.59) were associated with an increased risk for the UGIB development. In nonsteroidal anti-inflammatory drugs (NSAIDs) users, the six variants evaluated modified the magnitude of the risk of UGIB, whereas in low-dose aspirin (LDA) users, an increased risk of UGIB was observed for four of them (rs1330344, rs10306114, rs2070744, and rs1799983). Personal ulcer history (p-value: < 0.001); Helicobacter pylori infection (p-value: < 0.011); NSAIDs, LDA, and oral anticoagulant use (p-value: < 0.001); and alcohol intake (p-value: < 0.001) were also identified as independent risk factors for UGIB.Conclusion: This study presents two unprecedented analyses within the scope of the UGIB (rs10306114 and rs2070744), and our findings showing an increased risk of UGIB in the presence of the genetic variants rs10306114 and rs5788, regardless of the drug exposure. Besides, the presence of the evaluated variants might modify the magnitude of the risk of UGIB in LDA/NSAIDs users. Therefore, our data suggest the need for a personalized therapy and drug use monitoring in order to promote patient safety.

scholarly journals Role of Helicobacter pylori in Upper Gastrointestinal Bleeding Among Ischemic Stroke Hospitalizations: A Nationwide Study of Outcomes

2019 ◽  
Vol 1 (3) ◽  
pp. 358-371
Author(s):  
Urvish K. Patel ◽  
Mihir Dave ◽  
Anusha Lekshminarayanan ◽  
Nidhi Patel ◽  
Abhishek Lunagariya ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Ischemic Stroke ◽  
Risk Stratification ◽  
Gastrointestinal Bleeding ◽  
Health Care Cost ◽  
Upper Gastrointestinal Bleeding ◽  
Increased Risk ◽  
H Pylori ◽  
Upper Gastrointestinal

Introduction: Helicobacter pylori (H. pylori) is a well-recognized risk factor for upper gastrointestinal bleeding (UGIB). The exposure to tissue plasminogen activator (tPA), anti-platelets, and anticoagulants increases the risk of UGIB in acute ischemic stroke (AIS) patients, the risk stratification of H. pylori infection is not known. In this retrospective cross-sectional study, we aimed to evaluate the relationship between H. pylori and GIB in patients hospitalized with AIS. Methods: In the nationwide data, hospitalization for AIS was identified by primary diagnosis using International Classification of Diseases, clinical modification (ICD-9-CM) codes. Subgroup of patients with GIB and H. pylori were identified in AIS cohort. A stepwise multivariable logistic regression model was fitted to evaluate the outcome of upper GIB and role of H. Pylori in UGIB. Results: Overall 4,224,924 AIS hospitalizations were identified, out of which 18,629 (0.44%) had UGIB and 3122 (0.07%) had H. pylori. The prevalence of H. pylori-induced UGIB among UGIB in AIS was 3.05%. The prevalence of UGIB was markedly elevated among the H. pylori infection group (18.23% vs. 0.43%; p < 0.0001) compared to the non-H. pylori group. In multivariable regression analysis, H. pylori was associated with markedly elevated odds of UGIB (aOR:27.75; 95%CI: 21.07–36.55; p < 0.0001). Conclusion: H. pylori infection had increased risk-adjusted occurrence of UGIB amongst the AIS hospitalized patients. H. pylori testing may improve risk stratification for UGIB and lower the health care cost burden in stroke hospitalization.

scholarly journals Upper Gastrointestinal Bleeding in Adults Under Veno-Arterial Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Study

2021 ◽  
Author(s):  
jules stern ◽  
Claire Dupuis ◽  
Jean Reuter ◽  
Camille Vinclair ◽  
Marylou Para ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Extracorporeal Membrane Oxygenation ◽  
Upper Gastrointestinal Bleeding ◽  
Univariate Analysis ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Claude Bernard ◽  
Increased Risk ◽  
Va Ecmo ◽  
Upper Gastrointestinal

Abstract Objective. Upper gastrointestinal bleeding is a common complication in adults treated with veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) for refractory cardiogenic shock or cardiac arrest. We aimed to determine risk factors, prevalence and outcomes associated with upper gastrointestinal bleeding (UGIB) in adult patients under VA-ECMO.Design. We conducted a retrospective cohort study (2014-2017) on consecutive VA-ECMO patients.Setting. Medical and Infectious Disease intensive care unit of university hospital Bichat-Claude Bernard in Paris, France.Patients. UGIB was defined as 1) an overt bleeding (hematemesis, melena, hematochezia), or 2) acute anemia associated with a lesion diagnosed on upper gastrointestinal endoscopy. Cause-specific models were used to identify factors associated with UGIB and death, respectively.Measurements and Main Results. 257 patients were included, of whom 48 (19%) were diagnosed with UGIB after a median of 18 [7; 43] days following cannulation; median SAPS II was 59 [43; 76]. 100 (39%) patients were implanted after cardiac surgery. Mortality occurred in 31 (65%) patients with UGIB and 121 (58%) patients without. UGIB patients had longer ICU stays (41 [19; 82] vs. 15 [6; 26]; p<.01), longer ECMO (10.5 [7; 15] vs 6 [3; 10]; p <.01) and mechanical ventilation durations (31 [18; 45] vs. 9 [5; 18]; p <.01) in days, as compared to non-UGIB patients. Ninety-nine upper gastrointestinal endoscopies (UGE) were performed and the most frequent lesions detected were gastro-duodenal ulcers (n=28, 28%), leading to 12/99 therapeutic procedures. Neither antiplatelet therapy prior to ICU admission nor a history of peptic ulcer were associated with UGIB in univariate analysis. By multivariate analysis (table), a BMI (body mass index) > 30 kg/m2 (Cause-specific hazard ratio (CSHR) [95% CI]): 3.06 [1.56; 5.98]), and extracorporeal cardiopulmonary resuscitation (ECPR) (CSHR 2.34 [1.03; 5.35]) were independently associated with an increased risk of UGIB. Conclusions. In adult patients under VA-ECMO, obesity and ECPR were independently associated with UGIB. This study highlights the potential role of obesity and acute ischemia reperfusion injury in the pathophysiology of VA-ECMO-associated UGIB.

scholarly journals Low-Dose Acetylsalicylic Acid Use and the Risk of Upper Gastrointestinal Bleeding: A Meta-Analysis of Randomized Clinical Trials and Observational Studies

2013 ◽  
Vol 27 (3) ◽  
pp. 159-167 ◽  
Author(s):  
Vera E Valkhoff ◽  
Miriam CJM Sturkenboom ◽  
Catherine Hill ◽  
Sander Veldhuyzen van Zanten ◽  
Ernst J Kuipers
Keyword(s):  
Gastrointestinal Bleeding ◽  
Acetylsalicylic Acid ◽  
Observational Studies ◽  
Low Dose ◽  
Randomized Clinical Trials ◽  
Upper Gastrointestinal Bleeding ◽  
Meta Analysis ◽  
Case Control Studies ◽  
Increased Risk ◽  
Upper Gastrointestinal

BACKGROUND: Low-dose acetylsalicylic acid (LDA, 75 mg/day to 325 mg/day) is recommended for primary and secondary prevention of cardiovascular events, but has been linked to an increased risk of upper gastrointestinal bleeding (UGIB).OBJECTIVE: To analyze the magnitude of effect of LDA use on UGIB risk.METHODS: The PubMed and Embase databases were searched for randomized controlled trials (RCTs) reporting UGIB rates in individuals receiving LDA, and observational studies of LDA use in patients with UGIB. Studies were pooled for analysis of UGIB rates.RESULTS: Eighteen studies were included. Seven RCTs reported UGIB rates in individuals randomly assigned to receive LDA (n=22,901) or placebo (n=22,923). Ten case-control studies analyzed LDA use in patients with UGIB (n=10,816) and controls without UGIB (n=30,519); one cohort study reported 207 UGIB cases treated with LDA only. All studies found LDA use to be associated with an increased risk of UGIB. The mean number of extra UGIB cases associated with LDA use in the RCTs was 1.2 per 1000 patients per year (95% CI 0.7 to 1.8). The number needed to harm was 816 (95% CI 560 to 1500) for RCTs and 819 (95% CI 617 to 1119) for observational studies. Meta-analysis of RCT data showed that LDA use was associated with a 50% increase in UGIB risk (OR 1.5 [95% CI 1.2 to 1.8]). UGIB risk was most pronounced in observational studies (OR 3.1 [95% CI 2.5 to 3.7]).CONCLUSIONS: LDA use was associated with an increased risk of UGIB.

scholarly journals Regional Differences in Outcomes of Nonvariceal upper Gastrointestinal Bleeding in Saskatchewan

2014 ◽  
Vol 28 (3) ◽  
pp. 135-139 ◽  
Author(s):  
Michael O’Byrne ◽  
Erin L Smith-Windsor ◽  
Chris R Kenyon ◽  
Sanchit Bhasin ◽  
Jennifer L Jones
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Health Region ◽  
Patient Status ◽  
Improved Outcomes ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Upper Gastrointestinal ◽  
Overall Mortality ◽  
Significant Mortality

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is associated with significant mortality.OBJECTIVE: To examine several factors that may impact the mortality and 30-day rebleed rates of patients presenting with NVUGIB.METHODS: A retrospective study of the charts of patients admitted to hospital in either the Saskatoon Health Region (SHR) or Regina Qu’Appelle Health Region (RQHR) (Saskatchewan) in 2008 and 2009 was performed. Mortality and 30-day rebleed end points were stratified according to age, sex, day of admission, patient status, health region, specialty of the endoscopist and time to endoscopy. Logistic regression modelling was performed, controlling for the Charlson comorbidity index, age and sex as covariates.RESULTS: The overall mortality rate observed was 12.2% (n=44), while the overall 30-day rebleed rate was 20.3% (n=80). Inpatient status at the time of the rebleeding event was associated with a significantly increased risk of both mortality and rebleed, while having endoscopy performed in the RQHR versus SHR was associated with a significantly decreased risk of rebleed. A larger proportion of endoscopies were performed both within 24 h and by a gastroenterologist in the RQHR.CONCLUSION: Saskatchewan has relatively high rates of mortality and 30-day rebleeding among patients with NVUGIB compared with published rates. The improved outcomes observed in the RQHR, when compared with the SHR, may be related to the employ of a formal call-back endoscopy team for the treatment of NVUGIB.

P1953Risk of upper gastrointestinal bleeding following myocardial infarction: a novel prediction model for assessing appropriateness of proton pump inhibition therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T S G Sehested ◽  
P Blanche ◽  
P W Hansen ◽  
M G Charlot ◽  
C Torp-Pedersen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Gastrointestinal Bleeding ◽  
Prediction Model ◽  
Proton Pump ◽  
Upper Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
Upper Gastrointestinal

Abstract Background Upper gastrointestinal bleeding following myocardial infarction continues to be a severe complication associated with increased mortality; however, bleeding events might be avoided by appropriate therapy with proton pump inhibitors. Purpose To develop and validate a prediction model aimed at identifying patients at increased risk of upper gastrointestinal bleeding following myocardial infarction. Methods Based on multiple nationwide Danish registers, all patients initiating dual antiplatelet or anticoagulant therapy in combination with antiplatelet following myocardial infarction between 2003 and 2016 were identified. Primary outcome of interest was one-year risk of upper gastrointestinal bleeding. A derivation cohort including all patients between 2003 and 2013 was selected, whereas patients identified between 2014 and 2016 was employed for internal validation. Multiple logistic regression was used to predict person specific risks based on age, history of gastrointestinal bleeding or peptic ulcer, anaemia or gastrointestinal cancer, use of nonsteroidal anti-inflammatory drugs, oral anticoagulants, selective serotonin reuptake inhibitors or loop diuretics. We compared our model with the European Society of Cardiology (ESC) guideline recommendation on gastrointestinal bleeding risk assessment. Results A total of 61 543 patients with myocardial infarction were identified for the study. In the total cohort, the median age was 68 years (IQR: 58–77), 85.0% (52 334) underwent coronary angiography, 2.6% (1 608) had a history of gastrointestinal bleeding and 7.1% (4 354) used oral anticoagulants. The average one-year risk of upper gastrointestinal bleeding was 1.04% (95% CI: 0.95–1.14%), and mean predicted risk of the model was 1.04% (IQR: 0.64–1.26%). The discriminative ability of the model evaluated by area under the curve was 74.2% (95% CI: 66.9–78.6%) in the validation cohort. The proposed risk model demonstrated improved sensitivity and specificity at the specific threshold of the ESC risk schemes (Figure 1). Results remain principally unchanged regardless of inclusion or exclusion of patients initiating proton pump inhibitors at baseline. Furthermore, using cross-validation for the model evaluation produced similar discrimination results. Figure 1 Conclusion Based on nationwide registers a novel prediction model aimed at identifying patients at increased risk of upper gastrointestinal bleeding was developed and validated; the model observed moderate discrimination in the validation cohort providing possible benefit for clinicians in terms of communicating absolute risk to the patients and determining the appropriateness of initiating preventive therapy. Acknowledgement/Funding The Danish Heart Foundation

scholarly journals Older age and diclofenac are associated with increased risk of upper gastrointestinal bleeding in gout patients

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11468
Author(s):  
Wan Syamimee Wan Ghazali ◽  
Wan Mohd Khairul Bin Wan Zainudin ◽  
Nurul Khaiza Yahya ◽  
Asmahan Mohamed Ismail ◽  
Kah Keng Wong
Keyword(s):  
Risk Factors ◽  
Uric Acid ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Gouty Arthritis ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Older Age ◽  
Increased Risk ◽  
Upper Gastrointestinal

Background Gouty arthritis is a disease of global burden in which defective metabolism of uric acid causes arthritis. Gouty arthritis or medications used for its treatment may lead to uric acid-associated complications such as upper gastrointestinal bleeding (UGIB) and renal impairment. Methods In this cross-sectional study with retrospective record review, 403 established gouty arthritis patients were recruited to determine the incidence of UGIB and associated factors among gout patients who were on regular nonsteroidal anti-inflammatory drugs (NSAIDs). Results The mean age of the 403 gouty arthritis patients was 55.7 years old and the majority (n = 359/403; 89.1%) were male. The incidence of UGIB among gouty arthritis patients who were on NSAIDs was 7.2% (n = 29/403). Older age (p < 0.001), diclofenac medication (p = 0.003), pantoprazole medication (p = 0.003), end-stage renal failure (ESRF) (p = 0.007), smoking (p = 0.035), hypertension (p = 0.042) and creatinine (p = 0.045) were significant risk factors for UGIB among the gouty arthritis patients in univariable analysis. Older age (p = 0.001) and diclofenac medication (p < 0.001) remained significant risk factors for UGIB among the gouty arthritis patients in multivariable analysis. Conclusions Age and diclofenac were significantly associated with UGIB among patients with gouty arthritis on regular NSAIDs, indicating that these factors increased the risks of developing UGIB in gout patients. Hence, these high-risk groups of gouty arthritis patients should be routinely monitored to avoid the potential onset of UGIB. Our data also suggest that diclofenac should be prescribed for the shortest duration possible to minimize the risk of developing UGIB in gout patients.

Sign in / Sign up

Export Citation Format

Share Document