scholarly journals Impact of first wave of COVID-19 on outcomes of hospitalization for upper gastrointestinal bleeding in Hong Kong: a population-based study

2021 ◽  
Vol 09 (03) ◽  
pp. E284-E288
Author(s):  
Thomas K.L. Lui ◽  
Vivien W.M. Tsui ◽  
Wai K. Leung
Keyword(s):  
Hong Kong ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Pearson Correlation ◽  
Public Hospitals ◽  
Historical Cohort ◽  
Local Case ◽  
Number Of Patients ◽  
The Impact ◽  
Upper Gastrointestinal

Abstract Background and study aims The COVID-19 pandemic has caused a major disruption in the healthcare system. This study determined the impact of the first wave of COVID-19 on the number and outcome of patients hospitalized for upper gastrointestinal bleeding (UGIB) in Hong Kong. Patients and methods Records of all patients hospitalized for UGIB in Hong Kong public hospitals between October 2018 and June 2020 were retrieved. The number and characteristics of patients hospitalized for UGIB after COVID-19 was compared by autoregressive integrated moving average (ARIMA) model prediction and historical cohort. Results Since the first local case of COVID-19, there was an initial drop in UGIB hospitalizations (observed 29.8 vs predicted 35.5 per week; P = 0.05) followed by a rebound (39.8 vs 26.7 per week; P < 0.01) with a turning point at week 14 (Petitt’s test, P < 0.001). There was a negative association between the number of COVID-19 cases and the number of patients hospitalized for UGIB (Pearson correlation –0.53, P < 0.001). Patients admitted after the outbreak of COVID-19 had lower hemoglobin (7.5 vs baseline 8.3 g/dL; P < 0.01) and a greater need for blood transfusion (64.5 % vs baseline 50.4 %; P < 0.01), but similar rates of all-cause mortality (6.9 % vs 7.1 %; P = 0.82) and rebleeding (6.7 % vs 5.1 %; P = 0.11). There was also a higher proportion of patients with variceal bleeding (10.5 % vs baseline 5.3 %; P < 0 .01). Conclusions There was a dynamic change in the number of patients hospitalized for UGIB in Hong Kong during the first wave of the COVID-19 outbreak, with more obvious impact during the initial phase only.

scholarly journals Impact of the COVID-19 Pandemic on Acute Upper Gastrointestinal Bleeding in Xingtai City

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Zhihui Duan ◽  
Qiong Duan ◽  
Kun Liu ◽  
Xiaochong Zhang ◽  
Shengyun Zhou ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Bleeding ◽  
Daily Practice ◽  
Absolute Number ◽  
Web Based ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Before And After ◽  
The Impact ◽  
Upper Gastrointestinal

Background and Aims. The coronavirus disease 2019 (COVID-19) has severely impacted the daily practice of gastrointestinal endoscopy worldwide. Most endoscopy centers in China were shut down in late January 2020. We investigated the impact of the shutdown on acute upper gastrointestinal bleeding (AUGIB) events in Xingtai City, Hebei Province, China. Methods. A web-based survey collected information on gastroscopy workload and AUGIB events. The study period was from 4 weeks before to 4 weeks after lockdown initiation in Xingtai City. Fourteen public gastrointestinal endoscopy centers performing emergency endoscopies were contacted via e-mail to collect weekly emergency gastroscopy volumes and the number of AUGIB events. AUGIB was defined as recent melena, hematemesis, or both, with an endoscopically visible source of bleeding. Results. Twelve (85.7%) of the 14 surveyed gastrointestinal endoscopy centers in the city- and county-level hospitals responded. Altogether, 4,045 and 1,077 gastroscopy procedures were performed 4 weeks before and after lockdown initiation (73.4% reduction), respectively. Peptic ulcer-related AUGIB and variceal AUGIB events showed a 58.5% and 52.9% decline, respectively, compared with pre-COVID-19 data. Although the absolute number of AUGIB events decreased during the pandemic (from 149 to 66), the likelihood of detecting AUGIB during gastroscopy increased (3.68% (pre-COVID-19 period) versus 6.13% (COVID-19 period); P < 0.05 ). Conclusion. The COVID-19 pandemic resulted in a considerable reduction in gastroscopy workload and AUGIB events; however, the likelihood of detecting AUGIB increased significantly during gastroscopies.

scholarly journals Mo1281 – The Impact of Urgent Upper Endoscopy on Clinical Outcomes in Patients with Acute Upper Gastrointestinal Bleeding

2019 ◽  
Vol 156 (6) ◽  
pp. S-745
Author(s):  
Uayporn Kaosombatwattana ◽  
Manassawee Chakpaisan ◽  
Julajak Limsrivilai ◽  
Nonthalee Pausawasdi ◽  
Phunchai Charatcharoenwitthaya ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Clinical Outcomes ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Endoscopy ◽  
Acute Upper Gastrointestinal Bleeding ◽  
The Impact ◽  
Upper Gastrointestinal

Pre-Endoscopy Use of Proton Pump Inhibitor Intravenous Bolus Dosing in Hemodynamically Stable Patients With Suspected Upper Gastrointestinal Bleeding: Results of a Pharmacist-Managed Hospital Protocol to Reduce Continuous Infusion Pantoprazole Use

2021 ◽  
pp. 001857872110468
Author(s):  
Andrew C. Faust ◽  
Lauren Schwaner ◽  
Drew Thomas ◽  
Shilpa Sannapanei ◽  
Mark Feldman
Keyword(s):  
Gastrointestinal Bleeding ◽  
Phase I ◽  
Phase Ii ◽  
Proton Pump ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Care ◽  
Intervention Group ◽  
Acute Upper Gastrointestinal Bleeding ◽  
The Impact ◽  
Upper Gastrointestinal

Background: Guidelines for acute upper gastrointestinal bleeding (UGIB) recommend use of proton pump inhibitors (PPI) administered by continuous IV infusion (CI). Although data suggest comparable outcomes with CI and IV push (IVP) dosing post-endoscopy, there are limited data to support IVP PPI as the pre-endoscopy regimen. Objective: To evaluate the impact of a pharmacist-managed protocol for reducing PPI CIs and substitution of PPI IVP dosing in hemodynamically stable patients with suspected acute upper gastrointestinal bleeding (UGIB) prior to endoscopic intervention. Design, Setting, and Participants: Retrospective study; Tertiary-care community teaching hospital; Hemodynamically stable adults with confirmed or suspected UGIB. Hemodynamic stability was defined as a systolic blood pressure >90 mmHg, heart rate <100 beats, mean arterial pressure >65 mmHg, and no requirement for vasopressors. Intervention: All iterations of treatment recommendations encouraged an initial pantoprazole 80 mg IVP dose. In the pre-intervention group, patients were then treated at the at the provider’s discretion with the majority receiving CI pantoprazole. After implementation of the original protocol ( Phase I), all hemodynamically stable patients were allowed 1 bag of CI pantoprazole (80 mg infused over 10 hours) before being transitioned by the pharmacist to pantoprazole 40 mg IVP every 12 hours. After internal analysis, the protocol was revised to allow patients to be immediately transitioned to IVP dosing without an initial CI ( Phase II). Main Outcome: Incidence of continued bleeding or re-bleeding within 7 days of initial PPI dose. Results: A total of 325 patients were included across all 3 study phases. The median number of CI bags per patient was reduced from 4 pre-intervention, to 1.5 in phase I, and to 0 in phase II ( P < .001). The primary endpoint of continued bleeding or re-bleeding within 7 days was similar across all 3 groups (5.0% vs 6.5% vs 5.2%, P = .92). Mean intravenous pantoprazole costs were reduced by $21.73/patient. Conclusions: Movement toward preferential use of IVP PPI prior to endoscopy for hemodynamically stable patients with confirmed or suspected UGIBs resulted in similar rates of continued bleeding or re-bleeding and generated modest cost savings. These findings warrant further investigation.

scholarly journals Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323054
Author(s):  
Cosmos L T Guo ◽  
Sunny H Wong ◽  
Louis H S Lau ◽  
Rashid N S Lui ◽  
Joyce W Y Mak ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Therapeutic Endoscopy ◽  
Public Hospitals ◽  
Icu Admission ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Early Endoscopy ◽  
All Cause Mortality ◽  
Upper Gastrointestinal

ObjectiveWhile it is recommended that patients presenting with acute upper gastrointestinal bleeding (AUGIB) should receive endoscopic intervention within 24 hours, the optimal timing is still uncertain. We aimed to assess whether endoscopy timing postadmission would affect outcomes.DesignWe conducted a retrospective, territory-wide, cohort study with healthcare data from all public hospitals in Hong Kong. Adult patients (age ≥18) that presented with AUGIB between 2013 and 2019 and received therapeutic endoscopy within 48 hours (n=6474) were recruited. Patients were classified based on endoscopic timing postadmission: urgent (t≤6), early (6<t≤24) and late (24<t≤48). Baseline characteristics were balanced with inverse probability of treatment weighting. 30-day all-cause mortality, repeated therapeutic endoscopy rate, intensive care unit (ICU) admission rate and other endpoints were compared.ResultsResults showed that urgent timing (n=1008) had worse outcomes compared with early endoscopy (n=3865), with higher 30-day all-cause mortality (p<0.001), repeat endoscopy rates (p<0.001) and ICU admission rates (p<0.001). Late endoscopy (n=1601) was associated with worse outcomes, with higher 30-day mortality (p=0.003), in-hospital mortality (p=0.022) and 30-day transfusion rates (p=0.018).ConclusionCompared with urgent and late endoscopy among patients who have received therapeutic endoscopies, early endoscopy was associated with superior outcomes especially among patients with non-variceal bleeding. This supports the notion that non-variceal AUGIB patients should receive endoscopy within 24 hours, but also emphasises the importance of prior resuscitation and pharmacotherapy.

scholarly journals EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING SECONDARY TO PEPTIC DISEASE IN A TERTIARY REFERRAL BRAZILIAN HOSPITAL

2021 ◽  
Author(s):  
Marcela FORGERINI ◽  
Gustavo URBANO ◽  
Tales Rubens de NADAI ◽  
Maruxa ZAPATA-CACHAFEIRO ◽  
Rafael KEMP ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Peptic Ulcer Disease ◽  
Clinical Symptoms ◽  
Upper Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Tertiary Referral ◽  
Ulcer Disease ◽  
Number Of Patients ◽  
Upper Gastrointestinal

ABSTRACT BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) secondary to peptic ulcer disease is a medical digestive emergency and could be one of the most serious adverse drug reactions. OBJECTIVE: To identify the frequency of diagnosis of NVUGIB secondary to peptic ulcer disease. METHODS: Prospective and epidemiological study conducted in a tertiary referral Brazilian hospital, from July 2016 to December 2019. Upper gastrointestinal endoscopies (UGE) reports were evaluated daily. The diagnosis of NVUGIB secondary to peptic ulcer disease was defined through endoscopic findings of peptic ulcer and erosive gastric lesions, and clinical symptoms. The frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was estimated through the ratio between the number of patients diagnosed and the number of patients underwent UGE in the same period. RESULTS: A total of 2,779 endoscopic reports (2,503 patients) were evaluated, and 178 patients were eligible. The total frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was 7.1%. The annual frequency of diagnosis between 2017 and 2019 ranged from 9.3% to 5.7%. Most patients were men (72.8%); self-declared white (71.8%); older people (56.7%); and, had no familiar or personal history of gastrointestinal diseases (60.1%). 90% of the patients had a peptic ulcer and melena (62.8%). Patients made chronic use of low-dose aspirin (29.3%), other antiplatelet agents (21.9%) and, oral anticoagulants (11.2%); and non-steroidal anti-inflammatories use in the week a prior to the onset of clinical symptoms (25.8%). CONCLUSION: Seven in every 100 patients admitted and underwent UGE in a tertiary hospital were diagnosed with NVUGIB secondary to peptic ulcer disease.

scholarly journals How Can Patient’s Risk Dictate the Timing of Endoscopy in Upper Gastrointestinal Bleeding?

2021 ◽  
pp. 1-10
Author(s):  
Marta Freitas ◽  
Vítor Macedo Silva ◽  
Tiago Cúrdia Gonçalves ◽  
Carla Marinho ◽  
José Cotter
Keyword(s):  
Gastrointestinal Bleeding ◽  
Endoscopic Treatment ◽  
Lower Risk ◽  
Upper Gastrointestinal Bleeding ◽  
Positive Impact ◽  
Outcome Data ◽  
Optimal Timing ◽  
Early Endoscopy ◽  
The Impact ◽  
Upper Gastrointestinal

<b><i>Introduction:</i></b> Although upper gastrointestinal bleeding (UGIB) management has improved substantially in the last decades, there is still much controversy regarding the optimal timing for performance of endoscopy. Recent guidelines suggest performing an early endoscopy within 24 h of nonvariceal UGIB (NVUGIB) presentation, although its impact on patients with different bleeding risks remains unclear. <b><i>Aim:</i></b> To evaluate the impact of performing endoscopy within 24 h on NVUGIB outcomes and to compare it in patients with lower-risk vs. higher-risk bleeding. <b><i>Methods:</i></b> This is a retrospective cohort study including consecutive patients undergoing upper endoscopy for suspected NVUGIB over 4 years. Demographic, clinical, biochemical, endoscopic, and outcome data were collected. Lower-risk bleeding was defined as a Glasgow-Blatchford score (GBS) &#x3c;12 and higher-risk bleeding was defined as a GBS ≥12. <b><i>Results:</i></b> A total of 298 patients with suspected NVUGIB were included, 55% of whom had higher-risk bleeding. Endoscopy was performed within 24 h in 62.1% of the patients. In lower-risk bleeding patients, performance of endoscopy within 24 h was associated with a higher need for endoscopic treatment (OR = 2.6; 95% CI 1.2–5.7; <i>p</i> = 0.004), a lower 30-day mortality (OR = 0.41; 95% CI 0.27–0.63; <i>p</i> = 0.03), and a lower need for transfusion (OR = 0.58; 95% CI 0.36–0.92; <i>p</i> = 0.02). In higher-risk bleeding patients, there were no statistically significant differences in NVUGIB outcomes in performing endoscopy within 24 h. <b><i>Conclusion:</i></b> Endoscopy within 24 h of presentation was associated with a lower need for transfusion, a higher need for endoscopic treatment, and a lower 30-day mortality in lower-risk NVUGIB patients. Thus, performing endoscopy within the first 24 h of presentation can have a positive impact on NVUGIB outcomes even in lower-risk bleeding.

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