Prognostic factors associated with upper gastrointestinal bleeding based on the French multicenter SANGHRIA trial

Abstract Background and study aims Prognostic and risk factors for upper gastrointestinal bleeding (UGIB) might have changed overtime because of the increased use of direct oral anticoagulants and improved gastroenterological care. This study was undertaken to assess the outcomes of UGIB in light of these new determinants by establishing a new national, multicenter cohort 10 years after the first. Methods Consecutive outpatients and inpatients with UGIB symptoms consulting at 46 French general hospitals were prospectively included between November 2017 and October 2018. They were followed for at least for 6 weeks to assess 6-week rebleeding and mortality rates and factors associated with each event. Results Among the 2498 enrolled patients (mean age 68.5 [16.3] years, 67.1 % men), 74.5 % were outpatients and 21 % had cirrhosis. Median Charlson score was 2 (IQR 1–4) and Rockall score was 5 (IQR 3–6). Within 24 hours, 83.4 % of the patients underwent endoscopy. The main causes of bleeding were peptic ulcers (44.9 %) and portal hypertension (18.9 %). The early in-hospital rebleeding rate was 10.5 %. The 6-week mortality rate was 12.5 %. Predictors significantly associated with 6-week mortality were initial transfusion (OR 1.54; 95 %CI 1.04–2.28), Charlson score > 4 (OR 1.80; 95 %CI 1.31–2.48), Rockall score > 5 (OR 1.98; 95 %CI 1.39–2.80), being an inpatient (OR 2.45; 95 %CI 1.76–3.41) and rebleeding (OR 2.6; 95 %CI 1.85–3.64). Anticoagulant therapy was not associated with dreaded outcomes. Conclusions The 6-week mortality rate remained high after UGIB, especially for inpatients. Predictors of mortality underlined the weight of comorbidities on outcomes.

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Outcomes of upper gastrointestinal bleeding are similar between direct oral anticoagulants and vitamin K antagonists

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.16236 ◽

2021 ◽

Author(s):

Claire Gouriou ◽

Guillaume Bouguen ◽

Pierre Lahmek ◽

Agnes Pelaquier ◽

Ramuntxo Arotcarena ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Vitamin K ◽

Upper Gastrointestinal Bleeding ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Upper Gastrointestinal

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Effect of gastroprotective agents on upper gastrointestinal bleeding in patients receiving direct oral anticoagulants

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2018.1541478 ◽

2018 ◽

Vol 53 (12) ◽

pp. 1490-1495 ◽

Cited By ~ 2

Author(s):

Sung Hee Youn ◽

Hyun Lim ◽

Yeonmi Ju ◽

Jae Seung Soh ◽

Ji Won Park ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Upper Gastrointestinal

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Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Gut ◽

10.1136/gutjnl-2018-316276 ◽

2018 ◽

Vol 67 (10) ◽

pp. 1757-1768 ◽

Cited By ~ 52

Author(s):

Joseph JY Sung ◽

Philip WY Chiu ◽

Francis K L Chan ◽

James YW Lau ◽

Khean-lee Goh ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Working Group ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Therapy ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Asia Pacific ◽

Endoscopic Management ◽

Three Stages ◽

Upper Gastrointestinal

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

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AF.6 IMPACT OF VITAMIN-K ANTAGONISTS AND DIRECT ORAL ANTICOAGULANTS ON SEVERITY OF UPPER GASTROINTESTINAL BLEEDING: A RETROSPECTIVE ANALYSIS OF ITALIAN AND UK DATA

Digestive and Liver Disease ◽

10.1016/s1590-8658(21)00569-7 ◽

2021 ◽

Vol 53 ◽

pp. S139-S140

Author(s):

M. Brigida ◽

S. Di Caro ◽

C. Petruzziello ◽

M.E. Riccioni ◽

F. Franceschi ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Retrospective Analysis ◽

Vitamin K ◽

Upper Gastrointestinal Bleeding ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Upper Gastrointestinal

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Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis

Endoscopy International Open ◽

10.1055/a-1005-6401 ◽

2020 ◽

Vol 08 (01) ◽

pp. E50-E58 ◽

Cited By ~ 1

Author(s):

Santi Mangiafico ◽

Flavia Pigò ◽

Helga Bertani ◽

Angelo Caruso ◽

Giuseppe Grande ◽

...

Keyword(s):

High Risk ◽

Mortality Rate ◽

Propensity Score ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Conventional Group ◽

First Line ◽

Over The Scope Clip ◽

Rockall Score ◽

Upper Gastrointestinal

Abstract Background and study aims The over-the-scope clip (OTSC) is a novel tool used to improve the maintenance of hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB); however, studies on the comparison with “conventional” techniques are lacking. In this study, we aimed to compare first-line endoscopic hemostasis achieved using conventional techniques with that achieved using OTSC placement for NVUGIB. Patients and methods From January 2007 to March 2018, 793 consecutive patients underwent upper endoscopy with the hemostasis procedure. Among them, 327 patients were eligible for inclusion (112 patients had OTSC placement and 215 underwent conventional hemostasis). After propensity score matching and adjustment for confounding factors, 84 patients were stratified into the “conventional” group and 84 into the OTSC group. Patient characteristics and outcomes (rebleeding rate, mortality rate within 30 days, and adverse events) were compared between the two groups. Results In the unmatched cohort, hemostasis with OTSC was more frequent in cases of duodenal ulcers with Forrest Ia to IIa and in patients with a higher Rockall score compared with the “conventional group”. In the matched cohort, 93 % of the patients in the “conventional group” underwent hemostasis with epinephrine + through-the-scope clip. Rebleeding events were significantly less frequent in the OTSC group (8 % vs 20 %, 95 %CI 3 – 16 vs 12 – 30; P = 0.02); however, the mortality rate in the two groups was not significantly different (6 % vs 2 %, 95 %CI 1 – 8 vs 2 – 13; P = 0.4). Conclusions OTSC is a safe and effective tool for achieving hemostasis, and we recommend its use as the first-line therapy for lesions with a high risk of rebleeding and in patients with a high risk Rockall score.

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Is upper gastrointestinal bleeding still a life-threatening condition?

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0013.1366 ◽

2019 ◽

Vol 13 (2) ◽

pp. 18-23

Author(s):

Dariusz Janczak ◽

Paweł Marschollek ◽

Karol Marschollek ◽

Marcin Owczarzak ◽

Wojciech Bąkowski ◽

...

Keyword(s):

Mortality Rate ◽

Conservative Treatment ◽

Gastrointestinal Bleeding ◽

Esophageal Varices ◽

Upper Gastrointestinal Bleeding ◽

Clinical Problem ◽

Endoscopic Hemostasis ◽

Peptic Ulcers ◽

First Choice ◽

Upper Gastrointestinal

Background: Upper gastrointestinal bleeding is a common clinical problem and one of the main reasons for emergency hospitalization. It is associated with an overall mortality rate of 2% to 13%, despite advances in medical therapy. First-choice management is conservative treatment with endoscopic hemostasis. Aim of the study: The aim of the study was to examine the epidemiological and clinical characteristics of patients with upper gastrointestinal bleeding with a focus on the course of hospitalization based on the etiology Material and methods: A retrospective study was conducted in the Department of Surgery at the 4th Military Teaching Hospital in the years 2011–2016, comprising a total of 200 hospitalizations. 150 (75%) of the study group were men, and the mean age was 63.6±15.8 years. Results: Patients most frequently presented with melena (n=105; 53.1%) and hematemesis (n=79; 40%) or coffee ground vomiting (n=57; 28.7%). . 138 (69%) of hemorrhages were managed with endoscopic hemostasis, and in 43 (21.5%) of cases conservative treatment was adequate. In 12 (6%) of cases, laparotomy was the first-choice therapy and in 7 (3.5%) cases, surgery was performed after an attempt at endoscopic treatment had failed. The sources of bleeding were: gastric ulcer – 58 (29%), duodenal ulcer – 48 (24%), esophageal varices – 31 (15.5%), gastric tumor – 15 (7.5%), Mallory-Weiss syndrome – 10 (5%), and Dieulafoy’s lesion – 3 (1.5%). 16 (8%) of the hospitalizations were fatal. Conclusions: Upper gastrointestinal bleeding still has a high mortality rate (8%). It more frequently affects men and the elderly. Gastric and duodenal ulcers are the most common etiologies of bleeding. Esophageal varices and neoplasms are also a significant source of bleeding. Despite the progress in the pharmacological treatment of peptic ulcers, the complications resulting from gastrointestinal bleeding continue to be a serious clinical problem.

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