UPPER GASTROINTESTINAL BLEEDING IN PATIENTS WITH CIRRHOSIS: BEYOND VARICEAL BLEEDING

2020 ◽  
Author(s):  
G Demetriou ◽  
A Veniamin ◽  
E Orfanudaki ◽  
V Valatas ◽  
M Koulendaki ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

The outcomes of emergency hospital admissions with non-malignant upper gastrointestinal bleeding in England between 2003 and 2015

Endoscopy ◽  
2021 ◽  
Author(s):  
James Rees ◽  
Felicity Evison ◽  
Jemma Mytton ◽  
Prashant Patel ◽  
Nigel Trudgill
Keyword(s):  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Key Management ◽  
Hospital Admissions ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Emergency ◽  
Emergency Admissions ◽  
Co Morbidity ◽  
Standardized Mortality Rate ◽  
Upper Gastrointestinal

Abstract Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency with significant mortality. Despite developments in endoscopic and clinical management, only minor improvements in outcomes have been reported. Methods This was a retrospective cohort study of patients with non-malignant UGIB emergency admissions in England between 2003 and 2015, using Hospital Episode Statistics. Multilevel logistic regression analysis examined the associations with mortality. Results 242 796 patients with an UGIB admission were identified (58.8 % men; median age 70 [interquartile range (IQR) 53 – 81]). Between 2003 and 2015, falls occurred in both 30-day mortality (7.5 % to 7.0 %; P < 0.001) and age-standardized mortality (odds ratio (OR) 0.74, 95 % confidence interval [CI] 0.69 – 0.80; P < 0.001), including from variceal bleeding (OR 0.63, 95 %CI 0.45 – 0.87; P < 0.005). Increasing co-morbidity (Charlson score > 5, OR 2.94, 95 %CI 2.85 – 3.04; P < 0.001), older age (> 83 years, OR 6.50, 95 %CI 6.09 – 6.94; P < 0.001), variceal bleeding (OR 2.03, 95 %CI 1.89 – 2.18; P < 0.001), and a weekend admission (Sunday, OR 1.18, 95 %CI 1.12 – 1.23; P < 0.001) were associated with 30-day mortality. Of deaths at 30 days, 8.9 % were from ischemic heart disease (IHD) and the cardiovascular age-standardized mortality rate following UGIB was high (IHD deaths within 1 year, 1188.4 [95 %CI 1036.8 – 1353.8] per 100 000 men in 2003). Conclusions Between 2003 and 2015, 30-day mortality among emergency admissions with non-malignant UGIB fell by 0.5 % to 7.0 %. Mortality was higher among UGIB admissions at the weekend, with important implications for service provision. Patients with UGIB had a much greater risk of subsequently dying from cardiovascular disease and addressing this risk is a key management step in UGIB.

scholarly journals Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

2021 ◽  
Vol 8 (2) ◽  
pp. 105-111
Author(s):  
Sunil Adhikari ◽  
Suraj Rijal ◽  
Darlene Rose House
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Clinical Presentation ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Hospital ◽  
Clinical Profile ◽  
Ulcer Bleeding ◽  
Cross Sectional ◽  
Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

scholarly journals Management of acute upper gastrointestinal bleeding

BMJ ◽  
2019 ◽  
pp. l536 ◽  
Author(s):  
Adrian J Stanley ◽  
Loren Laine
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Ulcer Bleeding ◽  
Vasoactive Drugs ◽  
Upper Gastrointestinal

Abstract Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.

scholarly journals Acute upper gastrointestinal bleeding in southern Saudi Arabia: A retrospective observational study

2020 ◽  
Vol 8 (3) ◽  
pp. 105-113
Author(s):  
Alzahrani MA ◽  
Alfaifi M ◽  
Alzaher SA ◽  
Saad SS ◽  
Alshehri FM ◽  
...  
Keyword(s):  
Risk Factors ◽  
Saudi Arabia ◽  
Observational Study ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Manifestations ◽  
Retrospective Observational Study ◽  
Mortality And Morbidity ◽  
Upper Gastrointestinal

Context: Upper gastrointestinal bleeding (UGIB) is a common life-threatening emergency that carries considerable mortality and morbidity; it remains a common cause for admission to hospitals worldwide. UGIB is classified as variceal bleeding and non-variceal bleeding because of distinct etiologies and management. Aims: To describe present clinical manifestations in southern Saudi Arabian UGIB patients, including both endoscopic and basic laboratory parameters, to assess the risk factors, and compare the predictive power and clinical usefulness of three risk scoring systems (AIMS65 score, Glasgow-Blatchford score, Rockall risk score) for the management of patients presenting with UGIB. Methods: This was a retrospective observational study. We included 283 patients admitted to the gastrointestinal unit at Abha city, southern Saudi Arabia, from November 2017 to October 2019. The study findings were the etiology of UGI bleeding, the endoscopic findings and clinical outcome of UGI bleeding. Results: Ages ranged from 18 to 97 years old with mean age of 54.5 ± 18.5 years. The majority of patients were males (72%; 203). Melina was the most common presenting symptom, in 66 (49.3%) patients. Diabetes mellitus was the most frequently recorded risk factor for UGIB (53.9%) followed by hypertension (44.9%), and aspirin use (35.7%). Endoscopic hemostatic treatment was applied in 70 patients (24.7%); 4.9% of patients re-bled, and 21 patients (7.4%) died during the study period. Conclusions: Comorbidities such as hypertension and diabetes, in addition to some medicines including ASA, steroids and NSAIDs were identified as risk factors of upper GIT bleeding among this study casesa list of risk factors for severe UGIB, leading to hospitalization and even death.

scholarly journals Should vasoconstrictors be considered in a cirrhotic patient with acute non-variceal upper gastrointestinal bleeding?

2017 ◽  
Vol 5 (4) ◽  
pp. 240-244 ◽  
Author(s):  
Xingshun Qi ◽  
Hongyu Li ◽  
Xiaodong Shao ◽  
Zhendong Liang ◽  
Xia Zhang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
International Normalized Ratio ◽  
Endoscopic Examination ◽  
Vein Thrombosis ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

Abstract Varices manifest as a major etiology of upper gastrointestinal bleeding in patients with chronic liver diseases, such as liver cirrhosis and hepatocellular carcinoma. By contrast, non-variceal upper gastrointestinal bleeding is rare. Pharmacological treatment differs between patients with variceal and non-variceal bleeding. Vasoconstrictors are recommended for the treatment of variceal bleeding, rather than non-variceal bleeding. In contrast, pump proton inhibitors are recommended for the treatment of non-variceal bleeding, rather than variceal bleeding. Herein, we present a case with liver cirrhosis and acute upper gastrointestinal bleeding who had a high risk of rebleeding (i.e., Child–Pugh class C, hepatocellular carcinoma, portal vein thrombosis, low albumin, and high international normalized ratio and D-dimer). As the source of bleeding was obscure, only terlipressin without pump proton inhibitors was initially administered. Acute bleeding episode was effectively controlled. After that, an elective endoscopic examination confirmed that the source of bleeding was attributed to peptic ulcer, rather than varices. Based on this preliminary case report, we further discussed the potential role of vasoconstrictors in a patient with cirrhosis with acute non-variceal upper gastrointestinal bleeding.

scholarly journals Recurrent upper gastrointestinal bleeding masquerading as gastric variceal bleeding on endoscopy after liver transplantation

2013 ◽  
Vol 19 (8) ◽  
pp. 926-928 ◽  
Author(s):  
Ibrahim A. Hanouneh ◽  
Bradley D. Confer ◽  
Nizar N. Zein ◽  
Naim Alkhouri ◽  
Bijan Eghtesad
Keyword(s):  
Liver Transplantation ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

scholarly journals Upper gastrointestinal bleeding in patients with liver cirrhosis, Is the difference of clinical outcomes depend on the source?

2020 ◽  
Author(s):  
Mohamed Sorour Mohamed ◽  
Marwan N Elgohary ◽  
Mohamed A A Bassiony ◽  
Amr Shaaban Hanafy
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Clinical Outcomes ◽  
Variceal Bleeding ◽  
Hospital Readmission ◽  
Upper Gastrointestinal Bleeding ◽  
Length Of Hospital Stay ◽  
Hospital Length Of Stay ◽  
Prolonged Hospital ◽  
Upper Gastrointestinal

Abstract Background and Study Aims Acute upper gastrointestinal bleeding (UGIB) is the most common gastroenterological emergency in patients with cirrhosis; It increases the hospital length of stay (LOS), and Chance of 30-day hospital readmission. It has not been clarified if there is a difference in the prognosis of UGIB in cirrhosis depending on the source of bleeding. We aimed to investigate clinical outcomes in patients with cirrhosis with either acute variceal bleeding (AVB) or non-variceal bleeding (NVB) and risk factors for prolonged hospital LOS in both groups.Patients and Methods From July 2016 to January 2017, all adult eligible patients hospitalized with cirrhosis and UGIB were enrolled in the retrospective study, we assessed clinical outcomes in both groups and factors associated with prolonged hospital LOS.Results Of the 608 patients included in the study, 416 had variceal and 192 non-variceal bleeding. Mortality was higher in AVB group compared to NVB (12.5% vs. 8.3%, P= 0.023). There was a trend towards increased the length of hospital stay for those who had an AVB compared to NVB (5.84±2.16 vs. 4.33±1.18, p=0.001). Rate of hospital Readmission was also higher in the AVB group. Risk factors for prolonged hospital LOS were in hospital rebleeding, presence of Hepatic encephalopathy or ascites, higher MELD score and Patients with child score B, C.Conclusion Patients with cirrhosis and AVB have higher mortality rate, longer hospital LOS and re-hospitalization rate than those with NVB.

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