140. Antibiotic Prophylaxis for Upper Gastrointestinal Bleed in Liver Cirrhosis: Less May Be More

Abstract Background Antibiotics in patients with cirrhosis and upper gastrointestinal bleeding are shown to improve outcomes. Little is known regarding optimum duration of prophylactic antibiotics, with 7 days of therapy generally recommended. Antibiotic duration has not been compared to outcomes in current scientific literature. The goal of our study was to study the effect of shorter antibiotic duration on outcomes. Methods This was a retrospective cohort study of patients with cirrhosis presenting with upper GI bleeding at our institute from 2010-2018. Patients were divided into three cohorts based on duration of antibiotic administration: 1-3 days, 4-6 days, and 7 days or more. Rates of infection within 30 days, time to infection, rebleeding and mortality were compared between the three groups. Multivariable analysis was conducted to evaluate independent risk factors for infection. Results Medical charts of 943 patients with cirrhosis and upper GI bleed were reviewed. 303 patients did not have concomitant confirmed or suspected infection on presentation, of these 243 patients received antibiotics for prophylaxis and were included for analysis. Seventy-seven patients received antibiotic therapy for 3 days or less, 69 patients for 4-6 days, and 97 patients >6 days. The groups were well matched in demographic & clinical variables. 27 patients developed infections within 30 days of bleed. High MELD score at presentation and presence of ascites were associated with infection within 30 days. Rates of infection were not statistically different between the antibiotic groups (p= 0.78). In the 30 days following GI bleed, pneumonia was the most diagnosed infection (11 patients) followed by UTI (8 patients). Four patients developed spontaneous bacterial peritonitis and 3 were diagnosed with bacteremia. There was no difference in time to infection (p= 0.75), early re-bleeding (p=0.81), late re-bleeding (p= 0.37) and in-hospital mortality (p= 0.94) in the three groups. Six patients developed C. Difficile infection, none of whom were in the short antibiotic group. Conclusion Short course of antibiotics for prophylaxis (3 days) appears safe and adequate for prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding if bleeding has abated and there is no active infection. Disclosures All Authors: No reported disclosures

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Variceal Bleeding is Leading Cause of Upper GI Bleed: A Study from Northern Part of Pakistan

10.53350/pjmhs211571837 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1837-1839

Author(s):

Tanveer Ahmed ◽

Mustafa Kamal ◽

Ramish Riaz ◽

Mashhood Ali

Keyword(s):

Hepatitis C ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Age Group ◽

Gastrointestinal Bleed ◽

Upper Gi ◽

Variceal Bleed ◽

History Of ◽

Gi Bleed ◽

Upper Gastrointestinal

Background: Upper gastrointestinal bleeding (UGIB) is a leading cause of hospitalization in medical emergencies around the world, with a high death and morbidity rate. In all cases of upper gastrointestinal bleeding, endoscopy is the primary diagnostic tool. Key management of depends on diagnosing the exact cause of disease. Methodology: This descriptive study was carried out at Gastroenterology Department, PIMS, Islamabad from January 2019 to December 2019. All patients having history of upper gastrointestinal bleed were included in the study. Patients unfit for endoscopy i.e. with perforation, peritonitis, comatose needing intubation and those unwilling to undergo the procedure were excluded. Total 490 patients fulfilled the criterion. The cause of GI bleed was noted upon endoscopy. Data was noted on set performa and further statistical analysis was performed via SPSS v 26. Results: Among 490 patients, 298 (61%) were males while 192 (39%) were females. Most common age group presenting with upper GI bleed belongs to old age group i.e. had age above 60 years (n=235, 47.9%) followed by 40 to 59 years (n=174, 35.5%).Most common cause of upper GI bleed was found to be variceal bleed (n=292, 59.5%), followed by ulcer bleed (n=88, 18.0%) and stomach cancer (n=28, 6%). In 82 (17%) cases no reason for gastrointestinal bleed could be found out. Chi-square test showed Variceal bleed to be the most significant reason (χ2=65.2, P-Value<0.001) of Upper GI bleed. Conclusion: Variceal bleed is the most significant cause of upper GI bleed in our study population. This trend can be attributed to increased prevalence of hepatitis C in Pakistan. Special attention to the patient’s symptoms especially with history of HCV can help in early diagnosis and timely management. Keywords: Variceal Bleed, Upper GI Bleed, Endoscopy, Ulcer, Hepatitis C.

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(A155) Acute Myocardial Infarction with Upper Gastrointestinal Bleeding

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11001531 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s44-s44

Author(s):

S. Tandon ◽

P. Bordoloi ◽

T. Kole

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Inferior Wall ◽

Upper Gi ◽

Coffee Ground ◽

History Of ◽

Gi Bleed ◽

Upper Gastrointestinal

ObjectiveTo report a rare case of Acute Myocardial Infarction (AMI) along with Upper Gastrointestinal bleeding (UGIB).Presentation and InterventionA 58 year old male with history of black coloured stools was admitted in ER for chest pain and coffee ground emesis. ECG showed an acute inferior wall MI. After doing the necessary interventions, patient was inserted with a nasogastric tube and started on medications in the Emergency for UGIB followed by immediate endoscopy. Endoscopy confirmed presence of multiple superficial Ulcers in the stomach along with Esophagitis.ConclusionWe support Esophagogastroduodenoscopy (EGD) prior to cardiac catheterisation in patients with AMI associated with overt Upper GI Bleed. This results in fewer complications as compared with direct catheterization

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Upper GI Bleed, Etiology, Role of Endoscopy in Rural Population of Punjab

Innovations in Data Methodologies and Computational Algorithms for Medical Applications ◽

10.4018/978-1-4666-0282-3.ch012 ◽

2012 ◽

pp. 208-221

Author(s):

Ravinder Singh Malhotra ◽

K. S. Ded ◽

Arun Gupta ◽

Darpan Bansal ◽

Harneet Singh

Keyword(s):

Peptic Ulcer ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Common Cause ◽

Endoscopic Techniques ◽

Upper Gi ◽

Gi Bleed ◽

Upper Gastrointestinal ◽

Common Variable

Haematemesis and malena are the two most important symptoms of upper gastrointestinal bleeding . The most common cause of upper gastrointestinal bleeding is due to a peptic ulcer. In this paper, the authors research the cause of bleeding. Contrary to previous studies, results favor esophageal varices, e.g., alcoholism or cirrhosis liver post necrotic, as the most common cause of bleeding rather than a peptic ulcer. The authors’ study is based on an observational retrospective protocol with records of 50 consecutive patients with GI bleeding, attending the emergency room from February 2007 until September 2009. Results show that the treatment of UGI bleeding has made important progress since the introduction of emergency endoscopy and endoscopic techniques for haemostasis. The application of specific protocols significantly decreases rebleeding and the need for surgery, whereas mortality is still high. The data highlight the decreasing trend of peptic ulcer as the sole cause of bleeding, as shown in previous literature, ascertaining that varices are now the most common variable.

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Upper GI Bleed, Etiology, Role of Endoscopy in Rural Population of Punjab

International Journal of Computational Models and Algorithms in Medicine ◽

10.4018/jcmam.2010070103 ◽

2010 ◽

Vol 1 (3) ◽

pp. 55-68 ◽

Cited By ~ 1

Author(s):

Ravinder Singh Malhotra ◽

K. S. Ded ◽

Arun Gupta ◽

Darpan Bansal ◽

Harneet Singh

Keyword(s):

Peptic Ulcer ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Common Cause ◽

Endoscopic Techniques ◽

Gi Bleed ◽

Upper Gastrointestinal ◽

Common Variable ◽

Important Progress

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ENDOSCOPIC PROFILE OF UPPER GASTROINTESTINAL BLEEDING IN A TERTIARY CARE CENTRE.

10.36106/ijsr/3904472 ◽

2021 ◽

pp. 45-46

Author(s):

Pavan Kumar V ◽

Kani Shaikh Mohamed

Keyword(s):

Peptic Ulcer ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Tertiary Care ◽

Gi Bleeding ◽

Care Centre ◽

Gastric Erosions ◽

Tertiary Care Centre ◽

Upper Gi ◽

Upper Gastrointestinal

Background:Astudy describing the endoscopic prole of upper gastrointestinal bleeding in a tertiary care centre. Aim:The aim was to study endoscopic prole in patients presenting with upper GI bleeding. Introduction: Upper gastrointestinal bleeding is a common medical emergency associated with signicant morbidity and mortality. The presentation of bleeding depends on the amount and location of bleed. The primary diagnostic test for evaluation of upper gastrointestinal bleeding is endoscopy. The aim was to study endoscopic prole in patients presenting with upper GI bleeding. Methods: This is a cross sectional study data conducted in Department of Gastroenterology DDHD Anna nagar Chennai from January 2019 to January 2020 . In this patients presenting with manifestations of upper gastrointestinal bleed were included and were subjected to upper GI endoscopy. Results: Atotal of 160 patients presenting with hematemesis and melena were studied. 124(77.5%) were males and 36(22.5%) were females. The mean age was 47.15 ± 17.12 . The most common ndings on endoscopy of upper gastrointestinal bleeding was portal hypertension related (esophageal and gastric varices, portal hypertensive gastropathy ) seen in 40% of patients, gastric erosions in 17.5% patients, peptic ulcer disease was seen in 13.75%, Esophagitis in 6.25% cases, Mallory-Weiss tear was seen in 6.25% patients, gastric malignancy in 5% patients, post EVL ulcers in 3.75% patients, Normal study in 3.75%, Duodenal erosions in 2.5% patients, Vascular ectasia of stomach in 1.25%. Conclusion: The present study reported portal hypertension as the most common cause of upper gastrointestinal bleeding, while most common endoscopic lesions reported were esophageal varices, followed by gastric erosions and peptic ulcer.

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Can the Presence of Endoscopic High-Risk Stigmata be Bredicted before Endoscopy? A Multivariable Analysis Using the RUGBE Database

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2014/245386 ◽

2014 ◽

Vol 28 (6) ◽

pp. 301-304 ◽

Cited By ~ 3

Author(s):

Yen-I Chen ◽

Jonathan Wyse ◽

Alan Barkun ◽

Marc Bardou ◽

Ian M Gralnek ◽

...

Keyword(s):

High Risk ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Multivariable Analysis ◽

Hemoglobin Level ◽

National Database ◽

Asa Score ◽

Acute Upper Gastrointestinal Bleeding ◽

The Mean ◽

Upper Gastrointestinal

BACKGROUND: Many aspects in the management of acute upper gastrointestinal bleeding rely on pre-esophagogastroduodenoscopy (EGD) stratification of patients likely to exhibit high-risk stigmata (HRS); however, data predicting the presence of HRS are lacking.OBJECTIVE: To determine clinical and laboratory predictors of HRS at the index EGD in patients presenting with acute upper gastrointestinal bleeding using retrospective data from a validated national database – the Canadian Registry in Upper Gastrointestinal Bleeding and Endoscopy registry.METHODS: Relevant clinical and laboratory parameters were evaluated. HRS was defined as spurting, oozing, nonbleeding visible vessel or adherent clot after vigorous irrigation. Multivariable modelling was used to identify predictors of HRS including age, sex, hematemesis, use of antiplatelet agents, American Society of Anesthesiologists (ASA) classification, nasogastric tube aspirate, hemoglobin level and elapsed time from the onset of bleeding to EGD.RESULTS: Of the 1677 patients (mean [± SD] age 66.2±16.8 years; 38.3% female), 28.7% had hematemesis, 57.8% had an ASA score of 3 to 5, and the mean hemoglobin level was 96.8±27.3 g/L. The mean time from presentation to endoscopy was 22.2±37.5 h. The best fitting multivariable model included the following significant predictors: ASA score 3 to 5 (OR 2.16 [95% CI 1.71 to 2.74]), a shorter time to endoscopy (OR 0.99 [95% CI 0.98 to 0.99]) and a lower initial hemoglobin level (OR 0.99 [95% CI 0.99 to 0.99]).CONCLUSION: A higher ASA score, a shorter time to endoscopy and lower initial hemoglobin level all significantly predicted the presence of endoscopic HRS. These criteria could be used to improve the optimal selection of patients requiring more urgent endoscopy.

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Upper gastro-intestinal bleeding: Aetiology and demographic profile based on endoscopic examination at Dhulikhel Hospital, Kathmandu University Hospital

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i2.3560 ◽

1970 ◽

Vol 8 (2) ◽

pp. 208-211 ◽

Cited By ~ 3

Author(s):

RB Gurung ◽

G Joshi ◽

N Gautam ◽

P Pant ◽

B Pokhrel ◽

...

Keyword(s):

Peptic Ulcer ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Examination ◽

Oesophageal Varices ◽

Gi Bleeding ◽

Ulcer Disease ◽

Upper Gi Bleeding ◽

Upper Gi ◽

Upper Gastrointestinal

Background: The upper gastrointestinal bleeding (UGIB) is defined as bleeding within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. It is one of the important medical emergencies worldwide. Objective: The objective of this study is to study the aetiology of upper gastrointestinal bleeding based on endoscopic examination findings in patients of various demographic characteristics. Materials and methods: This is a retrospective observational study. The endoscopic record book from 2007 January to 2009 October was reviewed for all the cases who underwent oesophago-gastro-duodenoscopic examination for upper GI bleeding. The clinico-epidemiological data of all the patients was reviewed and analyzed in concert with the aetiology of bleeding. Results: A total of 90 patients (58 males, 32 females; mean age 45.32+ 18.47 years) of upper gastrointestinal bleeding was studied and analyzed in terms of aetiology of bleeding and demographic profile. Among the ethnic groups, Aryan 46 (51%) was the most common ethnic group to have upper GI bleeding followed by Newars 24 (27%), Mongolians 16 (18%), Dalits 3 (3%) and others 1 (1%). Out of 90 patients, 47( 52.2%) cases was less than 45 years of age, 30(33.3%) of 46 to 65 age ; and 13(14.4 %) more than 65 years of age. Gastric ulcer 23(25.6%) was the most common endoscopic finding, followed by oesophageal varices 14 (15.6%), acute erosive/haemorrhagic gastropathy 11 (12.2%), duodenal ulcer 9(10%), growth 7(7.8%), vascular lesions 3(3.3%), Mallory-Weiss tear 1(1.1%), fundal varices 1(1.1%) and, no cause was identified in 21(23.3%) cases. The peptic ulcer bleeding was the most common finding in Aryan 22(47.9%), whereas oesophageal varices and growth were more common in Newar 7(29.2%) and 3 (12.5%) respectively. Conclusion: Peptic ulcer disease is the most common cause of upper GI bleeding which was most commonly found in Aryan population; followed by oesophageal varices and growth as second and third most common causes and were more prevalent in Newar and Mongolian people. Key words: Endoscopy; Peptic ulcer disease; Upper GI bleeding; Varices DOI: 10.3126/kumj.v8i2.3560 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 208-211

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

PeerJ ◽

10.7717/peerj.11468 ◽

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.

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Hemosuccus Pancreaticus: 15-Year Experience from a Tertiary Care GI Bleed Centre

ISRN Radiology ◽

10.5402/2013/191794 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 16

Author(s):

Ashwin Rammohan ◽

Ravichandran Palaniappan ◽

Sukumar Ramaswami ◽

Senthil Kumar Perumal ◽

Anand Lakshmanan ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Tertiary Care ◽

Alcoholic Pancreatitis ◽

Team Approach ◽

Chronic Alcoholic Pancreatitis ◽

Hemosuccus Pancreaticus ◽

Management Protocol ◽

Gi Bleed ◽

Upper Gastrointestinal

Background. Hemosuccus pancreaticus (HP) is a very rare and obscure cause of upper gastrointestinal bleeding. Due to its rarity, the diagnostic and therapeutic strategy for the management of this potentially life threatening problem remains undefined. The objective of our study is to highlight the challenges in the diagnosis and management of HP and to formulate a protocol to effectively and safely manage this condition. Methods. We retrospectively reviewed the records of all patients who presented with HP over the last 15 years at our institution between January 1997 and December 2011. Results. There were a total of 51 patients with a mean age of 32 years. Nineteen patients had chronic alcoholic pancreatitis; twenty-six, five, and one patient had tropical pancreatitis, acute pancreatitis, and idiopathic pancreatitis, respectively. Six patients were managed conservatively. Selective arterial embolization was attempted in 40 of 45 (89%) patients and was successful in 29 of the 40 (72.5%). 16 of 51 (31.4%) patients required surgery. Overall mortality was 7.8%. Length of followup ranged from 6 months to 15 years. Conclusions. Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. All hemodynamically stable patients with HP should undergo prompt initial angiographic evaluation, and if possible, embolization. Hemodynamically unstable patients and those following unsuccessful embolization should undergo emergency haemostatic surgery. Centralization of GI bleed services along with a multidisciplinary team approach and a well-defined management protocol is essential to reduce the mortality and morbidity of this condition.

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Endoscopic Profile of the Patients with Upper Gastrointestinal Bleeding in a North–Eastern State of India - A Hospital-Based Cross-Sectional Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/231 ◽

2021 ◽

Vol 8 (18) ◽

pp. 1201-1205

Author(s):

Koushik Chakma ◽

Saumik Chakraborty ◽

Avik Chakraborty

Keyword(s):

Gastrointestinal Bleeding ◽

Gastrointestinal Endoscopy ◽

Upper Gastrointestinal Bleeding ◽

Upper Gastrointestinal Endoscopy ◽

Erosive Gastritis ◽

Cross Sectional ◽

Ulcer Disease ◽

Upper Gi ◽

North Eastern ◽

Upper Gastrointestinal

BACKGROUND Upper gastrointestinal bleeding (UGIB) is one of the common medical emergencies throughout the world that may require hospital admission and results in high patient morbidity and mortality. The presentation of UGI bleeding depends on the amount and location of haemorrhage. Upper gastrointestinal endoscopy (UGIE) is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. The present study has been carried out to evaluate the different aetiological causes of UGIB in a tertiary care centre in the North Eastern part of India and compare the same with other studies done globally. METHODS This was a hospital based observational study with cross sectional design carried out in the Department of Medicine at Tripura Medical College & DR BRAM Teaching Hospital, Agartala. Total 376 patients were selected for this study for over a period of 2 years from January 2017 to December 2018. Upper GI endoscopy was performed in all patients after hemodynamic stabilisation. Rockall scoring system was used in non-variceal cases to predict the mortality in patients with upper GI bleeding. RESULTS A total of 376 patients had endoscopy for UGIB which included 260 (69.1 %) males and 116 (30.9 %) females, and the mean age was 47.9 (± 17.0) years. The most common cause of UGIB was peptic ulcer disease (duodenal ulcer and gastric ulcer) consisting of 31.38 %, followed by erosive gastritis (23.94 %), oesophageal varix (11.17 %), portal hypertensive gastropathy (10.64 %), duodenitis (8.51 %). Gastrointestinal malignancy (gastric and oesophageal cancers) was reported in 3.98 % and rare causes of UGIB were Mallory-Weiss syndrome (1.86 %), and esophagitis (1.60 %). Among them 4.26 % of the patients had normal endoscopy findings. CONCLUSIONS In the present study, peptic ulcer disease was the most common cause of upper gastrointestinal bleeding, followed by erosive gastritis. Rockall score of more than 4 was numerically associated with increased incidence of mortality. KEYWORDS Upper Gastrointestinal Bleeding (UGIB), Upper Gastrointestinal Endoscopy (UGIE

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