OUTCOME OF UPPER GASTROINTESTINAL BLEEDING AS PREDICTED BY TRANSFUSION REQUIREMENTS AND APACHE-II SCORE

BACKGROUND: Performance of endoscopy within 24 h is recommended for patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). It is unknown whether performing endoscopy early within this 24 h window is beneficial for clinically high-risk patients.METHODS: A retrospective review was performed to identify patients presenting to two tertiary care centres with ANVUGIB and either systolic blood pressure lower than 100 mmHg or heart rate greater than 100 beats/min on presentation between 1999 and 2004. Patients receiving endoscopy within 6 h (rapid endoscopy [RE]) were compared with patients undergoing endoscopy between 6 h and 24 h (early endoscopy [EE]). The primary outcome measure was the development of any adverse bleeding outcome (rebleeding, surgery for control of bleeding, in-hospital mortality or readmission within 30 days for ANVUGIB).RESULTS: There were 169 patients who met the entry criteria (77 RE patients and 92 EE patients). There was no significant difference in the development of any adverse bleeding outcomes between RE and EE patients (25% RE versus 23% EE, difference between groups 2%, 95% CI −9% to 13%). Transfusion requirements and length of hospital stay also did not differ between the comparator groups. RE was not associated with fewer adverse outcomes, even after adjusting for confounders.CONCLUSION: For clinically high-risk ANVUGIB patients, performing endoscopy within 6 h of presentation is no more effective than performing endoscopy between 6 h and 24 h after presentation. The role of RE in high-risk ANVUGIB patients requires further delineation in a prospective fashion.

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Time to Endoscopy and Outcomes in Upper Gastrointestinal Bleeding

Canadian Journal of Gastroenterology ◽

10.1155/2009/604639 ◽

2009 ◽

Vol 23 (7) ◽

pp. 489-493 ◽

Cited By ~ 42

Author(s):

Nitin Sarin ◽

Neerav Monga ◽

Paul C Adams

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Morbidity And Mortality ◽

University Hospital ◽

Large Teaching Hospital ◽

Early Endoscopy ◽

Transfusion Requirements ◽

London Health ◽

The University ◽

Upper Gastrointestinal

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common problem associated with significant morbidity and mortality. Previous studies show that immediate endoscopies do not affect outcomes in patients; however, endoscopic interventions have evolved. The present retrospective review of endoscopies performed at a large teaching hospital assessed the timing of endoscopy with respect to the morbidity and mortality of UGIB.METHODS: Diagnostic billing codes were used to assess all inpatients of gastroenterologists at the University Hospital of the London Health Sciences Centre, London, Ontario, from July 2004 to June 2006, using a centralized data recording system. Time to endoscopy (within 6 h, 6 h to 24 h and beyond 24 h) were compared for the outcomes of mortality, need for surgery and transfusion requirements.RESULTS: From July 2004 to June 2006, there were 502 upper endoscopies performed for the indication of suspected UGIB and 375 for overt acute nonvariceal UGIB. Approximately 10% of cases revealed variceal bleeding. When comparing endoscopy within 6 h with endoscopy at 6 h to 24 h, there were no significant differences in mortality, need for surgery (OR 3.6 and 2.8, respectively, compared with endoscopy beyond 24 h) or transfusion requirements. Even when assessing the group that received endoscopic hemostasis, time to endoscopy was not associated with better outcomes. Multivariate analysis did not demonstrate any advantages for early endoscopy (less than 6 h) compared with endoscopy within 24 h.CONCLUSIONS: Most patients with acute gastrointestinal bleeding can be effectively managed with endoscopy within 24 h.

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Clinical Correlation Analysis of Complications in Elderly Patients with Sequelae of Stroke with Different Barthel Index in Tianjin Emergency Department

BioMed Research International ◽

10.1155/2021/6625440 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Xingzhen Zheng ◽

Haidong Wang ◽

Xiaolin Bian

Keyword(s):

Emergency Department ◽

Elderly Patients ◽

Barthel Index ◽

Upper Gastrointestinal Bleeding ◽

Severity Of Illness ◽

Decubitus Ulcer ◽

Apache Ii ◽

Apache Ii Score ◽

Stroke Patients ◽

Upper Gastrointestinal

Objective. The Barthel index (BI) is the most commonly used measure of poststroke disability. The purpose of this article is to explore the different complications and severity of the sequelae of elderly stroke patients with different BI in the emergency department, so as to provide a theoretical basis for strengthening the treatment of elderly patients with stroke sequelae. Methods. A retrospective study was adopted, and 1896 patients were divided into two groups according to the BI: 823 patients in the bedridden group ( BI ≤ 40 points ) and 1073 patients in the nonbedridden group ( BI > 40 points ). The type and number of complications and APACHE II score were compared between the two groups. Results. Compared with the two groups, pneumonia, renal insufficiency, respiratory failure, and decubitus ulcer in the bedridden group had a higher incidence, but the incidence of upper gastrointestinal bleeding and fractures in the nonbedridden group was significantly higher ( P < 0.05 ). The APACHE II score of the patients in the bedridden group was higher than that of the nonbedridden group, and they were critical ( P < 0.001 ). And the number of complications was higher than that in the nonbedridden group. Moreover, the BI was negatively correlated with the APACHE-II score and the number of complications, and the APACHE II score was positively correlated with the number of complications ( P < 0.001 ). Conclusion. Different complications and severity of illness occur in elderly patients with sequelae of stroke after different BI in the emergency department.

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Intravenous pantoprazole (IVP) and continuous infusion cimetidine (C) prevent upper gastrointestinal bleeding (UGIB) regardless of APSII score (APACHE II) in high risk intensive care unit (ICU) patients

Gastroenterology ◽

10.1016/s0016-5085(03)83170-0 ◽

2003 ◽

Vol 124 (4) ◽

pp. A625-A626 ◽

Cited By ~ 13

Author(s):

Mitchell Fink ◽

Robyn G. Karlstadt ◽

Robert T. Maroko ◽

Brian Field

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

High Risk ◽

Gastrointestinal Bleeding ◽

Continuous Infusion ◽

Upper Gastrointestinal Bleeding ◽

Apache Ii ◽

Icu Patients ◽

Score Apache ◽

Upper Gastrointestinal

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Recurrent Upper Gastrointestinal Bleeding from Isolated Gastric Varices as Primary Symptom of Myelofibrosis: A Case Report on Combining Interventional and Pharmacologic Treatment Options

Digestive Diseases ◽

10.1159/000518766 ◽

2021 ◽

Author(s):

Benjamin Giszas ◽

Marko Weber ◽

Florian H. Heidel ◽

Philipp A. Reuken

Keyword(s):

Portal Hypertension ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Treatment Options ◽

Primary Myelofibrosis ◽

Gastric Varices ◽

Janus Kinase ◽

Transfusion Requirements ◽

Isolated Gastric Varices ◽

Upper Gastrointestinal

Portal hypertension leads to pronounced venous collateralization and development of varices. Besides manifest liver cirrhosis, primarily left-sided portal hypertension is causal for the development of gastric varices. We present a case of a 36-year-old female patient with splenomegaly, underlying primary myelofibrosis, and detection of somatic Janus-kinase-2 driver-mutation JAK2V617F. Following first upper gastrointestinal bleeding, isolated gastric varices could be detected as a result of underlying left-sided portal hypertension. Within a few months, repeated life-threatening bleedings with transfusion requirements and frequent hospitalizations occurred. Despite multiple injections of cyanoacrylates, the proven therapy of choice, varices could not be stabilized. Combination of targeted JAK-inhibitor therapy in conjunction with the use of EUS-guided application of coils with subsequent cyanoacrylate injection resulted in acute and long-term bleeding control.

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