scholarly journals Approach to Upper Gastrointestinal Bleeding - When to Treat?

1990 ◽  
Vol 4 (9) ◽  
pp. 647-649
Author(s):  
P Rutgeerts
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Surgical Treatment ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Fatal Outcome ◽  
Ulcer Bleeding ◽  
Recurrent Bleeding ◽  
Life Threatening ◽  
Upper Gastrointestinal

Upper gastrointestinal bleeding from peptic ulcer is a life threatening emergency. Clinical risk factors for fatal outcome have been defined, and endoscopic predictors for rebleeding have been identified. Active ulcer bleeding at endoscopy carries an 80% chance of persistent or recurrent bleeding. A non bleeding visible vessel is associated with a 50% chance of rebleeding. These endoscopic lesions should be treated endoscopically. Failure to obtain definitive hemostasis endoscopically will necessitate emergency surgical treatment.

scholarly journals Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding – a single center experience

2017 ◽  
Vol 05 (11) ◽  
pp. E1159-E1164 ◽  
Author(s):  
Oscar Cahyadi ◽  
Markus Bauder ◽  
Benjamin Meier ◽  
Karel Caca ◽  
Arthur Schmidt
Keyword(s):  
Gastrointestinal Bleeding ◽  
Salvage Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Success ◽  
Treatment Algorithm ◽  
Endoscopic Hemostasis ◽  
Ulcer Bleeding ◽  
Recurrent Bleeding ◽  
Technical Success ◽  
Upper Gastrointestinal

Abstract Background and study aims TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB. Patients and methods Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods Results Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs. Conclusions TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an “add-on” therapy after unsuccessful hemostasis. However, rebleeding was frequent in this cohort and further studies are warranted to exactly define a treatment algorithm for TC-325 use.

W1912 Acute Non-Variceal Upper Gastrointestinal Bleeding in Israel 1995-2004: A Significant Decrease in Incidence, Related to a Decrease in Peptic Ulcer Bleeding

2008 ◽  
Vol 134 (4) ◽  
pp. A-732-A-733
Author(s):  
Tiberiu Hershcovici ◽  
Ziona Haklai ◽  
Ethel-Sherry Gordon ◽  
Joseph Zimmerman
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Ulcer Bleeding ◽  
Peptic Ulcer Bleeding ◽  
Upper Gastrointestinal

scholarly journals Significance of Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs in patients with bleeding from upper part of the gastrointestinal tract

2007 ◽  
Vol 64 (7) ◽  
pp. 445-448
Author(s):  
Gradimir Golubovic ◽  
Ratko Tomasevic ◽  
Biljana Radojevic ◽  
Aleksandar Pavlovic ◽  
Predrag Dugalic
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Ulcer Bleeding ◽  
Significant Difference ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
H Pylori ◽  
Upper Gastrointestinal

Background/Aim. Helicobacter pylori (H. pylori) infection and nonsteroidal anti-inflammatory drugs (NSAIDs) use are considered to be the most important risk factors having influence on the onset of bleeding gastroduodenal lesions. Whether there is an interaction between H. pylori infection and the use of NSAIDs in the development of peptic ulcer disease is still controversial. The aim of the present study was to evaluate the prevalence of NSAIDs use and H. pylori infection in patients presented with bleeding gastroduodenal lesions. Methods. During the period from January 2003 - December 2003 we prospectively obtained data of all the patients (n=106) presented with signs of upper gastrointestinal bleeding. All the patients were admitted to the intensive care unit, with the endoscopy performed within 12 hours after admission. Histologic analysis was used for the detection of H. pylori infection. The NSAIDs and aspirin use data were obtained by anamnesis. Results. The results of our study revealed that the most common sources of upper gastrointestinal bleeding were duodenal (57 patients, 53.77%) and ventricular (36 patients, 33.96%) ulcers. The majority of the examined cases were associated with both H. pylori infection and NSAIDs use. A statistically significant difference among the studied groups of patients was proven. Conclusion. The majority of bleeding gastroduodenal lesions were associated with the coexistence of H. pylori infection and NSAIDs use, while their independent influences were statistically less important. Eradication of H. pylori infection in patients using NSAIDs might prevent upper gastrointestinal hemorrhage and reduce peptic ulcer bleeding risk. .

scholarly journals Case Report: Peptic ulcer disease following short-term use of nonsteroidal anti-inflammatory drugs in a 3-year-old child

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 419
Author(s):  
Alin Dumitru Ciubotaru ◽  
Carmen-Ecaterina Leferman
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Peptic Ulcer Disease ◽  
Upper Gastrointestinal Bleeding ◽  
Short Term ◽  
Ulcer Disease ◽  
Coffee Ground ◽  
Inflammatory Drugs ◽  
Upper Gastrointestinal

Background: Peptic ulcer disease (PUD) affects 1-2 per 1000 people annually in the USA, the UK and Europe, and occurs less frequently in children than in adults. PUD in children occurs mainly during the second decade of development. Among risk factors, nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used to manage acute febrile illness or pain in healthy children, is rarely reported to lead to PUD and upper gastrointestinal bleeding. Case presentation: We present a rare case of upper gastrointestinal bleeding following a low dose ibuprofen treatment in a 3-year-old female. The patient with a family history of peptic ulcer was admitted for fever, coffee-ground vomiting and abdominal pain. The clinical examination revealed an altered general health status with a distended and mildly tender abdomen moving normally with respiration as well as normal stool. The initial laboratory test indicated anemia with reticulocytosis. During the first hours of hospitalization, the patient had a second episode of coffee-ground vomiting. An upper digestive endoscopy with biopsy was performed in the following six hours revealing a non-bleeding gastric ulcer at 2 cm from pylorus. Helicobacter pylori testing was negative. The patient was treated with a proton pump inhibitor (esomeprazole 10 mg/day) for 2 months. There were no further gastrointestinal symptoms and hemoglobin values returned to normal, indicating resolution of her gastrointestinal bleeding. Conclusion: The short-term utilization of NSAIDs in the appropriate dosage can lead to PUD, and considering the risk factors before administration can lead to an appropriate management.

scholarly journals Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience

2018 ◽  
Vol 06 (12) ◽  
pp. E1439-E1444 ◽  
Author(s):  
Amol Agarwal ◽  
Petros Benias ◽  
Olaya Brewer Gutierrez ◽  
Vivien Wong ◽  
Yuri Hanada ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Case Series ◽  
Endoscopic Hemostasis ◽  
Recurrent Bleeding ◽  
Technical Success ◽  
Endoscopic Suturing ◽  
Ulcer Disease ◽  
Upper Gastrointestinal

Abstract Background and study aims Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown. Patients and methods This is an international case series of patients who underwent endoscopic suturing for bleeding PUD. Primary outcome was rate of immediate hemostasis and rate of early rebleeding (within 72 hours). Secondary outcomes included technical success, delayed rebleeding (> 72 hours), and rate of adverse events (AEs). Results Ten patients (mean age 66.7 years, 30 % female) were included in this study. Nine (90 %) had prior failed endoscopy hemostasis with an average of 1.4 ± 0.7 (range 1 – 3) prior endoscopic sessions. Forrest classification was Ib in 5 (50 %), IIa in 3 (30 %), IIb in 1(10 %), and IIc in 1 (10 %). Mean suturing time was 13.4 ± 5.6 (range 3.5 to 20) minutes. Technical success was 100 %. Rate of immediate hemostasis was 100 % and rate of early rebleeding was 0 %. Mean number of sutures was 1.5 (range, 1 – 4). No AEs were observed. Delayed recurrent bleeding was not observed in any cases after a median of 11 months (range 2 – 56), after endoscopic suturing. Conclusions Oversewing of a bleeding or high-risk ulcer using endoscopic suturing appears to be a safe and effective method for achieving endoscopic hemostasis. It may be considered as rescue endoscopic therapy when primary endoscopic hemostasis fails to control the bleeding or when hemorrhage recurs after successful control of bleeding.

scholarly journals Case Report: Peptic ulcer disease following short-term use of nonsteroidal anti-inflammatory drugs in a 3-year-old child

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 419
Author(s):  
Alin Dumitru Ciubotaru ◽  
Carmen-Ecaterina Leferman
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Peptic Ulcer Disease ◽  
Upper Gastrointestinal Bleeding ◽  
Short Term ◽  
Ulcer Disease ◽  
Coffee Ground ◽  
Inflammatory Drugs ◽  
Upper Gastrointestinal

Background: Peptic ulcer disease (PUD) affects 1-2 per 1000 people annually in the USA, the UK and Europe, and occurs less frequently in children than in adults. PUD in children occurs mainly during the second decade of development. Among risk factors, nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used to manage acute febrile illness or pain in healthy children, is rarely reported to lead to PUD and upper gastrointestinal bleeding. Case presentation: We present a rare case of upper gastrointestinal bleeding following a low dose ibuprofen treatment in a 3-year-old female. The patient with a family history of peptic ulcer was admitted for fever, coffee-ground vomiting and abdominal pain. The clinical examination revealed an altered general health status with a distended and mildly tender abdomen moving normally with respiration as well as normal stool. The initial laboratory test indicated anemia with reticulocytosis. During the first hours of hospitalization, the patient had a second episode of coffee-ground vomiting. An upper digestive endoscopy with biopsy was performed in the following six hours revealing a non-bleeding gastric ulcer at 2 cm from pylorus. Helicobacter pylori testing was negative. The patient was treated with a proton pump inhibitor (esomeprazole 10 mg/day) for 2 months. There were no further gastrointestinal symptoms, hemoglobin values returned to normal and the follow-up endoscopy confirmed the healing of the ulcer. Conclusion: The short-term utilization of NSAIDs in the appropriate dosage can lead to PUD, and considering the risk factors before administration can lead to an appropriate management.

OC.06.6 RISK FACTORS FOR MORTALITY FROM NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING IN PATIENTS ALREADY HOSPITALIZED FOR ANOTHER CONDITION

2013 ◽  
Vol 45 ◽  
pp. S70
Author(s):  
R. Marmo ◽  
M. Koch ◽  
L. Cipolletta ◽  
E. Grossi ◽  
M.A. Bianco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

scholarly journals Epidemiology of upper gastrointestinal bleeding and Helicobacter pylori infection: review of 3,488 Thai patients

2017 ◽  
Vol 9 (1) ◽  
pp. 87-93
Author(s):  
Sakolwan Suchartlikitwong ◽  
Kamolyut Lapumnuaypol ◽  
Rungsun Rerknimitr ◽  
Duangporn Werawatganon
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Helicobacter Pylori Infection ◽  
Exclusion Criteria ◽  
Common Causes ◽  
Mucosal Lesions ◽  
H Pylori ◽  
Upper Gastrointestinal

Abstract Background The current epidemiology of upper gastrointestinal bleeding (UGIB) in Thailand is poorly understood and the reported prevalence of Helicobacter pylori infection is outdated. Objectives To investigate the etiologies of UGIB and prevalence of H. pylori infection in Thailand, including its association with UGIB. Methods We retrieved information regarding patients attending the endoscopic unit of King Chulalongkorn Memorial Hospital from June 2007 to January 2013. A database search using keywords “upper gastrointestinal bleeding” and “iron deficiency” was used. From 4,454 diagnoses, after exclusion criteria, 3,488 patients (2,042 male (58.5%) and 1,446 female (41.5%); mean age 63.3 ± 15.94 years, range 13–103 years) were included. Results The three most common causes of UGIB were peptic ulcer (38.2%), nonulcer-mucosal lesions (23.4%), and esophageal-related causes (20.4%). The 5 year-incidence of H. pylori was 25%–30%. The overall prevalence was 27%. The prevalence of H. pylori infection was found to decrease with age from 43.8% at <40 years to 21.7% at >79 years old. H. pylori infection was significantly associated with duodenal and gastroduodenal ulcers. Cirrhosis and nonulcer-mucosal lesions were significantly unrelated to H. pylori infection. Patients with concurrent cirrhosis with peptic ulcer were found to be negative for H. pylori infection. Conclusion Peptic ulcer is the leading cause of UGIB in Thailand. However, its incidence is declining. Patients who presented to hospital with UGIB were older, compared with those a decade ago. H. pylori infection plays an important role in UGIB and its incidence was stable during the past 5 years.

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.

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