Impact of the COVID-19 Pandemic on Acute Upper Gastrointestinal Bleeding in Xingtai City

Background and Aims. The coronavirus disease 2019 (COVID-19) has severely impacted the daily practice of gastrointestinal endoscopy worldwide. Most endoscopy centers in China were shut down in late January 2020. We investigated the impact of the shutdown on acute upper gastrointestinal bleeding (AUGIB) events in Xingtai City, Hebei Province, China. Methods. A web-based survey collected information on gastroscopy workload and AUGIB events. The study period was from 4 weeks before to 4 weeks after lockdown initiation in Xingtai City. Fourteen public gastrointestinal endoscopy centers performing emergency endoscopies were contacted via e-mail to collect weekly emergency gastroscopy volumes and the number of AUGIB events. AUGIB was defined as recent melena, hematemesis, or both, with an endoscopically visible source of bleeding. Results. Twelve (85.7%) of the 14 surveyed gastrointestinal endoscopy centers in the city- and county-level hospitals responded. Altogether, 4,045 and 1,077 gastroscopy procedures were performed 4 weeks before and after lockdown initiation (73.4% reduction), respectively. Peptic ulcer-related AUGIB and variceal AUGIB events showed a 58.5% and 52.9% decline, respectively, compared with pre-COVID-19 data. Although the absolute number of AUGIB events decreased during the pandemic (from 149 to 66), the likelihood of detecting AUGIB during gastroscopy increased (3.68% (pre-COVID-19 period) versus 6.13% (COVID-19 period); P < 0.05 ). Conclusion. The COVID-19 pandemic resulted in a considerable reduction in gastroscopy workload and AUGIB events; however, the likelihood of detecting AUGIB increased significantly during gastroscopies.

Download Full-text

Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2016/5610838 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Kyle J. Fortinsky ◽

Myriam Martel ◽

Roshan Razik ◽

Gillian Spiegle ◽

Zane R. Gallinger ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Limited Data ◽

Web Based ◽

Initial Management ◽

Acute Upper Gastrointestinal Bleeding ◽

Clinical Vignettes ◽

Red Blood Cell Transfusions ◽

Artery Disease ◽

Upper Gastrointestinal

Introduction. There is limited data evaluating physician transfusion practices in patients with acute upper gastrointestinal bleeding (UGIB).Methods. A web-based survey was sent to 500 gastroenterologists and hepatologists across Canada. The survey included clinical vignettes where physicians were asked to choose transfusion thresholds.Results. The response rate was 41% (N=203). The reported hemoglobin (Hgb) transfusion trigger differed by up to 50 g/L. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean Hgb of 86.7 g/L versus 71.0 g/L;p<0.001). Many clinicians (24%) reported transfusing a hemodynamically unstable patient at a Hgb threshold of 100 g/L and the majority (57%) are transfusing two units of RBCs as initial management. Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L;p<0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L;p<0.01) were transfused more liberally than healthy patients. Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge.Conclusions. The transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB.

Download Full-text

Mo1281 – The Impact of Urgent Upper Endoscopy on Clinical Outcomes in Patients with Acute Upper Gastrointestinal Bleeding

Gastroenterology ◽

10.1016/s0016-5085(19)38796-7 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-745

Author(s):

Uayporn Kaosombatwattana ◽

Manassawee Chakpaisan ◽

Julajak Limsrivilai ◽

Nonthalee Pausawasdi ◽

Phunchai Charatcharoenwitthaya ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Clinical Outcomes ◽

Upper Gastrointestinal Bleeding ◽

Upper Endoscopy ◽

Acute Upper Gastrointestinal Bleeding ◽

The Impact ◽

Upper Gastrointestinal

Download Full-text

Pre-Endoscopy Use of Proton Pump Inhibitor Intravenous Bolus Dosing in Hemodynamically Stable Patients With Suspected Upper Gastrointestinal Bleeding: Results of a Pharmacist-Managed Hospital Protocol to Reduce Continuous Infusion Pantoprazole Use

Hospital Pharmacy ◽

10.1177/00185787211046854 ◽

2021 ◽

pp. 001857872110468

Author(s):

Andrew C. Faust ◽

Lauren Schwaner ◽

Drew Thomas ◽

Shilpa Sannapanei ◽

Mark Feldman

Keyword(s):

Gastrointestinal Bleeding ◽

Phase I ◽

Phase Ii ◽

Proton Pump ◽

Upper Gastrointestinal Bleeding ◽

Tertiary Care ◽

Intervention Group ◽

Acute Upper Gastrointestinal Bleeding ◽

The Impact ◽

Upper Gastrointestinal

Background: Guidelines for acute upper gastrointestinal bleeding (UGIB) recommend use of proton pump inhibitors (PPI) administered by continuous IV infusion (CI). Although data suggest comparable outcomes with CI and IV push (IVP) dosing post-endoscopy, there are limited data to support IVP PPI as the pre-endoscopy regimen. Objective: To evaluate the impact of a pharmacist-managed protocol for reducing PPI CIs and substitution of PPI IVP dosing in hemodynamically stable patients with suspected acute upper gastrointestinal bleeding (UGIB) prior to endoscopic intervention. Design, Setting, and Participants: Retrospective study; Tertiary-care community teaching hospital; Hemodynamically stable adults with confirmed or suspected UGIB. Hemodynamic stability was defined as a systolic blood pressure >90 mmHg, heart rate <100 beats, mean arterial pressure >65 mmHg, and no requirement for vasopressors. Intervention: All iterations of treatment recommendations encouraged an initial pantoprazole 80 mg IVP dose. In the pre-intervention group, patients were then treated at the at the provider’s discretion with the majority receiving CI pantoprazole. After implementation of the original protocol ( Phase I), all hemodynamically stable patients were allowed 1 bag of CI pantoprazole (80 mg infused over 10 hours) before being transitioned by the pharmacist to pantoprazole 40 mg IVP every 12 hours. After internal analysis, the protocol was revised to allow patients to be immediately transitioned to IVP dosing without an initial CI ( Phase II). Main Outcome: Incidence of continued bleeding or re-bleeding within 7 days of initial PPI dose. Results: A total of 325 patients were included across all 3 study phases. The median number of CI bags per patient was reduced from 4 pre-intervention, to 1.5 in phase I, and to 0 in phase II ( P < .001). The primary endpoint of continued bleeding or re-bleeding within 7 days was similar across all 3 groups (5.0% vs 6.5% vs 5.2%, P = .92). Mean intravenous pantoprazole costs were reduced by $21.73/patient. Conclusions: Movement toward preferential use of IVP PPI prior to endoscopy for hemodynamically stable patients with confirmed or suspected UGIBs resulted in similar rates of continued bleeding or re-bleeding and generated modest cost savings. These findings warrant further investigation.

Download Full-text