scholarly journals Complete Rockall score in predicting outcomes in acute upper gastrointestinal bleeding

2018 ◽  
Vol 14 (4) ◽  
pp. 178-183
Author(s):  
Kush Raj Dewan ◽  
Bhanumati Saikia Patowary ◽  
Subash Bhattarai ◽  
Gaurav Shrestha
Keyword(s):  
Medical Emergency ◽  
Gi Bleeding ◽  
Medical Sciences ◽  
Median Hospital Stay ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleed ◽  
Rockall Score ◽  
Upper Gastrointestinal

Background: Acute upper GI bleeding is a common medical emergency with a hospital mortality of approximately 10%. Higher mortality rate is associated with rebleeding. Complete Rockall scoring system identifies patients at higher risk of rebleed and mortality. Methods: This is a descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to December 2014. It included 200 patients at random presenting with manifestations of UGI bleed. Complete Rockall score was calculated in each patient and its correlation with mortality and rebleed was determined. Scores of >5 has been considered as one category as it comprises of patients with very high risks and scores of 0-4 as another category of low or lesser risks for the purpose of comparison of different risk factors. Results: Males were predominant (71%). Age ranged from 14 to 90 years, mean being 50.43+17.75 years. At presentation 110 patients (55%) had both hematemesis and malena, 56 patients (28%) had only malena and 34 patients (17%) had only hematemesis. Shock was detected in 21%, severe anemia and high blood urea were found in 31% and 41% respectively. Median hospital stay was 6.5+3.10 days.  Comorbidities were present in 83.3%. Complete Rockall score ranged from 0 to 9, mean being 4.30+2.19. One hundred and thirteen (56.5%) had complete Rockall score <4 and 87 (43.5%) >5. Rebleeding was found in 16 (8%) patients. One hundred and eighty eight patients (94%) recovered and discharged from the hospital and 12 patients (6%) expired. The correlations between high Rockall scores (>5) and the occurrence of rebleeding  (p=0.001) and mortality (p=0.001) were statistically significant. Conclusion: Acute Upper GI bleeding is a medical emergency. Predictors of mortality in this series were high complete Rockall score >5, esophageal varices with Child Pugh score C,  massive initial bleed as well as rebleed and multiple comorbidities. Keywords:  acute upper gastrointestinal  bleed, complete Rockall score, comorbiditis, rebleed, mortality        

scholarly journals Giant Left Atrium - A Rare Case of Acute Upper Gastrointestinal Bleeding

2016 ◽  
Vol 54 (201) ◽  
pp. 40-42
Author(s):  
Khus Raj Dewan ◽  
Bhanumati Saikia Patowary ◽  
Subash Bhattarai
Keyword(s):  
Left Atrium ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Emergency ◽  
Oesophageal Varices ◽  
Gi Bleeding ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Giant Left Atrium ◽  
Upper Gastrointestinal

Acute upper GI bleeding is a common medical emergency with a hospital mortality of approximately10%. Non variceal UGI bleeding is the most common cause followed by oesophageal varices. Variousrare causes have been described in the literature but there are very few cases of giant left atriumleading to oesophageal erosion and causing upper GI bleeding. We are presenting a case of rheumaticvalvular heart disease with giant left atrium who presented in our department with acute upper GIbleeding. Keywords: giant left atrium;oesophgeal erosion; upper GI bleeding. | PubMed

scholarly journals A Study of Clinical and Endoscopic Profile of Acute Upper Gastrointestinal Bleeding

2015 ◽  
Vol 12 (1) ◽  
pp. 21-25 ◽  
Author(s):  
KR Dewan ◽  
BS Patowary ◽  
S Bhattarai
Keyword(s):  
Gastrointestinal Bleeding ◽  
Scoring System ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Emergency ◽  
Ulcer Disease ◽  
Gastrointestinal Bleed ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleed ◽  
Rockall Score ◽  
Upper Gastrointestinal

Backgroud Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. Higher mortality rate is associated with rebleeding. Rockall scoring system identifies patients at higher risk of rebleed and mortality.Objective To study the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome.Method This is a prospective, descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to January 2013. It included 120 patients at random presenting with manifestations of upper gastrointestinal bleed. Their clinical and endoscopic profiles were studied. Rockall scoring system was used to assess their prognosis.Result Males were predominant (75%). Age ranged from 14 to 88 years, mean being 48.76+17.19. At presentation 86 patients (71.7%) had both hematemesis and malena, 24 patients (20%) had only malena and 10 patients (8.3%) had only hematemesis. Shock was detected in 21.7%, severe anemia and high blood urea were found in 34.2% and 38.3% respectively. Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices (47.5%), peptic ulcer disease (33.3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%). Median hospital stay was 7.28+3.18 days. Comorbidities were present in 43.3%. Eighty six patients (71.7%) had Rockall score < 5 and 34 (28.3%) had >6. Five patients (4.2%) expired. Risk factors for death being massive rebleeeding, comorbidities and Rockall score >6.Conclusion Acute Upper Gastrointestinal bleeding is a medical emergency. Mortality is associated with massive bleeding, comorbidities and Rockall score >6. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.Kathmandu University Medical Journal Vol.12(1) 2014: 21-25

Optimal timing of vitamin K antagonist resumption after upper gastrointestinal bleeding

2017 ◽  
Vol 117 (03) ◽  
pp. 491-499 ◽  
Author(s):  
Niklas Wallvik ◽  
Joakim Eriksson ◽  
Jonas Höijer ◽  
Matteo Bottai ◽  
Margareta Holmström ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Bleeding Event ◽  
Optimal Timing ◽  
Thromboembolic Events ◽  
Gi Bleeding ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Increased Risk ◽  
Upper Gastrointestinal

SummaryThe optimal timing of vitamin K antagonists (VKAs) resumption after an upper gastrointestinal (GI) bleeding, in patients with continued indication for oral anticoagulation, is uncertain. We included consecutive cases of VKA-associated upper GI bleeding from three hospitals retrospectively. Data on the bleeding location, timing of VKA resumption, recurrent GI bleeding and thromboembolic events were collected. A model was constructed to evaluate the ‘total risk’, based on the sum of the cumulative rates of recurrent GI bleeding and thromboembolic events, depending on the timing of VKA resumption. A total of 121 (58 %) of 207 patients with VKA-associated upper GI bleeding were restarted on anticoagulation after a median (interquartile range) of one (0.2–3.4) week after the index bleeding. Restarting VKAs was associated with a reduced risk of thromboembolism (HR 0.19; 95 % CI, 0.07–0.55) and death (HR 0.61; 95 % CI, 0.39–0.94), but with an increased risk of recurrent GI bleeding (HR 2.5; 95 % CI, 1.4–4.5). The composite risk obtained from the combined statistical model of recurrent GI bleeding, and thromboembolism decreased if VKAs were resumed after three weeks and reached a nadir at six weeks after the index GI bleeding. On this background we will discuss how the disutility of the outcomes may influence the decision regarding timing of resumption. In conclusion, the optimal timing of VKA resumption after VKA-associated upper GI bleeding appears to be between 3–6 weeks after the index bleeding event but has to take into account the degree of thromboembolic risk, patient values and preferences.

scholarly journals Less frequent causes of upper gastrointestinal bleeding

2007 ◽  
Vol 54 (1) ◽  
pp. 119-123
Author(s):  
P. Sabljak ◽  
D. Velickovic ◽  
D. Stojakov ◽  
M. Bjelovic ◽  
K. Ebrahimi ◽  
...  
Keyword(s):  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Gastric Varices ◽  
Peptic Ulcers ◽  
Gi Bleeding ◽  
Watermelon Stomach ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Initial Control ◽  
Upper Gastrointestinal

Upper gastrointestinal (GI) bleeding represents emergency which despites modern advances in treatment still carry substantial mortality. Mortality remained relatively constant in the last 50 years at approximately 12%. Peptic ulcers remain the most common cause of upper GI bleeding and account approximately 50% of all cases. Next leading causes are esophageal and gastric varices, and gastroduodenal erosions. Mallory Weiss tears, angiodysplasia and gastric antral vascular ectasia (GAVE)-Watermelon stomach are less frequent but important causes of upper GI bleeding that contribute substantially to the overall morbidity and mortality. Recognition of such lesions is crucial to provide effective hemostasis. In most cases endoscopic therapy is procedure of choice which significantly improved the outcome of patients. In cases where endoscopic hemostasis is not effective, or patients rebleed after initial control surgical therapy may be required. This article will review recent advances in diagnosis and therapy of upper GI bleeding caused by Mallory Weiss tears, angiodysplasia or Watermelon stomach.

scholarly journals Upper GI Endoscopy in Children: An Experience from Bangabandhu Sheikh Mujib Medical University (BSMMU)

2017 ◽  
Vol 40 (1) ◽  
pp. 17-20
Author(s):  
Md Wahiduzzaman Mazumder ◽  
Md Rukunuzzaman ◽  
Atiar Rahman ◽  
SM Baqui Billah ◽  
Kaniz Sultana ◽  
...  
Keyword(s):  
Esophageal Varices ◽  
Common Finding ◽  
Gi Bleeding ◽  
Gi Endoscopy ◽  
Upper Gi Bleeding ◽  
Endoscopic Findings ◽  
Upper Gi ◽  
Post Procedure ◽  
Upper Gi Endoscopy ◽  
Upper Gastrointestinal

Background: Upper gastrointestinal (UGI) endoscopy is a safe and sensitive investigation in the diagnosis of upper gastrointestinal diseases. There is limited study on paediatric upper GI endoscopy in our country. This study was done only in BSMMU, a tertiary care health facility of Bangladesh.Objectives: The aim of the study was to find out the indications, common endoscopic findings and immediate post procedure complication of UGI endoscopy in children.Methods: This is a retrospective analysis of 100 patients from August 2013 to October 2014. The indications for UGI endoscopy, common endoscopic findings and immediate post procedure complications were collected from case recording &were analyzed.Results: The commonest indication was upper GI bleeding in the form of hematemesis with or without melenae (41%). The most common finding was esophageal varices (49%). Less common findings were esophagitis, gastritis & gastro-duodenal ulcer. There was no post procedure complication.Conclusion: In the study, the commonest indication for Pediatric UGI endoscopy was upper GI bleeding and the commonest endoscopic abnormality was esophageal varices. No immediate post procedure complication was noted in the study.Bangladesh J Child Health 2016; VOL 40 (1) :17-20

Recent advances in the management of acute upper gastrointestinal bleeding

2020 ◽  
Vol 18 (6) ◽  
pp. 16-23
Author(s):  
Mikaeil Mirzaali ◽  
Ana Carmona Carrasco ◽  
Pradeep Mundre ◽  
Ruchit Sood
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Emergency ◽  
Red Blood Cell Transfusion ◽  
Endoscopic Management ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Suboptimal Care ◽  
Treatment Considerations ◽  
Rockall Score ◽  
Upper Gastrointestinal

Upper gastrointestinal bleeding is a common medical emergency with associated significant morbidity and mortality. There are multiple published national and international guidelines on the management of acute upper gastrointestinal bleeding (AUGIB). However, the 2015 National Confidential Enquiry into Patient Outcome and Death group (NCEPOD) report identified several areas of concern regarding suboptimal care. This article discusses the latest evidence and guidance on the pre-endoscopic, endoscopic and post-endoscopic management of patients presenting with AUGIB. AUGIB should be assessed for risk stratification using a validated score, such as the Glasgow-Blatchford Score, Rockall Score or AIMS65. Treatment considerations include the optimum threshold for red blood cell transfusion, as well as the reintroduction of antithrombotic agents. Novel endoscopic therapies include haemostatic powder spray, over-the-scope clips, ultrasound doppler probes and self-expandable oesophageal stents.

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

1970 ◽  
Vol 8 (2) ◽  
pp. 208-211 ◽  
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

scholarly journals Esophageal Hiatal Hernia: A Possible Scintigraphic Feature

2021 ◽  
Author(s):  
Saeed Farzanefar ◽  
Mahya Zarei ◽  
Arefeh Mirzabeigi ◽  
Mehrshad Abbasi
Keyword(s):  
Gastric Emptying ◽  
Hiatal Hernia ◽  
Supporting Evidence ◽  
Gi Bleeding ◽  
Esophageal Hiatal Hernia ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Paraesophageal Hiatal Hernia ◽  
Solid Liquid ◽  
Upper Gastrointestinal

An 81-year-old woman with symptoms of upper Gastrointestinal (GI) obstruction but with no supporting evidence for obstruction in previous endoscopies was studied with a solid-liquid gastric emptying scintigraphic examination. There was evidence of accumulation of the tracer in a part of the stomach in the thorax before filling the stomach. The paraesophageal hiatal hernia was suspected. The diagnosis was not confirmed by other modalities and the patient passed away after upper GI bleeding a month later.

scholarly journals Clinical Profile and Endoscopic Findings in Patients with Upper Gastrointestinal Bleed Attending a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2020 ◽  
Vol 58 (226) ◽  
Author(s):  
Subash Bhattarai
Keyword(s):  
Upper Gastrointestinal Bleeding ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Medical Emergency ◽  
Sectional Study ◽  
Cross Sectional ◽  
Gastrointestinal Bleed ◽  
Upper Gastrointestinal Bleed ◽  
Rockall Score ◽  
Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is a common acute medical emergency. Endoscopyis the gold standard diagnostic and therapeutic tool in the management of upper gastrointestinalbleed. This study was undertaken to address the clinical profile, endoscopic profile, and outcomes inpatients with upper gastrointestinal bleed. Methods: A descriptive cross-sectional study was conducted in a tertiary care teaching hospital inGandaki Province, Nepal from January 2018 to December 2019 after obtaining ethical clearancefrom Institutional Review Committee (MEMG/IRC/291/GA) and informed consent fromthe patient or patient relatives. The sample size was calculated. Six hundred and sixty patientswith upper gastrointestinal bleed were included in the study. Data entry was done in StatisticalPackages for the Social Sciences version 20. Results: Peptic ulcers and ruptured oesophageal varices are the common aetiologies of uppergastrointestinal bleed. Inpatient mortality was seen in 98 (14.8 %) patients. Upper gastrointestinalbleed of variceal etiology presents with a higher Rockall score and has more chances of rebleedingand has higher mortality than those with non-variceal aetiologies. Bad prognostic factors wererebleeding, variceal etiology, and comorbidities including cirrhotic and Rockall score > 6. Conclusions: Upper gastrointestinal bleeding is a common acute medical emergency. Early uppergastrointestinal endoscopy preferably within 24 hours is recommended for diagnosis, timelyintervention, and management of the patients with an upper gastrointestinal bleed that helps inreducing morbidity and mortality.    

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