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

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 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.    

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 Histoacryl glue injection without lipiodol dilution and post sclerotherapy bleeding; prevalence among patients with upper GIT bleed.

2020 ◽  
Vol 27 (06) ◽  
pp. 1182-1186
Author(s):  
Muhammad Ayub ◽  
Sagheer Hussain ◽  
Salman Ahmed
Keyword(s):  
Liver Cirrhosis ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Gastric Varices ◽  
Recurrent Bleeding ◽  
Endoscopic Sclerotherapy ◽  
Ulcer Disease ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Glue Injection ◽  
Upper Gastrointestinal

Objectives: To determine role of histoacryl injection in preventing upper acute upper gastrointestinal bleeding. Study Design: Prospective Study. Setting: Gastroenterology ward of DHQ Teaching Hospital Gujranwala. Period: One year from 1st September 2017 to 31st August 2018. Material & Methods: Patients presented to the study hospital having upper gastrointestinal bleeding of acute onset due to gastric varices bleeding were included in this study. All other cases having upper GIT bleeding due to other causes like peptic ulcer disease, Mallory weise syndrome, gastritis or esophageal varices were not included in this study. Both male and female patients were included irrespective of their age. Hemostasis in these cases was achieved by endoscopic sclerotherapy using histoacryl glue (N-butyl-2-cyanoacrylate) injection without lipoidal dilution. After first session of injection patients were called on follow up after 5 days and they were assessed for recurrent GIT bleeding and treatment failure. All data was documented on a predesigned performa. Frequencies and percentage were calculated and results were expressed in tabular form and graphs. Results: Total 80 cases were studied including 56% male and 44% female cases. Endoscopic sclerotherapy using histoacryl injection proved successful in 87.5% cases and recurrent bleeding occurred in 12.5% cases. Minimum age of patients was 25 years and maximum age 70 years with mean age of 45 years. Total 450 cases presented in study institution with Upper GIT bleeding during study period and causes among them were liver cirrhosis in 92% cases, peptic ulcer disease in 4% cases, Malloryweise Syndrome in 2.5% and gastritis in 1.5% cases. In our study group cause of gastric varices was liver cirrhosis due to viral hepatitis in 73% cases and alcoholic hepatitis in 27% cases. After single session of endoscopic histoacryl glue injection to 80 cases, no bleeding occurred after 5 days in 71(88.7%) cases, recurrent bleeding occurred within 5 days in 9(11.2%) cases.  Two cases died due to massive recurrent bleeding and mortality rate was 2.5%. Conclusion: Endoscopic sclerotherapy using Histoacryl injection is very successful treatment for acute upper gastrointestinal bleeding with very low recurrence rate of bleeding and low mortality rate.

scholarly journals The Current Portrayal of Non-Variceal Upper Gastrointestinal Bleeding in a Portuguese Tertiary Center

2021 ◽  
pp. 1-6
Author(s):  
Daniela Falcão ◽  
Joana Alves da Silva ◽  
Tiago Pereira Guedes ◽  
Mónica Garrido ◽  
Inês Novo ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Hospital ◽  
Outcome Data ◽  
Surgical Interventions ◽  
Ulcer Disease ◽  
Tertiary Center ◽  
Rockall Score ◽  
Therapeutic Tools ◽  
Upper Gastrointestinal

<b><i>Introduction:</i></b> Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important healthcare problem whose epidemiology and outcomes have been changing throughout the years. The main goal of this study was to characterize the current demographics, etiologies, and risk factors of NVUGIB. <b><i>Methods:</i></b> Analysis of clinical, endoscopic, and outcome data from patients who were admitted for NVUGIB between January 2016 and January 2019 in an emergency department of a tertiary hospital center. <b><i>Results:</i></b> A total of 522 patients were included, with a median age of 71 years, mainly men, with multiple comorbidities. Most patients were directly admitted, while the others were transferred from other hospitals. Peptic ulcer disease was the most common cause of NVUGIB and it was followed by tumor bleeding. Esophagogastroduodenoscopy was performed within &#x3c;12 h after hospital admission in 51.9%. In-hospital rebleeding occurred in 6.9% and overall mortality was 4.2%. Transferred patients had superior Glasgow-Blatchford score (GBS), required more blood transfusion, endoscopic and surgical interventions, and presented higher rebleeding rate, with similar mortality. Complete Rockall score (CRS) and GBS were predictors of endoscopic therapy. Surgery need was only related to CRS. Patients who rebled had superior pre-endoscopic Rockall score (RS), CRS, and GBS. Mortality was increased in patients with higher RS and CRS. <b><i>Discussion/Conclusion:</i></b> Ageing and increasing comorbidities have not been related to worse outcomes in NVUGIB. These findings seem to be the consequence of the correct use of both diagnostic and therapeutic tools in an organized and widely accessible healthcare system.

scholarly journals Upper GI bleeding: Causes, morbidity and mortality in admitted patients at Tertiary Care Hospital of Karachi.

2019 ◽  
Vol 26 (11) ◽  
pp. 1916-1924
Author(s):  
Naresh Kumar Seetlani ◽  
Khalid Imran ◽  
Pooja Deepak ◽  
Fizza Tariq ◽  
Daniyal Mirza ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Peptic Ulcer Disease ◽  
Scoring System ◽  
Upper Gastrointestinal Bleeding ◽  
Morbidity And Mortality ◽  
Mortality Data ◽  
Ulcer Disease ◽  
Variceal Bleed ◽  
Upper Gastrointestinal

Objectives: Acute upper gastrointestinal bleed is one of the most common emergencies. Despite advancement in the medical field, gastrointestinal bleeding still carries significant mortality and fiscal burden on healthcare system. At present, limited data is available on the predictors of morbidity and mortality associated with acute upper gastrointestinal bleeding in our part of the country. Study Design: Descriptive analytical study. Setting: Medical wards of Civil Hospital Karachi. Period: From January 2018 to June 2018. Material and Methods: 260 patients of 12 years and above with complaint of upper gastrointestinal bleeding. After hemodynamic stabilization, patients were referred to undergo esophago-gastro-duodenoscopy at the endoscopy suite of the hospital. Their personal data and endoscopic findings were recorded after obtaining a written consent. The patients were followed for 2 weeks to document the factors leading to their morbidity and mortality. We used Rockall scoring system to identify risk of patient mortality. Data collected was analyzed using SPSS 22·0. Results: The survey included 260 patients having males (62·3%) more than females (37·7%) with age ranging from 12 to 85 years. Among all, variceal bleed was accounted in 186 (71·5%) patients while remaining 74 (28·4%) patients had non-variceal bleed; peptic ulcer disease being the most common etiology. The overall mortality rate of our study was 5·76%. Some factors influencing mortality of the patients were age > 60 years, comorbid, use of NSAIDS, rebleeding, deranged laboratory tests at the time of presentation- anemia (hemoglobin of < 10 g\dl), grade 3 thrombocytopenia (platelet count of < 50 cells\dl), serum creatinine > 1·5 and serum INR of > 1·6. Additionally, a direct proportion was seen in between Rockall scoring system and patient mortality with a significant p-value (0·000). Conclusion: In this study, variceal bleeding was found as the predominant lesion of upper gastro-intestinal bleeding followed by peptic ulcer disease. Certain factors are found that are strongly related in deteriorating patient’s outcome. Along with it, Rockall score is also a good predictor of outcome of patients.

Stopping antithrombotic therapy after acute upper gastrointestinal bleeding is associated with reduced survival

2017 ◽  
Vol 94 (1109) ◽  
pp. 137-142 ◽  
Author(s):  
Keith Siau ◽  
Jack L Hannah ◽  
James Hodson ◽  
Monika Widlak ◽  
Neeraj Bhala ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
Peptic Ulcer Disease ◽  
Antithrombotic Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
University Hospital ◽  
Ulcer Disease ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

IntroductionAntithrombotic drugs are often stopped following acute upper gastrointestinal bleeding (AUGIB) and frequently not restarted. The practice of antithrombotic discontinuation on discharge and its impact on outcomes are unclear.ObjectiveTo assess whether restarting antithrombotic therapy, prior to hospital discharge for AUGIB, affected clinical outcomes.DesignRetrospective cohort study.SettingUniversity hospital between May 2013 and November 2014, with median follow-up of 259 days.PatientsPatients who underwent gastroscopy for AUGIB while on antithrombotic therapy.InterventionsContinuation or cessation of antithrombotic(s) at discharge.Main outcomes measuresCause-specific mortality, thrombotic events, rebleeding and serious adverse events (any of the above).ResultsOf 118 patients analysed, antithrombotic treatment was stopped in 58 (49.2%). Older age, aspirin monotherapy and peptic ulcer disease were significant predictors of antithrombotic discontinuation, whereas dual antiplatelet use predicted antithrombotic maintenance. The 1-year postdischarge mortality rate was 11.3%, with deaths mainly due to thrombotic causes. Stopping antithrombotic therapy at the time of discharge was associated with increased mortality (HR 3.32; 95% CI 1.07 to 10.31, P=0.027), thrombotic events (HR 5.77; 95% CI 1.26 to 26.35, P=0.010) and overall adverse events (HR 2.98; 95% CI 1.32 to 6.74, P=0.006), with effects persisting after multivariable adjustment for age and peptic ulcer disease. On subgroup analysis, the thromboprotective benefit remained significant with continuation of non-aspirin regimens (P=0.016). There were no significant differences in postdischarge bleeding rates between groups (HR 3.43, 0.36 to 33.04, P=0.255).ConclusionIn this hospital-based study, discontinuation of antithrombotic therapy is associated with increased thrombotic events and reduced survival.

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