Background: Various scoring systems have been developed to predict endoscopic intervention, mortality, and rebleeding in patients with non-variceal upper gastrointestinal bleeding (NVUGIB); however, they have not been sufficiently validated in Korea. Therefore, this study aimed to evaluate the usefulness of several scoring systems in Korea by validating and comparing the Japanese score and other scores in Korean people with NVUGIB. Methods: The medical records of 1368 patients with NVUGIB were reviewed to collect statistical, clinical, laboratory, and endoscopic data. The Japanese score, ABC score, Glasgow-Blatchford Bleeding Score (GBS), and MAP score were calculated retrospectively at a single research institution. These scores for predicting the need for endoscopic intervention, mortality, and rebleeding were calculated and evaluated using the area under the receiver operating characteristic curve. Results: Of 1368 patients, 88.5% required endoscopic intervention, 4.1% died within 30 days, and 12.6% experienced rebleeding. The Japanese score was effective for predicting endoscopic intervention, and the ABC score was best for predicting 30-day mortality. Sex, age, hematemesis, blood urea nitrogen, and American Society of Anesthesiologists score were found to be predictors of the need for endoscopic intervention. Conclusion: The Japanese score did not prove useful in Koreans with upper gastrointestinal bleeding. Additional research is needed due to the limitations of a retrospective study conducted in a single research institute.
Background Enteric fever is a systemic disease caused by Salmonella enterica serovar Typhi or Salmonella enterica serovar Paratyphi, characterized by high fever and abdominal pain. Most patients with enteric fever improve within a few days after antibiotic treatment. However, some patients do not recover as easily and develop fatal life-threatening complications, including intestinal hemorrhage. Lower gastrointestinal bleeding has been reported in 10% of cases. However, upper gastrointestinal bleeding has rarely been reported in patients with enteric fever. We present a case of gastric ulcer hemorrhage caused by enteric fever. Case presentation A 32-year-old woman, complaining of fever lasting four days and right upper quadrant pain and melena that started one day before admission, consulted our hospital. Abdominal computed tomography revealed mild hepatomegaly and gastroscopy revealed multiple active gastric ulcers with flat black hemorrhagic spots. The melena of the patient stopped on the third day. On the fifth admission day, she developed hematochezia. At that time, Salmonella enterica serovar Typhi was isolated from the blood culture. The antibiotic regimen was switched to ceftriaxone. Her hematochezia spontaneously resolved the following day. Finally, the patient was discharged on the 12th admission day without clinical symptoms. However, her fever recurred one month after discharge, and she was readmitted and Salmonella enterica serovar Typhi was confirmed again via blood culture. She was treated with ceftriaxone for one month, and was discharged without complications. Conclusion Our case showed that although rare, active gastric ulcers can develop in patients with enteric fever. Therefore, upper and lower gastrointestinal bleeding should be suspected in patients with enteric fever, especially showing relapsing bacteremia.
Background: Risk stratification is recommended for patients with gastrointestinal (GI) bleeding. The ABC score is a new scoring tool with high accuracy for upper and lower GI bleeding. We aimed to evaluate the effectiveness of the ABC score in predicting the outcomes of patients with peptic ulcer bleeding. Methods: This single-center retrospective study included 809 patients, each with symptoms of upper GI bleeding, and who were diagnosed with ulcerative lesions between October 2011 and March 2021. The association between the ABC score’s variables and the patients’ outcome was analyzed. The score’s performance in predicting the patients’ outcome was validated using receiver-operating characteristic curve analysis and compared with that of other scores. Results: The study analyzed 772 patients with peptic ulcer bleeding. The primary outcome measure was all-cause 30-day mortality. Secondary outcome measures included rebleeding within 30 days and the need for radiologic/surgical intervention. Age (P = .013), serum albumin levels (P < .001), serum creatinine levels (P = .004), mental status (P < .001), and American Society of Anesthesiologists score (P < .001) were associated with the primary outcome. The ABC score predicted the 30-day mortality (area under the receiver-operating characteristic curve [AUROC] 0.927; 95% confidence interval [CI] 0.899–0.956) better than other scores. However, it was less accurate in predicting rebleeding (AUROC 0.630; 95% CI 0.563–0.697) and need for radiologic/surgical intervention (AUROC 0.641; 95% CI 0.550–0.732). Conclusions: The ABC score accurately predicts the 30-day mortality in patients with peptic ulcer bleeding. However, it may not be suitable for predicting rebleeding or the need for radiologic/surgical interventions.
BackgroundRisk stratification is recommended for patients presenting with gastrointestinal bleeding. The ABC score is a new scoring tool with high accuracy for both upper and lower gastrointestinal bleeding. This study aimed to evaluate the effectiveness of the ABC score in predicting the outcomes of patients with peptic ulcer bleeding.MethodsThis single-center retrospective study was conducted between October 2011 and March 2021. We identified 812 patients presenting with symptoms of upper gastrointestinal hemorrhage who were diagnosed with ulcerative lesions on endoscopy. The association between the ABC score’s variables and the patients’ outcome was analyzed using the chi-square test, Fisher’s exact test, and t-test. Additionally, the performance of the score in predicting the patients’ outcome was validated using ROC curve analysis and compared to the performance of other scores.ResultsA total of 772 patients with peptic ulcer bleeding were analyzed. The primary outcome measure (20 patients) was all-cause 30-day mortality. Secondary outcome measures (91 patients) included rebleeding within 30 days and need for radiologic/surgical intervention. Age (p = 0.013), serum albumin (p < 0.001), serum creatinine (p = 0.004), mental status (p < 0.001), and ASA score (p < 0.001) were factors associated with the primary outcome. The ABC score was 7, with a sensitivity of 90.0% and a specificity of 86.0%. It predicted the primary outcome with good accuracy (area under the receiver operating characteristic curve [AUROC] 0.927; 95% confidence interval [CI] 0.899–0.956), surpassing other scores. However, it was less accurate in predicting rebleeding (AUROC 0.630; 95% CI 0.563–0.697) and need for radiologic/surgical intervention (AUROC 0.641; 95% CI 0.550–0.732).ConclusionsThe ABC score is a good predictor of 30-day mortality in patients with peptic ulcer bleeding. However, it may not be suitable for predicting rebleeding or the need for radiologic/surgical interventions.
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