A Cost-Effective Approach to the Patient With Peptic Ulcer Bleeding

Jiranek, Geoffrey C.; Kozarek, Richard A.

doi:10.1016/s0039-6109(05)70424-2

Cited by 75 publications

(31 citation statements)

References 101 publications

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“…In this current study it was observed that 50.0% patients stayed in the hospital for 4-7 days and the mean duration of hospital stay was 6.36±4.5 days varied from 1 -22 days. Similarly, Jiranek and Kozarek (1996) found the average length of stay per patient was 6.45 days, which is consistent with the current study 2 .…”

Section: Discussionsupporting

confidence: 92%

Risk Assessment of Acute Upper Gastrointestinal Haemorrhage with Rockall Score In DMCH

et al. 2018

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Section: Discussionsupporting

confidence: 92%

Risk Assessment of Acute Upper Gastrointestinal Haemorrhage with Rockall Score In DMCH

et al. 2018

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“…Despite improved clinical risk stratification and the development of sophisticated techniques for endoscopic hemostasis, mortality rates have remained unchanged at 6–8% [31,32,33]. This reflects a number of factors particularly the fact that the disease often occurs in the elderly and infirm with multiple comorbidities.…”

Section: The Evolution Of Gastrinmentioning

confidence: 99%

“…Thus, the failure to reduce mortality rates reflects in part the overall increase in the numbers of high-risk patients (e.g., increased age, concurrent disease, greater exposure to aspirin and NSAIDS), or limited availability of improved techniques for endoscopic hemostasis [34, 35]. Apart from the human aspects, the economic burden of peptic ulcer bleeding on society is high, with studies estimating average hospital costs per admission of approximately USD 5,000 [31, 36, 37], and considerably greater in the high-risk categories.…”

Section: The Evolution Of Gastrinmentioning

confidence: 99%

Edkins and a Century of Acid Suppression

et al. 2005

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In 1905, John Edkins (1863–1940) undertook the studies of gastrin that have subsequently formed the basis for a century of investigation into the physiological basis of acid secretion and led to the elucidation of a variety of acid-suppressive pharmacological agents that have revolutionized the management of acid peptic disease. Although his name is known to few, his contributions to the physiology of gastric secretion and his study of spiral organisms in the stomach were prescient and to this day remain models of insightful and rigorous research. As a mentor, his educational impact was exemplified by the fact that he was the first to teach physiology to women in the United Kingdom. Gastrin has evolved from an initially unaccepted phenomenon, to be recognized as an important hormone and a fundamental component of regulatory biology as well as a clinically relevant biomarker of disease. Its critical role in the modulation of acid secretion has become a sine qua non and has been extended to include a broad regulatory proliferative role in the mucosa of the gastrointestinal tract. The pivotal role of gastrin in gastric physiology, biology and clinical medicine is now well accepted and reflects the fundamental contributions that Edkins made to the identification of the agent and the elucidation of its function. As a result of the delineation of the neural and hormonal regulatory mechanisms of acid secretion, the scientific basis of acid peptic disease has become apparent. The identification of histamine receptors and proton pumps has led to the discovery of novel pharmacotherapeutic agents capable of producing acid suppression of such efficacy that surgery has become virtually obsolete in the treatment of the disease process. A century after the initial observations by Edkins of gastrin, the identification of Helicobacter pylori and the ability to eradicate it, as well as the use of the proton pump inhibitor class of drugs, have revolutionized the management of gastroduodenal ulceration and gastroesophageal reflux disease. Both patients and physicians owe a great debt to Edkins, whose seminal observations regarding gastrin initiated an era of gastrointestinal scientific, clinical and pharmacological advance that has culminated in the ability to treat and cure acid peptic disease.

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“…It is for this reason that we performed a case-control study to determine the difference in prevalence between bleeding and non-bleeding gastric ulcers. The average hospital cost to manage patients hospitalized at Virginia Mason Hospital who bled from a peptic ulcer is approximately $5000 per patient as shown in a series of 30 patients" [1]. Both the human and economic costs of treating this infection and its complications are considerable.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Helicobacter pylori Infection in Bleeding and Non -Bleeding Gastric Ulcers: A Cross-Sectional Case-Control Study

Kgomo¹,

KS²

2016

J Bioanal Biomed

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Introduction: Helicobacter pylori is a known and important cause of peptic ulcer disease, and can result in many different complications, both gastrointestinal and systemic. The gastric complications include upper gastrointestinal bleeding.The costs associated with testing and treatment of complications of H. pylori infection is also high, both in private and public setting. Studies in Iran showed high prevalence of H. pylori infection, with figures as high as 89.2% in the adult population. In South Africa, patients with bleeding gastric ulcers receive empirical eradication therapy, an expensive practice in a resource limited country like South Africa. It is for this reason that we conducted a case-control study to determine the difference in prevalence of H. pylori infection in bleeding and non-bleeding gastric ulcers. Aim:To determine the difference in prevalence of H. pylori infection in bleeding and non-bleeding gastric ulcers. Methods:In this prospective cross-sectional case-control study, a total of 173 patients who underwent upper endoscopy at Steve Biko Academic Hospital were recruited. All patients with gastric ulcer on upper endoscopy had antral mucosal biopsy taken and CLO test done on this specimen, in addition to the CLO test, the 42 with a history of upper gastrointestinal bleeding had additional biopsies send for histology for detection of H. pylori. The CLO tests were evaluated 24 h later and results documented as either positive or negative. Results:From the 173 patients enrolled, 131 patients were found to have no history of upper gastrointestinal bleeding, while 42 patients were found to be bleeding on upper endoscopy or had a recent history of bleeding. Of the total of 173, 134(77.5%) tested negative for H. pylori infection on CLO test and 39(22.5%) tested positive. Of the bleeding group, 7(16.7%) were CLO test positive and 35(83.3%) were negative. In the non-bleeding group of patients, 99(75.6%) were CLO test negative and 32(24.4%) tested positive. There was a 100% correlation between CLO test and histology. Of the bleeding group 35(83%) tested negative on both CLO test and histology and 7(16.7%) tested positive. Conclusion:The prevalence of H. pylori infection in this South African population with bleeding gastric ulcer was found to be lower than in patients with gastric ulcers that were not bleeding. This was, however not statistically significant (p value 0.404). To our knowledge there is no South African data for comparison with our study group.The sensitivity of CLO test was as high as histology. This finding suggests that CLO test can be used reliably in bleeding peptic ulcer.

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A Cost-Effective Approach to the Patient With Peptic Ulcer Bleeding

Cited by 75 publications

References 101 publications

Risk Assessment of Acute Upper Gastrointestinal Haemorrhage with Rockall Score In DMCH

Risk Assessment of Acute Upper Gastrointestinal Haemorrhage with Rockall Score In DMCH

Edkins and a Century of Acid Suppression

The Prevalence of Helicobacter pylori Infection in Bleeding and Non -Bleeding Gastric Ulcers: A Cross-Sectional Case-Control Study

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