Accuracy of diagnostic procedures in acute upper gastrointestinal bleeding

Endoscopic Hydrogen Peroxide Spray May Facilitate Localization of the Bleeding Site in Acute Upper Gastrointestinal Bleeding

“…The advent of endoscopic therapy for UGI bleeding has obviated this to a large extent. However, the source of 24 % of acute UGI bleeds is still undiagnosed, mainly because of the difficulty of identifying bleeding sources which are obscured by overlying blood and clot [5]. Many methods to remove blood clots both before and during endoscopy have been attempted.…”

“…Emergency endoscopy is the test of choice for patients presenting with suspected acute VGI bleeding, in order to determine whether there is active bleeding, the rapidity of ongoing blood loss, and the source of bleeding. However, in 24 % (226/941) [5] of patients presenting with acute VGI bleeding there is no distinct source of bleeding identified at the time of initial endoscopy, partly because of poor visibility due to the presence of fresh blood and clots. Hankin et al [6] investigated the hemostatic effect of 3 % H 2 O 2 when topically applied to the bone-cement interface during total joint arthroplasty.…”

Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding

“…The distribution of patients classified into the three risk categories (low, moderate, high), as determined by the Rockall risk scoring system, and the observed percentages of rebleeding, surgery and mortality in each risk category are shown in Table 4. The Rockall score identified 114 of 341 patients as low risk ≤ 3), 110 of 341 patients as moderate risk (3)(4) and 117 of 341 patients as high risk ≥ 4). There were significant correlations between high Rockall scores and the occurrence of rebleeding, surgery and mortality in the entire patient population (χ 2 = 49.29, 23.10 and 27.64, respectively, P = 0.001).…”

“…Elderly patients and those with chronic medical diseases withstand AUGIB less well than younger, fitter patients, and have a higher risk of death [2,3] . AUGIB is defined as hemorrhage that emanates proximal to the ligament of Treitz, which differentiates it from lower gastrointestinal bleeding involving the colon, and middle gastrointestinal bleeding involving the small intestine distal to the ligament of Treitz [4] . Clinically, AUGIB often causes hypodynamia, hematemesis (vomiting of blood), melena (passage of black tarry stools due to the presence of altered blood), and systemic shock typically ensues upon loss of 15% or more of the circulating blood volume.…”

“…The rate and extent of hemorrhage, coupled with the patient's comorbidities, determine the clinical presentation of UGIB. AUGIB is a common medical emergency, the annual incidence of hospitalization for AUGIB is 50-150 per 10000 people in China, and it has a mortality of 4%-14% [4] . Early predictors of adverse prognosis in AUGIB, include increasing age (above 60 years), an increased number of co-morbid conditions, the underlying cause of bleeding (i.e., variceal), red blood cells (RBCs) in the emesis or stool, shock or hypotension on presentation, an increased number of units of blood transfused, active bleeding at the time of endoscopy, bleeding from large (> 2 cm) ulcers, onset of bleeding in the hospital, and emergency surgery [8][9][10] .…”