Acute upper gastrointestinal bleeding: A review

Weledji, Elroy Patrick

doi:10.1016/j.sipas.2020.100004

Cited by 7 publications

(9 citation statements)

References 63 publications

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“…The release of food and digestive enzymes into the peritoneal cavity initially causes a chemical peritonitis. Secondary bacterial peritonitis evolves later, and as with bleeding ulcers 10% of these patients will die (1,2,16). The presentation of gastric perforation is sudden onset severe epigastric pain, peritonism, a board-like abdominal rigidity caused by spasm of the recti muscles and sepsis, but may be non-specific in the elderly.…”

Section: Spontaneous Perforationmentioning

confidence: 99%

“…If no perforation site is evident on initial laparotomy, the posterior surface of the stomach is exposed in the lesser sac. Infrequently perforation and hemorrhage from an anterior ulcer may coexist, and, partial gastrectomy of the Billroth II (Kronlein-Polya) type is advisable (16,32,41). H. pylori is the most important factor for ulcer recurrence following operative repair of perforated duodenal ulcer and merits eradication along with PPI therapy for about 4-6 weeks.…”

Section: Dilemma Of Duodenal Ulcer Perforation and Operative Hazardsmentioning

confidence: 99%

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An Overview of Gastroduodenal Perforation

Weledji

2020

Front. Surg.

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Section: Spontaneous Perforationmentioning

confidence: 99%

Section: Dilemma Of Duodenal Ulcer Perforation and Operative Hazardsmentioning

confidence: 99%

An Overview of Gastroduodenal Perforation

Weledji

2020

Front. Surg.

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“…In Western countries, its incidence was estimated to be over 100 cases per 100 000 adults per year. 1 2 Fortunately, the mortality rates of AUGIB have decreased over the past few decades, largely attributable to improvements in endoscopic and pharmacological therapies. 2 Currently, it is recommended that endoscopy should be performed within 24 hours on presentation to hospital, to identify the source of bleeding, risk-stratify patients and provide potential endoscopic treatments.…”

Section: Introductionmentioning

confidence: 99%

Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study

Guo

Wong

Lau

et al. 2021

Gut

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ObjectiveWhile it is recommended that patients presenting with acute upper gastrointestinal bleeding (AUGIB) should receive endoscopic intervention within 24 hours, the optimal timing is still uncertain. We aimed to assess whether endoscopy timing postadmission would affect outcomes.DesignWe conducted a retrospective, territory-wide, cohort study with healthcare data from all public hospitals in Hong Kong. Adult patients (age ≥18) that presented with AUGIB between 2013 and 2019 and received therapeutic endoscopy within 48 hours (n=6474) were recruited. Patients were classified based on endoscopic timing postadmission: urgent (t≤6), early (6<t≤24) and late (24<t≤48). Baseline characteristics were balanced with inverse probability of treatment weighting. 30-day all-cause mortality, repeated therapeutic endoscopy rate, intensive care unit (ICU) admission rate and other endpoints were compared.ResultsResults showed that urgent timing (n=1008) had worse outcomes compared with early endoscopy (n=3865), with higher 30-day all-cause mortality (p<0.001), repeat endoscopy rates (p<0.001) and ICU admission rates (p<0.001). Late endoscopy (n=1601) was associated with worse outcomes, with higher 30-day mortality (p=0.003), in-hospital mortality (p=0.022) and 30-day transfusion rates (p=0.018).ConclusionCompared with urgent and late endoscopy among patients who have received therapeutic endoscopies, early endoscopy was associated with superior outcomes especially among patients with non-variceal bleeding. This supports the notion that non-variceal AUGIB patients should receive endoscopy within 24 hours, but also emphasises the importance of prior resuscitation and pharmacotherapy.

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“…Comparing with capsule endoscopy, the first advantage of esophagogastroduodenoscopy (EGD) is the capability of biopsy [ 13 ]. Overt or occult gastrointestinal bleeding in patients on DAPT not only indicates mucosal injury but also is an alarming symptom of gastrointestinal tumors [ 14 , 15 ]. Pathological biopsy results are the gold standard for determining precancerous or malignant lesions of the esophagus and/or stomach, and whether Helicobacter pylori ( H. pylori ) infection is present.…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitor in the prevention of upper gastrointestinal mucosal injury associated with dual antiplatelet therapy after coronary artery bypass grafting (DACAB-GI-2): study protocol for a randomized controlled trial

Zhu

Wang

Yang

et al. 2022

Trials

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Background Dual antiplatelet therapy (DAPT) is recommended in secondary prevention after coronary artery bypass grafting (CABG), but it is inevitably associated with the risk of bleeding, of which gastrointestinal bleeding accounts for more than half. Proton pump inhibitors (PPIs) may increase the risk of major cardiovascular adverse events when reducing the risk of upper gastrointestinal bleeding. Therefore, the optimal duration of a PPI in combination with DAPT is unclear. Methods The “Proton Pump Inhibitor Preventing Upper Gastrointestinal Injury in Patients on Dual Antiplatelet Therapy after CABG” (DACAB-GI-2) study is a prospective, single-center, open-label, parallel, randomized controlled trial. A total of 232 eligible subjects who are scheduled or initiated on DAPT (clopidogrel plus aspirin or ticagrelor plus aspirin) for 12 months immediately after CABG will be enrolled and be randomized in a 1:1 ratio to either a 12-month pantoprazole treatment arm or a 1-month treatment arm. The primary outcome is to assess the rate of gastroduodenal erosions and ulcers evaluated by esophagogastroduodenoscopy (EGD) within 12 months after randomization, based on the modified Lanza score. Secondary outcomes include reflux esophagitis and upper gastrointestinal bleeding. Other pre-specified outcomes include major adverse cardiovascular events, graft failure, and all-cause death. Discussion This study aims to compare the efficacy and safety of 12 months and 1 month of pantoprazole treatment in preventing DAPT-related upper gastrointestinal mucosal injury after CABG. Trial registration ClinicalTrials.gov NCT03908593.

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Acute upper gastrointestinal bleeding: A review

Cited by 7 publications

References 63 publications

An Overview of Gastroduodenal Perforation

An Overview of Gastroduodenal Perforation

Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study

Proton pump inhibitor in the prevention of upper gastrointestinal mucosal injury associated with dual antiplatelet therapy after coronary artery bypass grafting (DACAB-GI-2): study protocol for a randomized controlled trial

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