Bleeding Duodenal Ulcer

Branicki, Frank J.; Boey, John; Fok, P. J.; Pritchett, C. J.; Fan, Sheung‐Tat; Lai, Edward C. S.; Mok, F. P. T.; WONG, WAI-SANG; Lam, Shiu Kum; Hui, W. M.; Ng, Michael K.; Lok, Anna S.; Lam, David K.; Tang, Alan P. K.; Wong, John

doi:10.1097/00000658-199004000-00006

Cited by 57 publications

(7 citation statements)

References 19 publications

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“…Our study has also shown that the group of peptic ulcer patients treated with adrenaline injection had a reduction in rebleeding episodes, and this is in accordance with other studies 29 , 30 . As rebleeding is the most important risk factor for death from bleeding ulcer, 31 it is likely that endoscopic treatment does improve the prognosis in these patients.…”

Section: Discussionsupporting

confidence: 92%

Does Haemostatic Therapy Improve the Prognosis in Upper Gastrointestinal Bleeding?

Nikolopoulou

Katsakoulis

Thomopoulos

et al. 1995

Int J Clinical Practice

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SUMMARY A study was conducted of 816 patients with peptic ulcer haemorrhage, comparing outcome before and after the introduction of endoscopic therapy. The control group comprised 505 patients admitted with bleeding due to benign peptic ulcer over a 5‐year period before endoscopic therapy, and 311 patients after introduction of endoscopic therapy were studied prospectively. The two groups were well matched for age, sex, shock, endoscopic findings and use of ulcerogenic drugs. The introduction of endoscopic therapy was associated with a reduction in surgical intervention and mortality rates for gastric and duodenal ulcer. The beneficial effects of endoscopic therapy appear to be due to a reduction in the need for surgical intervention in patients with an ulcer base visible vessel. The authors suggest that endoscopic injection therapy may result in an improved outcome from peptic ulcer haemorrhage. Adrenaline injection treatment seems to be the treatment of choice in view of its simplicity, low cost and availability.

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Section: Discussionsupporting

confidence: 92%

Does Haemostatic Therapy Improve the Prognosis in Upper Gastrointestinal Bleeding?

Nikolopoulou

Katsakoulis

Thomopoulos

et al. 1995

Int J Clinical Practice

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“…In contrast to certain studies [10,25,26] and consistent with others [18,27], this review did not associate the presence of active bleeding or stigmata of recent hemorrhage with clinically significant rebleeding events. Though more hemorrhagic sequelae accompanied TE than surgical therapy, this difference did not reach statistical significance.…”

Section: Discussionsupporting

confidence: 41%

Impact of therapeutic endoscopy on the treatment of bleeding duodenal ulcers: 1980–1990

et al. 1995

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Therapeutic endoscopy (TE) has provided a new means for treating peptic ulcer disease, prompting a reevaluation of surgery's role. The aim of this study was to determine if surgical therapy of bleeding duodenal ulcers has changed since the advent of TE. This retrospective review involved consecutive time periods during which TE was (1985-1990) and was not (1980-1984) widely available. Exclusion criteria were prior gastric surgery, nonpeptic conditions, and untreated ulcers. Inclusion standards were met by 252 patients (180 men, 72 women) whose mean age was 67 years. Patients were grouped by the initial therapeutic intervention. Groups were similar in age, medical condition (mean APACHE II score 16), and morbidity. Seventy-five patients had surgery alone during 1980-1984 and 38 during 1985-1990. TE was initially performed on 134 patients during 1985-1990. Bleeding (n = 30) and perforation (n = 1) prompted emergent operation in 23% of cases following TE. Thus 69 (38 + 31) patients underwent surgery between 1985 and 1990. Preprocedure transfusions averaged 4.1 units in the endoscopic group and 8.2 units in the operative groups (p < 0.0001). Disagreement existed between the endoscopic and surgical descriptions of ulcer location in 53% of cases. Emergent surgery was required in 45% of hemodynamically unstable patients versus 14% of stable patients who initially underwent TE (p < 0.0001). Sixty-one percent of incompletely visualized TE-treated lesions required operation, and 18% of well visualized ulcers underwent operation (p < 0.0001). Hospital mortality was similar (8% versus 16%) in the endoscopic and operated groups (p = 0.7). Mean follow-up was 540 days.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…[ 2 , 3 ] Furthermore, these data are relevant with regard to higher peptic ulcer bleeding (PUB) complications and mortality rate compared with the general population. [ 4 – 6 ] Moreover, one of the predictors of mortality in validated upper gastrointestinal bleeding scoring systems, such as the Rockall score is renal insufficiency. [ 7 , 8 ] Improvement of outcomes in PUB was attained only after the introduction of interventional endoscopic therapy and high-dose acid suppression.…”

Section: Introductionmentioning

confidence: 99%

Risk factors influencing the outcome of peptic ulcer bleeding in chronic kidney disease after initial endoscopic hemostasis

et al. 2016

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Patients with chronic kidney disease (CKD) who had peptic ulcer bleeding (PUB) may have more adverse outcomes. This population-based cohort study aimed to identify risk factors that may influence the outcomes of patients with CKD and PUB after initial endoscopic hemostasis. Data from 1997 to 2008 were extracted from the National Health Insurance Research Database in Taiwan. We included a cohort dataset of 1 million randomly selected individuals and a dataset of patients with CKD who were alive in 2008. A total of 18,646 patients with PUB were screened, and 1229 patients admitted for PUB after endoscopic hemostasis were recruited. The subjects were divided into non-CKD (n = 1045) and CKD groups (n = 184). We analyzed the risks of peptic ulcer rebleeding, sepsis events, and mortality among in-hospital patients, and after discharge. Results showed that the rebleeding rates associated with repeat endoscopic therapy (11.96% vs 6.32%, P = 0.0062), death rates (8.7%, vs 2.3%, P < 0.0001), hospitalization cost (US$ 5595±7200 vs US$2408 ± 4703, P < 0.0001), and length of hospital stay (19.6 ± 18.3 vs 11.2 ± 13.1, P < 0.0001) in the CKD group were higher than those in the non-CKD group. The death rate in the CKD group was also higher than that in the non-CKD group after discharge. The independent risk factor for rebleeding during hospitalization was age (odds ratio [OR], 1.02; P = 0.0063), whereas risk factors for death were CKD (OR, 2.37; P = 0.0222), shock (OR, 2.99; P = 0.0098), and endotracheal intubation (OR, 5.31; P < 0.0001). The hazard ratio of rebleeding risk for aspirin users after discharge over a 10-year follow-up period was 0.68 (95% confidence interval [CI]: 0.45–0.95, P = 0.0223). On the other hand, old age (P < 0.0001), CKD (P = 0.0090), diabetes (P = 0.0470), and congestive heart failure (P = 0.0013) were the independent risk factors for death after discharge. In-hospital patients with CKD and PUB after endoscopic therapy had higher recurrent bleeding, infection, and mortality rates, and the need for second endoscopic therapy. Age was the independent risk factor for recurrent bleeding during hospitalization. After being discharged with a 10-year follow-up period, nonaspirin user was a significant factor for recurrent bleeding.

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Bleeding Duodenal Ulcer

Cited by 57 publications

References 19 publications

Does Haemostatic Therapy Improve the Prognosis in Upper Gastrointestinal Bleeding?

Does Haemostatic Therapy Improve the Prognosis in Upper Gastrointestinal Bleeding?

Impact of therapeutic endoscopy on the treatment of bleeding duodenal ulcers: 1980–1990

Risk factors influencing the outcome of peptic ulcer bleeding in chronic kidney disease after initial endoscopic hemostasis

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