Gastrointestinal Bleeding After Intracerebral Hemorrhage: A Retrospective Review of 808 Cases

Yang, Tiecheng; Li, Jianguo; Yu, Dong‐Ming; Shan, Kai; Li, Lixia; Dong, Xiaowei; Ren, Tianhua; Hong-mei, Shi

doi:10.1097/maj.0b013e318271a621

Cited by 19 publications

(32 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Gastrointestinal symptoms often occur in patients with non-traumatic intracranial haemorrhage (ICH), and proton pump inhibitors (PPIs) are therapeutically indicated for gastrointestinal disorders involving excessive acid production. 9 However, it has been reported that using acidsuppressive medication such as a PPI increases the risk of pneumonia in older people. [10][11][12] Several studies have confirmed that using prophylactic PPIs during an acute non-traumatic ICH stroke can increase the risk of hospital-acquired pneumonia through acute and irreversible gastric acid suppression.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Population-based cohort study on the risk of pneumonia in patients with non-traumatic intracranial haemorrhage who use proton pump inhibitors

Tsai

Teng

et al. 2014

BMJ Open

View full text Add to dashboard Cite

ObjectivesThis nationwide cohort study investigated the association between proton pump inhibitor (PPI) usage and the risk of pneumonia in patients with non-traumatic intracranial haemorrhage (ICH).DesignNationwide population-based cohort study.SettingLongitudinal Health Insurance Database 2010 (LHID2010) sampled from the Taiwan National Health Insurance Research Database.Participants4644 patients with non-traumatic ICH from 2010 to 2011 were identified. Patients aged <18 years and newly diagnosed with non-traumatic ICH complicated with pneumonia during the same admission period were excluded. A total of 2170 participants were eligible for the final analysis.Main outcome measurePatients using PPIs or not during the study period were tracked to identify the occurrence of any type of pneumonia.ResultsThe adjusted HR of the risk of pneumonia for ICH patients who used PPIs was 1.61 (95% CI 1.32 to 1.97, p<0.001). The risk of pneumonia was positively associated with the administration of PPIs. We observed a greater risk of pneumonia in patients who used PPIs than in those who did not. Moreover, we observed that the risk of pneumonia in patients who used PPIs was 2.60 and 2.04 (95% CI 2.01 to 3.38, p<0.001; 95% CI 1.34 to 3.10, p<0.001) greater than that in patients who did not use PPIs when the defined daily dose was <30 and 30−60, respectively.ConclusionsThe results of this study indicate that the use of PPIs in patients with non-traumatic ICH is associated with an increased risk of pneumonia, and the severity of this risk depends on the defined daily dose. Physicians should exercise caution when prescribing PPIs for patients with non-traumatic ICH.

show abstract

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Population-based cohort study on the risk of pneumonia in patients with non-traumatic intracranial haemorrhage who use proton pump inhibitors

Tsai

Teng

et al. 2014

BMJ Open

View full text Add to dashboard Cite

show abstract

“…Data collected from June 2008 to December 2009 for patients with ICH were retrospectively reviewed as we before reported [15]. ICH was defined as a neurological deficit with confirmation of the brain hemorrhage by computed tomography (CT).…”

Section: Methodsmentioning

confidence: 99%

Impact of Admission Hyperglycemia on Stroke-Associated Pneumoniain Acute Cerebral Hemorrhage: A Retrospective Observational Study

Ren¹,

Yang²,

Li³

et al. 2015

OJEM

Self Cite

View full text Add to dashboard Cite

Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific to stroke-associated pneumonia (SAP) on this topic is very small. Further, how to differentiate the predictive value of hyperglycemia with and without abnormal HbA1C in such patients is still a matter of debate and no universal consensus. We evaluated hyperglycemia as a marker for SAP in patients with ICH to assess its usefulness as a potential predictor. Materials and methods: Clinical characteristics for a sample of 551 patients with acute ICH were collected from the Beijing Tiantan Hospital of Capital Medical University, Beijing, China. Possible associated risk factors of SAP were reviewed. Hyperglycemia and HbA1C on admission were the main hypothetic predictor, SAP occurring within the first 7 days is the primary outcome. Results: The cohort study includes 551 hospitalized patients. The prevalence of hyperglycemia was 52.5% and SAP occurred in 147 (26.7%). The incidence of SAP was higher in the group with hyperglycemia than those without hyperglycemia (37.7% versus 14.5%, p < 0.01). Multivariate logistic regression analyses showed the SAP was significantly associated with hyperglycemia (OR, 2.48; 95% CI, 2.37 -5.72), in the subgroup analysis we found hyperglycemia with normal HgbA1C level (<6.5) had been shown to be significantly associated with increased incidence of SAP (OR, 3.86; 95%CI, 2.98 -6.72), however, hyperglycemia with high HgbA1C level (>6.5) (OR, 1.57; 95%CI, 0.81 -3.23) had not been shown to be associated with SAP. Conclusions: In this hospital-based co-hort of patients presenting with acute intra-hemorrhage, hyperglycemia on admission was associated significantly with SAP. The association was stronger for hyperglycemia with normal HgbA1C than for hyperglycemia with high HgbA1C. Hyperglycemia with normal HgbA1C might be a more sensitive predictor of early acute complication, such as SAP.

show abstract

“…Importantly, ICH may not only cause primary damage to the brain itself but also lead to secondary damage to remote organs, such as to the gastrointestinal tract, lung, and heart. Notably, intestinal barrier dysfunction is a common complication after ICH that leads to malabsorption, malnutrition, hypoimmunity, and poor prognosis in patients [2,3]. …”

Section: Introductionmentioning

confidence: 99%

“…The increased permeability of injured intestinal mucosa could result in the translocation of intestinal endotoxin, which, in turn, triggers both a systemic inflammatory response syndrome (SIRS) and a multiple organ dysfunction syndrome (MODS). In the clinic, patients with ICH manifesting gastrointestinal dysfunction have a longer hospitalization period and a higher mortality [2,6]. Although very common, effective strategies for preventing intestinal barrier dysfunction following ICH are still lacking [7].…”

Section: Introductionmentioning

confidence: 99%

Ghrelin Attenuates Intestinal Barrier Dysfunction Following Intracerebral Hemorrhage in Mice

Cheng

Wei

Yang

et al. 2016

IJMS

View full text Add to dashboard Cite

Intestinal barrier dysfunction remains a critical problem in patients with intracerebral hemorrhage (ICH) and is associated with poor prognosis. Ghrelin, a brain-gut peptide, has been shown to exert protection in animal models of gastrointestinal injury. However, the effect of ghrelin on intestinal barrier dysfunction post-ICH and its possible underlying mechanisms are still unknown. This study was designed to investigate whether ghrelin administration attenuates intestinal barrier dysfunction in experimental ICH using an intrastriatal autologous blood infusion mouse model. Our data showed that treatment with ghrelin markedly attenuated intestinal mucosal injury at both histomorphometric and ultrastructural levels post-ICH. Ghrelin reduced ICH-induced intestinal permeability according to fluorescein isothiocyanate conjugated-dextran (FITC-D) and Evans blue extravasation assays. Concomitantly, the intestinal tight junction-related protein markers, Zonula occludens-1 (ZO-1) and claudin-5 were upregulated by ghrelin post-ICH. Additionally, ghrelin reduced intestinal intercellular adhesion molecule-1 (ICAM-1) expression at the mRNA and protein levels following ICH. Furthermore, ghrelin suppressed the translocation of intestinal endotoxin post-ICH. These changes were accompanied by improved survival rates and an attenuation of body weight loss post-ICH. In conclusion, our results suggest that ghrelin reduced intestinal barrier dysfunction, thereby reducing mortality and weight loss, indicating that ghrelin is a potential therapeutic agent in ICH-induced intestinal barrier dysfunction therapy.

show abstract

Gastrointestinal Bleeding After Intracerebral Hemorrhage: A Retrospective Review of 808 Cases

Cited by 19 publications

References 20 publications

Population-based cohort study on the risk of pneumonia in patients with non-traumatic intracranial haemorrhage who use proton pump inhibitors

Population-based cohort study on the risk of pneumonia in patients with non-traumatic intracranial haemorrhage who use proton pump inhibitors

Impact of Admission Hyperglycemia on Stroke-Associated Pneumoniain Acute Cerebral Hemorrhage: A Retrospective Observational Study

Ghrelin Attenuates Intestinal Barrier Dysfunction Following Intracerebral Hemorrhage in Mice

Contact Info

Product

Resources

About