Gastrointestinal Bleeding

Nable, Jose V.; Graham, Autumn

doi:10.1016/j.emc.2015.12.001

Cited by 37 publications

(31 citation statements)

References 91 publications

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“…However, contrary to the literature, significant differences with respect to age, gender, and hemoglobin values in cases with mortality cannot be found in our study (3). From this point of view, our study shows that deciding the clinical severity of the patient in emergency department assessment on the basis of only these parameters can give rise to mistakes in patient management.…”

Section: Discussioncontrasting

confidence: 99%

Effects of Seasonal Variation on Upper Gastrointestinal System Bleeding in Emergency Department

Oğuzlar

Hatip

Coşkun

et al. 2019

Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi

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Özet Amaç: Birçok klinik değişken üst gastrointestinal sistem (GİS) kanamasında yüksek morbidite ve mortalite ile ilişkilendirilmiştir. Bu risk faktörlerine ek olarak, mevsimsel değişikliklerin üst GİS kanamasını etkileyebileceği öne sürülmektedir. Bu çalışma ile mevsimsel değişiklikler ile üst GİS kanamasının insidansı, Glasgow-Blactford risk skoru ve bazı klinik ve laboratuar değişkenler arasındaki ilişki araştırılmıştır. Materyal-Metot: Üst GİS kanama tanısıyla hastaneye yatırılan hastaların dosyaları tarandı. Yaş, cinsiyet, başvuru tarihi, başvurudaki laboratuar sonuçları, vital bulguları, Glasgow-Blacford skoru, yoğun bakım ihtiyacı, yatış süresi, eritrosit süspansiyonu ihtiyacı ve hasta sonlanımı kayıt edildi. Başka merkeze sevk edilen hastalar, yatışı süresinde üst GİS kanama tanısı dışlanan hastalar ve 18 yaş altı hastalar çalışma dışı bırakıldı. Bir yıllık süre kış, ilkbahar, yaz ve sonbahar olmak üzere 4 mevsime ayrıldı. Bulgular: Çalışmamıza 163 erkek, 108 kadın olmak üzere toplam 271 hasta dahil edildi. Yoğun bakıma yatan hasta sayısı 205, servise alınan hasta sayısı 66 idi. 187 hastaya eritrosit süspansiyonu uygulandığı, 35 hastanın ise öldüğü tespit edildi. Kan üre azotu, Glasgow-Blacford skoru, kalp hızı yüksekliği ile düşük sistolik ve diastolik kan basıncı değerleri yüksek mortalite ile ilişkili saptandı. Üst GİS kanamalı hasta sayısının özellikle mayıs ayında olmak üzere ilkbaharda arttığı, sonbaharda azaldığı saptandı. Mevsimler arasında klinik ve laboratuar bulgular açısından istatistiksel olarak anlamlı bir farklılık saptanmadı. Sonuç: Üst GİS kanamalı hasta sayısının ilkbahar aylarında arttığı görülmektedir. Acil servis hekimleri bu aylarda üst GİS kanama açısından daha dikkatli olmalıdırlar. Ayrıca mevsimler arasında hiçbir klinik ve laboratuar bulgusu açısından anlamlı farklılık olmadığı görülmektedir. Anahtar kelimeler: Acil Servis, Mevsimsel Değişiklikler, Üst GİS Kanama. AbstractObjective: Multiple factors are known to be associated with a high risk of morbidity and mortality in Upper Gastrointestinal Bleeding (UGB). In addition to these risk factors, it has been suggested that seasonal variations can influence UGB. In this study, it is investigated whether there is a relation between seasonal variation and the incidence of UGB, Glasgow-Blatchford risk score and clinical and laboratory parameters. Material-Method:We retrospectively reviewed the records of the patients who were diagnosed and hospitalized with UGB. Age, gender, admission date, laboratory parameters, vital signs and Glasgow-Blatchford risk score at admission, intensive care unit admission, length of stay, erythrocyte suspension transfusion requirement and outcome were all documented. Patients who were referred to another hospital despite having diagnosed UGB, patients who were found to have been misdiagnosed while follow-up and patients under 18 years old were excluded. The 12 months of the year were divided into four seasons as winter, spring, summer and autumn. Results: We included 271 patients, of whom 163 were males an...

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Section: Discussioncontrasting

confidence: 99%

Effects of Seasonal Variation on Upper Gastrointestinal System Bleeding in Emergency Department

Oğuzlar

Hatip

Coşkun

et al. 2019

Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi

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“…The mortality rate was 2%, and all three patients were in the severe group, which was comparable to the reported NUGIB mortality of about 1-5% [13]. The re-bleeding rate (21%) was higher than in other researches (about 10%) [13,15,16]. This difference may be related to the higher proportion of high-risk patients with Forrest I, Forrest IIa/b and Dieulafoy patients in this study.…”

Section: Discussionsupporting

confidence: 81%

“…On the contrary, the median span of hospitalization in the severe group was signi cantly longer than in the mild group. This was acceptable since patients in the severe group need more time for comprehensive treatment and drug treatment in hospital, which are also indispensable for UGIB therapy [16]. Overall, our results showed that anemia did not associate with the mortality and rebleeding of high-risk NUGIB patients underwent endoscopic intervention.…”

Section: Discussionmentioning

confidence: 64%

Impact of Anemia on the Outcomes of Endoscopic Intervention in High-Risk NUGIB Patients

Tan

Lan

Bai

et al. 2020

Preprint

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Background: It is common for high-risk, non-variceal upper gastrointestinal bleeding (NUGIB) patients coexisting anemia, but the role of anemia on the prognosis of endoscopic intervention is not clear. The aim of this study was to assess the impact of hemoglobin level on outcomes of endoscopic intervention in high-risk NUGIB patients. Methods: A retrospective study was performed on high-risk (Glasgow-Blatchford score ≥7) NUGIB patients who underwent endoscopic intervention within 24h of presentation. Patients were divided into three groups based on hemoglobin level before intervention: severe (<7g/dl), moderate (7g/dl ≤hemoglobin <9g/dl) and mild (≥9g/dl) group. Outcomes included mortality, length of ICU stay, re-bleeding rate, procedural adverse events, length of hospital stay, adverse events and transfusion requirement. Results: A total of 156 patients received endoscopic intervention were identified, 88 in the severe group, 45 in the moderate group, and 23 in the mild group. The total mortality rate in 45 days was 2%, and the re-bleeding rate was 21%. There was no significant difference in mortality, re-bleeding rate or length of ICU stay among the three groups. The average days of hospitalization in the severe group was significantly longer than that of the moderate group (13 vs 8, P < 0.05). No adverse events occurred. Low hemoglobin level was a predictor for more red-cell transfusion (OR=5.94, 2.69-13.11) and plasma transfusion (OR=2.34,1.21-4.51). Conclusions: Anemia does not affect the mortality and rebleeding of endoscopic intervention in high-risk NUGIB patients, but is associated with more transfusion and longer hospitalization.

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“…Other less common aetiologies of UGIB are listed in box 1. The initial work-up for any suspected UGIB is upper endoscopy which not only confirms the source of bleeding but also allows potential control of the bleeding 9. In our case, an oesophageal source was ruled out, but given the large clot burden in the stomach and duodenum, the exact source of bleeding could not be identified on endoscopy.

Differential diagnosis for obscure upper gastrointestinal (GI) bleed

Differential diagnosis for upper GI bleed

Oesophageal varices

Oesophageal ulcers

Gastritis

Gastric varices

Cameron erosions

Non-steroidal inflammatory drug-induced gastropathy

Vascular lesion (angioectasias)

Malignancy (adenocarcinoma, GI stromal tumour)

Mallory-Weiss tear

Portal hypertensive gastropathy

Haemobilia

Haemosuccus pancreaticus

Aortoenteric fistula

von Willebrand disease

Amyloidosis

…”

Section: Differential Diagnosismentioning

confidence: 99%

Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding

et al. 2017

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A 68-year-old man presented to the emergency department with haematemesis and shock. Upper endoscopy and selective angiography could not identify the source of bleeding. He underwent selective embolisation of the gastroduodenal artery. The patient then had a period of about 24 hours with relative haemodynamic stability before having another episode of massive upper gastrointestinal bleed. A second attempt to embolise the common hepatic artery and distal coeliac axis was unsuccessful. Hence, he was urgently taken to the operating room for exploratory laparotomy. The source of bleeding could not be identified in the operating room. The patient went into cardiac arrest and expired. Autopsy revealed a fistula between proximal jejunum and a previously unknown abdominal aortic aneurysm (AAA). We present an entity that has only been described a few times in the literature while highlighting the importance of having a broad differential with upper gastrointestinal bleeding, especially when the source is not clearly evident.

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Gastrointestinal Bleeding

Cited by 37 publications

References 91 publications

Effects of Seasonal Variation on Upper Gastrointestinal System Bleeding in Emergency Department

Effects of Seasonal Variation on Upper Gastrointestinal System Bleeding in Emergency Department

Impact of Anemia on the Outcomes of Endoscopic Intervention in High-Risk NUGIB Patients

Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding

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Gastrointestinal Bleeding

Cited by 37 publications

References 91 publications

Effects of Seasonal Variation on Upper Gastrointestinal System Bleeding in Emergency Department

Effects of Seasonal Variation on Upper Gastrointestinal System Bleeding in Emergency Department

Impact of Anemia on the Outcomes of Endoscopic Intervention in&nbsp;High-Risk NUGIB Patients

Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding

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Product

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Impact of Anemia on the Outcomes of Endoscopic Intervention in High-Risk NUGIB Patients