Management of Non-Variceal Upper Gastrointestinal Bleeding

Kim, Seung Young; Hyun, Jong Jin; Jung, Sung Woo; Lee, Sang Woo

doi:10.5946/ce.2012.45.3.220

Cited by 22 publications

(16 citation statements)

References 35 publications

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“…Bleeding is a major problem of peptic ulcers, as it is at times fatal (2). Peptic ulcer bleeding is diagnosed and treated by upper gastrointestinal (GI) endoscopy (3). Known causes of peptic ulcer bleeding are the long-term administration of non-steroidal anti-inflammatory drugs (NSAIDs), anti-platelet agents, anti-coagulants and infection with Helicobacter pylori (4).…”

Section: Introductionmentioning

confidence: 99%

Immunosuppressive agents are associated with peptic ulcer bleeding

Tomizawa

Shinozaki

Hasegawa

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Peptic ulcer bleeding can be fatal. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and immunosuppressive agents are administered for long-term usage. The present study assessed the association between peptic ulcer bleeding and administration of NSAIDs, corticosteroids and immunosuppressive agents. Furthermore, the efficacy of lowering the risk of peptic ulcer bleeding with proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) was evaluated. Medical records were retrospectively analyzed for patients subjected to an upper gastrointestinal (GI) endoscopy performed at the National Hospital Organization Shimoshizu Hospital (Yotsukaido, Japan) from October 2014 to September 2015. During this period, a total of 1,023 patients underwent an upper GI endoscopy. A total of 1,023 patients, including 431 males (age, 68.1±12.9 years) and 592 females (age, 66.4±12.3 years), who had been administered NSAIDs, corticosteroids, immunosuppressive agents, PPIs and H2RAs, were respectively enrolled. Endoscopic findings of the patients were reviewed and their data were statistically analyzed. Logistic regression analysis was used to determine the odds ratio of peptic ulcer bleeding for each medication; immunosuppressive agents had an odds ratio of 5.83, which was larger than that for NSAIDs (4.77). The Wald test was applied to confirm the correlation between immunosuppressive agents and peptic ulcer bleeding. Furthermore, χ 2 tests were applied to the correlation between peptic ulcer bleeding and administration of PPIs or H2RAs. Immunosuppressive agents had the largest χ 2 , and the P-value was 0.03. Administration of PPIs was significantly correlated with non-peptic ulcer bleeding (P= 0.02); furthermore, a tendency toward non-peptic ulcer bleeding with administration of H2RA was indicated, but it was not statistically significant (P= 0.12). In conclusion, immunosuppressive agents were correlated with peptic ulcer bleeding and PPIs were effective at lowering the risk of peptic ulcer bleeding.

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Section: Introductionmentioning

confidence: 99%

Immunosuppressive agents are associated with peptic ulcer bleeding

Tomizawa

Shinozaki

Hasegawa

et al. 2017

Experimental and Therapeutic Medicine

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“…It can be caused by colorectal polyps, colorectal cancer (CRC), or colonic diverticulum (2) and can be lethal in some patients, particularly the elderly (3). It is diagnosed and treated with colonoscopy (4,5).…”

Section: Introductionmentioning

confidence: 99%

Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding

et al. 2016

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Abstract. Lower gastrointestinal (GI) bleeding can be caused by colorectal polyps or cancer. The aim of the present study was to identify blood test variables and medications that can predict lower GI bleeding, which would allow for appropriate colonoscopy. The medical records of patients who underwent colonoscopy from September 2014 to September 2015 were retrospectively analyzed. The selected patients included 278 men (mean age, 67.0±11.5 years) and 249 women (mean age, 69.6±12.0 years). The diagnosis, medications, and blood test variables were compared between patients with and without bleeding. Logistic regression analysis was performed to determine the factors associated with lower GI bleeding. The presence of colorectal polyp and cancer was associated with lower GI bleeding (P=0.0044) with an odds ratio of 6.71 (P=0.0148). No lower GI bleeding was observed in patients taking non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or anticoagulants. The C-reactive protein (CRP) levels were significantly higher in patients with lower GI bleeding (P=0.0227). The Hb levels were lower in patients with lower GI bleeding, however this finding was not statistically significant (P>0.05). No blood test variable was associated with lower GI bleeding. Elevated CRP was associated with lower GI bleeding, while there was no association between the medications and lower GI bleeding. IntroductionLower gastrointestinal (GI) bleeding occurs if the bleeding source is located distally to the Treitz ligament (1). It can be caused by colorectal polyps, colorectal cancer (CRC), or colonic diverticulum (2) and can be lethal in some patients, particularly the elderly (3). It is diagnosed and treated with colonoscopy (4,5).Lower GI bleeding is usually chronic and stops spontaneously (6). The identification of the bleeding site is important in its management (7). Lower GI bleeding is usually diagnosed with screening colonoscopy. If the risk factors are known, it is be possible to perform colonoscopy for such patients. The risk factors of patients hospitalized for severe lower GI bleeding include medication with non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants (8). It is not clear whether NSAIDs and anticoagulants are related to lower GI bleeding diagnosed using screening colonoscopy. Corticosteroids, used in the treatment of autoimmune disease such as rheumatoid arthritis (9), are associated with bleeding from peptic ulcer (1). However, whether corticosteroids are associated with lower GI bleeding remains to be determined.Blood test variables are easy to obtain and quantitate. These variables can be useful in distinguishing upper from lower GI bleeding, which can aid the clinical diagnosis (10).In this study, we analyzed the diagnosis of screening colonoscopy and compared medication intake (i.e., NSAIDs, corticosteroids, and anticoagulants) between patients with or without lower GI bleeding. Blood test variables were also analyzed. Materials and methodsEthics statement. The National Hospital Organization Shi...

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“…Selection of the optimal hemostatic device depends upon the characteristics of the lesion, the physician's ability, the availability of the equipment, the patient's clinical conditions, and cost. In addition, adequate H. pylori eradication, PPI therapy, and the withdrawal of NSAIDs can further reduce the rebleeding and mortality rates 1,44…”

Section: Discussionmentioning

confidence: 99%

Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding

2014

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Endoscopy for acute nonvariceal upper gastrointestinal bleeding plays an important role in primary diagnosis and management, particularly with respect to identification of high-risk stigmata lesions and to providing endoscopic hemostasis to reduce the risk of rebleeding and mortality. Early endoscopy, defined as endoscopy within the first 24 hours after presentation, improves patient outcome and reduces the length of hospitalization when compared with delayed endoscopy. Various endoscopic hemostatic methods are available, including injection therapy, mechanical therapy, and thermal coagulation. Either single treatment with mechanical or thermal therapy or a treatment that combines more than one type of therapy are effective and safe for peptic ulcer bleeding. Newly developed methods, such as Hemospray powder and over-the-scope clips, may provide additional options. Appropriate decisions and specific treatment are needed depending upon the conditions.

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Management of Non-Variceal Upper Gastrointestinal Bleeding

Cited by 22 publications

References 35 publications

Immunosuppressive agents are associated with peptic ulcer bleeding

Immunosuppressive agents are associated with peptic ulcer bleeding

Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding

Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding

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