Raised blood urea concentration indicates considerable blood loss in acute upper gastrointestinal haemorrhage.

Pumphrey, C W; Beck, E R

doi:10.1136/bmj.280.6213.527-a

Cited by 14 publications

(9 citation statements)

References 3 publications

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“…Gastric biopsies taken at baseline from all dogs were positive for urease-producing bacteria. 17.5 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22) 13 (11)(12)(13)(14) 15 (11)(12)(13)(14)(15)(16)(17)(18)(19) Creatinine (mg/dL) revealed that differences were due to greater numbers of lesions during treatment for dogs in the aspirin (invasive erosions, day 14 only), prednisone (days 14 and 28), and prednisone/aspirin groups (days 14 and 28; P ≤ .008 for all comparisons). Erosion often was marked and multifocal (Figure 1), although primarily concentrated in the antrum.…”

Section: Endoscopic Findingssupporting

confidence: 76%

“…The BUN:creatinine ratio detects changes consistent with GI bleeding in absence of increases in BUN concentration, given the latter's poor sensitivity for bleeding. Ten percent of people experiencing acute GI blood loss of ≥1.1 L have BUN concentrations <24 mg/dL . Furthermore, only 66% of subjects with massive GI hemorrhage have BUN concentrations ≥31 mg/dL—the upper limit of the reference interval for BUN in this study.…”

Section: Discussionmentioning

confidence: 99%

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Clinical, clinicopathologic, and gastrointestinal changes from aspirin, prednisone, or combination treatment in healthy research dogs: A double‐blind randomized trial

Whittemore

Mooney

Price

et al. 2019

Veterinary Internal Medicne

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Background Dogs with immune‐mediated disease are often coadministered glucocorticoids and aspirin, but ulcerogenic effects of current protocols are unknown. Objectives To compare gastrointestinal changes among dogs administered aspirin, prednisone, and combination treatment. Animals Twenty‐four healthy research dogs. Methods Double‐blinded, placebo‐controlled randomized trial of dogs administered placebo, aspirin (2 mg/kg q24h), prednisone (2 mg/kg q24h), or combination treatment PO for 28 days. Clinical signs were recorded daily, with laboratory work performed at baseline and day 28. Gastrointestinal mucosal hemorrhages, erosions, and ulcers were numerated for endoscopic studies performed on days 0, 14, and 28; endoscopic mucosal lesion scores were calculated. Results were compared using mixed model repeated‐measures analyses of variance and generalized estimating equation proportional odds models. P < .05 was considered significant. Results Gastric mucosal lesion scores differed by treatment‐by‐time (F[6, 40] = 4.4, P = .002), treatment (F[3, 20] = 7.1, P = .002), and time (F[2, 40] = 18.9, P < .001). Post hoc analysis revealed increased scores in the aspirin (day 14 only), prednisone, and prednisone/aspirin groups during treatment. Ulcers were identified on 14 studies, representing 10 dogs. Dogs receiving prednisone and prednisone/aspirin had 11.1 times (95% CI, 1.7‐73.6) and 31.5 times (95% CI, 3.5‐288.0) higher odds, respectively, of having endoscopic mucosal lesion scores ≥4 than dogs receiving placebo (P ≤ .01). Conclusions and Clinical Importance Gastrointestinal bleeding occurs commonly in dogs administered aspirin, prednisone, or prednisone/aspirin treatment, with higher lesion scores for dogs receiving combination treatment. Even severe lesions are not accompanied by clinical signs.

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Section: Endoscopic Findingssupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Clinical, clinicopathologic, and gastrointestinal changes from aspirin, prednisone, or combination treatment in healthy research dogs: A double‐blind randomized trial

Whittemore

Mooney

Price

et al. 2019

Veterinary Internal Medicne

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“…Serum urea is known to rise in UGIH, and has been previously identified as a marker of severity of gastrointestinal haemorrhage 18 19. In our study the optimum discriminatory cut-off for association with RET was 10 mmol/L.…”

Section: Discussionmentioning

confidence: 55%

Factors at presentation predictive of a requirement for endoscopic therapy in patients presenting with overt upper gastrointestinal haemorrhage: a retrospective observational study

Irwin

Ferguson

Weilert

et al. 2013

Frontline Gastroenterol

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IntroductionIn patients with upper gastrointestinal haemorrhage (UGIH), endoscopic treatment of high-risk lesions reduces mortality. Performing out of office hours endoscopy places a strain on endoscopy services. This analysis aims to identify factors at presentation associated with lesions requiring endoscopic therapy, allowing triage of those likely to receive benefit from acute out of hours endoscopy.MethodsPatients presenting between 17 March 2001 and 12 October 2010 with UGIH had clinical and laboratory features on presentation, endoscopic findings and administered treatment recorded. Patients with known cirrhotic liver disease were excluded. Logistic regression was performed, identifying factors at presentation associated with a requirement of endoscopic therapy (RET), which were then used to create a scoring system predictive of RET.ResultsIn all, 1492 patients were analysed. The presence on presentation of fresh melaena (OR = 3.18, p<0.001), fresh haematemesis (OR=2.13, p<0.001), haemoglobin<130 g/L (OR=2.65, p<0.001), urea >10 mmol/L (OR=2.10, p<0.001), systolic blood pressure <100 mm Hg (OR=1.85, p<0.001), inpatient status (OR=1.43, p=0.04), a history of peptic ulcer disease (OR=1.96, p=0.02), male sex (OR=1.45, p=0.01), presentation within 8 h of symptom onset (OR=1.48, p=0.02), coffee ground vomitus (OR=0.47, p=0.004) and warfarin use (OR=0.57, p=0.005) were associated with RET. Using a simple scoring system (fresh haematemesis=2, fresh melaena=2, haemoglobin <130=2, urea >10=1, BP <100=1, male sex=1, history of peptic ulcer disease=1), a score ≥7 was associated with RET in 45% of cases and a score ≤4 in 7%.ConclusionsApplication of this scoring system when assessing patients presenting with UGIH out of office hours may help predict the likelihood of RET, and aid in the triage of endoscopy. Prospective validation of this score in an external cohort is required.

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“…The association between mild uraemia and subsequent haemorrhage might suggest that premonitory chronic low-level gastrointestinal bleeding was occurring in these patients at the time of their baseline FDS assessment. Digestion of the protein load resulting from haemorrhage can cause uraemia [29], but this relationship has been derived from studies of haematemesis rather than slow asymptomatic bleeding. As with retinopathy and peripheral vascular disease, an elevated serum urea concentration may simply be a surrogate for protein catabolism associated with diabetes tissue damage and dysfunction that involve the gastroduodenal mucosa.…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet therapy, Helicobacter pylori infection and complicated peptic ulcer disease in diabetes: The Fremantle Diabetes Study

et al. 2009

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Aims To assess whether, based on its relationship with complications of peptic ulcer disease (PUD), directed Helicobacter pylori serological screening is justified in diabetic patients prior to commencement of antiplatelet therapy. MethodsWe analysed data from the longitudinal, community-based Fremantle Diabetes Study (FDS). The present substudy included (i) 1301 patients (91.2% of the total FDS sample; mean age 62.0 ± 13.3 years, 49.5% male) with available sera from baseline assessment between 1993 and 1996, and (ii) a subset of 40 patients admitted to hospital for complicated PUD (bleeding and/or perforation) between baseline and end of June 2006. All hospital admissions for complicated PUD in the population of Western Australia were identified over the same period. Helicobacter pylori IgG antibodies were measured in all patients at baseline and in the subset at the FDS visit prior to hospital admission.Results Helicobacter pylori seropositivity was present in 60.6% of FDS patients at baseline and was independently associated with increasing age and non-Anglo-Celt/non-Asian ethnicity. There were 2.9 (95% confidence interval 2.1, 3.9) first admissions for complicated PUD per 1000 patient-years, an incidence more than seven times that in the local general population. Independent baseline predictors of hospital admission were increasing age, serum urea, non-aspirin anticoagulant therapy, sulphonylurea therapy, peripheral arterial disease and diabetic retinopathy, but not aspirin use, H. pylori seropositivity or their interaction.Conclusions There are diabetes-specific risk factors for complicated PUD, including sulphonylurea use and vascular complications. Knowledge of H. pylori serological status does not predict complicated PUD in diabetes regardless of use of antiplatelet therapy. Diabet. Med. 26, 70-75 (2009)

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Raised blood urea concentration indicates considerable blood loss in acute upper gastrointestinal haemorrhage.

Cited by 14 publications

References 3 publications

Clinical, clinicopathologic, and gastrointestinal changes from aspirin, prednisone, or combination treatment in healthy research dogs: A double‐blind randomized trial

Clinical, clinicopathologic, and gastrointestinal changes from aspirin, prednisone, or combination treatment in healthy research dogs: A double‐blind randomized trial

Factors at presentation predictive of a requirement for endoscopic therapy in patients presenting with overt upper gastrointestinal haemorrhage: a retrospective observational study

Antiplatelet therapy, Helicobacter pylori infection and complicated peptic ulcer disease in diabetes: The Fremantle Diabetes Study

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