The National ASGE Survey on Upper Gastrointestinal Bleeding

Silverstein, Fred E.; Gilbert, David A.; Tedesco, Francis J.; Buenger, Nancy K.; Persing, J. A.

doi:10.1016/s0016-5107(81)73156-0

Cited by 350 publications

(138 citation statements)

References 12 publications

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“…These studies similarly demonstrated that clinical parameters (e.g. hemodynamics [17,[20][21][22][23] , comorbid illnesses [17,[20][21][22][23] , NG aspirate [17,24,25] ), endoscopic findings (stigmata of recent hemorrhage [17,[21][22][23]26] , and the presence of varices [17,[21][22][23] ) were strongly associated with the worst outcome, the need for hospitalization or interventions. Multiple scoring systems in UGIB, e.g.…”

Section: Discussionmentioning

confidence: 80%

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

Pongprasobchai¹,

Nimitvilai²,

Chasawat³

et al. 2009

WJG

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AIM:To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score. METHODS:Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS:Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR 4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011).The UGIB Etiology Score was calculated from (3.1 × previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vomitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION:The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

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Section: Discussionmentioning

confidence: 80%

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

Pongprasobchai¹,

Nimitvilai²,

Chasawat³

et al. 2009

WJG

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“…Severe erosive antral gastritis and duodenitis was the commonest cause of upper GI bleeding in this study (45%). In other published studies duodenal erosions have been reported in 12.4% and 9.1% of the instances, by Shennak 15 and Silverstein et al 12 respectively, but severe antral gastritis and duodenitis have not been described as sources of upper gastro intestinal bleeding in other published studies. It seems that even in the absence of the true peptic ulceration, severe antral gastritis and duodenitis have been major predisposing factors for acute UGIB in this cohort of patients.…”

Section: Discussionmentioning

confidence: 87%

“…Admissions to the surgical units and other medical units with upper gastrointestinal bleeding had not been evaluated in this study. Chronic duodenal and gastric ulcers were the most common causes of upper gastrointestinal bleeding in most of the published studies 12,13,14,15 . In contrast the present study showed peptic ulcer disease in only 15% of the bleeders.…”

Section: Discussionmentioning

confidence: 99%

Aetiology and other features of a cohort of adult Sri Lankans presenting with upper gastrointestinal bleeding (UGIB)

Satarasinghe¹,

Silva²,

Arulnithy³

et al. 2011

J of Cey Coll of Phy

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Results: There were 342 (24%) upper GI bleeders. The mean age of presentation was 55.5 years +/-14.4 SD. A high proportion was seen between 50-70 years of age. Sex distribution was, male:female = 229:114 (2:1). 45% have presented with haematemesis, 31% with malaena, and 24% with both. Endoscopy showed the presence of severe antral gastritis and duodenitis, oesophageal varices, oesaphagitis, erosive gastropathy, portal hypertensive gastropathy, pangastritis and peptic ulcer disease in 38%, 35%, 28%, 28%, 20%, 17% and 15% of the instances respectively. Hiatus herniae were seen in 43% although its role was unclear. Often combined pathologies were seen. Only 52% of the varices showed endoscopic evidence of bleeding. Excess alcohol consumption was seen in 36% while 5% were on NSAIDs. 5% had endoscopic negatives.Conclusions: UGIB is a major problem to the endoscopist, constituting about 25% of the work load, in this part of the continent. Although approximately 50% of the varices found had bled, portal hypertension related pathologies are a cause for concern. Alcohol was a contributory factor in 1/3 of the endoscoped population. Bleeding from PUD was not a dominant feature compared to the west.

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“…Despite advances in medical and endoscopic treatment, morality remains at between 3 and 14%, rising to 33% for patients developing secondary upper gastrointestinal bleeding following admission for other reasons [1,2]. Gastroduodenal ulcer disease is the commonest cause of upper gastrointestinal bleeding, accounting for almost 50% of admission caused by acute upper gastrointestinal bleeding, with 15,000 annual hospital admissions in the United States and an estimated cost of $750 million [3,4].…”

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confidence: 99%