Upper Gastrointestinal Bleeding: Etiologies and Management

Kamboj, Amrit K.; Hoversten, Patrick; Leggett, Cadman L.

doi:10.1016/j.mayocp.2019.01.022

Cited by 118 publications

(139 citation statements)

References 24 publications

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“…Variceal hemorrhage accounts for the second most common cause of upper gastrointestinal bleeding [7]. Although endoscopy is a powerful method for GEV detection, it has limitations, such as its invasiveness and incomplete evaluation of the whole portal system.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of CTPV for Diagnostic and Therapeutic Assessment: Comparison with Endoscopy in Cirrhotic Patients with Gastroesophageal Varices

Cui

Yang

Jin

et al. 2020

Gastroenterology Research and Practice

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Background and Aims. Computed tomography portal venography (CTPV) shows potential in detecting varices that need treatment and their drainage pathways. However, its agreement with endoscopy requires further study. We investigated the feasibility of CTPV as an alternative tool to endoscopy in screening gastroesophageal varices (GEVs) and developed a CTPV-based model to provide a less invasive assessment of endotherapy for cirrhotic patients with GEVs. Methods. The study included 33 cirrhotic patients with a recent history of variceal hemorrhage. The presence, grade, and classification of GEVs on endoscopy and CTPV were compared (kappa test). Twenty-four patients were treated endoscopically, including 12 for esophageal varices (EVs), 8 for gastric varices (GVs), and 4 for GEVs. Treatment efficacies were assessed with the newly developed CTPV-based method at 1 week and 1 month after treatment. Efficiency evaluated by CTPV and endoscopy was compared by Fisher’s exact test to determine whether CTPV is efficient in the assessment of endotherapy efficacy. Results. For the screening and grading/classification of EVs and GVs, substantial agreement (EV kappa: 0.63 and 0.68; GV kappa: 0.62 and 0.75, respectively) was noted between endoscopy and CTPV. The therapeutic efficacy of EVs was higher when assessed by CTPV than when evaluated by endoscopy (37.50% vs. 12.50% at 1 week postoperation, P=0.22; 62.50% vs. 25.00% at 1 month postoperation, P=0.07), but without statistical significance. The same trend was also found in the assessment of therapeutic efficacy for GVs (25.00% vs. 16.67% at 1 week postoperation, P=1; 58.33% vs. 41.67% at 1 month postoperation, P=0.68). Conclusion. CTPV is comparable to endoscopy in the detection of GEVs and in the evaluation of endotherapy efficacy, which suggests that it could be a less invasive alternative for endoscopy in cirrhotic patients with GEVs needing treatment.

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Section: Discussionmentioning

confidence: 99%

Efficacy of CTPV for Diagnostic and Therapeutic Assessment: Comparison with Endoscopy in Cirrhotic Patients with Gastroesophageal Varices

Cui

Yang

Jin

et al. 2020

Gastroenterology Research and Practice

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“…PPI has been shown to reduce the severity of gastrointestinal mucosal injury by suppressing gastric acid secretion [33]. In addition, since most UGIB is caused by damage of the gastrointestinal mucosa [2], it is expected that the severity of UGIB will be reduced in habitual PPI users, most likely due to constant suppression of gastric acid secretion [34,35].…”

Section: Discussionmentioning

confidence: 99%

“…Using the review of Kamboj et al [ 2 ] as a reference, UGIB was defined as bleeding caused by benign/malignant diseases (ulcers, solid cancers, vascular abnormalities, etc.) in the esophagus, stomach, and duodenum.…”

Section: Methodsmentioning

confidence: 99%

“…Of the total 97 cases, 49 were classified as mild cases, and 48 were classified as moderate/severe cases according to bleeding severity. The effect of PPI use on bleeding severity was compared and analyzed between the groups, along with the lesions responsible for the bleeding, underlying diseases exacerbated by aging, and patient characteristics selected as risk factors for UGIB (age, sex, underlying disease [hypertension/diabetes/dyslipidemia/cerebrovascular disease/heart disease/hepatic cirrhosis/kidney disease/dementia/extra-gastrointestinal malignant tumors], antithrombotic drugs [antithrombotic drugs/anticoagulants], NSAID use) [ 1 , 2 , 7 , 19 – 21 ]. Additionally, correlations between PPI use/dose and clinical UGIB symptoms (estimated blood volume, SI, total transferred blood volume) were also analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…Upper gastrointestinal bleeding (UGIB) is a serious condition that can take a severe course [1,2]. UGIB can be fatal, particularly in elderly patients, whose physical strength has declined over time and who have various underlying diseases [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Daily Usage of Proton Pump Inhibitors May Reduce the Severity of Critical Upper Gastrointestinal Bleeding in Elderly Patients

Matsuda

Nosaka

Akazawa

et al. 2020

Gastroenterology Research and Practice

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Introduction. We retrospectively examined the relationship between daily proton pump inhibitor (PPI) use and severity of upper gastrointestinal bleeding (UGIB), mainly in the elderly. Methods. We included 97 patients with nonvariceal UGIB diagnosed at our hospital from January 2012 to October 2017. Bleeding severity was assessed using the shock index (SI) and estimated bleeding volume; 49 patients met the criterion for the mild group and 48 for the moderate/severe group. The effect of PPI use on bleeding severity was compared between the groups. The relationships of PPI use and dose with the clinical symptoms of UGIB were also analyzed. Results. Among the 97 patients, 17 (17.5%) habitually used PPIs. The rate of habitual PPI use was significantly higher in the mild group, indicating as an independent factor contributing to a reduction in the severity of UGIB in a multiple logistic regression analysis (30.6% vs. 4.2%; OR 10.147; 95% CI 2.174–47.358, P<0.01). When analyzing data for a subgroup of patients older than 75 years, we found the protective PPI effect to be even higher in the mild UGIB group than in the moderate/severe group (37.0% vs. 5.6%; OR 10.000; 95% CI 1.150–86.951, P<0.05). Conversely, we found no association between PPI prescription and UGIB symptoms in patients younger than 75 years. The mean estimated bleeding volume and SI in the 17 habitual PPI users were both significantly less than those among the 80 nonhabitual users, respectively (P<0.05). The proportion of patients with mild UGIB was similar between the low- and high-dose PPI users. Conclusions. Particularly in elderly patients with nonvariceal UGIB, habitual PPI use can alleviate the clinical symptoms of UGIB by suppressing the volume of bleeding, regardless of the adapted dose of PPIs.

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