Upper gastrointestinal bleeding following open heart surgery

Abstract

We reviewed our experience with endoscopically evaluated severe upper gastrointestinal hemorrhage following open heart surgery. Of 4892 patients undergoing open heart surgery, 18 (0.4%) sustained upper gastrointestinal hemorrhage requiring endoscopic evaluation. Endoscopy identified the source of bleeding in all cases. No significant complications of endoscopy were observed. Duodenal ulcers (DUs) were found in 16 (89%) of cases and were felt to be the source of bleeding in 15 (83%). Aggressive features, such as multiplicity, large size, or distal location were associated with 13 (81%) of the DU cases. Complications necessitated endoscopic or surgical therapy in eight (44%) patients with DUs. We conclude that aggressive DU disease accounts for the majority of severe upper gastrointestinal bleeding following open heart surgery.

Stress gastric ulcer after cardiac surgery: Pathogenesis risk factors and medical management

“…Kalz [33] and Lebovics, [34], found that patients with a history of peptic ulcer disease were more at risk for upper gastroduodenal bleeding after cardiac surgery than patients without previous peptic ulcer disease, but the current reports did find according to Halm et al [35], unlike in chronic ulcer, that Helicobacter pylori does not appear to be associated with stress ulceration in critically ill patients.…”

Pathogenesis, risk factors, and incidence of upper gastrointestinal bleeding after cardiac surgery: Is specific prophylaxis in routine bypass procedures needed?

“…Welsh [16] found in 9 patients that the origin of bleeding was an oesophageal varix in 1 patient, multiple gastric lesions in 1, multiple gastric and duodenal ulcers in 3, pre-pyloric ulcer in 1, ulceration of the esophagogastric junction in 1 and haemorrhagic enteropathy in 2. Ohri [17] found the site of bleeding in 5 patients to be the stomach and the duodenum in 6; Lebovic [18] found 16 duodenal ulcers, 4 erosive gastritis and 2 gastric ulcer. No predominant site (stomach or duodenum) can be extracted from these data but frequently the bleedings appeared not to be caused by stress ulceration.…”

“…Patients with a history of peptic ulcer disease were more at risk for UGIB after cardiac surgery than patients without previous peptic ulcer disease [12,16,18]. However, Hanks found only 1 patient with previous ulcer out of 19 patients with UGIB after cardiac surgery [21].…”

Upper gastrointestinal haemorrhage following coronary artery bypass grafting

“…Only one study has examined the safety of endoscopy post CABG. 4 The patient population undergoing the procedure is changing, with more frail and older patients accepted for surgery. These changes in this patient population may alter the incidence of UGI bleeding these issues in mind we reviewed the occurrence of significant UGI bleeding following CABG at our institution between 1976 and 1991. and/or the outcome from significant bleeding.…”