• Epidemiology
• Mortality
• Proton pump inhibitors
• Rebleeding
• Saudi Arabia
• Ulcer

• P-CAB
• endoscopic hemostasis
• hemostatic gel emulsion
• hemostatic powder spray
• peptic ulcer bleeding

• Care
• Hemorrhage
• Peptic
• Quality
• Ulcer

• Humans
• Female
• Male
• Middle Aged
• Length of Stay
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Retrospective Studies
• Cross-Sectional Studies
• Aged
• Endoscopy, Gastrointestinal/methods
• Time Factors

• P20 GM130457 NIGMS NIH HHS
• P30 DK123704 NIDDK NIH HHS
• UL1 TR001450 NCATS NIH HHS

• Alternative medicines
• Antiplatelets
• Forrest classification
• Mortality
• Non variceal bleed
• Re-bleed

• Humans
• Retrospective Studies
• Peptic Ulcer
• Hemorrhage
• Machine Learning
• Cohort Studies
• Medical Records

• Bleeding gastric ulcer
• Case report
• Gastric wall necrosis
• Lauromacrogol
• Sclerotherapy
• Tissue adhesive

• Bipolar coagulation
• Cautery
• Device failure
• Endoscopy
• Gastrointestinal bleeding
• Hemostasis
• Risks

• Antiinflamatorios no esteroideos
• COX-2 selective inhibitors
• Complicaciones gastrointestinales
• Gastroprotección
• Gastroprotection
• Helicobacter pylori
• Inhibidores selectivos COX-2
• Non-steroidal anti-inflammatory drugs
• Peptic ulcer disease
• Upper gastrointestinal complications
• Úlcera péptica

• Humans
• Proton Pump Inhibitors/therapeutic use
• Helicobacter Infections/complications
• Helicobacter Infections/diagnosis
• Helicobacter Infections/drug therapy
• Peptic Ulcer/complications
• Peptic Ulcer/diagnosis
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Endoscopy, Digestive System
• Helicobacter pylori

• Meta-analysis
• Over the scope clips
• Primary treatment
• Upper GI bleeding

• Humans
• Hemostasis, Endoscopic/methods
• Gastrointestinal Hemorrhage/surgery
• Endoscopy, Gastrointestinal
• Embolization, Therapeutic
• Recurrence

• Anticoagulant
• gastrointestinal hemorrhage
• hemostasis
• mortality
• recurrence

• Male
• Humans
• Gastrointestinal Hemorrhage
• Anticoagulants/adverse effects
• Multivariate Analysis
• Odds Ratio
• Albumins

• Peptic ulcer disease
• Splenic artery pseudoaneurysm
• Transcatheter arterial embolization
• Upper gastrointestinal bleeding

• Blood transfusion
• Critical care
• Global health
• Hemorrhage
• Hemorrhagic shock

• Blood Transfusion
• Female
• Hemorrhage/etiology
• Humans
• Pregnancy
• Shock, Hemorrhagic/diagnosis
• Shock, Hemorrhagic/therapy

• UG3 HL151595 NHLBI NIH HHS

• Follow-Up Studies
• Gastroscopy
• Humans
• Stomach Neoplasms/pathology
• Stomach Ulcer/diagnosis
• Ulcer

Acute upper gastrointestinal bleeding (UGIB) in acute coronary syndrome (ACS) patients are not uncommon, particularly under dual antiplatelet therapy (DAPT). The efficiency and safety of early endoscopy (EE) for UGIB in these patients needs to be elucidated. This multicenter randomized controlled trial randomized recent ACS patients presenting acute UGIB to non-EE and EE groups. All eligible patients received intravenous proton pump inhibitor therapy. Those in EE group underwent therapeutic endoscopy within 24 h after bleeding. The data regarding efficacy and safety of EE were analyzed. It was early terminated because the UGIB rate was lower than expected and interim analysis was done. In total, 43 patients were randomized to non-EE (21 patients) and EE (22 patients) groups. The failure rate of control hemorrhage (intention-to-treat [ITT] 4.55% vs. 23.81%, p < 0.001; per-protocol [PP] 0% vs. 4.55%, p = 0.058) and 3-day rebleeding rate (ITT 4.55% vs. 28.57%, p = 0.033; PP 0% vs. 21.05%, p = 0.027) were lower in EE than non-EE group. The mortality, minor and major complication rates were not different between two groups. Male patients were at higher risk of minor and major complications after EE with OR (95% CI) of 3.50 (1.15–10.63) and 4.25 (1.43–12.63), respectively. In multivariate analysis, EE was associated with lower needs for blood transfusion (HR 0.13, 95% CI 0.02–0.98). Among patients who discontinued DAPT during acute UGIB, a higher risk (OR 5.25, 95% CI 1.21–22.74) of coronary artery stent re-thrombosis within 6 months was noticed. EE for acute UGIB in recent ACS patients has higher rate of bleeding control, lower 3-day rebleeding rate and lower needs for blood transfusion, but more complications in male patients. Further enrollment is mandatory to avoid bias from small sample size (ClinicalTrial.gov Number NCT02618980, registration date 02/12/2015).

• delayed feeding
• early enteral nutrition
• early feeding
• endoscopic procedures
• endoscopic submucosal dissection

• humans
• acute disease
• endoscopy
• gastrointestinal hemorrhage
• gastrointestinal hemorrhage/therapy
• histamine h2 antagonists
• histamine h2 antagonists/therapeutic use
• proton pump inhibitors
• proton pump inhibitors/therapeutic use

• Acute Disease
• Endoscopy
• Gastrointestinal Hemorrhage/therapy
• Histamine H2 Antagonists/therapeutic use
• Humans
• Proton Pump Inhibitors/therapeutic use

• Acute gastrointestinal bleeding
• Health care
• Hub and spoke network
• Mortality
• Organizational setting

• Anti-thrombotics
• Guideline
• Non-steroidal anti-inflammatory drug
• Non-variceal upper gastrointestinal bleeding

• Endoscopy
• Hemostasis, Endoscopic
• Humans
• Peptic Ulcer
• Peptic Ulcer Hemorrhage/therapy
• Randomized Controlled Trials as Topic

• endoscopic surgery
• haemodynamics
• lower GI bleeding
• outcome
• upper gi bleeding

• Administration, Intravenous
• Administration, Oral
• Blood Transfusion
• Endoscopy, Gastrointestinal
• Equivalence Trials as Topic
• Humans
• Length of Stay
• Peptic Ulcer Hemorrhage/drug therapy
• Peptic Ulcer Hemorrhage/mortality
• Peptic Ulcer Hemorrhage/surgery
• Proton Pump Inhibitors/administration & dosage
• Secondary Prevention
• Treatment Outcome

Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU.

In total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis.

Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR] 3.43; 95% confidence interval [CI] 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR 5.80; 95% CI 2.08–16.2), and heart disease (OR 3.05; 95% CI 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR 8.24; 95% CI 2.36–28.7).

In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

• Activity of daily living
• Elderly
• Gastroduodenal ulcer
• Prognosis

• Tranexamic acid
• meta-analysis
• randomised controlled trials
• upper gastrointestinal bleeding

• Antithrombotics
• Guideline
• Nonsteroidal anti-inflammatory drug
• Nonvariceal upper gastrointestinal bleeding

• Endoscopy, Gastrointestinal
• Gastroenterology
• Gastrointestinal Hemorrhage
• Helicobacter Infections
• Helicobacter pylori
• Humans
• Practice Guidelines as Topic
• Republic of Korea

• Anatomical study
• Endoscopy
• Gastroduodenal artery
• Ulcus bleeding

• ABS, Ankaferd blood stopper
• APC, argon plasma coagulation
• ASGE, American Society for Gastrointestinal Endoscopy
• CPT, Current Procedural Terminology
• CSEMS, covered self-expandable metallic stent
• EBL, endoscopic band ligation
• EDP, endoscopic Doppler probe
• GAVE, gastric antral vascular ectasia
• HP, heater probe
• LGIB, lower GI bleeding
• MPEC, multipolar electrocoagulation
• OTSC, over-the-scope clip
• PTFE, polytetrafluoroethylene
• RCT, randomized controlled trial
• TTS, through-the-scope
• U.S. FDA, United States Food and Drug Administration
• UGIB, upper GI bleeding

• UL1 TR001863 NCATS NIH HHS

The Forrest classification is widely applied to guide endoscopic hemostasis for peptic ulcer bleeding. Accordingly, practice guidelines suggest medical treatment only for ulcer with a Forrest IIc lesion because it has low rebleeding risk even without endoscopic therapy, ranging from 0 to 13%. However, the risk ranges widely and it is unclear who is at risk of rebleeding with such a lesion. This study assessed whether the Rockall score, which evaluates patients holistically, could indicate the risk of recurrent bleeding among patients with a Forrest IIc lesion at the second-look endoscopy.

Patients who had peptic ulcer bleeding with Ia-IIb lesions received endoscopic hemostasis at the primary endoscopy, and they were enrolled if their Ia-IIb lesions had been fading to IIc at the second-look endoscopy after 48- to 72-h intravenous proton pump inhibitor (PPI) infusion. Primary outcomes were rebleeding during the 4th–14th day and 4^th–28th day after the first bleeding episode.

The prospective cohort study enrolled 140 patients, who were divided into a Rockall scores ≥ 6 group or a Rockall scores < 6 group. The rebleeding rates in the Rockall scores ≥ 6 group and the Rockall scores < 6 group during the 4th–14th day and the 4th–28th day were 13/70 (18.6%) versus 2/70 (2.9%), p = 0.003 and 17/70 (24.3%) versus 3/70 (4.3%), p = 0.001, respectively, based on an intention-to-treat analysis and 5/62 (8.1%) versus 0/68 (0%), p = 0.023 and 6/59 (10.2%) versus 0/67 (0%), p = 0.009, respectively, based on a per-protocol analysis. The Kaplan–Meier curves showed that the Rockall scores ≥ 6 group had a significantly lower cumulative rebleeding-free proportion than the Rockall scores < 6 group (p = 0.01).

Combined Rockall scores ≥ 6 on arrival with a Forrest IIc lesion at the second-look endoscopy can identify patients at risk of recurrent peptic ulcer bleeding following initial endoscopic and intravenous PPI treatment.

Trial registration Trial registration identifier: NCT01591083

• Forrest classification
• Peptic ulcer bleeding
• Recurrent bleeding
• Rockall score
• Second-look endoscopy

Peptic ulcer disease is a condition in which an important role has infection with H. pylori. The most common complication of peptic ulcer is bleeding. The presence of H. pylori triggers local and systemic cytokine signaling which may affect processes such as healing, gastric or duodenal rupture, and carcinogenesis. In this study, we examined the concentrations of IL-1β, IL-6, IL-10, TNF, TGF-β and IL-17A in serum by enzyme immunoassay and their mRNA expressions in periulcer biopsies obtained from patients with bleeding peptic ulcer by means of real-time-PCR.

We have shown that pro-inflammatory IL-6 and TNF concentrations in serum were significantly higher in patients who were infected with H. pylori, while the concentrations of TGF-β and IL-17A were significantly lower compared to non-infected subjects. IL-17A expression in periulcer mucosa was significantly higher in patients who were infected with H. pylori, while the expression of other cytokines, there was no significant difference compared to non-infected controls. Considering higher serum concentrations in non-infected subjects and higher IL-17A expression in mucosal tissue of infected patients, our data support the studies that found IL-17A has protective role in eradication of H. pylori infection in infected patients.

The online version of this article (10.1186/s13104-019-4310-4) contains supplementary material, which is available to authorized users.

• Bleeding ulcer
• Helicobacter pylori
• Proinflammatory cytokines
• Real-time-PCR

• Diagnostic yield
• Endoscopy
• Gastrointestinal hemorrhage
• Video capsule endoscopy

• Endoscopy
• Operative management
• Peptic ulcer disease
• Upper gastrointestinal bleed
• Variceal bleeding

Delayed bleeding after gastric endoscopic submucosal dissection (ESD) commonly occurs within 3 days, but it may also occur after 1 week following ESD, especially in antiplatelet agent users. We evaluated the risk of delayed bleeding in post-ESD ulcers using the Forrest classification.

Registry data on the Forrest classification of post-ESD ulcers (n=371) at 1 week or 2 weeks after ESD were retrospectively evaluated. The Forrest classification was categorized into two groups: increased risk (Forrest Ia to IIc) or low risk (Forrest III). The odds ratios (ORs) were calculated using logistic regression analysis.

Among 371 post-ESD ulcers, one ulcer (0.3%) was classified as Forrest Ib, two (0.5%) as Forrest IIa, 17 (4.6%) as Forrest IIb, 172 (46.4%) as Forrest IIc, and 179 (48.2%) as Forrest III. The proportion of increased-risk ulcers was 72.2% (140/194) at 1 week after ESD, which decreased to 29.4% (52/177) at 2 weeks after ESD (p<0.001). In the multivariate analysis, a post-ESD ulcer at 1 week after ESD (OR, 7.54), younger age (OR, 2.17), and upper/middle ulcer location (OR, 2.05) were associated with increased-risk ulcers.

One week after ESD, ulcers still have an increased risk of bleeding when assessed using the Forrest classification. This risk should be considered when resuming antiplatelet therapy.

• Endoscopic mucosal resection
• Forrest classification
• Hemorrhage
• Stomach neoplasms

• Gastrointestinal bleeding
• Gastrointestinal hemorrhage
• Non-variceal upper gastrointestinal bleeding

• Endoscopy
• Gastrointestinal Hemorrhage
• Outcome

Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment.

To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality.

A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization.

The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01).

In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

• gastrointestinal
• hemorrhage
• transcatheter arterial embolization

Risk scoring systems are used to evaluate patients with upper gastrointestinal bleeding (UGIB). We compared Glasgow-Blatchford score (GBS), modified GBS (mGBS), and Pre-endoscopy Rockall score (Pre-E RS) for immediate application without endoscopic findings in predicting the need of interventions and the 30-day mortality in patients with UGIB.

Patients who visited the emergency room with UGIB from January 2007 to June 2016 were included. GBS, mGBS, and Pre-E RS were obtained for all patients. The area under the receiver-operating characteristic curves (AUC) was used to assess the accuracy of the scoring systems to determine the need for interventions and 30-day mortality. Also, we investigated the potential cutoff scores for predicting 30-day mortality and the need for interventions.

In predicting the need for interventions, GBS (AUC = 0.727) and mGBS (AUC = 0.733) outperformed Pre-E RS (AUC = 0.564, P < 0.0001). In predicting 30-day mortality, Pre-E RS (AUC = 0.929) outperformed GBS (AUC = 0.664, P < 0.0001) and mGBS (AUC = 0.652, P < 0.0001). Based on AUC analyses of sensitivities and specificities, the optimal cutoff mGBS and GBS for the need for interventions was 9 (70.71% sensitivity, 89.35% specificity) and 9 (73.57% sensitivity, 82.90% specificity) respectively, and optimal cutoff Pre-E RS for 30-day mortality was 4 (88.0% sensitivity, 97.52% specificity).

GBS and mGBS are considered to be moderately accurate in making an early decision about the need of interventions in patients with UGIB. Pre-E RS is considered to be highly accurate in early detection of patients at high risk for 30-day mortality without endoscopic findings. In addition, we suggested potential cutoff scores to predict the need of interventions for GBS and mGBS, and 30-day mortality for Pre-E RS. Further studies are needed to confirm the clinical applicability of results.

• 30-day mortality
• Need of interventions
• Prediction
• Scoring system
• Upper gastrointestinal bleeding

In upper gastrointestinal bleeding (UGIB) patients, early risk stratification allows appropriate therapy that may be helpful for reducing morbidity and mortality.

to evaluate the efficacy of red-cell distribution width (RDW) for prediction of high-risk in UGIB patients.

We conducted a clinical retrospective observational study based on data for UGIB patients from 2012 to 2013. The primary outcome was the high-risk UGIB, defined as those who required urgent intervention and/or 30-days mortality. RDW was categorized into four quartiles: Q1 (≤12.8%), Q2 (12.9–14.4%), Q3 (14.5–16.5%), and Q4 (≥16.6%), and multivariable analysis was performed after adjustment of multiple other risk factor. We also evaluated the efficacy of addition of RDW scores to the Pre-endoscopic Rockall Score (PRS) and the Glasgow Blatchford Score (GBS) scoring system.

Of 360 UGIB patients, 229 (63.6%) were high risk. In multivariable analysis, Q3 and Q4 were strongly associated with high risk; odds ratio (95% Confidence Interval) was 3.144 (1.250–7.905) and 4.182 (1.483–11.790) respectively (all p < 0.05). For lower GBS score group (≤ 6), the incidence of high risk was higher in Q4 (30%) and Q3 (20%) than in Q2 (12.5%) and Q1 (11.4%). For lower PRS group (≤ 2), the incidence of high-risk was higher in Q4 (73.7%) and Q3 (57.1%) than in Q1 (35.4%). Receiver operating characteristic analysis showed higher discrimination power in PRS + RDW (Area Under Curve [AUC] = 0.749) than PRS (AUC = 0.715) alone (p = 0.036). Otherwise GBS + RDW (AUC = 0.873) did not show a significant higher discrimination power than the GBS (AUC = 0.864) alone (p = 0.098).

For UGIB patients, a high RDW (≥ 14.5%) was strongly associated with high risk UGIB. In practice, the combination of RDW with the PRS scoring indexes may increase the accuracy of risk stratification.

• Adult
• Aged
• Biomarkers/blood
• Erythrocytes/metabolism
• Female
• Gastrointestinal Hemorrhage/etiology
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors

• Konkuk University

• AIMS65
• Lactate
• Mortality
• Nonvariceal Upper Gastrointestinal Bleeding
• Rebleeding

• Aged
• Area Under Curve
• Female
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/mortality
• Hemostasis, Endoscopic
• Humans
• Lactic Acid/blood
• Male
• Middle Aged
• Odds Ratio
• Prognosis
• ROC Curve
• Recurrence
• Retrospective Studies
• Severity of Illness Index
• Stomach Ulcer/complications
• Stomach Ulcer/diagnosis
• Survival Rate