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Nagesh VK, Varughese VJ, Musalli J, Nageswaran GA, Russell E, Feldman SA, Weissman S, Atoot A. Readmission Events Following EGD for Upper Gastrointestinal Bleed: An Analysis Using the National Readmission Database. Med Sci (Basel) 2025; 13:45. [PMID: 40265392 PMCID: PMC12015878 DOI: 10.3390/medsci13020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2025] [Revised: 04/11/2025] [Accepted: 04/17/2025] [Indexed: 04/24/2025] Open
Abstract
Background: Upper Gastrointestinal Bleed (UGIB) is a common and potentially life-threatening condition with an annual incidence of 80-150 per 100,000 individuals and a mortality rate of 2-10%. Esophagogastroduodenoscopy (EGD) is the gold standard for both diagnosis and treatment, but post-discharge outcomes, including readmissions, remain underexplored. Methods: This study utilized the 2021 National Readmission Database (NRD) to analyze 30-day readmission rates following EGD for UGIB. Adult patients (≥18 years) admitted for UGIB and undergoing EGD were included; those who died during the index hospitalization were excluded. Demographic, clinical, and socioeconomic factors associated with readmission were examined using multivariate logistic regression. Results: Among 34,257 patients admitted for UGIB and undergoing EGD, 11,088 (32.4%) were readmitted within 30 days, with 5423 (49%) due to recurrent UGIB. Readmitted patients had a higher mean age (68.46 vs. 67.63 years) and greater prevalence of cirrhosis (16.71% vs. 13.84%). Hospital resource utilization was significantly higher among readmissions, with increased total hospital charges (USD 82,544.82 vs. USD 61,521.17) and longer hospital stays (5.38 vs. 4.97 days). Mortality was lower among readmitted patients (1.46% vs. 3.53%). Multivariate analysis identified cirrhosis (OR 7.20, 95% CI: 6.45-8.02), untreated H. pylori infection (OR 3.43, 95% CI: 2.15-4.30), atrial fibrillation (OR 1.52, 95% CI: 1.36-1.69), and chronic antithrombotic therapy (OR 1.63, 95% CI: 1.41-1.89) as significant predictors of recurrent UGIB readmission. Lower socioeconomic status was also associated with increased readmission risk (OR 1.15, 95% CI: 1.05-1.25). Conclusions: Readmission following EGD for UGIB is common and driven primarily by recurrent bleeding. Cirrhosis, untreated H. pylori infection, atrial fibrillation, and chronic anticoagulation therapy are key risk factors. These findings highlight the need for targeted interventions, including improved post-discharge management and optimization of anticoagulation strategies, to reduce readmission rates and improve patient outcomes.
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Affiliation(s)
- Vignesh Krishnan Nagesh
- Hackensack Palisades Medical Center, 7600 River Rd, North Bergen, NJ 07047, USA; (J.M.); (E.R.); (S.W.); (A.A.)
| | - Vivek Joseph Varughese
- Prisma Health, University of South Carolina, 2 Med Park, Richland, Columbia, SC 29203, USA;
| | - Jaber Musalli
- Hackensack Palisades Medical Center, 7600 River Rd, North Bergen, NJ 07047, USA; (J.M.); (E.R.); (S.W.); (A.A.)
| | | | - Erin Russell
- Hackensack Palisades Medical Center, 7600 River Rd, North Bergen, NJ 07047, USA; (J.M.); (E.R.); (S.W.); (A.A.)
| | - Susan Anne Feldman
- Prisma Health, University of South Carolina, 2 Med Park, Richland, Columbia, SC 29203, USA;
| | - Simcha Weissman
- Hackensack Palisades Medical Center, 7600 River Rd, North Bergen, NJ 07047, USA; (J.M.); (E.R.); (S.W.); (A.A.)
| | - Adam Atoot
- Hackensack Palisades Medical Center, 7600 River Rd, North Bergen, NJ 07047, USA; (J.M.); (E.R.); (S.W.); (A.A.)
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Wang J, Yu L, Liu L, Luo Y, Lv N, Shu X, Zhu Z. Non-epinephrine monotherapy matches combination therapy in high-risk PUB patients. Sci Rep 2025; 15:12763. [PMID: 40229353 PMCID: PMC11997162 DOI: 10.1038/s41598-025-97705-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 04/07/2025] [Indexed: 04/16/2025] Open
Abstract
Currently, there is no clear indication in the guidelines whether non-epinephrine injection monotherapy requires the addition of epinephrine for hemostasis.The purpose of this study is to compare the hemostatic efficacy of non-epinephrine injection monotherapy with combination therapy including extra epinephrine injection for peptic ulcer bleeding (PUB) patients . We retrospectively analyzed PUB patients who underwent endoscopic non-epinephrine injection as a monotherapy or combined non-epinephrine injection with epinephrine injection treatment in our center from March 2014 to January 2023 and the patients were divided into MT group or CT group. Subsequently, a propensity score matching analysis (PSM) was performed and rebleeding rates were calculated according to Forrest classifications via a stratified analysis. A total of 548 eligible patients were included in this study. After PSM, for PUB patients with nonbleeding visible vessels(FIIa), the recurrent bleeding rates by Days 3, 7, 14, and 30 after PSM were 17.6%, 26.5%, 27.9%, and 27.9% in the MT group, respectively, and rates were 1.4%, 5.6%, 6.9%, and 6.9% in the CT group, respectively, with significant differences observed between the 2 groups (P = 0.001, P = 0.001, P = 0.001 and P = 0.001, respectively).However, for PUB patients with spurting bleeding, oozing bleeding, and adherent clots, there were no significant differences between the two groups. For PUB patients with spurting bleeding(FIa) and oozing bleeding (FIb) ulcers, non-epinephrine injection monotherapy and epinephrine injection combined therapy have similar hemostatic efficacy. However, for PUB patients with visible blood vessel (FIIa) ulcers, combined therapy has higher hemostatic efficacy than non-epinephrine injection monotherapy.
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Affiliation(s)
- Jingsong Wang
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, 518116, P. R. China
| | - Lintao Yu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Linlin Liu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yixing Luo
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Nonghua Lv
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Zhenhua Zhu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
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Martyak M, Soult A, Britt LD. Diagnosis and management of gastrointestinal hemorrhage: What you need to know. J Trauma Acute Care Surg 2025:01586154-990000000-00961. [PMID: 40205645 DOI: 10.1097/ta.0000000000004599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
ABSTRACT Acute gastrointestinal (GI) hemorrhage is a common cause for hospital admission that requires prompt diagnosis and multidisciplinary management to optimize clinical outcomes. Acute gastrointestinal bleeding (GIB) includes both upper and lower GI tract sources with an extensive list of differential pathologies. This review provides a systematic approach to both upper and lower GIB management, emphasizing initial resuscitation, stabilization, diagnostic evaluation to identify the source, and treatment modalities. Endoscopy remains the cornerstone for diagnostic and interventional purposes, significantly reducing the need for surgical procedures. However, lower GIB and severe or refractory cases may necessitate additional imaging and interventions, including surgical management. Integrating clinical guidelines, evidence-based strategies, and individualized care, this review delineates what you need to know to diagnose and manage acute GI hemorrhage. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Michael Martyak
- From the Surgery Department, Eastern Virginia Medical School, Old Dominion University, Norfolk, Virginia
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Yi K, Ma Y, Zhang P, He H, Lin Y, Sun D. Environmental and Clinical Factors Concerning Gastrointestinal Bleeding: An Umbrella Review of Meta-Analyses. J Am Med Dir Assoc 2025; 26:105412. [PMID: 39818418 DOI: 10.1016/j.jamda.2024.105412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 11/05/2024] [Accepted: 11/05/2024] [Indexed: 01/18/2025]
Abstract
OBJECTIVES Gastrointestinal bleeding, an emergency and critical disease, is affected by multiple factors. This study aims to systematically summarize and appraise various factors associated with gastrointestinal bleeding. DESIGN Umbrella review. SETTING AND PARTICIPANTS Meta-analyses that evaluated environmental and clinical factors concerning gastrointestinal bleeding. METHODS We conducted a systematic search to identify eligible meta-analyses. For each included study, the risk estimates, heterogeneity estimates, small-study effects, excess significance tests, and publication biases were recalculated and appraised. Furthermore, we considered the methodologic quality and classified the evidence. RESULTS In this study, 51 beneficial and 44 harmful associations were found. This study found that preemptive transjugular intrahepatic portosystemic shunt was the most reliable treatment to reduce gastroesophageal variceal bleeding and mortality risk, followed by antibiotics. For gastroduodenal ulcer bleeding, Yunnan Baiyao and proton pump inhibitors (PPIs) were relatively dependable treatment drugs, and the comparatively reliable prophylactic drugs comprised PPIs and H2-receptor antagonists. Patients with hemodynamic instability and larger ulcers had a higher risk of rebleeding. Both weekend admissions and the combination of selective serotonin reuptake inhibitors and nonsteroidal anti-inflammatory drugs were high-risk factors for upper gastrointestinal bleeding and mortality. We also found that tranexamic acid was a credible drug for overall gastrointestinal bleeding. Meanwhile, aspirin, warfarin, diabetes, and renal failure were all high-risk factors. CONCLUSIONS AND IMPLICATIONS Altogether, many factors can substantially influence gastrointestinal bleeding. Therefore, in daily life and clinical practice, we should not only remain cautious in prescribing and taking some drugs but also pay attention to the management of lifestyle and underlying diseases. If necessary, protective drugs should be properly supplemented.
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Affiliation(s)
- Keqian Yi
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Yu Ma
- Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Pengcheng Zhang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Haiyu He
- Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China.
| | - Yueying Lin
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China.
| | - Dali Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
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Shahrebabak MG, Nezhad NZ, Azadmanesh MA, Shahpar A, Shahrebabak AG. Descriptive analysis of common causes of upper gastrointestinal bleeding in pediatric patients in Kerman: a study from 2022 to 2023. BMC Gastroenterol 2025; 25:152. [PMID: 40065200 PMCID: PMC11895127 DOI: 10.1186/s12876-025-03750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 03/03/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) in pediatric patients is a significant clinical concern requiring prompt diagnosis and management. This study aims to provide a descriptive analysis of the common causes of UGIB in pediatric patients in Kerman, Iran. METHODS A cross-sectional study was conducted at Afzalipour Hospital, Kerman, from January 2022 to December 2023. All pediatric patients under 18 years with UGIB were included. Data on demographics, clinical presentation, and endoscopic findings were collected and analyzed. RESULTS A total of 120 patients were included, with a mean age of 8.8 ± 4.7 years. Hematemesis was the predominant presenting feature (57.5%). All patients underwent endoscopy, with a diagnostic yield of 88.4%. Gastric erosion was the most common cause of UGIB (33.3%), followed by esophageal varices (13.3%). The etiology varied across age groups, with Mallory-Weiss syndrome being the second most common cause in infants. Blood transfusion was required in 31.67% of patients. CONCLUSION This study highlights the common causes and clinical features of pediatric UGIB in Kerman, Iran. Gastric erosion (33.3%) was the most frequent cause, and endoscopy achieved a high diagnostic yield (88.4%). Blood transfusion was necessary in 31.67% of patients. These findings emphasize the need for age-specific diagnostic strategies and reflect regional differences in UGIB etiology.
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Affiliation(s)
- Maryam Gholami Shahrebabak
- Department of Pediatrics, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Nazanin Zeinali Nezhad
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
| | | | - Amirhossein Shahpar
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman, Iran
| | - Azam Gholami Shahrebabak
- Department of Pediatrics Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Nagesh VK, Pulipaka SP, Bhuju R, Martinez E, Badam S, Nageswaran GA, Tran HHV, Elias D, Mansour C, Musalli J, Bhattarai S, Shobana LS, Sethi T, Sethi R, Nikum N, Trivedi C, Jarri A, Westman C, Ahmed N, Philip S, Weissman S, Weinberger J, Bangolo AI. Management of gastrointestinal bleed in the intensive care setting, an updated literature review. World J Crit Care Med 2025; 14:101639. [DOI: 10.5492/wjccm.v14.i1.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 11/08/2024] [Accepted: 12/02/2024] [Indexed: 12/11/2024] Open
Abstract
Gastrointestinal (GI) bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit (ICU). This literature review consolidates current insights on the epidemiology, etiology, management, and outcomes of GI bleeding in critically ill patients. GI bleeding remains a significant concern, especially among patients with underlying risk factors such as coagulopathy, mechanical ventilation, and renal failure. Managing GI bleeding in the ICU requires a multidisciplinary approach, including resuscitation, endoscopic intervention, pharmacologic therapy, and sometimes surgical procedures. Even with enhanced management strategies, GI bleeding in the ICU is associated with considerable morbidity and mortality, particularly when complicated by multi-organ failure. This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients, aiming to enhance survival rates and improve the quality of care within the ICU setting.
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Affiliation(s)
- Vignesh K Nagesh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sai Priyanka Pulipaka
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ruchi Bhuju
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Emelyn Martinez
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Shruthi Badam
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Gomathy Aarthy Nageswaran
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Hadrian Hoang-Vu Tran
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Daniel Elias
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Charlene Mansour
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jaber Musalli
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sanket Bhattarai
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Lokeash Subramani Shobana
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Tannishtha Sethi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ritvik Sethi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Namrata Nikum
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Chinmay Trivedi
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Amer Jarri
- Department of Pulmonology and Critical Care, HCA Florida Bayonet Point Hospital, Hudson, FL 34667, United States
| | - Colin Westman
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Nazir Ahmed
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Shawn Philip
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Simcha Weissman
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jonathan Weinberger
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Ayrton I Bangolo
- Department of Hematology & Oncology, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ 07601, United States
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Tang R, Guan B, Xie J, Xu Y, Yan S, Wang J, Li Y, Ren L, Wan H, Peng T, Zeng L. Prediction model of malnutrition in hospitalized patients with acute stroke. Top Stroke Rehabil 2025; 32:173-187. [PMID: 39024192 DOI: 10.1080/10749357.2024.2377521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE The prognosis of stroke patients is greatly threatened by malnutrition. However, there is no model to predict the risk of malnutrition in hospitalized stroke patients. This study developed a predictive model for identifying high-risk malnutrition in stroke patients. METHODS Stroke patients from two tertiary hospitals were selected as the objects. Binary logistic regression was used to build the model. The model's performance was evaluated using various metrics including the receiver operating characteristic curve, Hosmer-Lemeshow test, sensitivity, specificity, Youden index, clinical decision curve, and risk stratification. RESULTS A total of 319 stroke patients were included in the study. Among them, 27% experienced malnutrition while in the hospital. The prediction model included all independent variables, including dysphagia, pneumonia, enteral nutrition, Barthel Index, upper arm circumference, and calf circumference (all p < 0.05). The AUC area in the modeling group was 0.885, while in the verification group, it was 0.797. The prediction model produces greater net clinical benefit when the risk threshold probability is between 0% and 80%, as revealed by the clinical decision curve. All p values of the Hosmer test were > 0.05. The optimal cutoff value for the model was 0.269, with a sensitivity of 0.849 and a specificity of 0.804. After risk stratification, the MRS scores and malnutrition incidences increased significantly with escalating risk levels (p < 0.05) in both modeling and validation groups. CONCLUSIONS This study developed a prediction model for malnutrition in stroke patients. It has been proven that the model has good differentiation and calibration.
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Affiliation(s)
- Rong Tang
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Bi Guan
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Jiaoe Xie
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Ying Xu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Shu Yan
- Medical Affairs Department, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Jianghong Wang
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Yan Li
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Liling Ren
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Haiyan Wan
- Department of Endocrinology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Tangming Peng
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Liangnan Zeng
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
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Yarkaç A, Bozkurt S, Köse A, Buyurgan ÇS, Usluer HO, Temel G. AS score: a novel score for predicting clinical outcomes in upper gastrointestinal bleeding. Scand J Gastroenterol 2025; 60:213-218. [PMID: 39887700 DOI: 10.1080/00365521.2025.2459237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 01/02/2025] [Accepted: 01/18/2025] [Indexed: 02/01/2025]
Abstract
BACKGROUND Upper gastrointestinal tract bleeding (UGIB) is an significant cause of admission to emergency departments and hospitalizations. AIMS The aim of our study was to compare the pre-endoscopic risk scores used in the literature with our new score (AS score) in patients admitted to the emergency department due to upper gastrointestinal bleeding (UGIB). METHODS A total of 541 patients admitted to the emergency department of a tertiary care hospital due to UGIB were included in the study. Pre-endoscopic risk scores and AS score were compared in terms of the need for hospitalization, need for intensive care, need for endoscopic treatment, and mortality. RESULTS All of the scores analysed in the study were found to be effective in predicting the need for hospitalization, the need for intensive care, the need for endoscopic treatment, and mortality. The most effective score in predicting mortality was the AS score. In addition, the sensitivity of the AS score was higher than the other scores in predicting the need for intensive care. CONCLUSIONS The AS score is a new tool that may be useful in the management of patients admitted to the emergency department due to UGIB because of its advantages, such as not including laboratory parameters, being calculated in a very short time in the triage area at the time of patient presentation, and being integrated with the Charlson comorbidity index.
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Affiliation(s)
- Akif Yarkaç
- Faculty of Medicine, Department of Emergency Medicine, Mersin University, Mersin, Turkey
| | - Seyran Bozkurt
- Faculty of Medicine, Department of Emergency Medicine, Mersin University, Mersin, Turkey
| | - Ataman Köse
- Faculty of Medicine, Department of Emergency Medicine, Mersin University, Mersin, Turkey
| | - Çağrı Safa Buyurgan
- Faculty of Medicine, Department of Emergency Medicine, Mersin University, Mersin, Turkey
| | - Halil Oktay Usluer
- Emergency Department, Şanlıurfa Siverek State Hospital, Şanlıurfa, Turkey
| | - Gülhan Temel
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin University, Mersin, Turkey
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Liu K, Zhang W, Gao L, Bai J, Dong X, Wang Y, Chen H, Dong J, Fang N, Han Y, Liu Z. Efficacy of hemostatic powder monotherapy versus conventional endoscopic treatment for nonvariceal GI bleeding: a meta-analysis and trial sequential analysis. Gastrointest Endosc 2025; 101:539-550.e14. [PMID: 39265743 DOI: 10.1016/j.gie.2024.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/27/2024] [Accepted: 08/31/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND AND AIMS Hemostatic powder (HP) is a novel hemostasis modality for nonvariceal GI bleeding. This meta-analysis was performed to evaluate the efficacy of HP monotherapy versus conventional endoscopic treatment (CET) for nonvariceal GI bleeding. METHODS PubMed, EMBASE, and Cochrane Library databases were systematically searched from inception to October 16, 2023. The primary outcomes were the initial hemostatic rate and the 30-day recurrent bleeding rate. After the meta-analysis, a trial sequential analysis (TSA) was also conducted to decrease the risk of random errors and validate the result. RESULTS The meta-analysis included 8 studies, incorporating 653 patients in total. Given significant heterogeneity, all analyses were segregated into malignancy-related and nonmalignancy-related GI bleeding lesions. For the former, HP monotherapy significantly improved the initial hemostasis rate and 30-day recurrent bleeding rate compared with CET (relative risk [RR], 1.50; 95% confidence interval [CI], 1.28-1.75; P < .001; RR, .32; 95% CI, .12-.86; P = .02, respectively), and TSA supported the results. For nonmalignancy-related GI bleeding, HP monotherapy and CET have similar initial hemostasis and 30-day recurrent bleeding rates (RR, 1.08; 95% CI, .98-1.19; P = .11; RR, 1.15; 95% CI, .46-2.90; P = .76, respectively), but the TSA failed to confirm the results. CONCLUSIONS HP monotherapy surpassed CET in terms of the initial hemostasis rate and 30-day recurrent bleeding rate for patients with malignancy-related GI bleeding. However, their relative efficacy for nonmalignancy-related GI bleeding remains unresolved.
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Affiliation(s)
- Kai Liu
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Wei Zhang
- Department of Obstetrics and Gynecology, Ordos Central Hospital, Ordos School of Clinical Medicine, Inner Mongolia Medical University, Ordos, China
| | - Li Gao
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Jiawei Bai
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China; Department of Gastroenterology, School of Medicine, Yan'an University, Yan'an, China
| | - Xin Dong
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Yue Wang
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China; Department of Gastroenterology, Xi'an Medical University, Xi'an, China
| | - Hui Chen
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Jiaqiang Dong
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Nian Fang
- Department of Gastroenterology, Third Clinical Medical College, Nanchang University, Nanchang, China; Department of Gastroenterology, The First Hospital of Nanchang (The Third Affiliated Hospital of Nanchang University), Nanchang, China
| | - Ying Han
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China.
| | - Zhiguo Liu
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China.
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10
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He M, Desai S, Wang Y, Yang CW, Friedenberg F, Gillespie A. Inpatient Outcomes of Gastrointestinal Bleeding in Advanced CKD and Kidney Transplant Recipients: A National Analysis 2016-2019. KIDNEY360 2025; 6:379-390. [PMID: 40146553 PMCID: PMC11970864 DOI: 10.34067/kid.0000000662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/19/2024] [Indexed: 03/29/2025]
Abstract
Key Points Advanced CKD and ESKD are independent risk factors for gastrointestinal bleeding hospitalizations, angiodysplasia bleeding, and in-hospital mortality. Patients with ESKD with gastrointestinal bleeding exhibit significantly higher rates of adverse outcomes compared with those without CKD. Patients with advanced CKD and ESKD had lower rates of early endoscopy and higher rates of delayed endoscopy, with delayed endoscopy linked to increased mortality. Background Patients with kidney disease are at increased risk for gastrointestinal bleeding (GIB). This study aimed to investigate the incidence, causes, interventions, and inpatient outcomes of GIB in patients with advanced CKD (ACKD), ESKD, and kidney transplant (KT) recipients, compared with those without CKD (NCKD). Methods This retrospective study used the Nationwide Inpatient Sample database to identify adult patients admitted nonelectively with GIB from 2016 to 2019. Patients were stratified into five groups: ACKD (CKD stages 4 or 5), ESKD, KT, NCKD, and others (including CKD stages 1–3 and unspecified CKD). We compared outcomes across these groups and conducted subgroup analyses within the ACKD and ESKD groups to explore the association between mortality and the timing of endoscopic evaluation. Multivariate logistic regression (for binary outcomes) and linear regression (for continuous outcomes) models were used to analyze the dependent variables. Results A total of 2,163,929 patients were included. The incidence of GIB hospitalizations was higher in the ACKD (3.2%) and ESKD (3.4%) groups and lower in the KT group (2.1%) compared with the NCKD group (2.2%). All-cause in-hospital mortality was increased in ACKD, ESKD, and KT (3.0%, 3.1%, and 2.0%, respectively) compared with NCKD (1.7%). ESKD patients had higher rates of mechanical ventilation, vasopressor support, and blood transfusion, along with prolonged and costly hospitalizations (P < 0.001). ACKD and ESKD groups had lower rates of early endoscopy (<24 hours) and higher rates of delayed endoscopy (>48 hours), with delayed endoscopy linked to increased mortality. ACKD and ESKD were independent risk factors for angiodysplasia bleeding, while KT was a risk factor for diverticular and esophageal bleeding. Conclusions ACKD and ESKD are independent risk factors for GIB hospitalizations and in-hospital mortality, with delayed endoscopy further worsening outcomes. Tailored treatment plans are essential to improve outcomes in this complex population.
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Affiliation(s)
- Mingyue He
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Shaan Desai
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Yichen Wang
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chien-Wen Yang
- Department of Nephrology, Ochsner Medical Center, New Orleans, Los Angeles
- Department of Nephrology, Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Frank Friedenberg
- Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Avrum Gillespie
- Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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11
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Arıkoğlu S, Tezel O, Büyükturan G, Başgöz BB. The efficacy and comparison of upper gastrointestinal bleeding risk scoring systems on predicting clinical outcomes among emergency unit patients. BMC Gastroenterol 2025; 25:93. [PMID: 39972434 PMCID: PMC11840997 DOI: 10.1186/s12876-025-03684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 02/12/2025] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Gastrointestinal bleeding is a significant cause of morbidity and mortality among emergency unit patients. Several scoring systems are verified for predicting hospitalization and mortality such as Glasgow Blatchford Bleeding Score (GBS), AIMS65 score, Rockall score (RS), and International Bleeding Risk Score (INBS; ABC score). The aim of this study is to evaluate the efficacy and predictive value of these scoring systems. METHODS Adult emergency unit patients with gastrointestinal bleeding were retrospectively enrolled. The age, gender, complaints at admission, vitals and examination results, laboratory findings, outcomes, blood transfusion status, and endoscopic interventions were all reported, and GBS, AIMS65, RS, and INBS (ABC) scores were calculated individually for all enrollies. RESULTS A total of 311 patients were included. The median age of participants was 70 years (IQR (25-75%): 59-81), and 202 (65%) of them were male. The efficacy of all four scoring systems (GBS, AIMS65, RS, and INBS (ABC)) in predicting hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality was found to be statistically significant (p < 0.05 for all). ROC-AUC analysis was revealed that while GBS is the most beneficial in predicting hospitalization, INBS (ABC) has the best predictive value on mortality. Besides, the only scoring model with predictive value in determining the need for endoscopic intervention was RS (p < 0.05). CONCLUSION The present study showed that, among adult emergency unit patients with gastrointestinal bleeding, GBS, AIMS65, RS, and INBS (ABC) scores could successfully predict hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality. However, the only scoring system that could be used to determine the need of endoscopic intervention is RS. Finally, we believe further studies with prospective enrollment would be beneficial for more accurate conclusions.
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Affiliation(s)
- Sezer Arıkoğlu
- Gülhane School of Medicine, Department of Emergency Medicine, University of Health Sciences, Emrah/Etlik, Ankara, 06018, Turkey
| | - Onur Tezel
- Gülhane School of Medicine, Department of Emergency Medicine, University of Health Sciences, Emrah/Etlik, Ankara, 06018, Turkey.
| | - Galip Büyükturan
- Gülhane School of Medicine, Department of Gastroenterology, University of Health Sciences, Ankara, Turkey
| | - Bilgin Bahadır Başgöz
- Gülhane School of Medicine, Department of Internal Medicine, University of Health Sciences, Ankara, Turkey
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12
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Chang A, Sitthinamsuwan N, Pungpipattrakul N, Chienwichai K, Akarapatima K, Sangkaew S, Rugivarodom M, Rattanasupar A, Ovartlarnporn B, Prachayakul V. Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from Thailand. BMC Gastroenterol 2025; 25:86. [PMID: 39962393 PMCID: PMC11834220 DOI: 10.1186/s12876-025-03673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 02/10/2025] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND The findings on mortality, rebleeding rate, and hospital stay in patients who underwent early vs. late endoscopy are conflicting. We aimed to compare in-hospital outcomes and medical resource use in patients with acute non-variceal upper gastrointestinal bleeding. METHODS We retrospectively reviewed the medical records of patients with acute non-variceal upper gastrointestinal bleeding who underwent early or late endoscopy between 2016 and 2019. The primary outcome was in-hospital mortality. The secondary outcomes were the need for packed red blood cells and number of transfusions, the proportion of lesions with high-risk stigmata, endoscopic and additional hemostasis, in-hospital rebleeding, duration of stay, and admission cost. Statistical analysis was performed using Pearson's chi-squared or Fisher's exact test for categorical variables, Student's t-test, and Wilcoxon rank-sum test for continuous variables. RESULTS Early and late endoscopies were performed on 451 and 279 patients, respectively. After 1:1 propensity score matching, 278 patients from each group were included, and patients' baseline characteristics were similar in the matched groups. Compared with the late group, the early group had a significantly increased rate of endoscopic hemostasis (22.7% vs. 13.7%, P = 0.006) and a low rate of packed red blood cell transfusion (53.6% vs. 61.9%, P = 0.048). Duration of stay and admission costs were significantly higher in the late group than in the early group (all P < 0.05). After adjusting for confounding factors, early endoscopy was positively associated with ulcers with high-risk stigmata (adjusted odds ratio = 1.83, P = 0.023) and endoscopic hemostasis (adjusted odds ratio = 1.97, P = 0.004). It was negatively associated with the need for packed red blood cell transfusion (adjusted odds ratio = 0.62, P = 0.017) and duration of stay (adjusted coefficient=-0.10, P < 0.001) with no impact on in-hospital mortality, rebleeding, or radiological interventions. CONCLUSIONS The timing of endoscopy does not affect in-hospital mortality or rebleeding rate. This study supports using early endoscopy in patients with acute non-variceal upper gastrointestinal bleeding based on the potential benefits and feasibility of medical resource use.
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Affiliation(s)
- Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | | | - Nuttanit Pungpipattrakul
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | | | - Keerati Akarapatima
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Sorawat Sangkaew
- Department of Social Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Manus Rugivarodom
- Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Attapon Rattanasupar
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Bancha Ovartlarnporn
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Varayu Prachayakul
- Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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13
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Mega PF, Brunaldi VO, Bestetti AM, Kum AST, de Sousa IV, Lera dos Santos ME, de Moura EGH. Over-the-scope clips vs standard endoscopic interventions for first-line treatment of NVUGI bleeding: Meta-analysis of randomized trials. Endosc Int Open 2025; 13:a24657023. [PMID: 39958653 PMCID: PMC11827746 DOI: 10.1055/a-2465-7023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 10/08/2024] [Indexed: 02/18/2025] Open
Abstract
Background and study aims Recently, over-the-scope clips (OTSCs) have been extensively studied for hemostasis of nonvariceal upper gastrointestinal bleeding (NVUGIB). Our goal was to compare the efficacy of OTSCs with standard endoscopic interventions (SEIs) as first-line treatments. Patients and methods A comprehensive search of electronic databases was performed to identify randomized clinical trials (RCTs) comparing OTSCs with SEIs as first-line therapy for NVUGIB. This search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results Of 819 reviewed studies, five RCTs comprising 555 patients (277 OTSCs vs. 278 SEIs) were included. The OTSC group had a lower 30-day rebleeding rate (risk ratio [RR] 0.43; 95% confidence interval [CI] 0.24-0.77; I² = 0%; P = 0.004) and a higher clinical success rate (RR 1.19; 95% CI 1.11-1.28; I² = 0%; P < 0.00001). There was no significant difference in technical success (RR 1.06; 95% CI 0.98-1.14; I² = 73%; P = 0.13), 30-day all-cause mortality (RR 0.50; 95% CI 0.22-1.14; I² = 0%; P = 0.10), need for further intervention (RR 1.22; 95% CI 0.43-3.47; I² = 0%; P = 0.71), or length of hospital stay (mean difference 0.31; 95% CI: -1.08- 1.70; I² = 0%; P = 0.66). Risk of bias, which was assessed using the Cochrane Risk of Bias 2.0 tool, indicated some concerns about bias. Conclusions OTSCs are more efficient than SEIs as first-line treatment in terms of rebleeding within 30 days and clinical success rates.
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Affiliation(s)
- Paulo Ferreira Mega
- Gastroenterology - Gastrointestinal Endoscopy Unit, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | | | - Angelo So Taa Kum
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Igor Valdeir de Sousa
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
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14
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Alali AA, Pittayanon R, Martel M, Martins BC, Almadi MA, Chen YI, Barkun AN. TC-325 Superiority in Malignant Gastrointestinal Bleeding: An Individual Patient Data Meta-Analysis of Randomized Trials. Am J Gastroenterol 2025; 120:332-339. [PMID: 39248610 DOI: 10.14309/ajg.0000000000003078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/14/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION The efficacy of topical hemostatic agents, recommended for peptic ulcer bleeding, remains poorly characterized in malignant gastrointestinal bleeding (GIB). METHODS We performed an individual patient data meta-analysis assessing the efficacy of topical hemostatic agents in malignant GIB. The literature was searched using OVID MEDLINE, EMBASE, and ISI Web of Science databases (database inception to November 2023). Only randomized controlled trials (RCTs) comparing topical hemostatic agents with conventional endoscopic modalities in malignant GIB were included. Original RCT patient-level data were obtained. Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed. Quality of the evidence was evaluated using the revised Cochrane risk-of-bias tool and certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary outcome was immediate hemostasis; secondary outcomes were 30-day rebleeding and the composite measure of further bleeding (persistent bleeding or 30-day rebleeding). Other outcomes were all-cause mortality, adverse events, and need for additional nonendoscopic treatment. Odds ratios (ORs) from endpoint comparisons were pooled using logistic regression models. RESULTS Overall, 985 citations were identified; 3 RCTs (n = 160 patients) were included with all assessing TC-325 (Hemospray). TC-325 achieved immediate hemostasis more often than conventional endoscopic modalities (OR 46.6, 95% confidence interval [CI] 5.89-369.1) (low-level certainty). Thirty-day rebleeding (OR 0.28, 95% CI 0.11-0.70) and further bleeding (OR 0.11, 95% CI 0.05-0.26) were both significantly lower with TC-325 (very-low-level certainty). All-cause mortality and need for additional nonendoscopic treatment did not differ between groups. No adverse events were reported. Subgroup analysis confirmed TC-325 superiority in patients with upper GIB. DISCUSSION TC-325 seems superior to conventional endoscopic therapy in managing patients with malignant GIB. TC-325 results in improvements in immediate hemostasis, 30-day rebleeding, and further bleeding, based on very low-to-low certainties of evidence.
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Affiliation(s)
- Ali A Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- Thunayan Alghanim Gastroenterology center, Amiri Hospital, Sharq, Kuwait
| | - Rapat Pittayanon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Myriam Martel
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bruno Costa Martins
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Majid A Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Yen-I Chen
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Alan N Barkun
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
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15
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Thiebaud PC, Wassermann E, de Caluwe M, Prebin C, Noel F, Dechartres A, Raynal PA, Leblanc J, Yordanov Y. Assessment of Prognostic Scores for Emergency Department Patients With Upper Gastrointestinal Bleeding. Ann Emerg Med 2025; 85:31-42. [PMID: 39093247 DOI: 10.1016/j.annemergmed.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024]
Abstract
STUDY OBJECTIVE Early prognostic stratification could optimize the management of patients with upper gastrointestinal bleeding and reduce unnecessary hospitalizations. The aim of this study was to assess and compare the performance of existing prognostic scores in predicting therapeutic intervention and death. METHODS A systematic search of the literature identified existing prognostic scores. A multicenter retrospective cohort study included adult patients hospitalized for upper gastrointestinal bleeding from January 1, 2019, to December 31, 2020. The primary outcome was a composite including therapeutic intervention within 7 days (blood transfusion, endoscopic, surgical, or interventional radiology hemostasis) and/or 30-day death. Discrimination performance was estimated by the area under the curve (AUC). The ability to identify low-risk patients was analyzed using sensitivity and negative predictive value (NPV) for defined thresholds. RESULTS The systematic search identified 39 prognostic scores, 12 of which could be analyzed. Among the 990 patients included, therapeutic intervention and/or death occurred in 755 (76.4%) patients. Scores with the highest discriminative performance to predict the primary composite outcome were Glasgow-Blatchford score (GBS) (AUC 0.869 [0.842 to 0.895]), modified GBS (AUC 0.872 [0.847 to 0.898]) and modified GBS 2 (AUC 0.855 [0.827 to 0.884]). The best performance to identify low-risk patients was for GBS≤1 (sensitivity 0.99 [0.99 to 1.00], NPV 0.89 [0.75 to 0.97]) and modified GBS=0 (sensitivity 0.99 [0.98 to 1.00], NPV 0.84 [0.71 to 0.94]). CONCLUSIONS The GBS and the modified GBS are the 2 best performing scores because they achieve both key objectives: stratifying patients based on their risk of therapeutic intervention and/or death and identifying low-risk patients who may qualify for outpatient management.
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Affiliation(s)
- Pierre-Clément Thiebaud
- Université de Paris Cité, INSERM, UMR-S 942, Improving Emergency Care University Hospital Federation, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, UMR-S 1136, AP-HP, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France.
| | - Eliana Wassermann
- AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Unité de recherche clinique de l'Est Parisien, Paris, France
| | - Mathilde de Caluwe
- AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Clément Prebin
- AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Florent Noel
- AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, UMR-S 1136, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Pierre-Alexis Raynal
- AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Judith Leblanc
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Unité de recherche clinique Est Parisien, Paris, France
| | - Youri Yordanov
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, UMR-S 1136, AP-HP, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
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16
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Kumar S, Chou SHY, Smith CJ, Nallaparaju A, Laurido-Soto OJ, Leonard AD, Singla AK, Leonhardt-Caprio A, Stein DJ. Addressing Systemic Complications of Acute Stroke: A Scientific Statement From the American Heart Association. Stroke 2025; 56:e15-e29. [PMID: 39633600 DOI: 10.1161/str.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
Systemic, nonneurological complications are common after ischemic and hemorrhagic strokes, affect different organ systems, and have a major impact on patient outcomes. Despite their obvious implications, this area in stroke management remains inadequately researched, and current literature offers fragmentary guidance for care. The purpose of this scientific statement is to elucidate the major systemic complications of strokes that occur during hospitalization, to synthesize evidence from current literature and existing guidelines, to address gaps in knowledge, and to provide a coherent set of suggestions for clinical care based on interpretation of existing evidence and expert opinion. This document advocates for improved interdisciplinary collaboration, team effort, and effective implementation strategies to reduce the burden of these events in clinical practice. It also calls for further research on strategies for preventing and managing systemic complications after stroke that improve outcomes in stroke survivors.
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17
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Someili AM, Mobarki SJ, Moafa RH, Alsury LN, Shadad RH, Fathi SM, Hamrani AH, Darisi AM, Mohamed AH, Alqassmi S, Mohrag M, Abdulrasak M. Upper Gastrointestinal Bleeding: A Retrospective, Single-Center Experience on the Role of Endoscopy and Outcomes. J Clin Med Res 2025; 17:22-34. [PMID: 39866814 PMCID: PMC11753981 DOI: 10.14740/jocmr6134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Accepted: 01/02/2025] [Indexed: 01/28/2025] Open
Abstract
Background Upper gastrointestinal bleeding (UGIB) is a common and potentially fatal medical emergency. This study aimed to investigate the frequency, causes, outcomes, and efficacy of endoscopy in the treatment of UGIB at King Fahad Central Hospital in Jazan, Saudi Arabia. Methods Between January 2017 and December 2023, a retrospective study was performed including all hospitalized patients with UGIB. This research investigated sociodemographic characteristics, clinical history, endoscopic findings, treatment options, and results using statistical analysis, which included both descriptive and inferential approaches. Results The study included 483 patients (of which 74.1% men), with a mean age of 53.9 ± 19.5 years. Hematemesis was observed in 67.5% of the patients, whereas melena occurred in 49.7% of the cases. Two-hundred sixty-two (54.2%) patients underwent endoscopy within the first 24 h from presentation. The most frequent endoscopic findings were esophageal varices (52.2%) and duodenal ulcers (21.7%). Bandings accounted for 48.0% of all endoscopic procedures, whereas 36.9% of the patients received epinephrine injections along with endoclips. Medical therapy mostly consisted of a mix of proton pump inhibitors (PPIs) and octreotide. A significant minority (43.5%) of the patients stayed in the hospital for 1 - 3 days, while 59.6% did not need blood transfusions. During the first 3 days, 7% of patients experienced rebleeding, with a 6% mortality rate. Using multivariate regression analysis, rebleeding was strongly associated with initial presentation with shock (P < 0.001), renal disease (P = 0.01), and increased transfusion requirement (P = 0.001). Mortality was strongly associated with steroid usage (P = 0.007), increasing transfusion requirements (P < 0.0001), and rebleeding (P = 0.002). Conclusions Timely endoscopy and proper treatment dramatically improved UGIB results. Identifying those who are at high risk and acting swiftly is a critical step in reducing the likelihood of recurrent bleeding and fatality.
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Affiliation(s)
- Ali M. Someili
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Saudi Arabia
| | | | | | | | | | | | | | | | - Amal H. Mohamed
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Saudi Arabia
| | - Sameer Alqassmi
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Saudi Arabia
| | - Mostafa Mohrag
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Saudi Arabia
| | - Mohammed Abdulrasak
- Department of Clinical Sciences, Malmo, Lund University, Malmo, Sweden
- Department of Gastroenterology and Nutrition, Skane University Hospital, Malmo, Sweden
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18
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Tau JA. Topical hemostatic preventative and therapeutic agents: clinical impact and utility. Gastrointest Endosc 2025; 101:36-44. [PMID: 39111391 DOI: 10.1016/j.gie.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 06/23/2024] [Accepted: 07/28/2024] [Indexed: 10/05/2024]
Affiliation(s)
- J Andy Tau
- Austin Gastroenterology, Austin, Texas, USA
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19
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Yousif YF, Dhaif MB, Alaysreen AA, Mallah SI, AlHoda M, Alrahma HA, Alekri AA, Qaroof TH, Alsaegh A. Clinical Epidemiology, Etiology, and Outcomes of Upper Gastrointestinal Bleeding at a Tertiary Center in Bahrain: A Retrospective Study. Cureus 2025; 17:e77133. [PMID: 39791018 PMCID: PMC11717402 DOI: 10.7759/cureus.77133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2025] [Indexed: 01/12/2025] Open
Abstract
Background Upper gastrointestinal bleeding (UGIB) is one of the most common major medical emergencies. This study sought to determine the epidemiology, clinical characteristics, and outcomes of UGIB in the largest major tertiary care center in Bahrain, compared to regional and international cohorts. Methods We conducted a retrospective cohort study of all patients diagnosed with UGIB between April 2021 and April 2022 in Salmaniya Medical Complex, Bahrain's largest tertiary-level public hospital. The primary outcomes measured included 30-day mortality rates and one-year readmission rates. Other variables collected included demographic factors, baseline characteristics, comorbidities, symptomatology, endoscopic findings, and etiologies of the bleeding. Results A total of 212 patients with UGIB were included. The mean age of the patients was 56.7 ± 19.1 years. More than 50% of patients with UGIB presented with melena and symptoms of anemia. The most common cause of UGIB in Bahrain was duodenal ulcers, which were found in 75 patients (37.7%). One in two patients with UGIB required packed red blood cells, while fresh-frozen plasma and platelet transfusions were reserved for severe cases. The readmission rate within one year of discharge (14.2%) was associated with smoking, cardiac history, melena, gastric malignancy, and rescope during admission. The 30-day mortality (15.6%) was associated with comorbidities of chronic kidney disease, cerebrovascular disease, and hematochezia on presentation. Conclusion Overall, the mortality rate of UGIB in Bahrain is higher than in countries in the region, the UK, and the US, signaling potential gaps in management and a reflection of a more complex patient population.
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Affiliation(s)
- Yousif F Yousif
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, GBR
| | - Mahmood B Dhaif
- Department of Internal Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Ali A Alaysreen
- Department of Family Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Saad I Mallah
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Moosa AlHoda
- Department of Medicine, RCSI (Royal College of Surgeons in Ireland) - Medical University of Bahrain, Al Sayh, BHR
- Department of Internal Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Husain A Alrahma
- Department of Gastroenterology and Hepatology, Salmaniya Medical Complex, Manama, BHR
| | - Ahmed A Alekri
- Department of Internal Medicine, Salmaniya Medical Complex, Manama, BHR
- Department of General Practice, RCSI (Royal College of Surgeons in Ireland) - Medical University of Bahrain, Al Sayh, BHR
- Department of General Practice, Manama Medical Center, Manama, BHR
| | - Tahera H Qaroof
- Department of Psychiatry, Salmaniya Medical Complex, Manama, BHR
| | - Ahmed Alsaegh
- Department of Gastroenterology and Hepatology, Salmaniya Medical Complex, Manama, BHR
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20
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Tejedor-Tejada J, Ballester MP, Del Castillo-Corzo FJ, García-Mateo S, Domper-Arnal MJ, Parada-Vazquez P, Saiz-Chumillas RM, Jiménez-Moreno MA, Hontoria-Bautista G, Bernad-Cabredo B, Gómez C, Capilla M, Fernández-De La Varga M, Ruiz-Belmonte L, Lapeña-Muñoz B, Calvo Iñiguez M, Fraile-González M, Flórez-Díez P, Morales-Alvarado VJ, Delgado-Guillena PG, Cañamares-Orbis P, Saez-González E, García-Morales N, Montoro M, Murcia-Pomares Ó. Adherence to patient blood management strategy in patients with gastrointestinal bleeding: a prospective nationwide multicenter study. Eur J Gastroenterol Hepatol 2025; 37:15-23. [PMID: 39324889 DOI: 10.1097/meg.0000000000002843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
INTRODUCTION Patient blood management (PBM) adherence in clinical practice is unclear. This real-world practice study assessed the management of patients with gastrointestinal (GI) bleeding after the implementation of the PBM strategy. METHODS This was a nationwide multicenter and prospective study involving consecutive adults with GI bleeding between March 2019 and March 2021. Patients were examined according to hemoglobin (Hb) level at admission (<7 g/dl, n = 93; 7-8 g/dl, n = 47; 8-9 g/dl, n = 61; and >9 g/dl, n = 249). Study outcomes measures were morbidity and mortality during hospitalization and at 3- and 6-month follow-up. Appropriate anemia or iron deficiency management was considered when adherence to PBM policy was higher than 75%. RESULTS A total of 450 patients (57.6% men, median age: 74 years, interquartile range: 63-82) were included. Overall, 55.1% and 59.3% of patients received transfusion and iron supplementation, respectively. The rates of appropriate transfusion and iron supplementation adherence were 90.9% (range: 86.9-93.5%, P = 0.109) and 81.8% (range: 78.5-85.1%, P = 0.041), depending on Hb level, respectively. No associations were observed between adherence to the PBM strategy and length of stay ( P = 0.263) or risk of further bleeding ( P = 0.742). Patients who were transfused [hazard ratio (HR): 0.79, 95% confidence interval (CI): 0.27-0.85] and iron supplemented (HR: 0.91, 95% CI: 0.38-1.41), however, appropriately achieved a lower risk of death. Age (HR: 1.12, 95% CI: 1.12-1.25) and further bleeding (HR: 39.08, 95% CI: 4.01-181.24) were poor prognostic factors. No serious adverse events were reported. CONCLUSIONS In this nationwide study, there is a high level of adherence and safety of PBM for the treatment of GI bleeding. Adherence to the PBM strategy improved outcomes in patients with GI bleeding.
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Affiliation(s)
- Javier Tejedor-Tejada
- Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid
| | - María Pilar Ballester
- Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia
| | | | - Sandra García-Mateo
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza
| | | | - Pablo Parada-Vazquez
- Department of Gastroenterology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra
| | | | | | | | | | - Concepción Gómez
- Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia
| | - María Capilla
- Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia
| | | | - Lara Ruiz-Belmonte
- Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza
| | | | | | | | - Pablo Flórez-Díez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo
| | | | | | | | - Esteban Saez-González
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Valencia
| | | | - Miguel Montoro
- Department of Gastroenterology, Hospital General San Jorge, Huesca
| | - Óscar Murcia-Pomares
- Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
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21
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Genrikh SR, Durleshter VM, Kalachev AG, Bedanokov KM. [Choosing the optimal surgical method for duodenal ulcer complicated by bleeding]. Khirurgiia (Mosk) 2025:111-118. [PMID: 39918810 DOI: 10.17116/hirurgia2025021111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
Abstract
The treatment tactics for gastrointestinal bleeding (GIB), recommended by surgical societies, involve a certain sequence of actions taking into account the capabilities of the clinical institution. A mandatory requirement for all levels of care is the stabilization of post-hemorrhagic disorders and stopping bleeding by any available means. A mandatory requirement for all levels of care is the stabilization of post-hemorrhagic disorders and stopping bleeding by any available means. A clinical case of treatment of a patient with duodenal ulcer complicated by recurrent bleeding is presented. Taking into account morbid obesity, the indications for the endoscopic method of stopping recurrent bleeding against the background of adequate replacement therapy have been expanded. An analysis of the selected treatment tactics for complicated peptic ulcer was carried out.
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Affiliation(s)
- S R Genrikh
- Regional Clinical Hospital No. 2, Krasnodar, Russia
| | | | - A G Kalachev
- Regional Clinical Hospital No. 2, Krasnodar, Russia
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22
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Lei Y, Tau JA, Copland AP. Topical Hemostatic Agents. Am J Gastroenterol 2024:00000434-990000000-01514. [PMID: 39787339 DOI: 10.14309/ajg.0000000000003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 12/23/2024] [Indexed: 01/12/2025]
Affiliation(s)
- Yang Lei
- Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - J Andy Tau
- Austin Gastroenterology, Austin, Texas, USA
| | - Andrew P Copland
- Division of Gastroenterology & Hepatology, University of Virginia, Charlottesville, Virginia, USA
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23
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Khoury N, Stepensky D, Abu Freha N, Mahamid M, Khoury T, Mari A. Predictive Factors Associated with Inappropriate Intravenous Proton Pump Inhibitors Use in Hospitalized Patients: A Case-Control Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 61:10. [PMID: 39858992 PMCID: PMC11767144 DOI: 10.3390/medicina61010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 12/21/2024] [Accepted: 12/23/2024] [Indexed: 01/27/2025]
Abstract
Background and Objectives: Proton Pump Inhibitors (PPIs) are the most effective agents for treating acid-related gastrointestinal disorders. The prescription of an intravenous (IV) formulation of PPIs has increased dramatically. The aims of this study were to assess the appropriateness of IV PPI use and to define the risk factors and outcomes associated with its inappropriate use. Materials and Methods: A case-control retrospective study included all the hospitalized patients who received IV PPIs was conducted. Patient health records were reviewed, data were collected covering the period of the individual patients' admission to the hospital until discharge or death, and over the 3-month post-discharge period. The appropriateness of the IV PPI use and the resulting clinical outcomes were analyzed. Results: Overall, 540 patients were analyzed. Among them, 130/540 (24%) had inappropriate PPI use in terms of indication, dosage, and duration of treatment vs. 410 patients who had appropriate indications. Two parameters were associated with inappropriate use: congestive heart failure (OR 1.77; p = 0.02) and prescription of IV PPIs by surgeons vs. internists (OR 1.53; p = 0.05). Conclusions: Inappropriate IV PPI use is still common in daily clinical practice. Significant predictors of inappropriate use were the presence of congestive heart failure, elderly age, current use of anticoagulants and antithromotics, and the cases managed by surgeons, naturally due to suspected upper gastrointestinal bleedings.
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Affiliation(s)
- Niveen Khoury
- Pharmacy Department, EMMS Nazareth Hospital, Nazareth 16100, Israel;
| | - David Stepensky
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel;
| | - Naim Abu Freha
- The Institute of Gastroenterology and Hepatology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel;
| | - Mahmud Mahamid
- Gastroenterology Department, Shaare Zedek Medical Center, Jerusalem 9103102, Israel;
| | - Tawfik Khoury
- Gastroenterology Department, Nazareth Hospital, Nazareth 16100, Israel;
- Gastroenterology Department, Galilee Medical Center, Nahariya 22000, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan 5211401, Israel
| | - Amir Mari
- Gastroenterology Department, Nazareth Hospital, Nazareth 16100, Israel;
- The Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan 5211401, Israel
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24
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Improta L. Clinical landscape and treatment of acute non-variceal upper gastrointestinal bleeding: Insights from a high-volume center in Shaanxi, China. World J Clin Cases 2024; 12:6855-6858. [PMID: 39687644 PMCID: PMC11525905 DOI: 10.12998/wjcc.v12.i35.6855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 09/08/2024] [Accepted: 10/10/2024] [Indexed: 10/24/2024] Open
Abstract
In this editorial we comment on the article by Wang et al, recently published on World Journal of Clinical Cases. Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) represents a common and potentially serious gastroenterological emergency. Wang et al conducted a detailed study on the management of ANVUGIB in a high-volume center in the Shaanxi region, China. Analyzing data from over 530 patients provided a comprehensive overview of clinical, epidemiological, and treatment characteristics. Results highlighted a younger patient population compared to European studies, with a higher prevalence of gastric and duodenal ulcers as the leading cause of bleeding. Endoscopic treatment is currently the preferred therapeutic option, offering a variety of effective techniques. This study emphasizes the importance of implementing current guidelines in ANVUGIB management and highlights the crucial role of endoscopy in its management.
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Affiliation(s)
- Luca Improta
- Department of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome 00128, Italy
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25
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Belete MW, Kebede MA, Bedane MR, Berhe TT, Tekle AB, Shash EP, Eshetu MA, Bushiso GD, Loge BY. Factors associated with severity and length of hospital stay in patients with acute upper gastrointestinal bleeding: insights from two Ethiopian hospitals. Int J Emerg Med 2024; 17:185. [PMID: 39639237 PMCID: PMC11622544 DOI: 10.1186/s12245-024-00768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 11/17/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a critical emergency with substantial morbidity and mortality. Outcomes depend on bleeding severity, patient risk factors, and comorbidities. This study evaluated clinical patterns and factors influencing disease severity and hospital stay among patients present with UGIB symptoms at two major Ethiopian hospitals. METHODS A retrospective, cross-sectional review was conducted on 199 UGIB patients admitted to Yekatit 12 Hospital Medical College (Y12HMC) and Tikur Anbesa Specialized Hospital (TASH) from September 2022 to September 2023. Data on demographics, clinical presentations, endoscopic findings, and outcomes were analyzed using SPSS version 26. Binary logistic regression assessed associations, with statistical significance set at P < 0.05. RESULTS Of 199 patients, 70.9% were male, predominantly aged 18-40. Hematemesis (63.8%) and hematemesis with melena (27.6%) were common presentations. Endoscopy was not performed on more than half of the participants, with 116 patients (58.3%) not undergoing this procedure. Among the 83 cases who did have endoscopy, esophageal varices emerged as the most common condition, observed in 43.3% (36 cases. Smoking (AOR = 1.77), alcohol intake (AOR = 1.89), and drug use (AOR = 1.34) were linked to higher severity scores. Alcohol use, comorbidities, liver disease, and previous drug use correlated with prolonged hospital stays. CONCLUSION UGIB predominantly affects younger males, with hematemesis as the primary presentation. Key factors like smoking, alcohol intake, and drug use were associated with greater disease severity and longer hospital stays. These findings suggest the importance of lifestyle interventions, particularly in resource-limited settings.
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Affiliation(s)
- Missgana Worku Belete
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Molla Asnake Kebede
- Department of Medicine, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia.
| | - Meaza Rorisa Bedane
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Abeba, Ethiopia
| | - Trhas Tadesse Berhe
- Department of Epidemiology, Yekatit 12 Hospital Medical College, Addis Abeba, Ethiopia
| | - Alemayehu Beharu Tekle
- Emergency Department, School of Medicine, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Erkihun Pawlos Shash
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Misikr Alemu Eshetu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Girma Daniel Bushiso
- Department of Medicine, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Biruk Yacob Loge
- Internal Medicine Unite, Durame General Hospital, SNNPR, P.O. Box 143, Durame, Ethiopia
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26
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Peng YX, Chang WP. Risk factors for peptic ulcer bleeding one year after the initial episode. Gut Pathog 2024; 16:71. [PMID: 39609846 PMCID: PMC11606131 DOI: 10.1186/s13099-024-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 11/22/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND Peptic ulcers are a common gastrointestinal disease that could cause death when combined with bleeding. The aim of this study was to identify risk factors for peptic ulcer bleeding (PUB) recurrence after the initial episode. METHODS This retrospective study analyzed medical records of PUB patients who were admitted through the emergency department between January 1, 2020, and December 31, 2022. A multivariate logistic regression model was used to identify independent risk factors predicting readmission due to recurrent PUB within one year. RESULTS A total of 775 PUB inpatient samples were collected, among which 172 and 603 were placed respectively in the readmission group and non-readmission group. Multivariate analysis indicated that PUB inpatients who were aged 70 or above (OR = 1.62, 95% CI: 1.06-2.47), had more severe ulcers (Forrest 1a, 1b, 2a, or 2b) (OR = 2.41, 95% CI:1.57-3.71), had a CCI score of 3 or higher (OR = 2.25, 95% CI:1.45-3.50), had a medical history of peptic ulcers (OR = 3.87, 95% CI:2.56-5.85), had a medical history of cardiovascular disease (CVD) (OR = 2.31, 95% CI:1.53-3.50), or had an international normalized ratio (INR) > 1.2 on admission (OR = 2.14, 95% CI:1.28-3.57) were respectively more likely to be readmitted within a year due to PUB than those who were under the age of 70, had less severe ulcers (Forrest 2c or 3), had a CCI score of less than 3, had no medical history of peptic ulcers, had no medical history of CVD, or had admission INR ≤ 1.2. CONCLUSION This study confirmed that age (≥70 years), Forest classification (Forrest 1a, 1b, 2a, or 2b), multiple comorbidities, a medical history of peptic ulcers, a medical history of CVD, and admission INR > 1.2 were independent risk factors for patient readmission within a year due to recurrent PUB.
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Affiliation(s)
- Yu-Xuan Peng
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe, New Taipei City, 23561, Taiwan.
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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27
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Acehan F, Karsavuranoğlu B, Aslan M, Kalkan C, Sahiner ES, Inan O, Comoglu M, Yilmaz Y, Ates I. Improved outcomes in patients with non-variceal upper gastrointestinal bleeding while undergoing antithrombotic therapy: A propensity score matching analysis. Dig Liver Dis 2024; 56:1854-1862. [PMID: 38755023 DOI: 10.1016/j.dld.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/22/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This study sought to examine the effect of antithrombotic use on clinical outcomes in non-variceal upper gastrointestinal bleeding (UGIB). METHODS Patients consecutively diagnosed with non-variceal UGIB between February 2019 and September 2020 were divided into two groups based on their antithrombotic use: users and non-users. Using propensity score matching (PSM) and multivariable regression analyses, the impact of antithrombotic use prior to UGIB presentation on clinical outcomes was examined. RESULTS In the entire cohort, there were 210 and 260 patients in the antithrombotic user and non-user groups, respectively. Using PSM analysis with seven covariates, two matched groups of 157 patients were created at a 1:1 ratio. In the matched cohort, despite their longer hospital stays and a higher rate of intensive care unit admissions, the patients in the user group had lower 30- and 90-day mortality rates (4.5% vs. 14.0 %; p = 0.003 and 8.9% vs. 18.5 %; p = 0.014, respectively). In the entire cohort, multivariable analyses adjusted for confounding factors revealed that antithrombotic use was associated with lower risks of in-hospital (adjusted OR: 0.437; 95 % CI: 0.191-0.999), 30-day (adjusted OR: 0.261; 95 % CI: 0.099-0.689), and 90-day (adjusted OR: 0.386; 95 % CI: 0.182-0.821) mortality. CONCLUSION Antithrombotic use prior to UGIB presentation was found to be an independent protective factor for all-cause mortality.
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Affiliation(s)
- Fatih Acehan
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey.
| | | | - Meryem Aslan
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Cagdas Kalkan
- Department of Gastroenterology, Ankara City Hospital, Ankara, 06800, Turkey
| | - Enes Seyda Sahiner
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Osman Inan
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Mustafa Comoglu
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Yusufcan Yilmaz
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
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28
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Singh R, Gonzalez Lebron N, Aviles EA, Ramharack JB. Is it time to finally retire the pantoprazole "drip"? Postgrad Med 2024; 136:789-790. [PMID: 39365104 DOI: 10.1080/00325481.2024.2413356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/28/2024] [Accepted: 10/02/2024] [Indexed: 10/05/2024]
Affiliation(s)
- Ravnit Singh
- Department of Internal Medicine, Division of Cardiology, Saint Michael's Medical Center, Newark, NJ, USA
| | | | - Eduardo A Aviles
- Universidad Dr Jose Matias Delgado, Antiguo Cuscatlán, La Libertad, El Salvador
| | - Jonathan B Ramharack
- Division of Critical Care Medicine, St Mary's General Hospital, Passaic, NJ, USA
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29
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[Chinese guidelines for emergency management of bleeding in hemophilia patients (2024)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2024; 45:889-896. [PMID: 39622751 PMCID: PMC11579756 DOI: 10.3760/cma.j.cn121090-20240809-00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Indexed: 12/06/2024]
Abstract
Hemophilia is a X-linked recessive hemorrhagic disease. Bleeding is the most common complication of hemophilia, and it is also the main cause leading to death and disability or reducing the quality of life of hemophilia patients. Rapid identification and standardized management of the bleeding events is of great significance to improve the prognosis of hemophilia patients. Emergency department is the frontline department for hemophilia patients with bleeding. The emergent management process of hemophilia hemorrhage is complex and often needs multidisciplinary team cooperation. To increase the awareness of the related professionals who may involve in the management of bleeding events of hemophilia patients, in collaboration with the Thrombosis and Hemostasis Group, Chinese Society of Hematology, Chinese Medical Association, Hemophilia Treatment Center Collaborative Network of China issued the Chinese guidelines for emergency management of bleeding in hemophilia patients.
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Alamro SM, Alanazi MM, Suwayyid WK. Capsule Endoscopy for the Risk Stratification and Management of Acute Upper Gastrointestinal Bleeding in Emergency Departments: A Systematic Review on Triage, Risk Stratification, and Management. Cureus 2024; 16:e71530. [PMID: 39553035 PMCID: PMC11563759 DOI: 10.7759/cureus.71530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2024] [Indexed: 11/19/2024] Open
Abstract
Gastrointestinal bleeding is a common occurrence in emergency departments. The standard of care for it is an esophagogastroduodenoscopy within 24 hours to diagnose and potentially treat the bleeding. Several tools and pre-endoscopic risk assessment scores are used to help evaluate and manage upper gastrointestinal bleeding. Additionally, capsule endoscopy provides a non-invasive method to visualize the gastrointestinal tract and identify lesions. The aim of this review was to explore the role of capsule endoscopy in the triage, stratification, and management of upper gastrointestinal bleeding patients in the emergency department. Four databases, PubMed, Scopus, Embase, and the Cochrane Library, were searched using keywords related to capsule endoscopy and gastrointestinal bleeding in the emergency department. Studies were included if they assessed the use of capsule endoscopy in emergency settings for managing upper gastrointestinal bleeding. After screening titles, abstracts, and full texts and reviewing bibliographies for relevant articles, data on study design, participant demographics, capsule endoscopy procedure description, and outcomes were collected into a pre-designed spreadsheet. The review focused on the triage, risk stratification, management impact, and safety of capsule endoscopy. The literature search identified 712 records, with 37 studies screened for full-text review, resulting in nine studies included in the review. These studies involved 634 patients and primarily compared capsule endoscopy with standard care in emergency settings. Capsule endoscopy demonstrated potential advantages, including improved identification of high-risk lesions and reduced hospital admissions. Capsule endoscopy effectively detected bleeding and reduced the need for invasive procedures compared to standard practices. Capsule endoscopy also had lower costs relative to traditional triaging methods. The use of capsule endoscopy in the risk stratification and management of upper gastrointestinal bleeding in emergency settings is promising. Its high diagnostic accuracy can enhance patient outcomes by enabling timely and precise diagnosis, reducing the need for invasive procedures. Future research should focus on larger randomized trials to validate capsule endoscopy's efficacy and explore its cost-effectiveness.
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31
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Luo Q, Luo J, Luan Z, Xu K, Tian L, Zhang K, Peng X, Yuan M, Zheng C, Shu Z, Zhang Y, Tan S, Dan R, Mequanint K, Fan C, Xing M, Yang S. Blue Laser Triggered Hemostatic Peptide Hydrogel for Gastrointestinal Bleeding Treatment. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2405290. [PMID: 39011814 DOI: 10.1002/adma.202405290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/16/2024] [Indexed: 07/17/2024]
Abstract
In an emergency, nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic hemostasis is considered the gold standard intervention. However, current endoscopic hemostasis is very challenging to manage bleeding in large-diameter or deep lesions highly prone to rebleeding risk. Herein, a novel hemostatic peptide hydrogel (HPH) is reported, consisting of a self-assembly peptide sequence CFLIVIGSIIVPGDGVPGDG (PFV) and gelatin methacryloyl (GelMA), which can be triggered by blue laser endoscopy (BLE) for nonvariceal upper gastrointestinal bleeding treatment without recurring bleeding concerns. Upon contact with GelMA solution, PFV immediately fibrillates into β-sheet nanofiber and solvent-induced self-assembly to form HPH gel. HPH nanofiber networks induced ultrafast coagulation by enveloping blood cells and activating platelets and coagulation factors even to the blood with coagulopathy. Besides its remarkable hemostatic performance in artery and liver injury models, HPH achieves instant bleeding management in porcine NVUGIB models within 60 s by preventing the rebleeding risk. This work demonstrates an extraordinary hemostatic agent for NVUGIB intervention by BLE for the first time, broadening potential application scenarios, including patients with coagulopathy and promising clinical prospects.
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Affiliation(s)
- Qiang Luo
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Jie Luo
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Zhaohui Luan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Kaige Xu
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, R3T 2N2, Manitoba, Canada
| | - Lixing Tian
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Kebin Zhang
- Clinical Medical Research Center, Xinqiao Hospital, No.183, Xinqiao Street, Chongqing, 400037, China
| | - Xue Peng
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Mengxue Yuan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Chuanhao Zheng
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Zhenzhen Shu
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Yuchen Zhang
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Shali Tan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Ruijue Dan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Kibret Mequanint
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, London, N6A 5B9, Canada
| | - Chaoqiang Fan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Malcolm Xing
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, R3T 2N2, Manitoba, Canada
| | - Shiming Yang
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
- Chongqing Municipality Clinical Research Center for Gastroenterology, Chongqing, 400037, China
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Geeratragool T, Kaosombatwattana U, Boonchote A, Chatthammanat S, Preechakawin N, Srichot J, Sudcharoen A, Sirisunhirun P, Termsinsuk P, Rugivarodom M, Limsrivilai J, Maneerattanaporn M, Pausawasdi N, Leelakusolvong S. Comparison of Vonoprazan Versus Intravenous Proton Pump Inhibitor for Prevention of High-Risk Peptic Ulcers Rebleeding After Successful Endoscopic Hemostasis: A Multicenter Randomized Noninferiority Trial. Gastroenterology 2024; 167:778-787.e3. [PMID: 38582271 DOI: 10.1053/j.gastro.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND & AIMS High-dose proton pump inhibitor (PPI) therapy has been recommended to prevent rebleeding of high-risk peptic ulcer (PU) after hemostasis. Vonoprazan has been proven to be noninferior to PPIs in various acid-related diseases. This study aimed to compare the efficacy of vonoprazan vs PPI for preventing high-risk PU rebleeding after hemostasis. METHODS A multicenter, randomized, noninferiority study was conducted in 6 centers. Pre-endoscopic and endoscopic therapy were performed according to standard protocol. After successful hemostasis, patients with high-risk PU bleeding (Forrest class Ia/Ib, IIa/IIb) were randomized into 1:1 to receive vonoprazan (20 mg twice a day for 3 days, then 20 mg once a day for 28 days) or high-dose PPI (pantoprazole intravenous infusion 8 mg/h for 3 days, then omeprazole 20 mg twice a day for 28 days). The primary outcome was a 30-day rebleeding rate. Secondary outcomes included 3- and 7-day rebleeding rate, all-cause and bleeding-related mortality, rate of rescue therapy, blood transfusion, length of hospital stay, and safety. RESULTS Of 194 patients, baseline characteristics, severity of bleeding, and stage of ulcers were comparable between the 2 groups. The 30-day rebleeding rates in vonoprazan and PPI groups were 7.1% (7 of 98) and 10.4% (10 of 96), respectively; noninferiority (within 10% margin) of vonoprazan to PPI was confirmed (%risk difference, -3.3; 95% confidence interval, -11.2 to 4.7; P < .001). The 3-day and 7-day rebleeding rates in the vonoprazan group remained noninferior to PPI (P < .001 by Farrington and Manning test). All secondary outcomes were also comparable between the 2 groups. CONCLUSION In patients with high-risk PU bleeding, the efficacy of vonoprazan in preventing 30-day rebleeding was noninferior to intravenous PPI. (ClinicalTrials.gov, Number: NCT05005910).
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Affiliation(s)
- Tanawat Geeratragool
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj GI Endoscopy Center, Siriraj Hospital, Bangkok, Thailand
| | - Uayporn Kaosombatwattana
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj GI Endoscopy Center, Siriraj Hospital, Bangkok, Thailand.
| | - Arpapun Boonchote
- Division of Medicine, School of Medicine, Vachira Phuket Hospital, Phuket, Thailand
| | | | | | - Jompol Srichot
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Asawin Sudcharoen
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | | | - Panotpol Termsinsuk
- Gastroenterology Unit, School of Medicine, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand
| | - Manus Rugivarodom
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj GI Endoscopy Center, Siriraj Hospital, Bangkok, Thailand
| | - Julajak Limsrivilai
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj GI Endoscopy Center, Siriraj Hospital, Bangkok, Thailand
| | - Monthira Maneerattanaporn
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj GI Endoscopy Center, Siriraj Hospital, Bangkok, Thailand
| | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj GI Endoscopy Center, Siriraj Hospital, Bangkok, Thailand
| | - Somchai Leelakusolvong
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj GI Endoscopy Center, Siriraj Hospital, Bangkok, Thailand
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Kavitt RT, Gralnek IM. Ideal strategy for nonvariceal upper gastrointestinal bleeding. Curr Opin Gastroenterol 2024; 40:342-347. [PMID: 38967918 DOI: 10.1097/mog.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
PURPOSE OF REVIEW Over 300 000 hospital admissions in the United States each year are due to patients with upper gastrointestinal (GI) bleeding (UGIB). Common etiologies of nonvariceal UGIB include peptic ulcers, mucosal erosions of the esophagus, stomach or duodenum, Mallory-Weiss tears, Dieulafoy lesions, upper GI tract malignancy, or other etiology. RECENT FINDINGS Peptic ulcers classified as Forrest Ia, Ib, or IIa require endoscopic hemostasis, while IIb ulcers may be considered for endoscopic clot removal with endoscopic treatment of any underlying major stigmata. Endoscopic hemostasis for ulcers classified as Forrest IIc or III is not advised due to the low risk of recurrent bleeding. Endoscopic hemostasis in ulcer bleeding can be achieved using injection, thermal, and/or mechanical modalities. SUMMARY This review focuses on the currently recommended endoscopic therapies of patients presenting with acute nonvariceal upper gastrointestinal hemorrhage.
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Affiliation(s)
- Robert T Kavitt
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois, USA
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Di Gioia G, Sangineto M, Paglia A, Cornacchia MG, Parente F, Serviddio G, Romano AD, Villani R. Limits of pre-endoscopic scoring systems in geriatric patients with upper gastrointestinal bleeding. Sci Rep 2024; 14:20225. [PMID: 39215015 PMCID: PMC11364688 DOI: 10.1038/s41598-024-70577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Upper gastrointestinal bleeding (UGIB) is a common cause of hospital admission worldwide and several risk scores have been developed to predict clinically relevant outcomes. Despite the geriatric population being a high-risk group, age is often overlooked in the assessment of many risk scores. In this study we aimed to compare the predictive accuracy of six pre-endoscopic risk scoring systems in a geriatric population hospitalised with UGIB. We conducted a multi-center cross-sectional study and recruited 136 patients, 67 of these were 65-81.9 years old ("< 82 years"), 69 were 82-100 years old ("≥ 82 years"). We performed six pre-endoscopic risk scores very commonly used in clinical practice (i.e. Glasgow-Blatchford Bleeding and its modified version, T-score, MAP(ASH), Canada-United Kingdom-Adelaide, AIMS65) in both age cohorts and compared their accuracy in relevant outcomes predictions: 30-days mortality since hospitalization, a composite outcome (need of red blood transfusions, endoscopic treatment, rebleeding) and length of hospital stay. T-score showed a significantly worse performance in mortality prediction in the "≥ 82 years" group (AUROC 0.53, 95% CI 0.27-0.75) compared to "< 82 years" group (AUROC 0.88, 95% CI 0.77-0.99). In the composite outcome prediction, except for T-score, younger participants had higher sensitivities than those in the "≥ 82 years" group. All risk scores showed low performances in the prediction of length of stay (AUROCs ≤ 0.70), and, except for CANUKA score, there was a significant difference in terms of accuracy among age cohorts. Most used UGIB risk scores have a low accuracy in the prediction of clinically relevant outcomes in the geriatric population; hence novel scores should account for age or advanced age in their assessment.
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Affiliation(s)
- Giuseppe Di Gioia
- Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Moris Sangineto
- Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Annalisa Paglia
- Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Internal Medicine Unit, Ospedale Vito Fazzi, Lecce, Italy
| | - Maria Giulia Cornacchia
- Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Gaetano Serviddio
- Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonino Davide Romano
- Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Rosanna Villani
- Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Maity R, Dhali A, Biswas J. Importance of risk assessment, endoscopic hemostasis, and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding. World J Clin Cases 2024; 12:5462-5467. [PMID: 39188600 PMCID: PMC11269988 DOI: 10.12998/wjcc.v12.i24.5462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/20/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024] Open
Abstract
Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a common medical emergency in clinical practice. While the incidence has significantly reduced, the mortality rates have not undergone a similar reduction in the last few decades, thus presenting a significant challenge. This editorial outlines the key causes and risk factors of ANVUGIB and explores the current standards and recent updates in risk assessment scoring systems for predicting mortality and endoscopic treatments for achieving hemostasis. Since ANUVGIB predominantly affects the elderly population, the impact of comorbidities may be responsible for the poor outcomes. A thorough drug history is important due to the increasing use of antiplatelet agents and anticoagulants in the elderly. Early risk stratification plays a crucial role in deciding the line of management and predicting mortality. Emerging scoring systems such as the ABC (age, blood tests, co-morbidities) score show promise in predicting mortality and guiding clinical decisions. While conventional endoscopic therapies remain cornerstone approaches, novel techniques like hemostatic powders and over-the-scope clips offer promising alternatives, particularly in cases refractory to traditional modalities. By integrating validated scoring systems and leveraging novel therapeutic modalities, clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with ANVUGIB.
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Affiliation(s)
- Rick Maity
- General Medicine, Institute of Post Graduate Medical Education and Research, Kolkata 700020, India
| | - Arkadeep Dhali
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield S5 7AU, United Kingdom
- School of Medicine and Population Health, University of Sheffield, Sheffield S102HQ, United Kingdom
| | - Jyotirmoy Biswas
- General Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, India
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Oppong B, Amponsah GM, Gyabaah S, Nicholas MK, Boateng S, Ameyaw PA, Asamoah DO, Nkum BC. Upper Gastrointestinal Endoscopic Findings and Their Clinical Correlates in Patients With Liver Cirrhosis in Northern Ghana. Cureus 2024; 16:e67725. [PMID: 39318930 PMCID: PMC11421874 DOI: 10.7759/cureus.67725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2024] [Indexed: 09/26/2024] Open
Abstract
Background and study aim Liver cirrhosis causes portal hypertension that leads to dysfunction of the gastrointestinal tract, which may result in complications including upper gastrointestinal (UGI) bleeding. This study sought to determine the prevalence and the clinical correlates of these UGI abnormalities in patients with liver cirrhosis receiving care at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Patients and methods One hundred and forty-five participants with liver cirrhosis were consecutively sampled and clinically evaluated for symptoms and signs of liver cirrhosis and then underwent esophagogastroduodenoscopy (EGD). Results The mean age of the respondents was 46.50 ± 12.14 years, with the majority being males (106, 73.10%) and in Child-Pugh class C (111, 76.55%). Fatigue (128, 88.28%) and ascites (127, 87.59%) were the most common symptoms and signs, respectively. Fatigue, itch, and ascites were significantly correlated with the severity of liver cirrhosis, with an adjusted odd ratio (AOR) (confidence interval (CI)) of 3.56 (1.11-11.47), p-value of 0.03, 4.35 (1.34-14.18), p-value of 0.02 and 22.50 (4.88-103.77), p-value < 0.01, respectively. Esophageal varices were the most common UGI endoscopic findings, occurring in 102 (70.34%) patients, and correlated with the severity of liver cirrhosis, AOR (CI) of 5.19 (1.70-15.87), p-value of 0.01. Other common findings included gastritis in 71 (48.97%), portal hypertensive gastropathy in 67 (46.2%), duodenitis in 49 (33.79%), and peptic ulcer in 46 (31.72%). Conclusions Fatigue, ascites, and esophageal varices were the most common symptoms, signs, and EGD findings, respectively. Fatigue, itch, ascites, esophageal varices, duodenitis, and gastric antral vascular ectasia correlate with the severity of liver cirrhosis.
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Affiliation(s)
- Bright Oppong
- Internal Medicine/Gastroenterolgy, Komfo Anokye Teaching Hospital, Kumasi, GHA
- Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
| | - Gordon M Amponsah
- Internal Medicine/Cardiology, Komfo Anokye Teaching Hospital, Kumasi, GHA
- Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
| | - Solomon Gyabaah
- Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, GHA
| | | | - Sarpong Boateng
- Internal Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport, USA
| | - Prince A Ameyaw
- Internal Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport, USA
| | | | - Bernard C Nkum
- Internal Medicine/Cardiology, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
- Medicine, Komfo Anokye Teaching Hospital, Kumasi, GHA
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Chiang HC. The Risk of Polysaccharide Hemostatic Powder for Peptic Ulcer Bleeding. Clin Gastroenterol Hepatol 2024; 22:1747. [PMID: 38040275 DOI: 10.1016/j.cgh.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Hsueh-Chien Chiang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Karna R, Hans B, Nasereddin T, Chaudhary D, Dhawan M. Comparison of mechanical and thermal therapy in upper gastrointestinal bleeding: an analysis of efficacy outcomes. Proc AMIA Symp 2024; 37:734-741. [PMID: 39165805 PMCID: PMC11332638 DOI: 10.1080/08998280.2024.2381180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 08/22/2024] Open
Abstract
Background Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a complication of dual antiplatelet therapy (DAPT) and direct oral anticoagulant therapy (DOAC). There is a lack of data comparing mechanical therapy (clips) with thermal therapy in this population. Methods We conducted a retrospective chart review of patients undergoing urgent/emergent endoscopy for NVUGIB while being on DAPT or DOAC. Patients who had DAPT/DOAC held as per American Society of Gastrointestinal Endoscopy guidelines were excluded from the study. Results A total of 122 patients were included in the study. There was no difference in primary hemostasis, rebleeding rate, rescue hemostatic procedure, and 30-day mortality between the mechanical and thermal therapy groups. The mechanical therapy group had a significantly higher rate of prolonged length of stay (61.2% vs 38.9%, P = 0.02), serious clinical outcomes (56% vs 37.5%, P = 0.04), and intensive care unit admissions (50% vs 20.8%, P = 0.001) than the thermal therapy group. Conclusion Patients on DAPT/DOAC presenting with NVUGIB can undergo mechanical or thermal endoscopic intervention without a significant difference in achieving primary hemostasis, rebleeding, requiring a secondary procedure, or mortality outcomes.
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Affiliation(s)
- Rahul Karna
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Bandhul Hans
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Thayer Nasereddin
- Indianapolis Gastroenterology and Hepatology, Indianapolis, Indiana, USA
| | - Dhruv Chaudhary
- Division of Gastroenterology and Hepatology, Columbus, Georgia, USA
| | - Manish Dhawan
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Alali AA, Almadi MA, Martel M, Barkun AN. The use of cap-mounted clips as a primary hemostatic modality in nonvariceal upper gastrointestinal bleeding: A systematic review and meta-analysis of randomized trials. Saudi J Gastroenterol 2024:00936815-990000000-00092. [PMID: 38988069 PMCID: PMC11379257 DOI: 10.4103/sjg.sjg_86_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/18/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Cap-mounted-clips, especially Over-The-Scope-Clip (OTSC™), are recommended for recurrent nonvariceal upper gastrointestinal bleeding (NVUGIB). There has been recent interest in their use as an initial hemostatic modality. We performed a systematic review of randomized controlled trials (RCTs) assessing cap-mounted clips' efficacy as a primary hemostatic modality in NVUGIB. METHODS A literature search of MEDLINE, EMBASE, and ISI Web of Science databases up to April 2024 identified RCTs comparing cap-mounted clips to standard endoscopic therapy (SET) as a primary hemostatic modality in NVUGIB. The primary endpoint was the composite outcome of further bleeding (persistent or recurrent) at 30 days. Secondary outcomes included persistent bleeding at index endoscopy and 30-day rebleeding, individually. Other pertinent outcomes were also recorded. A meta-analysis was performed to determine pooled risk ratios (RRs), comparing cap-mounted clip to SET. Out of 516 citations, five RCTs (n = 555), all assessing OTSC™, were included. RESULTS The composite outcome of further bleeding was lower with cap-mounted clip versus SET (RR = 0.33 [95% confidence interval {CI}: 0.20-0.54]). There was no difference in persistent bleeding at initial endoscopy (RR = 0.30 [95% CI: 0.07-1.30]), but 30-day rebleeding was lower with cap-mounted clip (RR = 0.38 [95% CI: 0.21-0.70]). There were no differences in other outcomes. Grading of the evidence ranged from very low to moderate, mainly due to risk of bias and imprecision. CONCLUSIONS Cap-mounted clips may be an efficacious primary hemostatic modality, associated with a lower further bleeding at 30 days compared to SET in NVUGIB. However, due to limitations in existing evidence, further research must better characterize an optimal subgroup of patients benefiting most from this approach before adopting its routine use.
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Affiliation(s)
- Ali A Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriyah, Kuwait
| | - Majid A Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
| | - Myriam Martel
- Research Institute of the McGill University Health Center, Montreal, Canada
| | - Alan N Barkun
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
- Division of Clinical Epidemiology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
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Almadi MA, Lu Y, Alali AA, Barkun AN. Peptic ulcer disease. Lancet 2024; 404:68-81. [PMID: 38885678 DOI: 10.1016/s0140-6736(24)00155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/22/2023] [Accepted: 01/24/2024] [Indexed: 06/20/2024]
Abstract
Annual prevalence estimates of peptic ulcer disease range between 0·12% and 1·5%. Peptic ulcer disease is usually attributable to Helicobacter pylori infection, intake of some medications (such as aspirin and non-steroidal anti-inflammatory medications), or being critically ill (stress-related), or it can be idiopathic. The clinical presentation is usually uncomplicated, with peptic ulcer disease management based on eradicating H pylori if present, the use of acid-suppressing medications-most often proton pump inhibitors (PPIs)-or addressing complications, such as with early endoscopy and high-dose PPIs for peptic ulcer bleeding. Special considerations apply to patients on antiplatelet and antithrombotic agents. H pylori treatment has evolved, with the choice of regimen dictated by local antibiotic resistance patterns. Indications for primary and secondary prophylaxis vary across societies; most suggest PPIs for patients at highest risk of developing a peptic ulcer, its complications, or its recurrence. Additional research areas include the use of potassium-competitive acid blockers and H pylori vaccination; the optimal approach for patients at risk of stress ulcer bleeding requires more robust determinations of optimal patient selection and treatment selection, if any. Appropriate continuation of PPI use outweighs most possible side-effects if given for approved indications, while de-prescribing should be trialled when a definitive indication is no longer present.
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Affiliation(s)
- Majid A Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Division of Gastroenterology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada
| | - Yidan Lu
- Division of Gastroenterology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada
| | - Ali A Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriyah, Kuwait
| | - Alan N Barkun
- Division of Gastroenterology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada; Division of Clinical Epidemiology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada.
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Long B, Gottlieb M. Emergency medicine updates: Upper gastrointestinal bleeding. Am J Emerg Med 2024; 81:116-123. [PMID: 38723362 DOI: 10.1016/j.ajem.2024.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Upper gastrointestinal bleeding (UGIB) is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency clinicians to be aware of the current evidence regarding the diagnosis and management of this disease. OBJECTIVE This paper evaluates key evidence-based updates concerning UGIB for the emergency clinician. DISCUSSION UGIB most frequently presents with hematemesis. There are numerous causes, with the most common peptic ulcer disease, though variceal bleeding in particular can be severe. Nasogastric tube lavage for diagnosis is not recommended based on the current evidence. A hemoglobin transfusion threshold of 7 g/dL is recommended (8 g/dL in those with myocardial ischemia), but patients with severe bleeding and hemodynamic instability require emergent transfusion regardless of their level. Medications that may be used in UGIB include proton pump inhibitors, prokinetic agents, and vasoactive medications. Antibiotics are recommended for those with cirrhosis and suspected variceal bleeding. Endoscopy is the diagnostic and therapeutic modality of choice and should be performed within 24 h of presentation in non-variceal bleeding after resuscitation, though patients with variceal bleeding may require endoscopy within 12 h. Transcatheter arterial embolization or surgical intervention may be necessary. Intubation should be avoided if possible. If intubation is necessary, several considerations are required, including resuscitation prior to induction, utilizing preoxygenation and appropriate suction, and administering a prokinetic agent. There are a variety of tools available for risk stratification, including the Glasgow Blatchford Score. CONCLUSIONS An understanding of literature updates can improve the ED care of patients with UGIB.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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Ouyang Q, Xia Y, Wang L, Qiu J, Zhang Y, Ding R, Zhu Z, Shu X, Pan X. The efficacy of sclerotherapy as the initial treatment in patients with bleeding from Dieulafoy's lesion of the upper gastrointestinal tract. Surg Endosc 2024; 38:3773-3782. [PMID: 38789624 DOI: 10.1007/s00464-024-10854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/10/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Dieulafoy's lesion (DL) is a rare and important cause of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), however, there is a lack of clear guidelines focus on the endoscopic hemostasis treatment for DL. Sclerotherapy, as the ANVUGIB guideline recommended endoscopic hemostasis method, is widely used in clinical practice. The aim of this study is to investigate the efficacy of sclerotherapy as the initial treatment for Dieulafoy's lesion of the upper gastrointestinal tract (UDL). METHODS Patients with UDL who underwent the ANVUGIB standard endoscopic hemostasis between April 2007 and January 2023 were enrolled. The endoscopic therapy method was left to the discretion of the endoscopist. RESULTS In total, 219 patients were finally obtained, with 74 (33.8%) receiving sclerotherapy and 145 (66.2%) receiving other standard endoscopic therapy. The rebleeding within 30 days was significantly lower in the sclerotherapy group compared to the other standard group (5.8% vs. 16.8%, p = 0.047). There were no significant differences between the two groups in terms of successful hemostasis rate (93.2% vs. 94.5%, p = 0.713), median number of red blood cell transfusions (3.5 vs. 4.0 units, p = 0.257), median hospital stay (8.0 vs. 8.0 days, p = 0.103), transferred to ICU rate (8.1% vs. 6.2%, p = 0.598), the need for embolization or surgery rate (12.2% vs. 9.7%, p = 0.567) and 30-day mortality (0 vs. 2.1%, p = 0.553). In addition, we found no difference in efficacy between sclerotherapy alone and combination (3.1% vs. 8.1%, p = 0.714). Further analysis revealed that thermocoagulation for hemostasis was associated with a higher rate of rebleeding (28.6% vs. 3.1%, p = 0.042) and longer hospital stay (11.5 vs. 7.5 days, p = 0.005) compared to sclerotherapy alone. CONCLUSION Sclerotherapy represents an effective endoscopic therapy for both alone and combined use in patients with upper gastrointestinal Dieulafoy's lesion. Therefore, sclerotherapy could be considered as initial treatment in patients with bleeding of UDL.
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Affiliation(s)
- Qingping Ouyang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yanhong Xia
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Liping Wang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jiayu Qiu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yanxia Zhang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ruiying Ding
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Zhenhua Zhu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xu Shu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
| | - Xiaolin Pan
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
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Pattarapuntakul T, Wong T, Wetwittayakhlang P, Netinatsunton N, Keeratichananont S, Kaewdech A, Jandee S, Chamroonkul N, Sripongpun P, Lakatos PL. Efficacy of Vonoprazan vs. Intravenous Proton Pump Inhibitor in Prevention of Re-Bleeding of High-Risk Peptic Ulcers: A Randomized Controlled Pilot Study. J Clin Med 2024; 13:3606. [PMID: 38930134 PMCID: PMC11204564 DOI: 10.3390/jcm13123606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Proton pump inhibitor (PPI) therapy is well-established for its effectiveness in reducing re-bleeding in high-risk peptic ulcer patients following endoscopic hemostasis. Vonoprazan (VPZ) has demonstrated the capacity to achieve gastric pH levels exceeding 4, comparable to PPIs. This study aims to evaluate the comparative efficacy of intravenous PPI infusion versus VPZ in preventing re-bleeding after endoscopic hemostasis in patients with high-risk peptic ulcers. Methods: A randomized, double-blind, controlled, and double-dummy design was employed. Patients with peptic ulcer bleeding (Forrest class IA/IB or IIA/IIB) who underwent endoscopic hemostasis were randomly assigned to either the PPI group or the VPZ group. Re-bleeding rates at 3, 7, and 30 days, the number of blood transfusions required, length of hospitalization, and ulcer healing rate at 56 days were assessed. Results: A total of 44 eligible patients were enrolled, including 20 patients (PPI group, n = 11; VPZ group, n = 9) with high-risk peptic ulcers. The mean age was 66 years, with 70% being male. Re-bleeding within 72 h occurred in 9.1% of the PPI group versus 0% in the VPZ group (p = 1.000). There was no significant difference in re-bleeding rates within 7 days and 30 days (18.2% vs. 11.1%, p = 1.000). Additionally, the ulcer healing rate did not significantly differ between the groups (87.5% vs. 77.8%). Conclusions: This pilot study demonstrates comparable efficacy between oral vonoprazan and continuous PPI infusion in preventing recurrent bleeding events among high-risk peptic ulcer patients following successful endoscopic hemostasis.
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Affiliation(s)
- Tanawat Pattarapuntakul
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (T.P.); (T.W.); (A.K.); (S.J.); (N.C.); (P.S.)
| | - Thanawin Wong
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (T.P.); (T.W.); (A.K.); (S.J.); (N.C.); (P.S.)
| | - Panu Wetwittayakhlang
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (T.P.); (T.W.); (A.K.); (S.J.); (N.C.); (P.S.)
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Nisa Netinatsunton
- Nanthana-Kriangkrai Chotiwattanaphan (NKC) Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (N.N.); (S.K.)
| | - Suriya Keeratichananont
- Nanthana-Kriangkrai Chotiwattanaphan (NKC) Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (N.N.); (S.K.)
| | - Apichat Kaewdech
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (T.P.); (T.W.); (A.K.); (S.J.); (N.C.); (P.S.)
| | - Sawangpong Jandee
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (T.P.); (T.W.); (A.K.); (S.J.); (N.C.); (P.S.)
| | - Naichaya Chamroonkul
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (T.P.); (T.W.); (A.K.); (S.J.); (N.C.); (P.S.)
| | - Pimsiri Sripongpun
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (T.P.); (T.W.); (A.K.); (S.J.); (N.C.); (P.S.)
| | - Peter L. Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, 1085 Budapest, Hungary
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Deng F, Cao Y, Zhao S. Upper gastrointestinal haemorrhage patients' survival: A causal inference and prediction study. Eur J Clin Invest 2024; 54:e14180. [PMID: 38376066 DOI: 10.1111/eci.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/11/2024] [Accepted: 02/03/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Upper gastrointestinal (GI) bleeding is a common medical emergency. This study aimed to develop models to predict critically ill patients with upper GI bleeding in-hospital and 30-day survival, identify the correlation factor and infer the causality. METHODS A total of 2898 patients with upper GI bleeding were included from the Medical Information Mart for Intensive Care-IV and eICU-Collaborative Research Database, respectively. To identify the most critical factors contributing to the prognostic model, we used SHAP (SHapley Additive exPlanations) for machine learning interpretability. We performed causal inference using inverse probability weighting for survival-associated prognostic factors. RESULTS The optimal model using the light GBM (gradient boosting algorithm) algorithm achieved an AUC of .93 for in-hospital survival, .81 for 30-day survival in internal testing and .87 for in-hospital survival in external testing. Important factors for in-hospital survival, according to SHAP, were SOFA (Sequential organ failure assessment score), GCS (Glasgow coma scale) motor score and length of stay in ICU (Intensive critical care). In contrast, essential factors for 30-day survival were SOFA, length of stay in ICU, total bilirubin and GCS verbal score. Our model showed improved performance compared to SOFA alone. CONCLUSIONS Our interpretable machine learning model for predicting in-hospital and 30-day mortality in critically ill patients with upper gastrointestinal bleeding showed excellent accuracy and high generalizability. This model can assist clinicians in managing these patients to improve the discrimination of high-risk patients.
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Affiliation(s)
- Fuxing Deng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Yaoyuan Cao
- Department of Forensic Medicine, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Shuangping Zhao
- Department of Intensive Critical Unit, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Mujadzic H, Noorani S, Riddle PJ, Wang Y, Metts G, Yacu T, Abougergi MS. Ulcer Bleeding in the United States: Epidemiology, Treatment Success, and Resource Utilization. Dig Dis Sci 2024; 69:1963-1971. [PMID: 38446313 DOI: 10.1007/s10620-024-08322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/09/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND GOALS Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting. METHODS Retrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients' demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis. RESULTS A total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67 years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs. CONCLUSIONS The ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.
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Affiliation(s)
- Hata Mujadzic
- Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Shayan Noorani
- Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Philip J Riddle
- Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA, USA
| | - Gracelyn Metts
- Department of Health Sciences, Clemson University, Clemson, SC, USA
| | - Tania Yacu
- Department of Health Sciences, Clemson University, Clemson, SC, USA
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Huntingdon Valley, PA, USA.
- Division of Gastroenterology, Department of Internal Medicine, INOVA Fairfax Hospital, INOVA Health, 3300 Gallows Road, Falls Church, VA, 22042, USA.
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46
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Hung KW. The Future is Bright (Red) for Hemostasis of Peptic Ulcers. Dig Dis Sci 2024; 69:1922-1924. [PMID: 38446312 DOI: 10.1007/s10620-024-08308-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Kenneth W Hung
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, P.O. Box 208019, New Haven, CT, 06520, USA.
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Butt N, Usmani MT, Mehak N, Mughal S, Qazi-Arisar FA, Mohiuddin G, Khan G. Risk factors and outcomes of peptic ulcer bleed in a Pakistani population: A single-center observational study. World J Gastrointest Pharmacol Ther 2024; 15:92305. [PMID: 38846968 PMCID: PMC11151881 DOI: 10.4292/wjgpt.v15.i3.92305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/24/2024] [Accepted: 05/20/2024] [Indexed: 05/27/2024] Open
Abstract
BACKGROUND Peptic ulcer disease (PUD) remains a significant healthcare burden, contributing to morbidity and mortality worldwide. Despite advancements in therapies, its prevalence persists, particularly in regions with widespread nonsteroidal anti-inflammatory drugs (NSAIDs) use and Helicobacter pylori infection. AIM To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal (GI) bleeding in Pakistani population. METHODS This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022. Data on demographics, symptoms, length of stay, mortality, re-bleed, and Forrest classification was collected. RESULTS The mean age of patients was 53 years, and the majority was men (68.3%). Hematemesis (82.4%) and epigastric pain (75.4%) were the most common presenting symptoms. Most patients (73.2%) were discharged within five days. The mortality rates at one week and one month were 10.6% and 14.8%, respectively. Re-bleed within 24 h and seven days occurred in 14.1% and 18.3% of patients, respectively. Most ulcers were Forrest class (FC) III (72.5%). Antiplatelet use was associated with higher mortality at 7 and 30 d, while alternative medications were linked to higher 24-hour re-bleed rates. NSAID use was associated with more FC III ulcers. Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality. CONCLUSION Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding, while alternative medicines are associated with early rebleeding.
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Affiliation(s)
- Nazish Butt
- Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi 75505, Sindh, Pakistan
| | - Muhammad Tayyab Usmani
- National Institute of Liver & GI Diseases, Dow University of Health Sciences, Karachi 75330, Sindh, Pakistan
| | - Nimrah Mehak
- Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi 75505, Sindh, Pakistan
| | - Saba Mughal
- School of Public Health, Dow University of Health Sciences, Karachi 75330, Sindh, Pakistan
| | - Fakhar Ali Qazi-Arisar
- National Institute of Liver & GI Diseases, Dow University of Health Sciences, Karachi 75330, Sindh, Pakistan
| | - Ghulam Mohiuddin
- Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi 75505, Sindh, Pakistan
| | - Gulzar Khan
- Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi 75505, Sindh, Pakistan
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Elbadry M, El-Raey F, Alboraie M, Abdel-Samiee M, Abdeltawab D, Ahmed MH, Sherief AF, Eliwa A, Tharwat M, Abdelmawgod A, Ahmed OA, Abdelsameea E, Mahros A, Moussa AM, Eid A, Raafat K, Yousef A, Rafea SAS, Alazzaq Y, Mare'y M, Abdelaziz A, Ibrahim ESA, El Dayem WAA, Abdelmoati AA, Tawheed A, Amer M, Zaky S, El-Kassas M. Clinical and endoscopic characteristics of patients undergoing gastrointestinal endoscopic procedures in Egypt: a nationwide multicenter study. BMC Gastroenterol 2024; 24:186. [PMID: 38807055 PMCID: PMC11134759 DOI: 10.1186/s12876-024-03262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Egypt faces a significant public health burden due to chronic liver diseases (CLD) and peptic ulcer disease. CLD, primarily caused by Hepatitis C virus (HCV) infection, affects over 2.9% of the population nationwide, with regional variations. Steatotic liver disease is rapidly emerging as a significant contributor to CLD, especially in urban areas. Acid-related disorders are another widespread condition that can significantly impact the quality of life. These factors and others significantly influence the indications and findings of gastrointestinal endoscopic procedures performed in Egypt. AIM We aimed to evaluate the clinico-demographic data, indications, and endoscopic findings in Egyptian patients undergoing gastrointestinal endoscopic procedures in various regions of Egypt. METHODS This study employed a retrospective multicenter cross-sectional design. Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt. RESULTS 5910 patients aged 38-63 were enrolled in the study; 75% underwent esophagogastroduodenoscopy (EGD), while 25% underwent a colonoscopy. In all studied patients, the most frequent indications for EGD were dyspepsia (19.5%), followed by hematemesis (19.06%), and melena (17.07%). The final EGD diagnoses for the recruited patients were portal hypertension-related sequelae (60.3%), followed by acid-related diseases (55%), while 10.44% of patients had a normally apparent endoscopy. Male gender, old age, and the presence of chronic liver diseases were more common in patients from upper than lower Egypt governorates. Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%). IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients, while normal colonoscopy findings were encountered in 18.21% of them. CONCLUSION This is the largest study describing the situation of endoscopic procedures in Egypt. our study highlights the significant impact of regional variations in disease burden on the utilization and outcomes of GI endoscopy in Egypt. The high prevalence of chronic liver disease is reflected in the EGD findings, while the colonoscopy results suggest a potential need for increased awareness of colorectal diseases.
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Affiliation(s)
- Mohamed Elbadry
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Ain Helwan, Cairo, 11795, Egypt
| | - Fathiya El-Raey
- Hepatogastroenterology and Infectious Diseases Department, Al-Azhar University, Damietta, Egypt
| | | | - Mohamed Abdel-Samiee
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
| | - Doaa Abdeltawab
- Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt
| | - Mohammed Hussien Ahmed
- Hepatology, Gastroenterology, and Infectious Diseases Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Ahmed F Sherief
- Tropical Medicine Department, Ain Shams University, Cairo, Egypt
| | - Ahmed Eliwa
- Internal Medicine Department, Al-Azhar University, Cairo, Egypt
| | - Mina Tharwat
- Tropical Medicine and Gastroenterology Department, Aswan University, Aswan, Egypt
| | - Amira Abdelmawgod
- Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt
| | | | - Eman Abdelsameea
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
| | - Aya Mahros
- Hepatology, Gastroenterology, and Infectious Diseases Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Abdelmajeed M Moussa
- Tropical Medicine and Gastroenterology Department, Aswan University, Aswan, Egypt
| | - Alshaimaa Eid
- Hepatogastroenterolgy and Infectious Diseases Department, AL-Azhar University, Cairo, Egypt
| | - Khaled Raafat
- Internal Medicine Department, Ain Shams University, Cairo, Egypt
| | - Ahmed Yousef
- Public Health and Community Medicine Department, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Saad A S Rafea
- Tropical Medicine Department, Ain Shams University, Cairo, Egypt
| | - Youssef Alazzaq
- Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed Mare'y
- Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ahmed Abdelaziz
- Hepatogastroenterology and Infectious Diseases Department, Al-Azhar University, Damietta, Egypt
| | | | | | | | - Ahmed Tawheed
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Ain Helwan, Cairo, 11795, Egypt
| | - Mohammad Amer
- Hepatology & Gastroenterology, Shebin Teaching Hospital, Shebin El Kom, Egypt
| | - Samy Zaky
- Hepatogastroenterolgy and Infectious Diseases Department, AL-Azhar University, Cairo, Egypt
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Ain Helwan, Cairo, 11795, Egypt.
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Ivashkin VТ, Mayev IV, Tsarkov РV, Korolev МР, Andreev DN, Baranskaya ЕК, Bordin DS, Burkov SG, Derinov АА, Efetov SК, Lapina ТL, Pavlov РV, Pirogov SS, Poluektova ЕА, Tkachev АV, Trukhmanov АS, Uljanin АI, Fedorov ЕD, Sheptulin АА. Diagnostics and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, the Russian Society of Colorectal Surgeons, the Russian Endoscopic Society and the Scientific Society for the Clinical Study of Human Microbiome). RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2024; 34:101-131. [DOI: 10.22416/1382-4376-2024-34-2-101-131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Aim. The guidelines set out the modern methods of diagnostics and treatment of peptic ulcer and are created for gastroenterologists, primary care physicians, general practitioners, surgeons, endoscopists.Key points. The clinical guidelines contain modern views on the etiology and pathogenesis of peptic ulcer, its clinical features, methods of laboratory and instrumental diagnostics, the main approaches to conservative and surgical treatment. They include the criteria for assessment of the quality of medical care, the algorithm of the doctor's actions, as well as information for the patient.Conclusion. Knowledge of modern methods of diagnostics and therapy of peptic ulcers will contribute to improving the results of its treatment.
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Affiliation(s)
- V. Т. Ivashkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - I. V. Mayev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - Р. V. Tsarkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - D. N. Andreev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - Е. К. Baranskaya
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - D. S. Bordin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry; A.S. Loginov Moscow Clinical Science Center
| | - S. G. Burkov
- Polyclinic No. 3 of Presidential Administration of Russian Federation
| | - А. А. Derinov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - S. К. Efetov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Т. L. Lapina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Р. V. Pavlov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - S. S. Pirogov
- P.A. Hertsen Moscow Oncology Research Center — Branch of “National Medical Research Radiological Center”
| | - Е. А. Poluektova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - А. S. Trukhmanov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - А. I. Uljanin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Е. D. Fedorov
- Pirogov Russian National Research Medical University
| | - А. А. Sheptulin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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50
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Xiao X, Liu X, Yan H, Xing X, Luo X, Yang J. Proton pump inhibitor therapy after transcatheter angiography in refractory nonvariceal acute upper gastrointestinal bleeding patients: a cohort study. BMC Gastroenterol 2024; 24:168. [PMID: 38760713 PMCID: PMC11100103 DOI: 10.1186/s12876-024-03261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/13/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Transcatheter angiography (TA) could help to diagnose and treat refractory nonvariceal upper gastrointestinal bleeding (NVUGIB). Proton pump inhibitors (PPIs) are the key medication for reducing the rebleeding rate and mortality and are usually continued after TA. It is unknown whether high-dose PPIs after TA are more effective than the standard regimen. METHODS We retrospectively collected data from patients who received TA because of refractory NVUGIB from 2010 to 2020 at West China Hospital. 244 patients were included and divided into two groups based on the first 3 days of PPIs treatment. All baseline characteristics were balanced using the inverse probability of treatment weighting method. The 30-day all-cause mortality, rebleeding rate and other outcomes were compared. The propensity score matching method was also used to verify the results. RESULTS There were 86 patients in the high-dose group and 158 in the standard group. The average daily doses of PPI were 192.1 ± 17.9 mg and 77.8 ± 32.0 mg, respectively. Cox regression analysis showed no difference in the 30-day all-cause mortality (aHR 1.464, 95% CI 0.829 to 2.584) or rebleeding rate (aHR 1.020, 95% CI 0.693 to 1.501). There were no differences found in red blood cell transfusion, hospital stay length and further interventions, including endoscopy, repeating TA, surgery and ICU admission. The results were consistent in the subgroup analysis of patients with transcatheter arterial embolization. CONCLUSION In refractory NVUGIB patients who received TA, regardless of whether embolization was performed, high-dose PPI treatment did not provide additional benefits compared with the standard regimen.
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Affiliation(s)
- Xue Xiao
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu, Sichuan Province, China
| | - Xinbing Liu
- Endoscopy Center, Sichuan Cancer Hospital, Chengdu, Sichuan Province, China
| | - Hailin Yan
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu, Sichuan Province, China
| | - Xiaocun Xing
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu, Sichuan Province, China
| | - Xuefeng Luo
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu, Sichuan Province, China
| | - Jinlin Yang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China.
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu, Sichuan Province, China.
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