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

• Helicobacter pylori
• ASA
• NSAIDs
• Peptic ulcer
• comorbidity
• epidemiology
• gastrointestinal bleeding

• Anatomical study
• Endoscopy
• Gastroduodenal artery
• Ulcus bleeding

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Blood Transfusion
• Cause of Death
• Child
• End Stage Liver Disease/mortality
• Endoscopy, Gastrointestinal
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/physiopathology
• Female
• Gastrointestinal Agents/therapeutic use
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/mortality
• Gastrointestinal Hemorrhage/physiopathology
• Gastrointestinal Hemorrhage/therapy
• Hematemesis/etiology
• Hematemesis/physiopathology
• Hematemesis/therapy
• Hepatic Encephalopathy/mortality
• Hormones/therapeutic use
• Hospital Mortality
• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/physiopathology
• Liver Failure/mortality
• Male
• Melena/etiology
• Melena/physiopathology
• Melena/therapy
• Middle Aged
• Multiple Organ Failure/mortality
• Octreotide/therapeutic use
• Proton Pump Inhibitors/therapeutic use
• Recurrence
• Severity of Illness Index
• Somatostatin/therapeutic use
• Young Adult

We compared the predictive value of the National Early Warning Score+Lactate (NEWS+L) score with those of other parameters such as the pre-endoscopic Rockall score (PERS), Glasgow-Blatchford score (GBS), and albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 years score (AIMS65) among patients with upper gastrointestinal bleeding (UGIB).

We conducted a retrospective study of patients with UGIB during 2 consecutive years. The primary outcome was the composite of in-hospital death, intensive care unit admission, and the need for ≥5 packs of red blood cell transfusion within 24 hours.

Among 530 included patients, the composite outcome occurred in 59 patients (19 in-hospital deaths, 13 intensive care unit admissions, and 40 transfusions of ≥5 packs of red blood cells within 24 hours). The area under the receiver operating characteristic curve of the NEWS+L score for the composite outcome was 0.76 (95% confidence interval, 0.70 to 0.82), which demonstrated a significant difference compared to PERS (0.66, 0.59–0.73, P=0.004), but not to GBS (0.70, 0.64–0.77, P=0.141) and AIMS65 (0.76, 0.70–0.83, P=0.999). The sensitivities of NEWS+L scores of 3 (n=34, 6.4%), 4 (n=92, 17.4%), and 5 (n=171, 32.3%) were 100%, 98.3%, and 96.6%, respectively, while the sensitivity of an AIMS65 score of 0 (n=159, 30.0%) was 91.5%.

The NEWS+L score showed better discriminative performance than the PERS and comparable discriminative performance to the GBS and AIMS65. The NEWS+L score may be used to identify low-risk patients among patients with UGIB.

• Bleeding
• Gastrointestinal
• Lactate
• Mortality
• Risk

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

Rebleeding is associated with mortality in patients with peptic ulcer bleeding (PUB), and risk stratification is important for the management of these patients. The purpose of our study was to examine the risk factors associated with rebleeding in patients with PUB.

The Korean Peptic Ulcer Bleeding registry is a large prospectively collected database of patients with PUB who were hospitalized between 2014 and 2015 at 28 medical centers in Korea. We examined the basic characteristics and clinical outcomes of patients in this registry. Univariate and multivariate analyses were performed to identify the factors associated with rebleeding.

In total, 904 patients with PUB were registered, and 897 patients were analyzed. Rebleeding occurred in 7.1% of the patients (64), and the 30-day mortality was 1.0% (nine patients). According to the multivariate analysis, the risk factors for rebleeding were the presence of co-morbidities, use of multiple drugs, albumin levels, and hematemesis/hematochezia as initial presentations.

The presence of co-morbidities, use of multiple drugs, albumin levels, and initial presentations with hematemesis/hematochezia can be indicators of rebleeding in patients with PUB. The wide use of proton pump inhibitors and prompt endoscopic interventions may explain the low incidence of rebleeding and low mortality rates in Korea.

• Peptic ulcer hemorrhage
• Rebleeding
• Risk factors

• Diagnosis
• endoscopy
• gastrointestinal bleeding
• nasogastric aspiration
• nasogastric lavage
• prognosis

Patients with chronic kidney disease (CKD) and Helicobacter pylori (H. pylori) infection have a higher incidence of gastroduodenal diseases and therefore are recommended to receive eradication therapies. This study aimed to assess the efficacy of a 7-day standard triple therapy in patients with CKD (eGFR < 60 ml/min/1.73 m²) and to investigate the clinical factors influencing the success of eradication.

A total of 758 patients with H. pylori infection receiving a 7-day standard first-line triple therapy between January 1, 2013, and December 31, 2014, were recruited. Patients were divided into two groups: CKD group (N = 130) and non-CKD group (N = 628).

The eradication rates attained by the CKD and non-CKD groups were 85.4% and 85.7%, respectively, in the per-protocol analysis (p = 0.933). The eradication rate in CKD stage 3 was 84.5% (82/97), in stage 4 was 88.2% (15/17), and in those who received hemodialysis was 87.5% (14/16). There were no significant differences in the various stages of CKD (p = 0.982). The adverse events were similar between the two groups (3.1% versus 4.6%, p = 0.433). Compliance between the two groups was good (100.0% versus 99.8%, p = 0.649). There was no significant clinical factor influencing the H. pylori eradication rate in the non-CKD and CKD groups.

This study suggests that the H. pylori eradication rate and adverse rate in patients with CKD are comparable to those of non-CKD patients.

• chronic kidney disease
• endoscopic treatment
• nationwide cohort study
• peptic ulcer bleeding
• rebleeding

• Adult
• Age Factors
• Aged
• Aspirin/therapeutic use
• Female
• Hemostasis, Endoscopic
• Hospital Costs
• Humans
• Intubation, Intratracheal/statistics & numerical data
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Peptic Ulcer Hemorrhage/complications
• Peptic Ulcer Hemorrhage/mortality
• Peptic Ulcer Hemorrhage/therapy
• Platelet Aggregation Inhibitors/therapeutic use
• Recurrence
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/mortality
• Retrospective Studies
• Risk Factors
• Shock/epidemiology
• Taiwan
• Young Adult

• bleeding peptic ulcers
• intravenous
• oral
• proton pump inhibitors

• Bleeding
• Mortality
• Peptic ulcer
• Risk factors

• Blood transfusion
• Duodenal ulcer
• Rebleeding
• Second look endoscopy
• Stomach ulcer

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Endoscopy, Digestive System
• Female
• Hemostasis, Endoscopic
• Humans
• Male
• Middle Aged
• Peptic Ulcer Hemorrhage/prevention & control
• Peptic Ulcer Hemorrhage/therapy
• Recurrence
• Risk Factors
• Second-Look Surgery
• Young Adult

• Mortality
• Re-bleeding
• Rockall scoring system
• Upper gastrointestinal bleeding

• Rockall score
• gastrointestinal bleeding
• lactate
• mortality in ICU

• Critical Illness
• Female
• Gastrointestinal Hemorrhage/blood
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/mortality
• Hospital Mortality
• Humans
• Lactates/blood
• Male
• Middle Aged
• Predictive Value of Tests
• Retrospective Studies
• Risk Assessment
• Sensitivity and Specificity

• gastrointestinal hemorrhage
• overall survival
• pancreatic cancer
• risk factor

AIM: To compare the effect of endoscopic variceal ligation (EVL) with that of endoscopic injection sclerotherapy (EIS) in the treatment of patients with esophageal variceal bleeding.

METHODS: We performed a systematic literature search of multiple online electronic databases. Meta-analysis was conducted to evaluate risk ratio (RR) and 95% confidence interval (CI) of combined studies for the treatment of patients with esophageal variceal bleeding between EVL and EIS.

RESULTS: Fourteen studies comprising 1236 patients were included in the meta-analysis. The rebleeding rate in actively bleeding varices patients in the EVL group was significantly lower than that in the EIS group (RR = 0.68, 95%CI: 0.57-0.81). The variceal eradication rate in actively bleeding varices patients in the EVL group was significantly higher than that in the EIS group (RR = 1.06, 95%CI: 1.01-1.12). There was no significant difference about mortality rate between the EVL group and EIS group (RR = 0.95, 95%CI: 0.77-1.17). The rate of complications in actively bleeding varices patients in the EVL group was significantly lower than that in the EIS group (RR = 0.28, 95%CI: 0.13-0.58).

CONCLUSION: Our meta-analysis has found that EVL is better than EIS in terms of the lower rates of rebleeding, complications, and the higher rate of variceal eradication. Therefore, EVL is the first choice for esophageal variceal bleeding.

• Esophageal variceal bleeding
• Endoscopic variceal ligation
• Endoscopic injection sclerotherapy
• Rebleeding
• Variceal eradication
• Meta-analysis

• Adult
• Aged
• Chi-Square Distribution
• Esophageal and Gastric Varices/complications
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/mortality
• Esophageal and Gastric Varices/therapy
• Female
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/mortality
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic/adverse effects
• Hemostasis, Endoscopic/methods
• Hemostasis, Endoscopic/mortality
• Humans
• Injections, Intralesional
• Ligation
• Male
• Middle Aged
• Odds Ratio
• Patient Selection
• Risk Factors
• Sclerosing Solutions/administration & dosage
• Sclerosing Solutions/adverse effects
• Sclerotherapy/adverse effects
• Sclerotherapy/mortality
• Treatment Outcome

Background. Proton pump inhibitor and histamine-2 receptor antagonist can prevent aspirin-related ulcers/erosions but few studies compare the efficacy of these two agents. Aims. We evaluated the efficacy of omeprazole and famotidine in preventing recurrent ulcers/erosions in low-dose aspirin users. Methods. The 24-week clinical outcomes of the patients using low-dose aspirin for cardiovascular protection with a history of ulcers/erosions and cotherapy of omeprazole or famotidine were retrospectively reviewed. The incidence of gastrointestinal symptoms, recurrent ulcers/erosions, erosive esophagitis, gastrointestinal bleeding, and thromboembolic events was analyzed. Results. A total of 104 patients (famotidine group, 49 patients; omeprazole group, 55 patients) were evaluated. Famotidine group had more gastrointestinal symptoms episodes than omeprazole group (46.9% versus 23.6%, P = 0.01). Fifteen famotidine group patients and 5 omeprazole group patients had recurrent ulcers/erosions (30.6% versus 9.1%, P = 0.005). Lanza scale was significantly lower in omeprazole group than in famotidine group (1.2 ± 0.7 versus 1.7 ± 1.1, P = 0.008). Only 1 famotidine group patient had ulcer bleeding. The incidences of erosive esophagitis and thromboembolic events were comparable between both groups. Conclusions. Omeprazole was superior to famotidine with less gastrointestinal symptoms and recurrent ulcers/erosions in patients using 24-week low-dose aspirin. The risk of erosive esophagitis, gastrointestinal bleeding, and thromboembolic events was similar between both groups.

• Aged
• Cerebro-cardiovascular diseases
• Forrest type
• Hematemesis
• Melena
• Shock

The preventive effects of histamine 2 receptor antagonists vs. proton pump inhibitors on low-dose aspirin (LDA)-related gastroduodenal mucosal injury have not been fully investigated. We conducted a cross-sectional study to compare the prevalence of gastroduodenal ulcers or erosions in patients taking LDA with either 40 mg/day of famotidine or 15 mg/day of lansoprazole for at least three months.

Of 84 eligible patients, two taking 40 mg/day of famotidine and four taking 15 mg/day of lansoprazole refused to undergo upper gastrointestinal endoscopy. Ultimately, we performed upper gastrointestinal endoscopy in 78 patients taking either 40 mg/day of famotidine (group F, n = 31) or 15 mg/day of lansoprazole (group L, n = 47). The prevalence of gastroduodenal ulcers or erosions and the magnitude of gastric mucosal injury evaluated using modified Lanza scores were compared between the two groups.

No patients in either group had gastroduodenal ulcers. Gastroduodenal erosions were more prevalent in group F than in group L (48.4% vs. 17.0%, p = 0.005). The modified Lanza scores (mean ± SD) were significantly higher in group F than in group L (0.9 ± 1.3 vs. 0.3 ± 0.7, p = 0.007). A multivariate logistic regression analysis showed that the use of lansoprazole was negatively associated with gastroduodenal erosions.

This study suggests that 15 mg/day of lansoprazole may be more effective in preventing the development of LDA-related gastroduodenal erosions than 40 mg/day of famotidine. The preventive effects of these two regimens on the development of LDA-related gastroduodenal ulcers require further investigation.

AIM: To evaluate whether weekend or nighttime admission affects prognosis of peptic ulcer bleeding despite early endoscopy.

METHODS: Retrospective data collection from four referral centers, all of which had a formal out-of-hours emergency endoscopy service, even at weekends. A total of 388 patients with bleeding peptic ulcers who were admitted via the emergency room between January 2007 and December 2009 were enrolled. Analyzed parameters included time from patients’ arrival until endoscopy, mortality, rebleeding, need for surgery and length of hospital stay.

RESULTS: The weekday and weekend admission groups comprised 326 and 62 patients, respectively. There were no significant differences in baseline characteristics between the two groups, except for younger age in the weekend group. Most patients (97%) had undergone early endoscopy, which resulted in a low mortality rate regardless of point of presentation (1.8% overall vs 1.6% on the weekend). The only outcome that was worse in the weekend group was a higher rate of rebleeding (12% vs 21%, P = 0.030). However, multivariate analysis revealed nighttime admission and a high Rockall score (≥ 6) as significant independent risk factors for rebleeding, rather than weekend admission.

CONCLUSION: Early endoscopy for peptic ulcer bleeding can prevent the weekend effect, and nighttime admission was identified as a novel risk factor for rebleeding, namely the nighttime effect.

• Early endoscopy
• Nighttime effect
• Peptic ulcer bleeding
• Rebleeding
• Weekend effect

• Bleeding
• Peptic ulce
• Proton pump inhibitor

Bleeding is the most common complication of peptic ulcer. Recent studies have suggested that male sex, blood type O, smoking, ulcer size and location, use of nonsteroidal anti-inflammatory drugs, and meteorological factors were risk factors for peptic ulcer bleeding, while age, Helicobacter pylori infection, psychological-social factors, and economic and educational levels were controversial risk factors for peptic ulcer bleeding.

• Peptic ulcer
• Peptic ulcer bleeding
• Upper gastrointestinal bleeding
• Risk factor

• Aged
• Anemia/blood
• Anemia/etiology
• Anemia/mortality
• Biomarkers/blood
• Chi-Square Distribution
• Female
• Hemoglobins/metabolism
• Hemostasis, Endoscopic/adverse effects
• Hemostasis, Endoscopic/mortality
• Hospital Mortality
• Humans
• Logistic Models
• Male
• Middle Aged
• Odds Ratio
• Peptic Ulcer Hemorrhage/blood
• Peptic Ulcer Hemorrhage/complications
• Peptic Ulcer Hemorrhage/mortality
• Peptic Ulcer Hemorrhage/therapy
• Prospective Studies
• Recurrence
• Risk Assessment
• Risk Factors
• Taiwan
• Time Factors
• Treatment Outcome

• Acute Disease
• Anti-Ulcer Agents/therapeutic use
• Cause of Death
• Histamine H2 Antagonists/therapeutic use
• Humans
• Peptic Ulcer Hemorrhage/drug therapy
• Peptic Ulcer Hemorrhage/mortality
• Proton Pump Inhibitors
• Randomized Controlled Trials as Topic
• Recurrence

• Anti-Infective Agents, Local
• Endoscopy, Gastrointestinal/methods
• Gastrointestinal Hemorrhage/diagnosis
• Humans
• Hydrogen Peroxide
• Image Enhancement
• Reproducibility of Results

Intractable bleeding from gastric and duodenal ulcers is associated with significant morbidity and mortality. Aggressive treatment with early endoscopic hemostasis is essential for a favourable outcome. In as many as 12%-17% of patients, endoscopy is either not available or unsuccessful. Endovascular therapy with selective catheterization of the culprit vessel and injection of embolic material has emerged as an alternative to emergent operative intervention in high-risk patients. There has not been a systematic literature review to assess the role for embolotherapy in the treatment of acute upper gastrointestinal bleeding from gastroduodenal ulcers after failed endoscopic hemostasis. Here, we present an overview of indications, techniques, and clinical outcomes after endovascular embolization of acute peptic-ulcer bleeding. Topics of particular relevance to technical and clinical success are also discussed. Our review shows that transcatheter arterial embolization is a safe alternative to surgery for massive gastroduodenal bleeding that is refractory to endoscopic treatment, can be performed with high technical and clinical success rates, and should be considered the salvage treatment of choice in patients at high surgical risk.

• Peptic ulcer
• Massive bleeding
• Endoscopy
• Angiography
• Embolization

• non-variceal bleeding
• endoscopy
• ulcer clot
• hydrogen peroxide

AIM: To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score.

METHODS: Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB.

RESULTS: Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR 4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011). The UGIB Etiology Score was calculated from (3.1 × previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vomitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively.

CONCLUSION: The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

• Non-variceal bleeding
• Predictor
• Score
• Upper gastrointestinal bleeding
• Upper gastrointestinal hemorrhage
• Variceal bleeding

• Aged
• Endoscopy
• Female
• Health Services Research
• Hospital Charges/statistics & numerical data
• Hospital Mortality
• Hospitalization
• Humans
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Patient Care/statistics & numerical data
• Peptic Ulcer/complications
• Peptic Ulcer Hemorrhage/mortality
• Peptic Ulcer Hemorrhage/therapy
• Time Factors
• Treatment Outcome
• United States