Acute Upper Gastrointestinal Bleeding Research Articles

Upper gastrointestinal bleeding: Diagnosis of Helicobacter pylori infection-Descriptive study.

The presence of blood in the stomach has been thought to affect the performance of diagnostic tests used in detecting Helicobacter pylori (H. pylori) in the stomach. This study evaluates the effect of upper gastrointestinal bleeding on the efficacy of a rapid urease test (RUT) and compares the results with the pathologic method. In this descriptive study, 100 patients presented with upper gastrointestinal bleeding, confirmed from endoscopy, referred to Shahid Rahimi Hospital in Khorramabad were enrolled. Antral biopsy was performed in all the patients and the samples were extracted for histopathology and RUT. A questionnaire was used to collect rapid urease test outcomes and associated parameters (antibiotic, bismuth, and proton pump inhibitors), histology and demographic data. Histopathology was used as the gold standard for diagnosis of H. pylori. Of the 52 patients who were reported positive for H. pylori in pathology, 36 had RUT-positive H. pylori, sensitivity 69.2%, and of 48 patients whose pathology was negative, 25 had negative RUT, specificity 52.1%. Of 59 RUT, 36 had positive pathology, positive predictive value was 61% and from 41 with negative RUT, 25 had negative pathology, negative predictive value was 61%. The prevalence of H. pylori infection was significantly associated with the age of 50 years and above, p = 0.042, and previous history of bleeding, p = 0.019. Gastrointestinal bleeding can reduce the sensitivity of RUT. The negative results of these tests in acute upper gastrointestinal bleeding should therefore be interpreted carefully.

Intravenous metoclopramide for increasing endoscopic mucosal visualization in patients with acute upper gastrointestinal bleeding: a multicenter, randomized, double-blind, controlled trial

Acute upper gastrointestinal hemorrhage (UGIH) is the most common emergency condition that requires rapid endoscopic treatment. This study aimed to evaluate the effects of pre-endoscopic intravenous metoclopramide on endoscopic mucosal visualization (EMV) in patients with acute UGIH. This was a multicenter, randomized, double-blind controlled trial of participants diagnosed with acute UGIH. All participants underwent esophagogastroduodenoscopy within 24 h. Participants were assigned to either the metoclopramide or placebo group. Modified Avgerinos scores were evaluated during endoscopy. In total, 284 out of 300 patients completed the per-protocol procedure. The mean age was 62.8 ± 14.3 years, and 67.6% were men. Metoclopramide group achieved a higher total EMV and gastric body EMV score than the other group (7.34 ± 1.1 vs 6.94 ± 1.6; P = 0.017 and 1.80 ± 0.4 vs 1.64 ± 0.6; P = 0.006, respectively). Success in identifying lesions was not different between the groups (96.5% in metoclopramide and 93.6% in placebo group; P = 0.26). In the metoclopramide group, those with active variceal bleeding compared with the control group demonstrated substantial improvements in gastric EMV (1.83 ± 0.4 vs 1.28 ± 0.8, P = 0.004), antral EMV (1.96 ± 0.2 vs 1.56 ± 0.6, P = 0.003), and total EMV score (7.48 ± 1.1 vs 6.2 ± 2.3, P = 0.02). Pre-endoscopic intravenous metoclopramide improved the quality of EMV in variceal etiologies of UGIH, which was especially prominent in those who had signs of active bleeding based on nasogastric tube assessment.Trial Registration: Trial was registered in Clinical Trials: TCTR 20210708004 (08/07/2021).

The impact of early gastroscopy examination on cardiovascular event-related indices in elderly patients with acute upper gastrointestinal bleeding.

To observe the effects of early gastroscopy examination on cardiovascular event-related indicators such as heart rate (HR), blood pressure, and electrocardiogram (ECG) in elderly patients with acute upper gastrointestinal bleeding. Sixty patients with upper gastrointestinal bleeding admitted from July 2022 to December 2022 were selected. Patients with relevant contraindications were excluded. All patients underwent early gastroscopy examination. Among them, 30 patients were aged 60 or above (elderly group) and 30 patients were aged below 60 (non-elderly group). Dynamic blood pressure and ECG recordings were obtained before, during, and after gastroscopy examination to assess changes in HR, blood pressure, and ECG. The HR and blood pressure levels of the elderly group were significantly lower than those of the non-elderly group before, during, and after gastroscopy examination (P < .05). In the elderly group, blood pressure and HR were higher during gastroscopy examination compared to before, but lower than during the examination afterward, with statistically significant differences (P < .05). The diastolic blood pressure was lower after the examination compared to before, with statistical significance, while the systolic blood pressure was lower, and the HR was higher after the examination, but without statistical significance (P > .05). In the non-elderly group, systolic blood pressure and HR were higher during gastroscopy examination compared to before, with statistically significant differences (P < .05), while diastolic blood pressure was higher but without statistical significance (P > .05). Blood pressure and HR were lower after the examination compared to during, with statistically significant differences (P < .05). The occurrence rates of ECG changes were 70% in the elderly group and 30% in the non-elderly group, with a statistically significant difference (χ2 = 5.45, P = .02 < .05). Early gastroscopy examination in elderly patients with gastrointestinal bleeding did not result in severe cardiovascular adverse events and was relatively safe. However, special attention should be given to the occurrence of cardiac arrhythmias.

Diagnosis value of the blood urea nitrogen to creatinine ratio in determining the need for intervention of acute upper gastrointestinal bleeding.

The blood urea nitrogen (BUN) to creatinine (Cr) ratio (BUN/Cr ratio) may be used to evaluate the need for intervention of acute upper gastrointestinal bleeding (AUGIB). This study aimed to explore the predictive value of the BUN/Cr ratio in the need for intervention of AUGIB. This retrospective observational study included patients with AUGIB in the hospital's emergency department between August 2019 and May 2023. The patients were grouped according to whether they underwent an intervention for AUGIB. Patients treated between August 2019 and May 2022 were selected as the training set and the others as the validation set. A total of 466 patients (328 males, 138 females) with AUGIB were enrolled in the intervention group (n=167) and the no-intervention group (n=299). In the training set, multivariable logistic regression showed that the BUN/Cr ratio (OR: 1.013, 95%CI: 1.003-1.023, P=0.009), hemoglobin (OR: 0.989, 95%CI: 0.981-0.997, P=0.010), and a previous history of esophageal variceal bleeding (OR: 6.898, 95%CI: 3.989-11.929, P<0.001) were independently associated with intervention for AUGIB. The area under receiver operating characteristic curve of BUN/Cr ratio and the prediction model based on logistic regression to predict the need for intervention of AUGIB were 0.604 (95%CI: 0.544-0.664) and 0.759 (95%CI: 0.706-0.812) in the training set and 0.634 (95%CI: 0.529, 0.740) and 0.708 (95% CI: 0.609, 0.806) in the validation set, respectively. The BUN/Cr ratio was associated with the need for AUGIB intervention. Combining it with other parameters might improve its diagnostic value to predict the need for intervention of AUGIB.

Review article: Upper gastrointestinal bleeding - review of current evidence and implications for management.

Acute upper gastrointestinal bleeding (UGIB) is a common emergency requiring hospital-based care. Advances in care across pre-endoscopic, endoscopic and post-endoscopic phases have led to improvements in clinical outcomes. To provide a detailed, evidence-based update on major aspects of care across pre-endoscopic, endoscopic and post-endoscopic phases. We performed a structured bibliographic database search for each topic. If a recent high-quality meta-analysis was not available, we performed a meta-analysis with random effects methods and odds ratios with 95% confidence intervals. Pre-endoscopic management of UGIB includes risk stratification, a restrictive red blood cell transfusion policy unless the patient has cardiovascular disease, and pharmacologic therapy with erythromycin and a proton pump inhibitor. Patients with cirrhosis should be treated with prophylactic antibiotics and vasoactive medications. Tranexamic acid should not be used. Endoscopic management of UGIB depends on the aetiology. For peptic ulcer disease (PUD) with high-risk stigmata, endoscopic therapy, including over-the-scope clips (OTSCs) and TC-325 powder spray, should be performed. For variceal bleeding, treatment should be customised by severity and anatomic location. Post-endoscopic management includes early enteral feeding for all UGIB patients. For high-risk PUD, PPI should be continued for 72 h, and rebleeding should initially be evaluated with a repeat endoscopy. For variceal bleeding, high-risk patients or those with further bleeding, a transjugular intrahepatic portosystemic shunt can be considered. Management of acute UGIB should include treatment plans for pre-endoscopic, endoscopic and post-endoscopic phases of care, and customise treatment decisions based on aetiology and severity of bleeding.

Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial.

Patients with Child-Turcotte-Pugh class B and C cirrhosis with upper gastrointestinal bleeding (UGIB) have systemic as well as localized (in the mucosa of the esophagus and stomach) fibrinolysis. The aim of this study was to evaluate the efficacy and safety of tranexamic acid in the treatment of acute UGIB in patients with cirrhosis. A total of 600 patients with advanced liver cirrhosis (Child-Turcotte-Pugh class B or C) presenting with UGIB were randomly allocated to either the tranexamic acid (n=300) or the placebo group (n=300). The primary outcome measure was the proportion of patients developing 5-day treatment failure. Failure to control bleeding by day 5 was seen in 19/300 (6.3%) patients in the tranexamic acid group and 40/300 (13.3%) patients in the placebo group ( p =0.006). Esophageal endoscopic variceal ligation (EVL) site as a source of failure to control bleeding by day 5 among patients undergoing first-time esophageal EVL (excluding patients with a previous post-EVL ulcer as a source of bleed) was seen in 11/222 (4.9%) patients in the tranexamic acid group and 27/225 (1212.0%) patients in the placebo group ( p =0.005). However, 5-day and 6-week mortality was similar in the tranexamic acid and placebo groups. Tranexamic acid significantly reduces the failure to control bleeding by day 5 and failure to prevent rebleeding after day 5 to 6 weeks in patients with advanced liver cirrhosis (Child-Turcotte-Pugh class B or C) presenting with UGIB, by preventing bleeding from the EVL site.

Learning curve of achieving competency in emergency endoscopy in upper gastrointestinal bleeding: how much experience is necessary?

ObjectivesThe management of upper gastrointestinal bleeding (UGIB) has seen rapid advancements with revolutionising innovations. However, insufficient data exist on the necessary number of emergency endoscopies needed to achieve competency in...

Endoscopy for acute upper gastrointestinal bleeding: a protocol for systematic review and network meta-analysis of randomized controlled trials

Background: Previous studies have reached mixed conclusions regarding the timing of endoscopic approaches for managing individuals with acute upper gastrointestinal bleeding (AUGIB). Therefore, the authors performed a protocol for systematic review and meta-analysis to assess the efficacy of various timing endoscopic approaches in managing individuals with AUGIB. Methods: The authors will search multiple databases, including PubMed, Embase, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database, WHO International Clinical Trials Registry Platform, and Chinese Clinical Trial Register. The search will cover the entire duration, starting from the establishment of these databases until July 2023. The selection criteria will focus on randomized controlled trials that assess the efficacy of endoscopy with varying timing in managing patients with AUGIB. The primary outcomes will include primary hemostasis and inpatient death. The secondary outcomes will include recurrent bleeding, need for surgical intervention, admission to the ICU, blood transfusion needs, and duration of hospitalization. Two reviewers will select the studies, extract data, and assess the risk of bias. A Bayesian approach will be used to conduct a network meta-analysis. Results: The results of this systematic review and meta-analysis will be published in peer-reviewed journals. Conclusion: This network meta-analysis provides comprehensive evidence of different timing endoscopic approaches for managing individuals with AUGIB.

Development and validation of machine learning models to predict the need for haemostatic therapy in acute upper gastrointestinal bleeding.

Acute upper gastrointestinal bleeding (AUGIB) is a major cause of morbidity and mortality. This presentation however is not universally high risk as only 20-30% of bleeds require urgent haemostatic therapy. Nevertheless, the current standard of care is for all patients admitted to an inpatient bed to undergo endoscopy within 24 h for risk stratification which is invasive, costly and difficult to achieve in routine clinical practice. To develop novel non-endoscopic machine learning models for AUGIB to predict the need for haemostatic therapy by endoscopic, radiological or surgical intervention. A retrospective cohort study. We analysed data from patients admitted with AUGIB to hospitals from 2015 to 2020 (n = 970). Machine learning models were internally validated to predict the need for haemostatic therapy. The performance of the models was compared to the Glasgow-Blatchford score (GBS) using the area under receiver operating characteristic (AUROC) curves. The random forest classifier [AUROC 0.84 (0.80-0.87)] had the best performance and was superior to the GBS [AUROC 0.75 (0.72-0.78), p < 0.001] in predicting the need for haemostatic therapy in patients with AUGIB. A GBS cut-off of ⩾12 was associated with an accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 0.74, 0.49, 0.81, 0.41 and 0.85, respectively. The Random Forrest model performed better with an accuracy, sensitivity, specificity, PPV and NPV of 0.82, 0.54, 0.90, 0.60 and 0.88, respectively. We developed and validated a machine learning algorithm with high accuracy and specificity in predicting the need for haemostatic therapy in AUGIB. This could be used to risk stratify high-risk patients to urgent endoscopy.

Lactate level as a predictor of outcomes in patients with acute upper gastrointestinal bleeding: A systematic review and meta‑analysis.

There remains no consensus on the prognostic value of lactate in predicting adverse outcomes such as mortality, rebleeding and higher intensive care unit (ICU) admission rates in patients with upper gastrointestinal bleeding (UGIB). The present study aimed to determine the prognostic accuracy of lactate level in predicting adverse clinical outcomes in patients with acute UGIB. Systematic literature search was conducted in PubMed Central, SCOPUS, EMBASE, MEDLINE, Google Scholar and ScienceDirect databases for studies published up to February 2023. Random-effects model was used for the meta-analysis and the results were presented as pooled standardized mean differences or odds ratio (OR) with 95% confidence interval (CIs). A total of 11 studies were included in the present review. Most of the studies had a high risk of bias. Pooled OR were as follows: 1.39 (95% CI: 1.29-1.51; I2=85%) for the prediction of mortality; 1.29 (95% CI: 1.17-1.42; I2=85.9%) for prediction of ICU admission, 1.14 (95% CI: 1.06-1.23; I2=42.4%) for rebleeding and 2.84 (95% CI: 2.14-3.77; I2=8.1%) for the need of packed red blood cell (pRBC) transfusion. Sensitivity and specificity for the mortality prediction were 72% (95% CI: 57-83%) and 75% (95% CI: 61-85%), respectively, with the area under the curve of 0.79 (95% CI: 0.72-0.85). In conclusion, the results showed that lactate level is a moderately accurate early prediction marker of most adverse clinical outcomes such as mortality, rebleeding, ICU admission and the need for pRBC transfusion in acute UGIB patients.

Prognostic significance of pretreatment albumin–bilirubin (ALBI) grade and platelet–albumin–bilirubin (PALBI) grade in patients with small cell lung cancer

Small cell lung cancer (SCLC) is a common cancer among the world’s lung cancers. Despite advances in diagnosis and treatment, the prognosis is still poor. There is no effective biomarker other than stage in daily practice. However, in daily practice, patients may have different features and survival times even though they have the same stage. Previously, albumin–bilirubin (ALBI) grade, platelet–albumin–bilirubin (PALBI) grade were used to determine the prognosis of acute-chronic liver failure and acute upper gastrointestinal bleeding in liver cirrhosis. In subsequent studies, they were found to be associated with prognosis in hepatocellular carcinoma (HCC) and other solid cancers. However, the prognostic relationship between ALBI grade, PALBI grade, and SCLC is unknown. Therefore, we conducted this study to examine the relationship between ALBI grade and PALBI grade and prognosis in SCLC patients. Data of 138 patients with advanced SCLC at diagnosis between 2009 and 2020 were analyzed retrospectively. The results of the multivariate analysis were as follows: ALBI grade 1 vs 2, hazard ratio (HR) = 1.608, p = 0.002 for OS and HR = 1.575, p = 0.002 for PFS; ALBI grade 1 vs 3, HR = 2.035, p < 0.001 for OS and HR = 2.675, p < 0.001 for PFS; PALBI grade 1 vs 2, HR = 1.302, p = 0.006 for OS and HR = 1.674, p = 0.002 for PFS; and PALBI grade 1 vs 3, HR = 1.725, p < 0.001 for OS and HR = 2.675, p < 0.001 for PFS. In conclusion, the ALBI and PALBI grades were determined to be associated with the prognosis of SCLC, and they can be used as easy, inexpensive, and practical markers in determining the follow-up treatment and prognosis of SCLC patients.

Life-threatening upper gastrointestinal hemorrhage from a Cameron ulcer

Introduction: Acute upper gastrointestinal bleeding can be life-threatening; however, Cameron lesions are an uncommon etiology. These lesions should be suspected with a previous history or endoscopic evidence of hiatus hernia. Case Report: A male in his 60s presented to the emergency department with hematemesis and melena for two days. He had no prior medical, surgical, or endoscopic history and took no regular medications. He was resuscitated with packed red blood cell transfusion and treated with proton pump inhibitor infusion then transferred to operating theaters for endoscopic hemostasis. Cardiac arrest occurred after anesthetic induction and airway intubation, return of spontaneous circulation was achieved after cardiopulmonary resuscitation and further blood transfusion. At endoscopy a Cameron ulcer was noted in the hiatus hernia with overlying blood clot with no active hemorrhage, treated with Hemospray®. Conclusion: Patients presenting with acute upper gastrointestinal hemorrhage and shock need urgent upper gastrointestinal (UGI) endoscopy. Topical hemostatic agents are successful in controlling bleeding when challenging anatomy precludes use of banding or clip application.

Long-Term Outcomes following Acute Upper Gastrointestinal Bleeding Remain Poor: A Single-Center Comparison over Two Distinct Time Periods within the Last 15 Years in Finland

Introduction: Acute upper gastrointestinal bleeding (AUGIB) is a common and life-threatening condition. This study aimed to compare the causes and long-term outcomes of AUGIB over two distinct periods in the last 15 years. Methods: This population-based study included consecutive patients who underwent emergency upper endoscopy for visible bleeding in 2006 and 2016. Our primary focus was on long-term mortality up to 5 years after the endoscopy, although short-term mortality was also reported. Results: A total of 832 patients (median age 67 [12–96] years, 37% female) were included, with peptic ulcer disease (48%), esophagitis (20%), and variceal bleeding (15%) being the most common diagnoses. The incidence of AUGIB increased with age, reaching 8.31 cases per 1,000 person-years among those aged 80 years or older. Mortality rates at 30 days, 90 days, 1 year, and 5 years were 13%, 16%, 27%, and 47%, respectively. The standardized mortality ratio was high in all age groups, with particularly elevated rates observed among younger patients compared to the standard population. Variceal bleeding, liver cirrhosis, and chronic alcohol abuse were associated with the highest mortality. Only two short-term deaths were attributed to failed hemostasis. The primary causes of death were malignancies, liver failure, and cardiac failure. No improvement in outcomes was observed between the two time periods. Conclusion: Although the treatment of AUGIB may be relatively straightforward, the outcomes following treatment remain poor. High mortality can be attributed to the presence of coexisting conditions and patients’ lifestyle.

Delay in post-endoscopic refeeding in patients with upper GI bleeding leads to increased hospital length of stay

BackgroundPatients with acute upper gastrointestinal bleeding (UGIB) are made NPO prior to endoscopy. It is standard practice in those found to have low risk lesions to immediately resume a usual diet. Here, we evaluated refeeding practices in hospitalized patients with UGIB after endoscopy. MethodsIn this retrospective single-center cross-sectional study, we examined patients over the age of 18 with acute UGIB and low risk or no endoscopic lesion(s). Appropriate refeeding was categorically defined as resuming normal diet ≤ 4 h post-endoscopy. ResultsOf 230 patients (mean age, 62 years; 57 % female) with acute UGIB and low-risk lesions or no lesion(s), 96 [41 % (95 % CI: 35 % to 48 %)] received their usual diet within 4 h after EGD. For the remaining 134 patients, refeeding was delayed on average from 13 (NPO until regular diet) to 31 (NPO until liquid diet, then regular diet) hours. Baseline clinical features were identical in patients who received their regular diet within 4 h after EGD and those who did not. Hospital length of stay was shorter in patients receiving usual diets promptly (5.3 days vs. 6.4 days, p = 0.03). Patients in an ICU at the time of their endoscopy had a statistically significantly higher probability of not being refed appropriately [OR 2.371, 95 % CI 1.191-4.722). ConclusionsInappropriate dietary restrictions are frequent in patients with UGIB caused by low risk lesions. This delay in refeeding leads to increased length of hospital stay - suggesting that appropriate refeeding is an opportunity to improve patient care.

The Role of Endoscopy-Independent Gastrointestinal Bleeding Scores in Predicting 30-day Mortality in Aged Over 65

Introduction: The aim of this study was to assess the power of clinical findings and scoring systems to predict mortality in patients over 65 years of age with non-variceal upper gastrointestinal bleeding. Materials and Method: Data on demographic profiles and risk estimation scores were retrospectively extracted from electronic hospital medical records and other electronic databases using a standard data extraction form. The AIMS65, pre-Rockall, modified Glasgow-Blatchford, T, and Baylor bleeding scores were calculated to estimate the 30-day mortality risk. The inclusion criteria were patients aged 65 and over who presented with active bleeding symptoms and had been diagnosed with acute upper gastrointestinal bleeding by the gastroenterology department. Results: The mean age was 75.23 years, and 23.6% of the patients died within 30 days. The 30-day mortality was associated with albumin levels, malignancy, and intensive care unit hospitalization. An inverse relationship was found between the albumin level and mortality, whereas the presence of cancer and the need for intensive care were associated with 2.8-fold and 2.2-fold increases in the risk of death, respectively. The AIMS65 score (AUC: 0.794) had the highest discriminative ability to predict 30-day mortality among all risk scores. Conclusion: Albumin levels, malignancy presence, and ICU admission were indicators of mortality risk in elderly patients with upper gastrointestinal bleeding. Calculating all the scores, excluding the Baylor Bleeding score, is beneficial for assessing the risk of mortality associated with upper gastrointestinal bleeding. The AIMS65 score demonstrates the highest discriminative ability. However, using these risk-scoring systems necessitates additional data. Keywords: Gastrointestinal Hemorrhage; Mortality; Aged.

Chinese herbal medicine Huangtu decoction in the treatment of acute upper gastrointestinal hemorrhage in a patient with chronic renal failure and related nursing measures

Chinese herbal medicine Huangtu decoction in the treatment of acute upper gastrointestinal hemorrhage in a patient with chronic renal failure and related nursing measures

Timing of endoscopy in patients with elevated lactate levels and acute upper gastrointestinal bleeding; a retrospective comparative study

Background/Aims While current guidelines recommend performing endoscopy within 24 h in case of acute upper gastrointestinal bleeding (AUGIB), the precise timing remains an issue of debate. Lactate is an established parameter for risk stratification in a variety of medical emergencies. This study evaluated the predictive ability of elevated lactate levels in identifying patients with UGIB, who may benefit from emergent endoscopy. Methods We retrospectively analyzed all patients with elevated lactate levels, who presented to our emergency department between 01 January 2015 and 31 December 2019 due to suspected AUGIB. Results Of 134 included cases, 81.3% had an Charlson comorbidity index of ≥3 and 50.4% presented with shock. Fifteen (11.2%) patients died and mortality rates rose with increasing lactate levels. Emergent endoscopy within 6 h (EE) and non-EE were performed in 64 (47.8%) and 70 (52.2%) patients, respectively. Patients who underwent EE had lower systolic blood pressure (107.6 mmHg vs. 123.2 mmHg; p = 0.001) and received blood transfusions more frequently (79.7% vs 64.3%; p = 0.048), but interestingly need for endoscopic intervention (26.6% vs 20.0%; p = 0.37), rebleeding (17.2% vs. 15.7%; p = 0.82) and mortality (9.4% vs. 11.4%; p = 0.7) did not differ significantly. Conclusion In conclusion, our findings support the recommendations of current guidelines to perform non-EE after sufficient resuscitation and management of comorbid illnesses.

Prophylactic Lactulose Therapy in Patients with Cirrhosis and Upper Gastrointestinal Bleeding: A Meta-analysis of Randomized Trials.

Lactulose is the first-line drug for both treatment and secondary prophylaxis for overt hepatic encephalopathy (HE). The use of lactulose for the primary prophylaxis of HE in patients with cirrhosis and acute upper gastrointestinal bleeding (AUGIB) has been debated. Hence, we conducted this meta-analysis to assess the role of lactulose in HE prophylaxis in patients with cirrhosis and AUGIB. A comprehensive search of literature from inception to December 2022 was performed of three databases for randomized studies comparing lactulose and placebo in patients with cirrhosis and AUGIB. Risk ratios (RR) with 95% confidence intervals were calculated for all the dichotomous outcomes. A total of five studies were included in the final analysis, out of which three studies had a low risk of bias, and two had a moderate risk of bias. Lactulose therapy was associated with a significantly lower risk of OHE compared to placebo, with a RR of 0.38 (0.23-0.62) and a number needed to treat of 6. There was no difference in the risk of mortality between the groups, with a RR of 0.71 (0.29-1.76). The pooled incidence rates of overall adverse events (AEs) and diarrhea with the use of lactulose therapy were 53.2% (42.2- 64.2) and 34.7% (17.7-51.7), but a majority did not require drug discontinuation. The certainty of the evidence was moderate to low. Prophylactic lactulose reduces the incidence of HE after AUGIB but has no effect on mortality. Diarrhea and abdominal discomfort are common AEs but do not need drug discontinuation.

Retracted: Somatostatin plus Gastroscopic Administration of Omeprazole for the Treatment of Acute Upper Gastrointestinal Bleeding: An Exploration of a Promising Alternative.

[This retracts the article DOI: 10.1155/2022/6329592.].

Emergency Endoscopic Interventions in Acute Upper Gastrointestinal Bleeding: A Cohort Study

Introduction: Acute upper gastrointestinal bleeding is a common cause of emergency department admissions. The standard approach for the diagnosis and treatment of acute upper gastrointestinal bleeding (AUGIB) involves an endoscopy of the upper gastrointestinal tract. While daytime emergency endoscopy has been well studied, there is limited evidence regarding its effectiveness during the nighttime. Patients and Methods: We conducted a retrospective cohort study at a single center, analyzing adult patients with AUGIB referred for emergency endoscopy outside of regular hospital hours. Patients treated with endoscopic hemostatic methods were categorized into day-hours and night-hours groups based on the timing of the gastroscopy. The primary clinical endpoint was 120-day all-cause mortality, with secondary endpoints including hemostasis and recurrence. Results: In the population of 752 enrolled patients with acute upper gastrointestinal bleeding symptoms, 592 had a gastroscopy during the day hours between 8.00 a.m. and 10.00 p.m., while 160 had procedures performed at night between 10:00 p.m. and 8:00 a.m. In the day-hours group, the median time from symptom onset to endoscopy was 10 h (IQR 6–15), compared to 6 h (IQR 4–16) in the night-hours group. The gastroscopy duration (time to reach hemostasis during endoscopy) was significantly shorter during the night hours (p &lt; 0.001). In both groups, endoscopic intervention after the sixth hour from symptom onset yielded improved outcomes, while treatment before the fifth hour resulted in poorer outcomes. Although the night-hours group had higher 120-day all-cause mortality, the difference was not statistically significant. Conclusions: Our findings indicate that emergency therapeutic gastroscopy for acute upper gastrointestinal bleeding is similarly effective during both day and night hours, particularly when performed after the sixth hour from symptom onset.