Bleeding Gastric Ulcer Research Articles

Clinical effect of digestive endoscopy combined with quadruple therapy in treatment of gastric ulcer bleeding

Clinical effect of digestive endoscopy combined with quadruple therapy in treatment of gastric ulcer bleeding

Analysis of Disease Classification of Upper Gastrointestinal Bleeding

Objective. To analyze and explore the disease diagnostic code for different parts of upper gastrointestinal bleeding. Methods. Utilizing ‘international statistical classification ICD-10 of diseases and related health problems’ to analyze 101 medical records of the cases diagnosed of upper gastrointestinal bleeding from July 1 2011 to June 31 2012 in a third-grade hospital from the choice of the leading words to disease diagnosis coding. Results. Of the 101 copies of medical records coded of K92.2, 92 copies of gastroscopy accounted for 91.09% of all cases diagnosed with upper gastrointestinal bleeding by doctors. By rereading the 92 copies of medical records of the cases who underwent gastroscopy, 23 cases of gastric ulcer bleeding and gastric mucosal lesions bleeding accounting for 25%, 2 cases of duodenal ulcer bleeding accounting for 2.17%, and 67 cases of esophageal variceal bleeding and esophageal mucosal laceration accounting for 72.83% were found. Conclusion. Coders should not only master the coding knowledge, but also read the medical records carefully, learn the related medical knowledge and code accurately in their daily work to serve medical treatment, teaching and research better.

Erythropoietin Antibody-Positive Pure Red Cell Aplasia Diagnosed after Surgical Intervention for Malignant Gastric Ulcer Bleeding

혈액투석 환자에서 빈혈의 주요 원인은 에리트로포이에틴 생성 장애이며 이에 대한 치료로 재조합 인 에리트로포이에틴이 널리 사용되고 있다. 이러한 치료에 저항성을 보이는 경우 만성 출혈 등에 의한 철분 부족을 우선적으로 고려해야 하지만 원인질환을 교정한 후에도 적혈구 수혈이 필요할 정도로 빈혈이 지속된다면 에리트로포이에틴 항체 형성에 의한 순수 적혈구 무형성증을 감별하기 위한 에리트로포이에틴에 항체 및 골수 조직검사 등이 적극적으로 이루어져야 할 것으로 보인다.

Treatment of hemorrhagic gastric ulcers with patients in right lateral position

Treatment of hemorrhagic gastric ulcers with patients in right lateral position

Nilotinib exacerbates diabetes mellitus by decreasing secretion of endogenous insulin

We report a 74-year-old female with chronic myelogenous leukemia (CML) in accelerated phase with pre-existing severe type 2 diabetes (T2D) and hemorrhagic gastric ulcers who was successfully treated with nilotinib. We first considered second-generation tyrosine kinase inhibitors for the treatment of this patient, as they elicit a superior response compared with imatinib. We next selected nilotinib, rather than dasatinib, since the increased risk of bleeding associated with dasatinib represented a greater risk of fatality than aggravation of T2D with nilotinib. After improvement of hemorrhagic gastric ulcers and T2D with exogenous insulin therapy, we began nilotinib administration; insulin dose was increased to maintain her glucose levels whereas urine C-peptide level decreased. Conversely, when nilotinib was discontinued due to liver dysfunction, the dosage of injected insulin was decreased and urine C-peptide levels increased. After re-starting nilotinib, the required dose of insulin gradually increased again, and urine C-peptide level decreased, indicating that nilotinib may have impaired secretion of endogenous insulin. The patient obtained a complete cytogenetic response after 3months of nilotinib treatment. Her T2D has since been well controlled by insulin therapy. To our knowledge, this is the first report that nilotinib treatment for patients with severe T2D may induce a reversible decrease in endogenous insulin secretion, although the precise underlying mechanisms remain unknown. We highly recommend sufficient screening and early intervention with exogenous insulin therapy for diabetic CML patients who receive nilotinib.

Post-Marketing Safety Experience with Edoxaban in Japan for Thromboprophylaxis Following Major Orthopedic Surgery

AbstractAbstract 4697 BackgroundEdoxaban, an oral, selective, direct factor Xa inhibitor, is approved in Japan as a once-daily dose (15 mg or 30 mg tablets) for the prevention of venous thromboembolism (VTE) following major orthopedic surgery, including total knee arthroplasty, total hip arthroplasty, and hip fracture surgery. Currently, edoxaban is in phase 3 clinical development for the prevention of stroke and systemic embolic events in patients with atrial fibrillation as well as treatment and prevention of recurrence of VTE. This report describes the adverse drug reactions (ADRs) that were spontaneously reported during early post-marketing phase vigilance (EPPV) since the July 2011 commercial launch in Japan. MethodsEPPV was conducted for the initial 6 months from launch: July 19, 2011, to January 18, 2012. All ADRs that were spontaneously reported, were collected and analyzed. ResultsThe estimated exposure was approximately 20,000 patients. A total of 67 ADRs were reported in 56 patients, of which 15 (in 14 patients) were serious. The mean age of the patients was 74.1 years, mean weight was 59.4 kg, and approximately 70% of the patients were female. The majority of ADRs were bleeding events (51 ADRs in 42 patients), and serious ADRs included cerebral hemorrhage (n=1), gastric hemorrhage (n=1), gastric ulcer hemorrhage (n=1), and surgical site hemorrhage (n=12). Most of these ADRs occurred within the first week of treatment and there were no fatalities. The majority of non-serious adverse events associated with bleeding that occurred in more than one patient included subcutaneous hemorrhage (n=9), wound hemorrhage (n=5), post-procedural hematoma (n=4), anemia (n=4), and hemarthrosis (n=3). Other non-serious adverse events occurring in more than one patient included abnormal hepatic function (n=4) and diarrhea (n=2).SystemADRSeriousNon-seriousTotalBloodAnemia44NervousCerebral hemorrhage11VascularVenous embolism11Vascular hemorrhage617GastrointestinalDiarrhea22Feces discolored11Gastric hemorrhage11Gastric ulcer hemorrhage11Gastrointestinal hemorrhage11Gingival bleeding11Hematemesis11Hematochezia11HepatobiliaryAbnormal hepatic function44Hyperbilirubinemia11Jaundice11Liver disorder11SkinSubcutaneous hemorrhage3912Rash11MusculoskeletalHemarthrosis33Joint swelling11RenalHematuria11ReproductiveMetrorrhagia11GeneralEdema11Test resultsAlanine aminotransferase increased11Aspartate aminotransferase increased11Hemoglobin decreased11Liver function abnormal11Platelet count increased11InjurySubcutaneous hematoma11Wound hemorrhage257Post-procedural hematoma44Wound hematoma11Total155267 ConclusionsPreliminary data from EPPV for the first 6 months of commercial use of edoxaban did not identify any unforeseen safety signals. This evidence confirms the known safety profile of edoxaban—that edoxaban has been shown to be well tolerated. Disclosures:Kuroda:Daiichi Sankyo Pharma Development: Employment. Hotoda:Daiichi Sankyo Co., Ltd.: Employment. Nishikawa:Daiichi Sankyo Co., Ltd.: Employment. Nishiwaki:Daiichi Sankyo Co., Ltd.: Employment.

Merkel Cell Cancer Masquerading as a Bleeding Gastric Ulcer

Merkel Cell Cancer Masquerading as a Bleeding Gastric Ulcer

Gastric Ulcer Bleeding Caused by Press‐Through Package Mis‐Swallowing

Gastric Ulcer Bleeding Caused by Press‐Through Package Mis‐Swallowing

Major complication after Histoacryl injection for endoscopic treatment of bleeding peptic ulcer

A 49-year-old man in hemorrhagic shock because of melena and hematemesis was referred from another hospital. On admission he was still normotensive (red cell count 2.08×106/μL, hemoglobin 61g/L). He had no prior known medical condition and did not take anymedication regularly. Emergency endoscopy revealed a large amount of fresh coagulated blood and bleeding from the arterial vessels in the stomach cardia. Endoscopic sclerotherapy was carried out with Sclerovein (Chemische Fabrik Kreussler & Co. GmbH, Wiesbaden, Germany) and N-butyl-2-cyanoacrylate (Histoacryl; B. Braun, Melsungen, Germany). After injection of 1.5mL Histoacryl, the bleeding stopped. On day 2, the patient had fever and complained of unbearable pain in the upper abdomen. A plain abdominal radiograph showed multiple linear radiopaque densities in all branches of celiac trunk (● Fig.1). Abdominal computed tomography (CT) revealed a perforated gallbladder with development of gangrene, as well as multiple infarctions in spleen, left liver lobe, and the hypoperfused distal part of pancreas (● Fig.2). On day 7, laparotomy was carried out, and the gallbladder and spleen were removed and abdominal drains were placed. The patient stayed in the intensive care unit for several days, with total parenteral nutrition and intravenous antibiotic therapy. He then developed acute pancreatitis with an external pancreatic fistula, which was treated conservatively. He was discharged on day 36 after the surgery. Serious complications of endoscopic injection therapy may be avoided by using of adhesive agents to treat bleeding gastric ulcers [1]. However, as the present case and a few similar cases show [1–3], inadvertent injection of any sclerosant can result in thrombosis of the splenic artery. Endoscopists should be aware of the close anatomic relationship between the stomach wall and the splenic artery. Inadvertent injection of Histoacryl into the splenic artery, in comparison with other agents, tends to obliterate several vessels of the celiac axis [3]. As suggested previously, Histoacryl injection should be considered as a last resort in the endoFig.2 Abdominal computed tomography (CT) scan showing a gallbladder necrosis with perforation and bmultifocal splenic infarctions and hypodense area in the left liver lobe. Fig.1 Plain abdominal radiogram after Histoacryl injection in a 49-year-old man in hemorrhagic shock because of melena and hematemesis. Radiopaque densities in the branches of the celiac trunk can be seen. UCTN – Unusual cases and technical notes E204

The efficacy of transcatheter arterial embolization as the first‐choice treatment after failure of endoscopic hemostasis and endoscopic treatment resistance factors

The aim of this retrospective study was to evaluate the efficacy of transcatheter arterial embolization (TAE) as the first-choice treatment in patients with bleeding peptic ulcer after the failure of endoscopic hemostasis. An additional objective was to clarify endoscopic treatment resistance factors. Between April 2004 and December 2010, 554 patients were admitted to Kasugai Municipal Hospital for necessary endoscopic hemostasis for bleeding gastric ulcer or duodenal ulcer. In the patients for whom endoscopic hemostasis failed, TAE was attempted. If TAE failed, the patients underwent surgery. The backgrounds of the patients in whom endoscopic treatment was successful and in whom it failed were compared. TAE was attempted in 15 patients (2.7%). In 12 (80.0%) of 15 patients, embolization with coils was successful. In one patient (6.7%), embolization was ineffective. This patient underwent emergent salvage surgery. In two (13.3%) of 15 patients, no extravasation was observed during arteriography. These patients were cured with medication. In two patients, ulcer perforation was observed during endoscopy after rebleeding. These patients underwent surgery. In total, 3 (0.5%) of 554 patients underwent surgery. No recurrent bleeding was observed after TAE. Hemoglobin level <8 g/dL at presentation (P = 0.02), Rockall score ≥7 at presentation (P = 0.002), and Forrest class Ia/Ib at initial endoscopic hemostasis (P < 0.001) were found to be independent significant endoscopic treatment resistance factors. TAE is a safe and effective first-choice treatment for patients in whom endoscopic hemostasis has failed.

Sa1641 Effectiveness of Absolute Ethanol As an Agent in Injection Therapy of Gastric Ulcer Bleeding: Even Ulcer Enlargement Could Be the Certain Proof of Hemostasis

Effectiveness of Absolute Ethanol As an Agent in Injection Therapy of Gastric Ulcer Bleeding: Even Ulcer Enlargement Could Be the Certain Proof of Hemostasis Shigeru Koyama* Gastroenterology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan Background and Aim: Injection therapy has been the most widely practiced method of endoscopic hemostasis. In Japan, absolute ethanol has been most commonly used in cases of gastric ulcer bleeding. But globally it has fallen out of favor because of tissue necrosis and ulceration by dehydration and fixation. The aim of this study was to evaluate its effectiveness and availability. Methods: Patients admitted with gastric ulcer bleeding who underwent urgent endoscopy at Tokyo Metropolitan Hiroo Hospital between 1/1/2005 and 12/31/2009 were reviewed. Clinical factors were identified retrospectively from the records. We evaluated some outcomes such as rebleeding, failure of endoscopic hemostasis, and mortality. We also compared ulcer enlargement cases with no enlargement cases by some factors and outcomes. Ethanol injection is usually performed by disposable injection needle. Aliquots of 0.10.3 mL are injected around the bleeding vessel. Results: A total of 204 patients (156 men, 48 women) were admitted after urgent endoscopic treatment. The most common endoscopic findings were Forrest class IIa (58.3%), followed by Forrest class IIb (11.3%), Ib (8.8%) and Ia (5.4%). In 176 cases, endoscopic hemostasis was performed mainly by ethanol injection in combination with hemoclips (96 cases, 54.5%) and ethanol injection singly (53 cases, 30.1%). There were seven rebleeding cases (3.4%), and two cases (1.0%) of failure of endoscopic hemostasis which went to IVR successfully. There were three fatal cases (1.5%) due to other background diseases. Ulcer enlargement cases totaled 48 (43 cases were after initial treatment and 5 were after second treatment). No rebleeding or perforation occurred in ulcer enlargement cases. In comparison with no enlargement cases, ulcer enlargement cases had more total amount of ethanol (1.9 mL vs. 1.3 mL, P 0.016), more times of injection (6.1 vs. 5.0, P 0.011) and more cases of stomach body, but there was no significance of endoscopic findings, blood transfusion units (P 0.31) and hospital stays (P 0.87). Conclusions: Absolute ethanol was proved to be an effective and available injection agent when used appropriately. Single ethanol injection or combination therapy with hemoclips could lead to a high rate of hemostasis and low rate of rebleeding. Ulcer enlargement is not a complication but the result of positive and careful treatment and certain proof of hemostasis.

Endoscopic Hemostasis for Bleeding Gastric Ulcer Caused by Ibuprofen in a 16-month-old Infant

Gastric ulcers are rare in children and are typically seen in cases of Helicobacter pylori (H. pylori) infection, non-steroidal anti-inflammatory drugs (NSAIDs) use, and critical illnesses such as sepsis. The risk of a bleeding ulcer due to use of NSAIDs is dependent on the dose, duration, and the individual NSAIDs, but the bleeding may occur soon after the initiation of NSAID therapy. An experience is described of a 16-month-old infant with a bleeding gastric ulcer after taking the usual dosage of ibuprofen for 3 days. The infant was also successfully treated with endoscopic hemostasis. Even a small amount of ibuprofen may be associated with bleeding gastric ulcers in infant. (Pediatr Gastroenterol Hepatol Nutr 2012; 15: 105∼110)

出血性胃潰瘍と脳炎を合併した重症ツツガ虫病の1例

ツツガ虫病はダニが媒介するリケッチア感染症であり，稀に重症化する。症例は64歳，女性。入院9日前にキノコ狩りに出かけた後に頭痛と39℃台の発熱を認めた。その後，意識障害と呼吸不全も発症し，他院から転院となった。敗血症性ショック，播種性血管内凝固症候群，急性呼吸窮迫症候群を伴う多臓器不全の状態であり，ICUに入室した。経過中2度にわたり出血性胃潰瘍から出血性ショックとなり，内視鏡下緊急止血術を要した。病歴と特徴的な皮疹からツツガ虫病を疑い，ミノサイクリンを投与したところ，全身状態は改善した。第10病日以降も認知機能低下と性格変化が持続し，髄液蛋白の増加も認めたため，ツツガ虫病による脳炎と診断した。第27病日に脳炎は改善し退院した。ツツガ虫病の主な病態は血管内皮細胞障害による血管炎と考えられており，多臓器不全のみならず，今回見られた多発胃粘膜障害と脳炎も血管炎に伴う病態であった可能性が考えられた。

Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharmacotherapy during the healing process are essential.

Comparison of haemostatic efficacy for endoscopic injection therapy of epinephrine and combination therapy of epinephrine and hemoclips for bleeding peptic ulcers

Endoscopic injection therapy of epinephrine is safe and effective in the treatment of bleeding peptic ulcer, but with high risk of rebleeding. The combination therapy of epinephrine and hemoclips could lead to a reduction of rebleeding and a potential reduction in mortality. To investigate the efficacy and safety of epinephrine injection therapy and combination therapy with epinephrine and hemoclips in treating bleeding peptic ulcers. A prospective randomized study included 58 patients with bleeding gastric or duodenal ulcer. In 30 patients endoscopic injection therapy with diluted epinephrine was applied (group I), while in 28 patients combination therapy of epinephrine and hemoclips was applied (group II). RESULTS; Initial haemostasis was achieved in most patients treated with epinephrine injection therapy (93.3%) and patients treated with combination therapy of epinephrine and hemoclips (96.4%). After initial haemostasis was achieved rebleeding was significantly more frequent in the patients treated with epinephrine (28.5%) than in the patients treated with combination therapy (3.7%, p < 0.05). Two patients treated with epinephrine injection therapy were subjected to surgical intervention, whereas no patient treated with combination therapy needed surgery. Lethal ending occurred in one patient treated with epinephrine and in one patient treated with combination therapy. The difference between the two groups of patients in need for surgical intervention and mortality was not statistically significant. Combination therapy with epinephrine and hemoclips is more efficient than epinephrine alone in the treatment of bleeding peptic ulcers.

Gastric Submucosal Hematoma after Endoscopic Hemostasis in Patient with Dual Antiplatelet Therapy

Intramural hematoma of the gastrointestinal tract is uncommon, with the majority being localized to the esophagus or duodenum. Hematoma of the gastric wall is extremely rare and caused by coagulopathy, peptic ulcer disease or blunt trauma. Recently due to the increase in patients with antiplatelet use, liver cirrhosis, and/or end stage reanal disease, occurrence of gastric submucosal hematomas after endoscopic hemostasis can increase. This is a case of gastric submucosal hematoma which occurred in a patient taking dual antiplatelet therapy after endoscopic hemostasis for gastric peptic ulcer bleeding. We report a case of gastric submucosal hematoma which improved with medical therapy and healed naturally with an ulcer scar. (Korean J Helicobacter Up Gastrointest Res 2012;12:112-115)

Endoscopic Hemostasis for Bleeding Gastric Ulcer Caused by Ibuprofen in a 16-month-old Infant

Endoscopic Hemostasis for Bleeding Gastric Ulcer Caused by Ibuprofen in a 16-month-old Infant

The combination of short and long type hemoclips therapy was effective for hemorrhagic gastric ulcer

The combination of short and long type hemoclips therapy was effective for hemorrhagic gastric ulcer

An Unusual Case of a Bleeding Gastric Ulcer Due to Multiple Phytobezoars Consisting of Peach Pits: A Case Report and Review

An Unusual Case of a Bleeding Gastric Ulcer Due to Multiple Phytobezoars Consisting of Peach Pits: A Case Report and Review

Major Adverse Upper Gastrointestinal Events in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Coronary Intervention and Dual Antiplatelet Therapy

The aim of this study was to investigate the incidence of composite short-term and long-term major adverse upper gastrointestinal (UGI) events (MAUGIEs; defined as gastric ulcer, duodenal ulcer, gastroduodenal ulcer, or UGI bleeding) in patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and routinely received dual-antiplatelet therapy. From May 2002 to September 2010, a total of 1,368 consecutive patients who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention were prospectively enrolled in the study. The incidence of in-hospital UGI bleeding complications and composite MAUGIEs was 8.9% and 9.9%, respectively. The in-hospital mortality rate was significantly higher in patients with in-hospital MAUGIEs than in those without (p <0.001). Multivariate analysis showed that age, advanced Killip score (≥3), and respiratory failure were the strongest independent predictors of in-hospital composite MAUGIEs (all p <0.003). The cumulative composite of MAUGIEs after uneventful discharge in patients without adverse UGI events who continuously received dual-antiplatelet therapy for 3 to 12 months, followed by aspirin therapy, was 10.4% during long-term (mean 4.0 years) follow-up. In conclusion, the results of this study show a remarkably high incidence of composite short-term and long-term MAUGIEs in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and received routine dual-antiplatelet therapy. Age, advanced Killip score, and respiratory failure were significantly and independently predictive of in-hospital composite MAUGIEs.