Bleeding Peptic Ulcer Disease Research Articles

Rate of Coexisting Esophageal Varices and Peptic Ulcer in Patients With Cirrhosis of Liver

Background and Aim: Hematemesis in cirrhosis of liver patients sometimes raise a question whether it is from rupture varices or from bleeding peptic ulcer disease. This study has been done to make an understanding about this issue among those centers where endoscopy facilities are not available in Bangladesh. Methods: During last one month a total of 27 consecutive patients with cirrhosis of liver were enrolled at Kurmitola General Hospital, when found oesophageal varices during endoscopy and data had been collected retrospectively. Results: Among this 27 patients age range were between 25 and 70 years, 16 were male. Cause of cirrhosis was HBV in 16 patients (59.26%), HCV in 2 and NBNC in 9 patients. CTP score were between 5 and 12. Eleven patients presented at emergency department with hematemesis. Sixteen patients had grade 3 esophageal varices, 9 had grade 2. Among this 27 patients we had found peptic ulcer disease in 17 (62.96%) in the form of gastric ulcer, duodenal ulcer or both. Portal hypertensive gastropathy was associated in 15 patients who had peptic ulcer disease. Conclusion: In the primary health care facilities we should have to keep in mind that hematemesis in cirrhosis patients not always from rupture varices, it may be also from bleeding peptic ulcer disease. Needs large sample sized study at different center at Bangladesh to compare the results with different regions over the globe. The authors have none to declare.

Is There a the Mortality Difference from Upper GI Bleeding Between Obese vs Non-obese Patients?

Introduction: Upper gastrointestinal tract bleeding (UGIB) is a frequent diagnosis for inpatient admission. Bleeding peptic ulcer disease and esophageal varices are two of the most common causes of bleeding in UGIB related mortality. Over the past few decades, obesity has become widespread. The link between obesity and inpatient mortality of those admitted with UGIB has not been described to date and it's the focus of our study Methods: A retrospective analysis using National Inpatient Sample (NIS) database from Healthcare Cost and Utilization Project (HCUP) for 2010 was performed. Patients with bleeding peptic ulcer and bleeding esophageal varices were identified using ICD 9 codes. Target population age, sex, race, socio economic-status, commorbities and obesity status were examined. Inpatient mortality between obese vs. non obese groups were compared using a Chi-square (McNemar) statistical tests. Results: Inpatient mortality rate in the obese with UGIB cohort as 1.2%. The mortality rate in the nonobese with UGIB group was 2.1%. Both cohorts were homogenous with respect to age, sex, race, and socioeconomic status. Percentage of People who had endoscopy during the first 3 days of admission were very close; 1761(14.2%) in non obese Vs. 141(13.4%) in obese group. There appears to be mortality difference between the two groups (p=0.054). There was no significant difference in the length of stay (5.4 vs. 5.1 days) for obese vs. non obese group. Conclusion: Non obese patients seem to have a higher mortality rate following UGIB related inpatient admission while having similar length of stay compared to the obese group. Further studies will be needed to elucidate mechanism to account for this difference

GENETIC ASPECTS OF PREDICTION OF GASTROINTESTINAL BLEEDING IN CHILDREN WITH PEPTIC ULCER

Purpose. To study the distribution and to investigate the associative links of the IL-1β-511CT gene polymorphism and frequency of tandem repeats of the gene IL-1RA in children of Chernivtsy region with complicated gastrointestinal bleeding ulcer. Material and methods. The study involved 94 children with complicated gastrointestinal bleeding and uncomplicated peptic ulcer disease and 50 healthy children aged 7-18 years who lived in the Chernivtsy region and the city of Chernivtsy. Genetic polymorphisms of genes IL-1β-511CT and IL-1RA in children was defined by polymerase chain reaction. Results. The risk of bleeding in children with uncomplicated illness doubled in the presence of the alleles of IL-1β-511*T, and 5,0 and 5,79 times - R2 alleles of IL-1RА and genotype R2R2-IL-1RA. Genotype of the IL-1β-511СС and R2R2-IL-1PА carriage increases the risk of bleeding ulcer in healthy children at 3,50 and 2,88 times. Conclusion. The study of genetic polymorphism of genes made possible to identify the factors of increased risk of gastrointestinal bleeding cased by ulcer and protective factors.

UPPER GASTRO-INTESTINAL BLEEDING IN THE YOUNG - GASTRIC GIST TUMOR OR PEPTIC ULCER DISEASE?

GIST tumors is very unusual in the young and middle aged and a high index of suspicion is needed for the diagnosis in young patients who present with upper gastrointestinal bleeding. Appropriate imaging such as a Computed tomographic scan (CT scan) may identify this tumor which may easily be misdiagnosed as a bleeding Peptic Ulcer Disease in the young. We present a case of a healthy 38 year old man with no alcohol use who presented with epigastric pain and melena and subsequent torrential bleeding uncontrolled during endoscopy necessitating an emergency exploratory laparotomy by the general surgery team. The bleeding intraluminal component of the tumor with gross splenic and pancreatic involvement was identified and surgical management consisted of a wedge resection of the greater curvature of the stomach incorporating the tumor and the spleen with successful dissection of the tumor off the tail of the pancreas. Histology was positive for C-KIT and DOG-1 markers. Postoperative course was uneventful and he is presently on Imatinib Mesylate.

Prospective Assessment of the Rockall Risk Scoring System in Egyptian Patients with Upper Gastrointestinal Bleeding

Background: One of the major challenges in managing acute upper gastrointestinal bleeding involves the identification of patients who are at high risk of rebleeding and death; conversely, the identification of patients who are suitable for early discharge and outpatient endoscopy is also important for effective resource. The use of Rockall system has been shown to represent accurate and valid predictor of rebleeding and death. The aim of this prospective study was to evaluate validity of Rockall score for prediction of rebleeding and mortality in Egyptian patients with upper gastrointestinal bleeding. Patients and Methods: 50 patients presented with upper GI bleeding were subjected to detailed clinical, laboratory, sonographic and endoscopic examination together with Rockall score calculation. Results: According to the findings of upper GI endoscopy patients were further subdivided into two subgroups as follows: Group 1 (n = 32): Patients with portal hypertension manifested by variceal bleeding and/or portal hypertensive gastropathy; and Group 2 (n = 18): other causes of acute upper gastrointestinal bleeding (peptic ulcer disease, Mallory Weiss syndrome…). Clinical condition of the patients was assessed after 48 hours and mortality was recorded. Rockall score was the highest in mortality group, and higher in rebleeding group than stable group (P < 0.01). Rockall score was higher in Child C than Child B and Child A among hepatic patients (P < 0.01). The cutoff value of Rockall score = 3.5 was the best for prediction of rebleeding with sensitivity 100%, specificity 53%, while the cutoff value = 6.5 was the best for prediction of mortality with sensitivity 100% and 93.5% specificity. Conclusion: Rockall score is clinically useful in prediction of rebleeding and mortality in patients with upper gastrointestinal bleeding. It can accurately differentiate between patients with stable condition that could be discharged from hospital and those who require hospitalization and this could help to minimize hospital stay and cost.

Vagotomy/Drainage Is Superior to Local Oversew in Patients Who Require Emergency Surgery for Bleeding Peptic Ulcers

To compare early postoperative outcomes of patients undergoing different types of emergency procedures for bleeding or perforated gastroduodenal ulcers. Although definitive acid-reducing procedures are being used less frequently during emergency ulcer surgery, there is little published data to support this change in practice. A retrospective analysis of data for patients from the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program database who underwent emergency operation for bleeding or perforated peptic ulcer disease was performed to determine the association between surgical approach (local procedure alone, vagotomy/drainage, or vagotomy/gastric resection) and 30-day postoperative outcomes. Multivariable regression analysis was used to adjust for a number of patient-related factors. A total of 3611 patients undergoing emergency ulcer surgery (775 for bleeding, 2374 for perforation) were included for data analysis. Compared with patients undergoing local procedures alone, vagotomy/gastric resection was associated with significantly greater postoperative morbidity when performed for either ulcer perforation or bleeding. For patients with perforated ulcers, vagotomy/drainage produced similar outcomes as local procedures but required a significantly greater length of postoperative hospitalization. Conversely, vagotomy/drainage was associated with a significantly lower postoperative mortality rate than local ulcer oversew when performed for bleeding ulcers. Simple repair is the procedure of choice for patients requiring emergency surgery for perforated peptic ulcer disease. For patients requiring emergency operation for intractable ulcer bleeding, vagotomy/drainage is associated with lower postoperative mortality than with simple ulcer oversew.

Low Adherence to Helicobacter pylori Testing in Hospitalized Patients with Bleeding Peptic Ulcer Disease

Helicobacter pylori (H. pylori) testing in patients with bleeding ulcers is recommended by society guidelines and considered a quality indicator. The aim of the study is to examine the proportion of patients with bleeding ulcers who had H. pylori testing and identify predictors associated with H. pylori testing. Consecutive hospitalized patients with bleeding ulcers documented endoscopically at a single center from 10/2004-5/2011 were identified retrospectively from an endoscopy database. The proportion of patients undergoing direct H. pylori testing (histology, rapid urease test, breath test or stool antigen) and any H. pylori testing (direct or serologic) were determined. Among 330 patients with bleeding ulcers, 105 (32%, 95% CI 27-37%) underwent direct testing and another 52 (16%, 95% CI 12-20%) had serologic testing during a median follow-up of 9 months (range, 0-86). H. pylori testing occurred at the index hospitalization in 146 (93%) of the 157 patients tested. Among the 105 patients who had direct H. pylori testing, 90 (86%) had biopsy-based testing during the initial endoscopy. On multivariate analysis, undergoing biopsy of a gastric ulcer was strongly associated with having direct H. pylori testing performed (OR = 5.1, 95% CI 2.3-11.5; p < .0001). Among patients hospitalized with bleeding ulcers, less than half received H. pylori testing and less than a third received the more accurate direct testing. Most of the direct H. pylori testing was biopsy-based with very few being tested after the index hospitalization. Efforts to increase H. pylori testing in patients with bleeding ulcers are needed to improve outcomes.

Current Opinions in Bleeding Peptic Ulcer Disease

Background: Peptic ulcer is the commonest cause of acute upper gastrointestinal bleeding accounting for the majority of cases of non-variceal haemorrhage. Its incidence is rising in the older population and accounts for a considerable clinical and economic burden. Methods: A MEDLINE/EMBASE based search of the literature from 1985 to 2013 inclusive was performed using the medical subject terms peptic ulcer disease, duodenal ulcer, upper gastrointestinal non-variceal bleeding, endoscopic therapy, pharmacological therapy, haemostasis, surgery for bleeding peptic ulcer. Manual retrieval of relevant articles in the reference lists of the original papers was then performed. Conclusions were drawn from published evidence on the current opinions and treatment options available for bleeding peptic ulcer disease. Results: The incidence of bleeding peptic ulcer disease and hospital admission rates has not changed significantly in the last two decades. Progress in the development and the use of endoscopic and pharmacological therapies has revolutionised the management of bleeding peptic ulcer disease. However, the improved survival accrued to these advances is offset by the mortality in the increasing elderly population with associated medical co-morbid factors. The operation for bleeding peptic ulcer disease is still being performed in small but significant number of patients who fail endoscopy. Conclusion: The management of patients with bleeding peptic ulcer disease requires a multidisciplinary approach. Clinical presentation, patient’s age, presence of co-morbidity and the endoscopic appearances of the ulcer including the presence of stigmata of recent haemorrhage are used to determine the subsequent level of care. Endoscopic therapy provides unique opportunities for early diagnosis and maintenance of primary haemostasis in bleeding peptic ulcer disease.

Dieulafoy lesion in the ascending colon presenting with gastrointestinal bleeding and severe anemia complicated by a coexisting severe resistant chronic idiopathic thrombocytopenic purpura.

Background. GI (gastrointestinal) bleeding can be due to a variety of etiologies ranging from being common like bleeding peptic ulcer disease or esophageal varices. One of the rarely documented causes is the Dieulafoy lesion which is known as an abnormally large ectatic artery that penetrates the gut wall, occasionally eroding through the mucosa causing massive bleeding. In addition to that, we refer to the uncommon presentation of Dieulafoy lesion itself as it is well known to be found in the stomach, esophagus, duodenum, and jejunum but not the ascending colon as in our case. The patient had a coexisting ITP (idiopathic thrombocytopenic purpura) that was resistant to different therapies. Case Report. We report a case of a 48-year-old Egyptian female known for chronic ITP resistant to treatment. The patient presented with bright red bleeding per rectum and severe life threatening anemia. Endoscopic study showed a Dieulafoy lesion. Endoscopic clipping was successful in controlling the bleeding. Conclusion. Dieulafoy lesion is a rare reason for GI bleeding and can present in common or unexpected places. Also extreme caution should be used in patients with bleeding tendency due to different reasons, like ITP in our case.

State-of-the-art management of acute bleeding peptic ulcer disease

The management of patients with non variceal upper gastrointestinal bleeding has evolved, as have its causes and prognosis, over the past 20 years. The addition of high-quality data coupled to the publication of authoritative national and international guidelines have helped define current-day standards of care. This review highlights the relevant clinical evidence and consensus recommendations that will hopefully result in promoting the effective dissemination and knowledge translation of important information in the management of patients afflicted with this common entity.

Low Adherence to Helicobacter pylori Testing in Hospitalized Patients with Bleeding Peptic Ulcer Disease

Low Adherence to Helicobacter pylori Testing in Hospitalized Patients with Bleeding Peptic Ulcer Disease

Second-look Endoscopy for Bleeding Peptic Ulcer Disease

Second-look endoscopy after initial therapeutic endoscopy for bleeding peptic ulcer disease may decrease the risk of rebleeding; however, it is not recommended routinely. Understanding conditions under which second-look endoscopy is beneficial might be useful for clinical decision making. Using a decision model, literature-based probabilities, and Medicare reimbursement costs, we compared routine second-look endoscopy with no second-look endoscopy. We measured rebleeding, need for surgery, hospital mortality, and costs, and calculated the cost to avoid each outcome, expressed as the number needed to treat, along with the cost per outcome prevented. In the base case, routine second-look endoscopy reduced rebleeding from 16% to 10% (needed to treat=16) but had no effect on other outcomes. The cost to prevent 1 case of rebleeding was nearly $13,000. Threshold analysis revealed a rebleeding threshold of 31% to neutralize the cost difference between routine second-look endoscopy and no routine second-look endoscopy. If routine second-look endoscopy was 100% effective in preventing rebleeding, then the rebleeding threshold for cost neutrality would be 17.5%. When rebleeding risks after the index endoscopy and second-look endoscopy were simultaneously considered, the cost per bleed prevented ranged from a cost savings of $165 when the respective risks were 25% and 5%, to a cost of nearly $33,000 when the risks were 20% and 15%. The results suggest that routine second-look endoscopy is not indicated after therapeutic endoscopy for bleeding peptic ulcer disease. However, if rebleeding risk is 31% or greater, then routine second-look endoscopy reduces this risk at no additional cost.

The efficacy of endoscopic therapy in bleeding peptic ulcer patients

Endotherapy is the primary modality for the control of bleeding from peptic ulceration. To assess the efficacy of endoscopic intervention for high-risk bleeding peptic ulcer disease and to benchmark our surgical and mortality rates. Two hundred and twenty-seven patients with peptic ulcers stratified by Rockall and Forrest scores as at high risk for re-bleeding underwent therapeutic intervention (adrenalin injection) between January 2004 and December 2009. The median age of the patients was 57 years (range 19 - 87 years); 60% were males. Results. Primary endoscopic haemostasis failed in 51/227 patients (22.5%); 18 patients (7.9%) required surgery for bleeding not controlled at initial or second endoscopy; and 29 patients (12.8%) died, 12 by day 3 and 17 by day 30. Fifteen patients, all with significant medical co-morbidity, died after successful primary endotherapy, and 4 died after surgery. Surgical patients required more blood (odds ratio (OR) 1.45, p=0.0001) than those not undergoing surgery, but had similar mortality. Rebleeding was the only predictor of death in patients who died by day 3 (OR 18.77). A high Rockall score was the only predictor of death by day 30 (OR 1.98). The overall surgical and mortality rates were 7.9% and 12.8%, respectively. Over half the deaths resulted from medical co-morbidity, despite successful primary endotherapy. This finding is supported by the use of the Rockall score as a predictor of mortality at day 30. Improving the technical success of primary endoscopic haemostasis, currently 77.5%, has the potential to reduce rebleeding after primary endotherapy, a predictor of death at day 3 in this study.

Risk factors for peptic ulcer bleeding in terms of Helicobacter pylori, NSAIDs, and antiplatelet agents

Objectives. The role of the Helicobacter pylori, nonsteroidal anti-inflammatory drugs (NSAIDs), and antiplatelet agents in the risk of peptic ulcer bleeding has not yet been established. This study was performed to identify the risk factors for peptic ulcer bleeding compared with non-bleeding peptic ulcer disease (PUD). Material and methods. A total of 475 patients, 265 with bleeding PUD and 210 with non-bleeding PUD were consecutively recruited. H. pylori status was determined by histology, rapid urease test, and culture. Exposure to NSAIDs, aspirin, and antiplatelet agents (clopidogrel and ticlopidine) within 4 weeks was obtained. Results. Compared with non-bleeding PUD, bleeding PUD had a higher proportion of male gender and current smoking, alcohol drinking, history of aspirin/antiplatelet use, and history of PUD. Whereas the proportion of H. pylori infection and history of H. pylori eradication in bleeding PUD were significantly lower than that in non-bleeding PUD. In multivariate analysis, male gender (OR 1.78, 95% CI 1.10–2.89), drinking alcohol (OR 2.08, 95% CI 1.29–3.14), aspirin/antiplatelet use (OR 2.35, 95% CI 1.45–3.82), and history of PUD (OR 2.46, 95% CI 1.36–4.46) remained independent risk factors for bleeding PUD. When H. pylori status and aspirin/antiplatelet agent use were combined, highest risk of bleeding peptic ulcers was found among H. pylori-negative patients with a history of aspirin/antiplatelet agent use (OR 3.03 95% CI 1.48–6.18) compared with H. pylori-positive patients with no history of aspirin/antiplatelet agent use. Conclusions. Patients with H. pylori-negative peptic ulcers who continuously took aspirin or antiplatelet agents had the highest peptic ulcer bleeding risk.

Impact of End Stage Renal Disease on Outcomes of Patients Hospitalized With Peptic Ulcer Disease Bleeding

Impact of End Stage Renal Disease on Outcomes of Patients Hospitalized With Peptic Ulcer Disease Bleeding

Obesity is Associated With High Risk Stigmata of Peptic Ulcer Disease

Obesity is a worsening epidemic in the United States (US). National Health and Nutrition Examination Survey (NHANES) data shows that one third of the US population is obese (BMI >30). Patients with obesity are at increased risk for a variety of GI conditions including GERD symptoms, erosive esophagitis, Barrett's esophagus, esophageal adenocarcinoma, gallstones, colonic adenomas, colon cancer, non-alcoholic fatty liver disease, and liver cirrhosis. Population studies suggest that obesity is a risk factor for peptic ulcer disease (PUD). The endoscopic appearance or stigmata of bleeding on initial esophagogastroduodenoscopy (EGD) predicts recurrent bleeding. AIM: To evaluate if obesity is a risk factor for high risk endoscopic stigmata of PUD. METHODS: This study was an IRB-approved protocol. 8050 EGD between 11/17/05 and 2/28/10 were reviewed for the finding of ulcer. Inclusion criteria: 1) Initial EGD with the finding of gastric or duodenal ulcer. Exclusion criteria: 1) malignant ulcer, 2) esophageal ulcer, and 3) incomplete documentation. Data collected: age, sex, BMI, ulcer stigmata, location, size, inpatient/outpatient status, NSAID and aspirin status, and H. pylori status. Ulcer appearance was documented by the Forrest classification. High risk stigmata: active spurting of blood (IA) or oozing blood (IB), a nonbleeding visible vessel or pigmented protuberance (IIA), and an adherent clot (IIB). Low risk stigmata: flat, pigmented spot (IIC), and clean-based ulcer (III). Statistical analysis: Chi square, logistic regression. RESULTS: 350 patients (mean age 64.8) with PUD were included. The mean BMI was 27.8. There were 95.7% males, 32.6% of the patients were obese (BMI >30), 30.3% were positive for H. pylori, and 68.9% were taking NSAIDS. 42% were inpatients and 58% were outpatients. Of all ulcers, the mean size was 8.6 mm, 58.0% were located in the stomach, 87.1% were low risk, and 12.9% were high risk. The distribution of stigmata by the Forrest classification: IA 2.9%(n=10), IB 2.6%(n=9), IIA 5.7%(n=20), IIB 1.7%(n=6), IIC 11.7%(n=41), and III 75.4%(n=264). High risk stigmata was not associated with age, sex, H. pylori status, or use of NSAIDS. However, it was significantly associated with BMI category (BMI ≥35: high risk stigmata 23.3%; BMI < 35: high risk stigmata 11.4% (p = 0.03)) and location (duodenum: high risk stigmata 17.7% vs. stomach: high risk stigmata 9.4% (p = 0.02)). Both BMI category (p=0.03) and PUD location (p=0.02) were significant independent predictors of high risk stigmata. CONCLUSION: A BMI ≥ 35 was associated with a significantly higher risk of stigmata on initial EGD in patients with PUD. A BMI≥ 35 may be helpful in risk stratification of patients with suspected PUD bleeding.

Non-Automated Intervention to Improve H. pylori Testing in Active Peptic Ulcer Disease does not Work

Purpose:Helicobacter pylori (H. pylori) is a common cause of peptic ulcer disease (PUD). Evidence shows that ulcer remission rates for duodenal and gastric ulcers are much higher in patients successfully eradicated of this infection. The American College of Gastroenterology recommends that all patients with active PUD be tested and treated for H. pylori infection. Our clinical experience suggested testing rates in this clinical scenario were suboptimal at our institution, so we designed a quality improvement project focused on increasing the testing rates of H. pylori for patients with bleeding PUD.Table: [1075] Patients presenting with signs of perforation after diagnostic/therapeutic colonoscopiesMethods: An e-mail communication was sent to all staff that perform endoscopy in patients with active bleeding, requesting they provide clear recommendations for H. pylori testing in their endoscopy reports if PUD was identified (previously recommendations were never included in these reports). All charts for patients undergoing endoscopy over the next two months were reviewed to identify patients with bleeding PUD. After a one month washout period an e-mail reminder was sent and charts were reviewed for an additional two months. Results: In the initial review, 16 patients were identified with bleeding PUD. H. pylori testing was appropriately completed in 9/16 (56%) patients, however, only 5/16 (31%) had recommendations included in their endoscopy reports (vs 0% during baseline analysis, P<0.001, Fisher exact test). When recommended in the endoscopy report, H. pylori testing was done in 5/5 (100%), while only 4/11 patients (36%) without recommendations were tested. After a second e-mail communication, an additional 25 patients with active PUD were identified. Testing was done in 16/25 patients (64%). Recommendations regarding H. pylori testing were made in 11/25 patients (44%) and performed in all 11 of these patients (100%), while only 5/14 patients (36%) without recommendations were tested. The rate of recommending H. pylori testing after the second e-mail was not significantly improved from previous (P=0.52), but remained significantly improved from baseline (P<0.001). Conclusion: Testing rates for H. pylori in patients with clinically significant bleeding due to peptic ulcer disease are excellent (100%) when recommendations were explicitly stated in endoscopy reports. However, compliance with implementing this non-automated intervention was low, and there was only marginal improvement in compliance by sending an additional reminder to staff. Poor clinician compliance is a major limitation of any intervention reliant on a non-automated clinician response. In this situation, an alternative would be an automated message system that would provide the testing recommendation to ordering physicians if their patients are found to have bleeding PUD.

S1098 Suboptimal Utilization of Antiplatelet Therapy in the Setting of Treated Peptic Ulcer Disease Bleeding Post Coronary Artery Stenting

tion or outpatient, hemorrhagic recidive and Rockall score). Our outcomes were mortality directly related to the hemorrhage (in-hospital), mortality up 30 days and length of stay in hospitalized patients. For statistical analysis we used the Chi-square test and t Student test, with p<0.05 as significant differences. Results: 832 patients (532 male, 300 female), with median age 69 years; admission in weekdays 610 patients (73.1%) and weekend/holydays 222 patients (26.6%). The groups A and B are similar (Table) Mortality in-hospital 24 patients (2.88%)(6 patients admitted weekend/holidays vs 18 patients in weekdays, p=1), and total mortality 41 patients (4.92%) (9 patients admitted in weekend/holydays vs 32 patients in weekdays, p=0.588); length stay of hospitalized patients 5.4 ± 4.7 days (5.4 ± 4.4 in group A vs 5.5 ± 5.9 in group B, p=0.873). Conclusions: In our hospital does not exist weekend effect on patients with NVUGIH

Comparison of the Effectiveness of Interventional Endoscopy in Bleeding Peptic Ulcer Disease according to the Timing of Endoscopy

Background/AimsThe optimal timing for interventional endoscopy in bleeding peptic ulcer disease is controversial. This study compared the outcomes between early endoscopy and delayed endoscopy in patients with bleeding peptic ulcer disease.MethodsWe conducted a prospective analysis of data from 90 patients with bleeding peptic ulcer disease who visited the emergency room between May 2006 and September 2007. Patients were categorized into two groups: the early-endoscopy group (admitted during the daytime or at night with prompt endoscopic management) and the delayed-endoscopy group (admitted at night or during weekends, with endoscopic management delayed until the next day). We compared the clinical outcomes of endoscopy between the two groups.ResultsThere were 49 patients in the early-endoscopy group and 41 patients in the delayed-endoscopy group. Patient demographics, clinical characteristics, bleeding control modality, and Rockall score did not differ between the two groups. There were also no significant differences between the early- and delayed-endoscopy groups in the re-bleeding rate (3/49 vs 5/41, p=0.313), the duration of hospital stay (10.7 vs 9.3 days, p=0.437), and the total amount of blood transfused (3.4 vs 2.7 units, p=0.240).ConclusionsThe effectiveness of interventional endoscopy for patients with bleeding peptic ulcer disease is not significantly affected by the timing of endoscopy.

Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease

Patients with end-stage renal disease (ESRD) and peptic ulcer disease (PUD) bleeding may be at high risk of bleeding complications. To investigate the outcomes of patients with ESRD and PUD bleeding. ESRD patients with PUD bleeding were evaluated retrospectively. Two tertiary, university-affiliated hospitals. A total of 150 PUD bleeding patients were evaluated in 3 groups; end-stage renal disease (ESRD) patients on dialysis (ESRD group) (n = 50) were age matched with patients with chronic kidney disease (CKD) not requiring dialysis (CKD group) (n = 50) and those with normal kidney function (normal group) (n = 50). Rebleeding, transfusions, length of hospitalization, mortality. Multivariate analysis showed significant predictors of rebleeding to be ESRD and high-risk stigmata. The ESRD group had an odds ratio (OR) of 3.8 (95% CI, 1.4-10.5; P = .008) for rebleeding compared with the normal group, and an OR of 3.8 (95% CI, 1.4-10.3; P = .01) compared with the CKD group. The mean number of (+/- SD) transfusions was higher in the ESRD group (6.3 +/- 5.7 units) than in the normal group (3.6 +/- 3.9 units; P = .01). The mean length of hospitalization was higher in the ESRD group than in the normal group (34.0 vs 16.6 days; P = .01). A greater level of comorbidity was the only significant predictor of mortality (OR 6.0; 95% CI, 2.9-12.3; P = .001). Retrospective study. ESRD dialysis patients with PUD bleeding have greater rebleeding than patients not on dialysis. ESRD patients should be managed as a high-risk group.