Cause Of Non-variceal Upper Gastrointestinal Bleeding Research Articles

Nonvariceal Upper Gastrointestinal Bleeding: What an Interventional Radiologist Should Know

AbstractAcute nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency associated with significant morbidity and mortality. The most common cause of NVUGIB is peptic ulcer disease, but the differential diagnosis is diverse. The management of NVUGIB begins with resuscitation of the patient followed by early upper gastrointestinal (GI) endoscopy for diagnosis and initial treatment. Endovascular interventions have largely replaced surgery for the cases where endoscopic therapy fails, reflecting a paradigm shift toward minimally invasive and effective management strategies. It is essential to have a comprehensive understanding of arterial anatomy, common vascular variations, and different collateral pathways for successful endovascular management of NVUGIB. This review provides a thorough overview of NVUGIB, encompassing the management algorithm, imaging protocol, anatomical considerations, embolization techniques, types of embolic agents, and potential complications that interventional radiologists should consider when managing cases of NVUGIB.

Risk Assessment in Non-Variceal Upper Gastrointestinal Bleeding: A Comprehensive Review of Scoring Systems

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a critical medical emergency with significant morbidity and mortality rates. The primary cause of NVUGIB is peptic ulcers. Proper risk assessment is vital for the efficient management of NVUGIB patients, impacting both clinical decisions and healthcare resources. Established scoring systems like the Rockall score (RS), Glasgow-Blatchford score (GBS), and AIMS65 have been instrumental in guiding clinical decisions. Their strengths, limitations, and areas of application are discussed. The emerging ABC score, with its potential to outperform existing systems, is highlighted, emphasizing its relevance in both upper and lower GI bleedings. However, The ABC score, though promising, necessitates further research for broader clinical adoption.

Diagnostic And Therapeutic Approaches For Non-Variceal Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding (UGIB) is a common, life-threatening medical condition. Non-variceal causes account for more than 90% of bleeding episodes. Peptic ulcer disease is the most frequent cause of non-variceal UGIB. Patients present with hematemesis and/or melena but hematochezia might be present in patients with severe bleeding. Despite advances in diagnostic and therapeutic methods, mortality remains high in the elderly and patients with comorbidities. Endoscopy is the primary procedure that should be performed to identify the etiology of UGIB and for treatment purposes following adequate resuscitation of patients. Early endoscopy (within the first 24 hours) has considerably improved the clinical outcomes. A number of scoring systems are being used in patients with UGIB to identify the risk of complications, rebleeding risk, the need for interventional procedures and the risk of death. The most commonly used scoring tools are the Rockall score, Glasgow-Blatchford score and AIMS65 score. Primary treatment modalities include adequate resuscitation, intravenous fluid support, transfusion of red blood cell suspension, acid suppression therapy and administration of prokinetic agents. In general, angiography, computed tomography, technetium-99m-labeled red blood cell scintigraphy and capsule endoscopy may be used in patients whose bleeding cannot be detected endoscopically. Interventional radiological procedures should be initially performed for hemorrhages that cannot be stopped endoscopically and surgical options should be considered when interventional radiological procedures are out of reach or unsuccessful.

The Current Portrayal of Non-Variceal Upper Gastrointestinal Bleeding in a Portuguese Tertiary Center

Introduction: Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important healthcare problem whose epidemiology and outcomes have been changing throughout the years. The main goal of this study was to characterize the current demographics, etiologies, and risk factors of NVUGIB. Methods: Analysis of clinical, endoscopic, and outcome data from patients who were admitted for NVUGIB between January 2016 and January 2019 in an emergency department of a tertiary hospital center. Results: A total of 522 patients were included, with a median age of 71 years, mainly men, with multiple comorbidities. Most patients were directly admitted, while the others were transferred from other hospitals. Peptic ulcer disease was the most common cause of NVUGIB and it was followed by tumor bleeding. Esophagogastroduodenoscopy was performed within <12 h after hospital admission in 51.9%. In-hospital rebleeding occurred in 6.9% and overall mortality was 4.2%. Transferred patients had superior Glasgow-Blatchford score (GBS), required more blood transfusion, endoscopic and surgical interventions, and presented higher rebleeding rate, with similar mortality. Complete Rockall score (CRS) and GBS were predictors of endoscopic therapy. Surgery need was only related to CRS. Patients who rebled had superior pre-endoscopic Rockall score (RS), CRS, and GBS. Mortality was increased in patients with higher RS and CRS. Discussion/Conclusion: Ageing and increasing comorbidities have not been related to worse outcomes in NVUGIB. These findings seem to be the consequence of the correct use of both diagnostic and therapeutic tools in an organized and widely accessible healthcare system.

Peptic Ulcer Is the Most Common Cause of Non-Variceal Upper-Gastrointestinal Bleeding (NVUGIB) in China.

BackgroundThis study aimed to discover the common cause of non-variceal upper-gastrointestinal bleeding (NVUGIB) by conducting a multi-center retrospective study from 2008 to 2012.Material/MethodsHospitalized patients ages ≥18 years old, from 8 hospitals in China, diagnosed with NVUGIB by endoscopy from 1 January 2008 to 31 December 2012 were enrolled. Questionnaires were developed and a data-entry graphical user interface was designed by using EpiData software.ResultsTotal of 2977 hospitalized patients from 8 medical centers were included. A total of 95.47% (2842/2977) of patients were admitted to a general ward, 3.53% (105/2977) were admitted to an emergency ward, and 1.00% (31/2977) were admitted to an intensive care unit. Peptic ulcer remained the most common cause of NVUGIB (73.26%), but there was a declining trend in its constituent ratio, from 2008 to 2012. A total of 14.41% (429/2977) of patients had co-morbid conditions, 92.85% (2764/2977) used proton-pump inhibitors (PPIs) prior to endoscopic treatment, 19.65% (585/2977) underwent emergency endoscopy, and 23.45% (698/2977) received a transfusion of red blood cell suspensions. A total of 5.34% (159/2977) underwent endoscopic therapy, with a treatment rate of 16.9% in high-risk peptic ulcer patients (96/568). A total of 7.69% (237/2977) were administered aspirin, of whom 32.50% (77/237) resumed aspirin intake after gastrointestinal bleeding was controlled. The median length of hospitalization was 8 days (IQR, 5–11) and the mortality rate was 1.71% (51/2977).ConclusionsPeptic ulcer was still the most common cause of NVUGIB in China. The proportion of patients with high-risk peptic ulcer bleeding who received endoscopic therapy was 16.9%. Only 19.65% of NVUGIB patients underwent emergency endoscopy.

Prevalence and outcome of peptic ulcer bleeding in patients with liver cirrhosis

BackgroundUpper gastrointestinal bleeding is usually classified as either variceal or non-variceal. In cirrhotic patients, variceal bleeding has been extensively studied but, 30–40% of cirrhotic patients who bleed have non-variceal upper gastrointestinal bleeding (NVUGIB) that is frequently caused by gastro duodenal ulcers. Peptic ulcer bleeding (PUB) leads to substantial morbidity and mortality in patients with liver cirrhosis. AimThe aim of this study was to assess the prevalence and outcome of PUB in patients with liver cirrhosis. Materials and methodsThis was a cross-sectional study. Data on cirrhotic patients with PUB over a seven-year period between January 2006 and January 2013 were collected. ResultsAmong 103 patients with NVUGIB, 62 patients (60%) having PUB were assessed. Fifty percent were male. Ages ranged from 37 to 72years, mean 59±7years. The most common symptom on presentation was hematemesis (53%). Hemodynamic instability on admission was found in 30 patients (48%). Eighteen patients (29%) had initial hemoglobin less than 7g/dl. Twenty-seven patients (44%) required blood transfusion and the average number of transfused blood units was two. Forty patients (65%) bled from gastric ulcers. Eleven patients (18%) had ulcers with adherent clot. Twenty-four percent of patients had a Rockall score more than five. Five patients (8%) rebled. Complications were reported in seven patients (11%), mainly liver failure. Overall mortality was 8%. Male gender, adherent clot, bleeding recurrence, development of complications during admission and a Rockall score >5 were significant factors for increasing mortality (P=0.02, 0.016, 0.00001, 0.034 and 0.00003 respectively). ConclusionThe commonest cause of NVUGIB in patients with liver cirrhosis was PUB. Mortality in patients with PUB was particularly high among males, patients who had adherent clot, bleeding recurrence, development of complications and a high Rockall score.

Baseline Proton Pump Inhibitor Use to Predict Need for Clinical Intervention for Patients with Nonvariceal Upper Gastrointestinal Tract Bleeding

Purpose: Early endoscopy (within 24 hour of admission) has been advocated for the management of acute upper gastrointestinal bleeding (UGIB) and identifies many patients who may be safely treated without hospitalization. Proton Pump inhibitor (PPI) therapy is associated with significant expense and there is little evidence to support that PPI usage prior to presentation with UGIB (baseline PPI use) leads to less likely need for early clinical intervention. We hypothesized that those patients taking PPIs prior to admission will be less likely need early endoscopy when they are admitted for overt UGIB. Methods: A retrospective chart review was performed from January 2005 to December 2008 on patients presenting for endoscopic evaluation of overt UGIB defined as hematemesis, bloody nasogastric tube lavage, melena, hematochezia +/- acute hematocrit drop or orthorstasis. Patients who had UGIB secondary to varices, portal hypertensive gastropathy, and patients who had no significant finding on upper endoscopy were excluded. Eligible patients were assigned to two groups: patients who were taking a PPI prior to admission and patients who were not taking a PPI prior to admission. Logistic regression analysis was performed using treatment with a PPI within the last 4 weeks prior to admission as a predictor variable in both groups. Peptic ulcer disease, erosions, esophagitis, gastritis, duodenitis and arterial bleeding were considered to be a cause of non-variceal UGIB. Results: 843 consecutive patients were referred for endoscopic evaluation of UGIB, 658 patients met the inclusion criteria. There were 110 patients who were on PPI prior to admission and 548 patients who were not on PPI prior to admission. Demographic and clinical data are shown in Table.Table: No Caption available.Conclusion: Patients taking a PPI prior to admission were less likely to have an early endoscopy (p=0.01) when admitted for overt UGIB.

Predicting the outcome of nonvariceal upper GI bleeding: can we guess right?

Upper gastrointestinal bleeding (UGIB) represents a common emergency in clinical practice, with an estimated incidence of about 100/100,000 people per year [1]. Traditionally, patients with UGIB are routinely hospitalised, and this results in substantial resource consumption. While there is no doubt that hospitalisation is mandatory for variceal haemorrhage in cirrhotic patients [2], it has become increasingly clear that peptic ulcer bleeding (by far the most common cause of nonvariceal UGIB) is highly inconstant in severity and outcome [3]. In fact, if patients are stratified according to the most commonly used classification of bleeding ulcers [4], the risk of rebleeding varies between 5% in patients with a clean ulcer base and 55% in those with active bleeding at endoscopy, the need for surgical intervention ranges between 0.5 and 35%, and mortality varies between 2 and 13% [3]. Even more importantly, patients in the lowest risk class account for about 40% of the entire population of ulcer bleeders [3], and could be managed as outpatients, leading to substantial cost savings.