Cause Of Upper Gastrointestinal Bleeding Research Articles

Predictors of Rebleeding in Upper Gastrointestinal Dieulafoy Lesions.

Background/AimsDieulafoy lesions (DLs) are a rare but significant cause of upper gastrointestinal bleeding. We aimed to define the clinical significance of rebleeding and identify the predictors of rebleeding and mortality in upper gastrointestinal Dieulafoy lesions (UGIDLs).MethodsPatients diagnosed with UGIDLs between January 2004 and June 2013 were retrospectively evaluated. Multivariate logistic regression analyses were performed to define the predictors of rebleeding and mortality in patients with UGIDLs.ResultsThe study group consisted of 81 male and 36 female patients. Primary hemostasis was achieved in 115 out of 117 patients (98.3%) with various endoscopic therapies. Rebleeding occurred in 10 patients (8.5%). The mortality rate was significantly higher in patients with rebleeding than in those without rebleeding (30.0% vs. 4.7%, p=0.020). Multivariate logistic regression analysis revealed that kidney disease (p=0.006) and infection (p=0.005) were significant predictors of rebleeding in UGIDLs and that kidney disease (p=0.004) and platelet count (p=0.013) were significant predictors of mortality.ConclusionsRebleeding has an important prognostic significance in patients with UGIDLs. Kidney disease and infection are major predictors of rebleeding and mortality in patients with UGIDLs.

Downhill varices: an uncommon cause of upper gastrointestinal bleeding.

Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but "Downhill Varices" (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications. A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass. DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS.

Massive Gastric Hemorrhage due to Dieulafoy's Lesion in a Preterm Neonate: A Case Report and Literature Review of the Lesion in Neonates.

Dieulafoy's lesion is an extremely rare cause of upper gastrointestinal bleeding in the neonatal age group. Till now, only 6 cases of Dieulafoy's lesion in neonatal period have been reported in the international literature. Herein, we report an extremely rare case of Dieulafoy's lesion in a preterm neonate.

Acute esophageal necrosis: Black esophagus in setting of diabetic ketoacidosis

Introduction: Acute esophageal necrosis (AEN) is a rare cause of upper gastrointestinal bleeding with an unclear etiology that may be related to ischemic insults resulting in caustic injury primarily to the distal segment of the esophagus along with damage caused by underlying coronary artery disease or diabetes mellitus. If not diagnosed correctly, treatment may incorrectly focus on proton pump rather than underlying medical conditions which if not addressed, can lead to repeat episodes of the condition. case report: We report a case in which a patient presented in diabetic crises. Esophagogastroduodenoscopy (EGD) revealed circumferential necrotic discoloration and friable tissue of the gastroesophageal junction with a normal appearing stomach. treatment with a proton pump inhibitor and aggressive insulin management led to cessation of symptoms. conclusion: Upper gastrointestinal bleeding is a common complaint in both the inpatient and outpatient settings. While many cases may be related to bacterial infection (Helicobacter pylori) or iatrogenic insults (NsAID or alcohol use), rare cases may be related to poorly controlled underlying medical conditions such Brooke Colin Bear1, Jacob Mathew1, Calvin W. Parker III2 Affiliations: 1Resident Physician, Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA; 2Gastroenterologist, Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA. Corresponding Author: Brooke Colin Bear, 1 Jarrett White Road, Honolulu, HI USA, 96859-5000, 808-433-6641; Fax: 808-433-1556; Email: brooke.c.bear.civ@mail.mil Received: 06 May 2015 Accepted: 25 August 2015 Published: 01 December 2015 as coronary artery disease or diabetes. Our case highlights the need to keep heightened suspicion for entities such as AEN in patients who have appropriate underlying medical conditions to prevent further episodes.

Aorto-Esophageal Fistula: A Rare Fatal Case of Gastrointestinal Hemorrhage Caused by Foreign Body

Aorto-oesophageal fistula (AOF) is a rare cause of upper gastro-intestinal hemorrhage. A fistulous tract develops between the aorta and the esophagus most commonly in association with thoracic aortic aneurysms, foreign bodies, esophageal malignancy, and the presence of an aortic prosthetic graft or following trauma [1]. High mortality still accompanies the cases [2]. We report a case of AEF caused by a fish bone. Computed tomography demonstrated a fistula from the proximal descending thoracic aorta to the mid esophagus.This patient died when rupture into the esophageal lumen caused exsanguinating hemorrhage.Their clinical causes and treatment are reviewed and discussed below.

Availability of Blood Urea Nitrogen/Creatinine Ratio in Gastrointestinal Bleeding with Melena in Children

PurposeThe aims of our study were to evaluate the blood urea nitrogen to creatinine ratio (BUN/Cr ratio) for distinguishing between an upper and lower gastrointestinal bleeding (GIB), and differentiating between the two most common causes of upper gastrointestinal bleeding (UGIB) presenting with melena in children.MethodsRetrospective data of patients with GIB presenting with melena were analyzed. The data from 60 cases were reviewed including demographics, laboratory findings, diagnostic modalities and results, treatments, and transfusions.ResultsAmong the 60 cases, UGIB and lower gastrointestinal bleeding (LGIB) were found in 35 cases (58.3%) and 14 cases (23.3%), respectively. The two common causes of UGIB were varices (37.1%), and peptic ulcer diseases (PUD) (31.4%). The BUN/Cr ratio of 30 or greater was higher in UGIB than LGIB (odds ratio [OR], 6.9; 95% confidence interval [95% CI], 1.3-37.2). In UGIB, the BUN/Cr ratio of the varices group was higher than that of the PUD group (p=0.015). The OR for the BUN/Cr ratio appeared as 1.2 per unit increase in the varices group than the PUD group (95% CI, 1.03-1.3). There was no difference between the PUD group and Meckel's diverticulum group.ConclusionThe BUN/Cr ratio was not uneven in differentiating UGIB from LGIB of children with melena in our study. This suggests that BUN/Cr ratio should be interpreted carefully.

Chicken Bone Impaction Diagnosed by Computer Tomography Angiography: A Rare Cause of Lower Gastrointestinal Bleeding

A 71-year-old man presented with hematochezia and paraumbilical abdominal pain. The patient had a history of left hemicolectomy for unresectable large colonic polyps, but he had no prior episodes of gastrointestinal bleeding and was not on anticoagulants, antiplatelet therapy, or non-steroidal anti-inflammatory drugs. Upon arrival, the patient was hemodynamically stable with a normal complete blood count and international normalized ratio (INR). A computerized tomography angiogram (CTA) utilizing a “bleeding scan protocol” was performed. The radiologist identified a foreign body in the proximal sigmoid colon with adjacent inflammatory changes, with structural characteristics suggesting a chicken gracile bone (Figure 1). The radiologist felt that the location of the gracile bone was the likely source of gastrointestinal hemorrhage due to visible extravasation of contrast. The patient underwent colonoscopy, which demonstrated an impacted gracile bone not adjacent to any diverticula at 25 cm from the anal verge, which was removed via snare (Figure 2). No residual bleeding was detected on careful inspection of the colon after extraction of the bone. Although gracile bone impaction has been described in the past as a cause of upper gastrointestinal bleeding, only 1 case report described lower gastrointestinal bleeding from a chicken bone.1-4 Vosskamp et al described a case in which the patient underwent a hemicolectomy for lower gastrointestinal bleeding that showed a submucosal gracile bone adjacent to a bleeding diverticulum.4 Our case report exemplifies a rare etiology of lower gastrointestinal bleeding caused by acute gracile bone impaction in the sigmoid colon.

Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome.

We have recognized a unique clinical syndrome in patients with upper gastrointestinal bleeding who are found to have severe esophagitis. We aimed to more clearly describe the clinical entity of upper gastrointestinal bleeding in patients with severe esophagitis. We conducted a retrospective matched case-control study designed to investigate clinical features in patients with carefully defined upper gastrointestinal bleeding and severe esophagitis. Patient data were captured prospectively via a Gastrointestinal Bleeding Healthcare Registry, which collects data on all patients admitted with gastrointestinal bleeding. Patients with endoscopically documented esophagitis (cases) were matched with randomly selected controls that had upper gastrointestinal bleeding caused by other lesions. Epidemiologic features in patients with esophagitis were similar to those with other causes of upper gastrointestinal bleeding. However, hematemesis was more common in patients with esophagitis 86% (102/119) than in controls 55% (196/357) (p < 0.0001), while melena was less common in patients with esophagitis 38% (45/119) than in controls 68% (244/357) (p < 0.0001). Additionally, the more severe the esophagitis, the more frequent was melena. Patients with esophagitis had less abnormal vital signs, lesser decreases in hematocrit, and lesser increases in BUN. Both pre- and postRockall scores were lower in patients with esophagitis compared with controls (p = 0.01, and p < 0.0001, respectively). Length of hospital stay (p = 0.002), rebleeding rate at 42 days (p = 0.0007), and mortality were less in patients with esophagitis than controls. Finally, analysis of patients with esophagitis and cirrhosis suggested that this group of patients had more severe bleeding than those without cirrhosis. We have described a unique clinical syndrome in patients with upper gastrointestinal bleeding who have erosive esophagitis. This syndrome is manifest by typical clinical features and is associated with favorable outcomes.

Clinical and endoscopic profile of patients with upper gastrointestinal bleeding at tertiary care center of North India

Abstract Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency associated with significant morbidity and mortality. The presentation of bleeding depends on the amount and location of hemorrhage and the endoscopic profile varies according to different etiology. Despite advancements in medical intervention UGIB still carries considerable morbidity, mortality and economic burden on health care system. At present, there is limited epidemiological data on UGIB and associated mortality from India. Aims: The aim was to study clinical, endoscopic profile, and associated mortality in patients presenting with UGIB. Materials and Methods: One hundred and fourteen patients came to Emergency Department with UGIB during the study period and were subjected to endoscopy to identify the etiology. The clinical and endoscopic profile was analyzed and mortality pattern was studied. Results: The mean age of patients was 49 ± 14.26. Majority of them were males (83.33%) and male to female ratio was 5:1. The most common cause of UGIB was portal hypertension related (Esophageal and gastric varices) seen in 56.14% of patients, peptic ulcer-related bleed was seen in 14.91% patients, gastric erosions were responsible for bleed in 12.28% patients, Mallory–Weiss tear was seen in 8.77% cases, gastric malignancy accounted for 4.38% of cases, Dieulafoy’s lesion was responsible for bleed in 1.75% cases and 1.75% had Duodenal polyp. The mortality rate because of UGIB in our cohort of patients was 21.05%. Conclusions: In the present study, variceal bleed was the most common cause of UGIB, followed by peptic ulcer bleed. Overall mortality was seen in 21.05% of cases; however, majority of mortality was seen in portal hypertension related bleeding.

A Retrospective Analysis and a New Type of Clinical Classification of Mallory-Weiss Syndrome

Introduction: Mallory-Weiss Syndrome (MWS) is one of the important causes of upper gastrointestinal bleeding and it is mainly induced by severe vomiting. Now the causes of MWS have changed partly and the treatment of which has almost turned to endoscopic therapy. A new type of clinical classification may be helpful for the evaluation of MWS. Methods: Retrospective analysis of 64 MWS cases in our hospital from January 2010 to March 2014. The causes, endoscopic findings, treatment and prognosis were evaluated according to a new type of clinical classification. Results: The ratio of male to female in 64 MWS cases is 3.3:1 and the average age is 50.2 years old. 53.1% of MWS is caused by over drinking or inappropriate diet occasionally. 37.5% of MWS is caused by underlying gastric diseases such as peptic ulcer (26.6%), gastric cancer (6.3%) or Dieulafoy disease (4.7%). And 9.4% of MWS is caused by endoscopic examination or treatment. 62.5% of MWS developed only one lesion of cardia and/or lower esophagus and 29.7% developed 2˜3 lesions. The lesions may happen in all the four walls of cardia and/or lower esophagus and the right wall is relatively common location (32.5%). According to a new type of clinical classification introduced here during endoscopic examination, 17.2% of MWS was found out with active bleeding (Type A) such as spouting, pulsating or oozing. 21.9% was found out with fresh blood clot (Type B) and 32.8% with old blood clot (Type C). The rest 28.1% was found with line ulcer or scar (Type D). All Type A patients were treated with endoscopic metal clip treatment and partly combined with noradrenalin spraying. Part of Type B patients were treated with metal clip or noradrenalin spraying. Only one patient of Type A died because of suspected underlying intestinal bleeding and all other patients were cured. Conclusion: Underlying gastric diseases are also important causes of MWS and easy to be ignored especially Dieulafoy disease. Endoscopic metal clip is the first choice for treatment of MWS and the new type of clinical classification is useful for evaluation.

Evidence-based review of gastrointestinal bleeding in the chronic kidney disease patient.

Patients with end-stage renal disease are more likely to suffer from gastrointestinal (GI) problems, including bleeding from upper and lower sources. Peptic ulcer disease is the most common cause of upper GI bleeding, and although there is some debate in the literature regarding whether the frequency of ulcer disease is higher in patients with kidney disease, it is well established that outcomes are worse in patients with compromised renal function. Angioectasias can be found throughout the GI tract and are another common cause of bleeding; management can be divided into localized endoscopic therapy and systemic hormonal treatment, or surgery for refractory cases. The most frequent causes of lower GI bleeding in this population, in addition to angioectasias, are diverticulosis, hemorrhoids, and ischemic colitis.

Effect of Omeprazole Dose, Nonsteroidal Anti-inflammatory Agents, and Smoking on Repair Mechanisms in Acute Peptic Ulcer Bleeding

Peptic ulcer bleeding (PUB) is a major cause of upper gastrointestinal bleeding. The effect of omeprazole on mucosal repair is unknown. We studied the effect of omeprazole, nonsteroidal anti-inflammatory agents, and smoking on PUB. There were 43 PUB patients who received regular or high dose of omeprazole for 72h. Biopsies from antrum and corpus were taken before and after treatment. Biopsy samples from 20 celiac disease patients worked as controls. The expression of Ki-67, Bcl-2, COX-2, Hsp27, and Hsp70 was analyzed from patients and controls. Bcl-2 expression in PUB patients was lower than in controls. However, Bcl-2 increased significantly from 5.0 (SD 4.5) to 9.1% (SD 6.7), p=0.0004, in the antrum after omeprazole. In univariate analysis, a high omeprazole dose caused a more profound increase in Ki-67 expression in the corpus: 35.3% (SD 54.8) than a regular dose: -10.1% (SD 40.6), p=0.022. In multivariate analysis, Ki-67 decreased significantly in the corpus between the pre- and posttreatment period (p=0.011), while a high omeprazole dose (p=0.0265), the use of NSAIDs (p=0.0208), and smoking (p=0.0296) significantly increased Ki-67 expression. Bcl-2 in the corpus increased significantly (p=0.0003) after treatment. Our findings suggest that Bcl-2 may be an important factor in the pathogenesis of a peptic ulcer and PUB. In addition, high-dose omeprazole increased the expression of Ki-67, which may enhance the healing process of a peptic ulcer.

Gastric pH Comparison Between Mild and Severe Cirrhotic Portal Hypertensive Gastropathy

Background: One of the causes of upper gastrointestinal bleeding in patients with liver cirrhosis is thepresence of portal hypertensive gastropathy (PHG). The prevalence of PHG in patients with liver cirrhosis isquite high but there is still inconsistency regarding the studies about gastric pH in cirrhosis patient. The aim of this study is to compare the gastric pH in mild and severe PHG due to liver cirrhosis.Method: Cross sectional method with consecutive sampling was done to all liver cirrhotic patients who came to Clinic of Gastroenterology and Hepatology in Cipto Mangunkusumo hospital from March to May 2014. Sixtytwo patients with portal hypertensive gastropathy underwent endoscopy to measure the degree of gastropathy based on Mc Cormack classification ad the mean basal gastric pH using pH-metric.Results: There are 50 (80.6%) male patients and 12 (19.4%) female patients participated in this study. Portal hypertensive gastropathy is mostly caused by hepatitis C (56.5%), hepatitis B (32.3%), non-hepatitis (8.1%) and alcohol (3.2%). The mean of gastric pH in all liver cirrhosis patients with portal hypertensive gastropathy was 2.13.The mean gastric pH in liver cirrhosis patient with mild portal hypertensive gastropathy (2.00 mEq/L) was lower than the gastric pH in severe portal hypertensive gastropathy (2.25 mEq/L) with significant differences (p0.05)Conclusion: The gastric pH in liver cirrhosis patient between mild and severe portal hypertensive gastropathy are significantly different Keywords: gastric pH, liver cirrhosis, portal hypertensive gastropathy, pH-metric

Treatment resistant gastric antral vascular ectasia in a patient undergoing haemodialysis.

Gastric antral vascular ectasia (GAVE) is an important cause of upper gastrointestinal bleeding and has a high prevalence in patients with renal insufficiency. We report the first documented case of a 52-year-old patient on haemodialysis with GAVE refractory to repeated endoscopic argon plasma coagulation (APC) therapy and highlight the difficulties in its management. We recognise the need for further studies to investigate the optimal management of this condition and suggest alternative treatment strategies to be considered in patients with APC refractory GAVE, such as endoscopic band ligation and changing dialysis modality.

Oesophageal varices, schistosomiasis, and mortality among patients admitted with haematemesis in Mwanza, Tanzania: a prospective cohort study.

BackgroundUpper gastrointestinal bleeding (UGIB) is a common cause of hospital admissions worldwide. Aetiologies vary by sociodemographics and geography. Retrospective studies of endoscopies in much of Africa have documented oesophageal varices as a leading cause of UGIB. Prospective studies describing outcomes and associations with clinical factors are lacking.MethodsWe conducted a prospective cohort study at a referral hospital in Mwanza, Tanzania where schistosomiasis is endemic. Adults admitted with haematemesis underwent laboratory workup, schistosomiasis antigen testing and elective endoscopy, and were followed for two months for death or re-bleeding. We assessed predictors of endoscopic findings using logistic regression models, and determined prediction rules that maximised sensitivity and positive predictive value (PPV).ResultsOf 124 enrolled patients, 13 died within two months (10%); active schistosomiasis prevalence was 48%. 64/91(70%) patients had oesophageal varices. We found strong associations between varices and numerous demographic or clinical findings, permitting construction of simple, high-fidelity prediction rules for oesophageal varices applicable even in rural settings. Portal vein diameter ≥ 13 mm or water sourced from the lake yielded sensitivity, specificity, PPV and NPV > 90% for oesophageal varices; presence of splenomegaly or water sourced from the lake maintained sensitivity and PPV > 90%.ConclusionsOur results guide identification of patients, via ultrasound and clinical examination, likely to have varices for whom referral for endoscopy may be life-saving. Furthermore, they support empiric anti-schistosome treatment for patients with UGIB in schistosome-endemic regions. These interventions have potential to reduce UGIB-related morbidity and mortality in Africa.

To transfuse or not to transfuse in upper gastrointestinal hemorrhage? That is the question

To transfuse or not to transfuse in upper gastrointestinal hemorrhage? That is the question

Mo1124 Retrospective Analysis of Upper Gastrointestinal Bleeding in 11,919 Patients Who Were Prescribed Antithrombotics in Japan

Background Antithrombotic drugs including low-dose aspirin, antiplatelet drugs and anticoagulants increase upper gastrointestinal bleeding (UGIB). This study aimed to clarify the features of UGIB in 11,919 Japanese patients taking antithrombotic drugs, and examine the temporal changes in the pathogenic mechanism for UGIB. Methods The characteristics of the cohort with those of the 11,919 patients, who were prescribed antithrombotic drugs in Saga Medical School Hospital during 2002 and 2011, were analyzed for examination of relationships between the use of acid-secretion inhibitors and antithrombotic drugs in the UGIB patients. During the period (2002-2011), retrospective chart review revealed 430 patients who underwent emergency endoscopy for UGIB in Saga Medical School Hospital. Results Numbers of UGIB patients were 186 in 2002-2006 and 244 in 2007-2011. In the second period, the proportion of UGIB patients infected with Helicobacter pylori decreased (76.9% in the first period vs. 49.6% in the second, p<0.0001), and the proportion of UGIB patients who took antithrombotic drugs increased (21.5% vs. 32.8%, p=0.012). The most common cause of UGIB was peptic ulcer disease, and the incidence of other causes, including reflux esophagitis, and gastric antral vascular ectasia, has increased in a time dependent manner. Significant risk factors for antithrombotic-related UGIB were hypertension (OR 6.546, 95%CI 4.091-10.477, p<0.001) and diabetes mellitus (OR 2.947, 95%CI 1.7534.956, p<0.001). The survey indicated the risk of UGIB in patients taking antithrombotics was 1.01% in 11,919 patients, whichwas 5-10-fold higher than that in the general population. The increased risk in UGIB caused by antithormbotics was significantly suppressed by acidsecretion inhibitors (OR 0.146, 95%CI 0.089-0.242, p<0.001). Conclusions The present large number study of 11,919 Japanese patients indicated the prevalence of UGIB in patients, who were prescribed antithrombotics, was 1.01%, and the increased risk of UGIB was attenuated by acid-secretion inhibitors.

Sa1679 Risk Factors of Bleeding Due to Dieulafoy's Lesion and Prognostic Factors for Rebleeding Due to Dieulafoy's Lesion

Sa1679 Risk Factors of Bleeding Due to Dieulafoy’s Lesion and Prognostic Factors for Rebleeding Due to Dieulafoy’s Lesion Sang Hun Park*, Chang-Hwan Park, Sung UK. Lim, Ho-Seok Ki, Chunghwan Jun, Seon-Young Park, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew Chonnam National University Hospital, Gwangju, Republic of Korea Background/Aims: Dieulafoy’s lesion (DL) is a rare but important cause of upper gastrointestinal bleeding (UGIB). This study was carried out to reveal the risk factors of bleeding due to Dieulafoy’s lesion and identify prognostic factors for recurrent bleeding (RB). Patients and Methods: One hundred seventy two patients with UGIB due to DL between January 2004 and June 2013 were evaluated, retrospectively. We analyzed the demographic data, endoscopic findings, details of endoscopic therapy and recurrence of bleeding. Results: The study group consists of 115 male and 57 female patients with a mean age of 68.6 14.2 years. Fifty-seven patients received antiplatelet, anticoagulant and NSAID medication. The most common location was proximal stomach (36.6%) and the most common bleeding type was oozing (60.5%). Endoscopic therapy was successful in stopping the bleeding in 97.7%; single endoscopic treatment in 46.2% and combination treatment in 53.8%. Major risk factors were hypertention (43.6%), diabetes (32.0%), smoking (29.1%), kidney disease (22.7%), infection (20.3%), liver cirrhosis (16.9%), stroke (15.7%), viral hepatitis (14.5%), ischemic heart disease (13.4%), cancer (9.9%), congestive heart failure (8.7%), hematologic disease (6.4%), valvular heart disease (4.1%). Rebleeding occurred in 28 with mean duration of 5.9 days after initial hemostasis. There were significant differences in the distribution of kidney disease (acute kidney injury & chronic kidney disease) (15/28 vs. 25/144, pZ0.006, AORZ6.637, CI: 1.711w25.753) and infection (15/28 vs. 21/144, pZ0.001, AORZ6.421, CI:2.051w20.103) between two groups. The mean value of APTT (52.1 sec vs. 41.8 sec, p Z 0.001), creatinine (2.9vs 1.5 mg/dl, pZ0.008), and CRP (3.3vs 2.3 mg/dl, pZ0.021) were significantly higher in the RB. Mortality rate of RB was 39.3% compared to 3.5% of NRB (p!0.001). Conclusion: Kidney disease and infection were the risk factors of RB of DL. Control of underlying disease is important in the management of DL.

Mo1125 A Prospective Analysis of the Glasgow-Blatchford Score as a Predictor of Length of Hospital Stay for Upper Gastrointestinal Bleeding

Background Antithrombotic drugs including low-dose aspirin, antiplatelet drugs and anticoagulants increase upper gastrointestinal bleeding (UGIB). This study aimed to clarify the features of UGIB in 11,919 Japanese patients taking antithrombotic drugs, and examine the temporal changes in the pathogenic mechanism for UGIB. Methods The characteristics of the cohort with those of the 11,919 patients, who were prescribed antithrombotic drugs in Saga Medical School Hospital during 2002 and 2011, were analyzed for examination of relationships between the use of acid-secretion inhibitors and antithrombotic drugs in the UGIB patients. During the period (2002-2011), retrospective chart review revealed 430 patients who underwent emergency endoscopy for UGIB in Saga Medical School Hospital. Results Numbers of UGIB patients were 186 in 2002-2006 and 244 in 2007-2011. In the second period, the proportion of UGIB patients infected with Helicobacter pylori decreased (76.9% in the first period vs. 49.6% in the second, p<0.0001), and the proportion of UGIB patients who took antithrombotic drugs increased (21.5% vs. 32.8%, p=0.012). The most common cause of UGIB was peptic ulcer disease, and the incidence of other causes, including reflux esophagitis, and gastric antral vascular ectasia, has increased in a time dependent manner. Significant risk factors for antithrombotic-related UGIB were hypertension (OR 6.546, 95%CI 4.091-10.477, p<0.001) and diabetes mellitus (OR 2.947, 95%CI 1.7534.956, p<0.001). The survey indicated the risk of UGIB in patients taking antithrombotics was 1.01% in 11,919 patients, whichwas 5-10-fold higher than that in the general population. The increased risk in UGIB caused by antithormbotics was significantly suppressed by acidsecretion inhibitors (OR 0.146, 95%CI 0.089-0.242, p<0.001). Conclusions The present large number study of 11,919 Japanese patients indicated the prevalence of UGIB in patients, who were prescribed antithrombotics, was 1.01%, and the increased risk of UGIB was attenuated by acid-secretion inhibitors.

Sa1680 Predictive Risk Factors for Postoperative Gastrointestinal Bleeding in Patients Receiving Left Ventricular Assist Devices

Sa1679 Risk Factors of Bleeding Due to Dieulafoy’s Lesion and Prognostic Factors for Rebleeding Due to Dieulafoy’s Lesion Sang Hun Park*, Chang-Hwan Park, Sung UK. Lim, Ho-Seok Ki, Chunghwan Jun, Seon-Young Park, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew Chonnam National University Hospital, Gwangju, Republic of Korea Background/Aims: Dieulafoy’s lesion (DL) is a rare but important cause of upper gastrointestinal bleeding (UGIB). This study was carried out to reveal the risk factors of bleeding due to Dieulafoy’s lesion and identify prognostic factors for recurrent bleeding (RB). Patients and Methods: One hundred seventy two patients with UGIB due to DL between January 2004 and June 2013 were evaluated, retrospectively. We analyzed the demographic data, endoscopic findings, details of endoscopic therapy and recurrence of bleeding. Results: The study group consists of 115 male and 57 female patients with a mean age of 68.6 14.2 years. Fifty-seven patients received antiplatelet, anticoagulant and NSAID medication. The most common location was proximal stomach (36.6%) and the most common bleeding type was oozing (60.5%). Endoscopic therapy was successful in stopping the bleeding in 97.7%; single endoscopic treatment in 46.2% and combination treatment in 53.8%. Major risk factors were hypertention (43.6%), diabetes (32.0%), smoking (29.1%), kidney disease (22.7%), infection (20.3%), liver cirrhosis (16.9%), stroke (15.7%), viral hepatitis (14.5%), ischemic heart disease (13.4%), cancer (9.9%), congestive heart failure (8.7%), hematologic disease (6.4%), valvular heart disease (4.1%). Rebleeding occurred in 28 with mean duration of 5.9 days after initial hemostasis. There were significant differences in the distribution of kidney disease (acute kidney injury & chronic kidney disease) (15/28 vs. 25/144, pZ0.006, AORZ6.637, CI: 1.711w25.753) and infection (15/28 vs. 21/144, pZ0.001, AORZ6.421, CI:2.051w20.103) between two groups. The mean value of APTT (52.1 sec vs. 41.8 sec, p Z 0.001), creatinine (2.9vs 1.5 mg/dl, pZ0.008), and CRP (3.3vs 2.3 mg/dl, pZ0.021) were significantly higher in the RB. Mortality rate of RB was 39.3% compared to 3.5% of NRB (p!0.001). Conclusion: Kidney disease and infection were the risk factors of RB of DL. Control of underlying disease is important in the management of DL.