Cause Of Upper Gastrointestinal Bleeding Research Articles

Incidental diagnosis of gastric antral vascular ectasia in a case of chronic kidney disease from Nepal: a case report

IntroductionGastric antral vascular ectasia is an uncommon clinical disease that affects elder people and is characterized by severe chronic upper gastrointestinal bleeding mainly affecting the gastric antrum. It is generally unusual among patients undergoing maintenance hemodialysis for chronic kidney disease.Case presentationHere, we aim to present an uncommon case of incidental diagnosis of the gastric antral vascular ectasia and erosive gastritis in a 71-year-old Hindu male patient belonging to the Gurung ethnicity of Nepal undergoing maintenance hemodialysis due to chronic kidney disease. The patient presented with a history of melena and fatigue. On investigation, a low hemoglobin level of 7.3 gm% was used for blood transfusion. The patient was on regular hemodialysis after admission at our institution. Upper gastrointestinal bleeding was suspected after analyzing patient’s history and investigations. Therefore, an upper gastrointestinal endoscopy was performed that showed linear ectatic punctuate lesions radiating from the body of the stomach to the antrum, and hence, an incidental diagnosis of the gastric antral vascular ectasia was made. Initial fluid resuscitation, iron therapy, and a triple regimen were administered. Proper management with argon plasma coagulation therapy was scheduled at another institution due to lack of respective facilities in our institution.DiscussionGastric antral vascular ectasia is an unusual cause of upper gastrointestinal bleeding, primarily affecting the gastric antrum and pylorus with rare cases affecting the duodenum, jejunum, and gastric fundus. It is generally associated with other chronic disease conditions. Several hypotheses have been proposed for the pathogenesis of gastric antral vascular ectasia, especially its association with chronic kidney disease, as in our case, which is considered to be rare. Management varies from medical to endoscopic interventions to even surgery.ConclusionPrompt proper diagnosis and treatment for the gastric antral vascular ectasia should be sought, as it is frequently misdiagnosed or missed during upper gastrointestinal endoscopy. Our case report presents a case of gastric antral vascular ectasia in chronic kidney disease undergoing maintenance hemodialysis, which is quite uncommon, as literature has suggested the same point.

Gastric Bleeding in Stem Cell Transplantation: A Focus on Gastric Vascular Ectasia Under Post-Transplant Cyclophosphamide, Sirolimus, and Mycophenolate Mofetil Prophylaxis

Gastrointestinal bleeding (GIB) is a serious complication following allogeneic hematopoietic stem cell transplantation (HSCT), with limited data on its incidence and characteristics, particularly for upper gastrointestinal bleeding (UGIB) of gastric origin. We aimed to evaluate the incidence, clinical, endoscopic, and histopathologic features, and outcomes of UGIB, with a focus on gastric vascular ectasias (GVEs) in patients undergoing HSCT with graft-versus-host disease (GVHD) prophylaxis using post-transplant cyclophosphamide (PTCY), sirolimus or calcineurin inhibitors, and mycophenolate mofetil. This retrospective, single-center study included all adult patients who underwent allogeneic HSCT at a single institution between January 2017 and December 2023. Data were collected on transplant procedures, complications, and GIB incidents, with UGIB cases undergoing endoscopic and histologic examination. Out of 559 patients, 38 (6.6%) experienced UGIB, with 27 cases (70%) attributed to GVE. GVE typically presented as melena or hematemesis at a median time of 68 days (range, 29-125) after transplant. Endoscopy revealed diffuse oozing from gastric antral mucosa without distinct lesions, while histology showed vascular congestion and mild foveolar hyperplasia. The 6-month cumulative incidence of GVE was 5.1%. Older age (≥60 years) and diagnosis of myelodysplastic/myeloproliferative neoplasm were significant risk factors. All cases resolved with no attributable mortality with supportive measures including transfusions, proton-pump inhibitors, and sirolimus withdrawal in some cases. GVE is a notable cause of UGIB in HSCT recipients on PTCY-based GVHD prophylaxis, presenting significant morbidity but favorable outcomes with appropriate management. The potential role of sirolimus and conditioning agents in GVE pathogenesis warrants further investigation.

Peri-Ampullary Tumour; An Unusual Cause of Upper Gastrointestinal Bleeding

Periampullary tumors are cancers that arise in the region of the around the ampulla of Vater, where the bile duct and pancreatic duct converge and empty into the small intestine. This region is very critical for digestive enzyme and bile secretions. This may be associated with slow disease progression, age related changes delayed onset of symptoms and lack of screening and diagnostic facilities. These tumours can be challenging to diagnose and manage due to their proximity to several vital structures. Upper gastrointestinal bleeding may be a rare clinical presentation following tumoral ulceration, erosion into blood vessels or nearby structures or secondary complications like pancreatitis or portal hypertension. Identifying the anatomical origin of these malignancies is usually a herculean task. This will require prompt oesophagogastroduodenoscopy and imaging to determine the source and appropriate management. This is especially true given the region's transitional character, closeness to various structures, and overlapping features among them. We present periampullary tumour an unusual cause of upper gastrointestinal bleeding in a resource limited setting. A52 year old Nigerian male was admitted at the Usmanu Danfodiyo University Teaching Hospital, Sokoto for evaluation following a 3 months history of progressive weight loss, generalized body weakness and a burning and occasionally colicky, persistent, non-radiating epigastric pain, loss of appetite, easy fatiguability, occasional dizziness and recurrent non-projectile post-prandial non-billous vomiting. Though he had no hematemesis, he had history of passage of malaena. The patient was fully conscious on admission, pale, wasted with a markedly tender epigstric region. He was tachycardic with a minimal elevation in blood pressure level of 138/94mmHg. He had an international normalized ratio (INR) of 1.0. Oesophagogastroduodenoscopy was performed which showed a polypoid fungating mass at the1st extending to the 2nd part of the duodenum. A Computerized Tomogram scan of the abdomen showed a diffuse circumferential duodenal wall thickening of 1st and 2nd parts (more in 2nd part) with reduction in luminal calibre of duodenum and mildly dilated pancreatic, common bile, common hepatic ducts. Multiple biopsies were taken for histology which showed moderately differentiated aadenocarcinoma. Surface epithelium composed of columnar epithelial cells which can be seen in the top right of the image below with an invasive tumour, seen infiltrating the lamina propria in the lower left. He went on to have an exploratory laparotomy with triple bypass involving a side to side gastrojejunal anastomosis and cholecystojejunostomy and entero-enterotomy folowing which he went on to receive chemotherapy. As of the time of this write up the patient has recuperated well following his treatment.

Aortoesophageal fistula with hemorrhagic shock successfully treated with resuscitative endovascular balloon occlusion of the aorta

BackgroundAortoesophageal fistula (AEF) is a rare cause of upper gastrointestinal hemorrhage. Despite diagnostic and therapeutic advances, the mortality rate in AEF patients remains high because of its fulminant course, even with maximal intensive care. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a resuscitation technique to control life-threatening bleeding. It has become an important modality in the management of life-threatening, traumatic or non-traumatic, arterial bleeding. However, it’s use in hemorrhagic shock caused by cancer has rarely been reported.Case presentationA 51-year-old woman with a history of esophageal cancer presented to our emergency department with hematemesis. Computed tomography was performed because of a strong suspicion of hemorrhagic shock. With a diagnosis of AEF due to esophageal cancer, emergency thoracic endovascular aortic repair was performed while the bleeding was controlled using REBOA. Staged elective esophageal reconstruction was successfully performed.ConclusionsHemostasis is crucial in patients who present with suspected hemorrhagic shock attributable to AEF. The timely implementation of REBOA has shown promise and potential effectiveness in such cases.

Uncommon cause of upper gastrointestinal bleeding: Spontaneous large gastric intramural hematoma

Uncommon cause of upper gastrointestinal bleeding: Spontaneous large gastric intramural hematoma

Esophagitis dissecans superficialis: a rare cause of upper GI bleeding

BackgroundEsophagitis dissecans superficialis (EDS) is a rare desquamative esophageal condition with a wide range of presentations, from asymptomatic cases to those with severe, life-threatening symptoms. EDS has a strong association with several conditions, such as autoimmune diseases, smoking, and certain medications, although it can also occur without any apparent cause (idiopathic). Diagnosis involves a comprehensive approach, including clinical assessment (history and examination), endoscopic examination, histopathological analysis, and the exclusion of other potential causes. There is still no established standard treatment for EDS, as many cases resolve spontaneously without long-term complications.Case presentation.We present a case of a 73-year-old female with an episode of upper gastrointestinal bleeding (UGIB) due to Esophagitis dissecans superficialis, which had a favorable outcome after therapy with a proton pump inhibitor (PPI).ConclusionAlthough EDS is a rare condition, it should be considered a cause of UGIB in patients with risk factors.

Beyond the usual suspects: an unusual cause of upper gastrointestinal bleeding in alcohol-related liver disease

Beyond the usual suspects: an unusual cause of upper gastrointestinal bleeding in alcohol-related liver disease

Transcatheter embolization for duodenal ulcer bleeding originating from cystic artery erosion

BackgroundUlcer erosion into the cystic artery is a rare cause of bleeding in duodenal ulcers, with only a limited number of cases described in the literature. Historically, treatment has predominantly involved surgical intervention. We present three cases of duodenal ulcer bleeding due to cystic artery erosion, which were successfully managed with cystic artery embolization.Case presentationThis case series includes three male patients with duodenal ulcer bleeding, aged 90, 81, and 82 years, respectively, and no prior history of biliary system disorders. The ulcer locations were identified as two in the post-bulbar region and one in the anterior bulb. After the failure of medical and endoscopic treatment, transcatheter arterial embolization was adopted. Initial angiography did not reveal any contrast medium extravasation. Empirical embolization of the gastroduodenal artery using gelatin sponge particles and coils failed to achieve hemostasis. Super-selective cystic artery angiography confirmed the source of bleeding as the cystic artery. One patient was embolized with gelatin sponge particles and coils, while the other two patients were embolized with N-butyl-cyanoacrylate. All patients achieved successful hemostasis without gallbladder infraction.ConclusionsCystic artery embolization proved to be a minimally invasive technique for achieving hemostasis in these cases, indicating that it may be a safe and effective alternative to surgery for this uncommon cause of upper gastrointestinal bleeding. Validation through further studies is warranted.

Systematic review and meta-analysis of endoscopic versus medical management of peptic ulcers with adherent clots.

Peptic ulcer disease is an important cause of upper gastrointestinal bleeding. Current guidelines recommend endoscopic treatment for ulcers with active bleeding or non-bleeding visible vessels, but the optimal management of ulcers with adherent clots is unclear. We performed a systematic review of the efficacy of endoscopic versus medical management of peptic ulcers with adherent clots. A systematic literature search was performed through September 2022 (MEDLINE, Embase, and CENTRAL). Randomized controlled trials (RCTs)comparing the effect of endoscopic versus medical management alone for peptic ulcers with adherent clots on the outcome of recurrent bleeding were incuded. A random-effects meta-analysis was performed to estimate the overall treatment effect. We included seven RCTs reporting on the endoscopic versus medical management of peptic ulcers with adherent clots. The pooled cohort comprised 268 patients with a mean age of 62.8years and a mean follow up of 20days. There was a significant reduction in the risk of recurrent bleeding with endoscopic hemostatic treatment for peptic ulcers with adherent clots, compared with medical management alone (risk ratio [RR]=0.40, 95% confidence interval [CI] 0.16-0.95, 268 participants). However, there was no difference in mortality (RR=0.90, 95% CI 0.23-3.59, 52 participants) or need for ulcer surgery (RR=0.48, 95% CI 0.10-2.28, 52 participants) between endoscopic and medical management groups. In summary, there was evidence for a reduction in recurrent bleeding from peptic ulcers with adherent clots treated with endoscopic hemostatic techniques compared with medical management alone but no difference in rates of mortality or need for surgery.

Frequency of Different Causes of Upper GI Bleed Using Endoscopic Procedure

Background: Upper gastrointestinal (GI) bleeding is a significant clinical emergency that necessitates swift and precise diagnostic and therapeutic interventions. Due to its diverse etiologies, ranging from peptic ulcers to variceal bleeding, understanding these causes is crucial for effective management. Objective: To evaluate the prevalence of various causes of upper GI bleeding through endoscopic examination. Methods: This descriptive cross-sectional study was conducted at the Department of Gastroenterology, Asian Institute of Medical Sciences (AIMS), Hyderabad, involving 150 hemodynamically stable patients who had fasted for 6 to 8 hours. A comprehensive physical examination and detailed medical history preceded the endoscopic procedures. Data were captured on a structured proforma and analyzed using SPSS software, version 26.0. Results: The cohort's mean age was 50.35 years (range 18-85 years), with a male predominance of 72%. Variceal bleeding was the most common finding (64.7%), followed by peptic ulcers (24%), Mallory-Weiss tears (12.7%), vascular anomalies (13.3%), gastric ulcers (7.3%), duodenal ulcers (6%), erosive gastritis (3.3%), and esophagitis (2.7%). Conclusion: Upper GI bleeding predominantly affects older adult males, with variceal bleeding accounting for about two-thirds of cases. The diversity of underlying causes highlights the need for accurate diagnostics and tailored treatments for high-risk groups.

Ulcer Bleeding in the United States: Epidemiology, Treatment Success, and Resource Utilization.

Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting. Retrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients' demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis. A total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs. The ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.

Aortoesophageal fistula with formation of secondary aortic pseudoaneurysm due to esophageal neoplasia: case report

Aortoesophageal fistula as a cause of upper gastrointestinal bleeding is a very rare event with a high immediate mortality rate. Some of the causes include foreign bodies, post-surgical complications, and malignancy. The following case describes how esophageal cancer invaded the walls of the descending aorta, leading to the formation of a pseudoaneurysm that subsequently fistulized into the esophagus, secondary to radiotherapy treatment. This case highlights the importance of evaluating the thoracic aorta before and during radiotherapy treatments, to investigate the existence of aortic vascular compromise adjacent to the esophagus. If the existence of an aortic pseudoaneurysm is detected, radiotherapy treatment should be suspended until the pseudoaneurysm is corrected, reducing the lethality of patients undergoing advanced treatments.

A201 AORTO-ESOPHAGEAL FISTULA AS A COMPLICATION OF ESOPHAGEAL VARICEAL BANDING

Abstract Aims This is the first reported case of bleeding from an aorto-esophageal fistula as a consequence of ischemic esophageal ulceration post esophageal variceal banding. Methods A 46-year-old male presented with epigastric pain for one-week, which was not associated with fever, jaundice, or symptoms of GI bleed. He was hemodynamically stable with an unremarkable exam and basic labs. He underwent a CT scan which showed chronic portal vein thrombosis extending from the main portal vein into the superior mesenteric vein and evidence of portal hypertension, along with massive esophageal varices. Anticoagulation was not started due to risk of GI bleed. Upper endoscopy confirmed the presence of three columns of large esophageal varices in the distal and mid esophagus, the largest was 3 cm in size. There was no stigmata of recent bleeding and no gastric varices. Seven bands were applied. CT abdomen was repeated on the seventh day of admission, showing extension of portal vein thrombosis. As such, the thrombosis team started a low dose of anticoagulation. (dalteparin 7500 IU). He tolerated it well and showed no signs of bleeding prior to discharge. The day after discharge, the patient presented again with an episode of melena. Examination was remarkable for tachycardia, hypotension and melena. Hemoglobin was stable. Patient was admitted with impression of upper GI bleed most likely secondary to post banding ulcer. He was started on medical therapy. Anticoagulation was held. Next day, the patient had an episode of hematemesis with large amount of blood and clots. Emergent upper endoscopy showed active bleeding in the distal esophagus. Further examination showed a full-thickness, 7 mm defect in the lower esophagus with fresh red blood emptying from it into the esophagus (Figure 1). Thoracic surgery was consulted and suspected a perforated esophageal ulceration at the site of previous banding, with an aorto-esophageal fistula. Patient deteriorated immediately and passed away. The cause of death was cardiac arrest secondary to acute blood loss anemia. Results AEF is a recognized cause of upper GI bleeding with a high mortality rate. While rare, it can occur secondary to ischemic esophageal ulcer post EV banding. Conclusions This is the first reported case of an aorto-esophageal fistula as a consequence esophageal variceal band ligation. While extremely rare, this complication should be considered as a potentially fatal complication of variceal banding, especially in the setting of a diseased or previously repaired aorta.

A155 METASTATIC EPITHELIOID ANGIOSARCOMA AND RECURRENT GASTROINTESTINAL BLEEDING: A CASE REPORT

Abstract Background Angiosarcomas are aggressive tumors of the vascular endothelium that represent less than 3% of all sarcomas. Epithelioid angiosarcomas are a distinct subtype, and in exceedingly rare circumstances can involve the gastrointestinal tract leading to significant bleeding. Aims Report a case of metastatic epithelioid angiosarcoma as a cause of recurrent gastrointestinal bleeding and the utility of endoscopy in obtaining a diagnosis. Methods A retrospective case report. Results A 71 year old female with a history of type two diabetes and coronary artery disease presented to a peripheral hospital with a two week history of fatigue, abdominal pain, and intermittent fevers for which she was diagnosed with pyelonephritis. Computed tomography (CT) scan of the abdomen/pelvis was unremarkable on admission. Her stay was complicated by cardiac ischemia prompting the initiation of dual antiplatelet therapy and anticoagulation. After a few days she developed melena and an acute hemoglobin drop requiring red blood cell (RBC) transfusion. Gastroscopy revealed a few superficial erosions in the stomach and duodenum. She went on to develop hypercalcemia prompting a repeat CT abdomen/pelvis which showed multiple lytic bone lesions, innumerable small lung nodules, and areas of hypoattenuation in the liver. Contrast enhanced MRI abdomen was performed to better assess the liver, showing a geographic area of signal abnormality without mass like features. The patient was transferred to a tertiary centre for ongoing work-up and management. Shortly after arrival, a bone biopsy from a lytic lesion of the iliac crest was taken. Initial histopathology was inconclusive for malignancy. During this time, she had ongoing melena and need for intermittent RBC transfusions. Enteroscopy revealed multiple centrally ulcerated, hemorrhagic, erythematous/purpuric lesions throughout the stomach and proximal small bowel (Figure 1a). A duodenal lesion with fresh clot was clipped and multiple biopsies were taken from the stomach and duodenum. Histopathology from a gastric biopsy confirmed the diagnosis of epithelioid angiosarcoma (Figure 1b). PET scan revealed uptake in bone, lungs, and liver. The patient received 1 cycle of palliative chemoradiation, however this was discontinued due to frailty. Overt bleeding and intermittent RBC transfusions continued. The patient was transferred to full comfort care and died within 4 months of initial presentation to hospital. Conclusions Epithelioid angiosarcoma involving the gastrointestinal tract should be considered as a cause for upper gastrointestinal bleeding. Our case highlights the endoscopic characteristics and the importance of endoscopic biopsy in obtaining a histopathologic diagnosis. Figure 1a. Enteroscopy showing metastatic angiosarcoma to the stomach and small bowel. A. Gastroesophageal junction; B. Cardia and fundus; C. Duodenal bulb; D. Second portion of duodenum. Figure 1b. Metastatic epithelioid angiosarcoma to the stomach. A-B. Low and medium power H&E; C. Cytokeratin AE1/3; D. Ber-EP4; E. CD31; F. ERG. Funding Agencies None

Endoscopically resected duodenal lipoma as an uncommon cause of upper gastrointestinal bleeding: a case report

Endoscopically resected duodenal lipoma as an uncommon cause of upper gastrointestinal bleeding: a case report

Causes and outcomes of upper gastrointestinal bleeding in referral hospitals in Rwanda: a prospective study

INTRODUCTION: Upper gastrointestinal (GI) bleeding is a common emergency that results in significant morbidity and mortality. In Rwanda, data on causes and outcomes are lacking. The aim of this study was to identify the causes and outcomes of upper gastrointestinal bleeding in patients referred to tertiary referral centers.
 METHODS: This is an observational prospective study for which we enrolled all patients who presented with presumed upper gastrointestinal bleeding and underwent upper gastrointestinal endoscopy. We studied causes and outcomes during 3 months of follow-up after initial presentation from February 2019 to September 2019.
 RESULTS: We enrolled 194 participants. The mean age was 49.6 ± 17.66 years. The common causes of upper GI bleeding were peptic ulcer disease in 82 (43.3%) patients, esophageal varices 32 (16.5%), gastric malignancies 22 (11.3%), and gastritis 21 (10.8%). The upper GI endoscopy was reported to be normal in only 20 cases (10.3%). The mortality and rebleeding rates after 3 months were 37 (19.07%) and 70 (36%) respectively. The esophageal varices were associated with increased rebleeding (OR: 10.791, P value <0.001), while gastric cancer was associated with increased mortality (OR: 4.405, P value 0.008).
 CONCLUSION: Upper gastrointestinal bleeding is a considerable problem in Rwandan teaching hospitals. Our findings are in agreement with the reported causes of upper GI bleeding worldwide. From this study, we consider that variceal hemorrhage and peptic ulcer may have the potential to be better managed.

Clinical and Endoscopic Profile of Upper Gastrointestinal Bleed Patients

Background: Acute upper gastrointestinal (UGI) bleeding is a common medical condition, potentially lifethreateningemergency presents with hematemesis and/or melena. The hospitalization rate for UGIB is estimatedto be six-fold higher than for lower GI bleeding. The incidence of UGIB is significantly higher in men than inwomen and increases with age. In the present study, we aim to address the clinical profile and endoscopic profile,in patients with upper gastrointestinal bleeding.Methods and Results: This was a cross-sectional study conducted for 22 months at a tertiary care center in a ruralpart of Northern India. Patients admitted with a history of hematemesis and melena, satisfying the inclusioncriteria were taken consecutively. Clinical and endoscopic profiles were noted. Statistical analysis was performedusing a chi-square test for qualitative variables and an independent t-test for quantitative variables.A total of 190 patients were studied during this period. The male-to-female ratio in the study was 3.4:1. The meanage was 43.7±15.42 years, ranging between 17 to 82 years.The most common clinical presentation was Malena in 77 patients (40.5%) followed by haematemesis and melenain 71 patients (37.4%) and 42 patients (22.1%) presented with only hematemesis. The most common cause ofendoscopy was portal hypertension-related oesophageal and gastric varices (52.63%) followed by antral gastritis(15.26%). The cause of UGI bleeding could not be identified in 5.26% in which the endoscopy was normal.Conclusion: The most common causes of UGI bleed are portal hypertension-related gastric and oesophagealvarices. The in-hospital mortality in the study was 7.82%.

Management of Antithrombotic Agents During Emergency Endoscopy for Upper Gastrointestinal Bleeding: A Propensity Score Matching Analysis

Background/Aims: This study is aimed at comparing the outcomes of upper gastrointestinal bleeding (UGIB) during emergency endoscopy between patients taking and not taking antithrombotic agents to inform antithrombotic management.Methods: We conducted a retrospective analysis of 389 patients who underwent emergency endoscopy for UGIB from 2016 to 2021. The patients were categorized into group A (taking antithrombotic agents) and group NA (not taking antithrombotic agents). The clinical characteristics, types of antithrombotic agents, patient status upon admission, and causes of UGIB were examined. Treatment outcomes and adverse events were assessed by propensity score matching (PSM).Results: Group A was significantly older and the primary antithrombotic agent was low‐dose aspirin, with multiple antithrombotics taken by 38 patients (29.0%). Peptic ulcers were the most common cause of UGIB in both groups. PSM generated 83 matched pairs. The success rate of endoscopic hemostasis in group A was significantly higher than in group NA (96.4% vs. 84.3%, P = 0.02). Despite promptly resuming antithrombotic agent posthemostasis, there was no significant difference in the rebleeding rate or 30‐day mortality.Conclusion: The high success rate of endoscopic hemostasis and no difference in adverse events made the prompt resumption of antithrombotic medications after emergency endoscopy for UGIB acceptable.Trial Registration: ClinicalTrials.gov identifier: UMIN000053561

Turn over the new leaf of the treatment in peptic ulcer bleeding: a review of the literature.

Peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, which has a high mortality risk. The standard therapy for acute peptic ulcer bleeding combines medication administration and endoscopic therapies. Both pharmacologic and endoscopic therapies have developed continuously in the past few decades. Proton pump inhibitors (PPIs) already reached a high efficacy in ulcer healing and have been widely used in the past few decades. Endoscopic hemostasis, which includes local epinephrine injection, heater probe coagulation, use of hemostatic clips, and/or band ligation, is highly effective with an overall hemostatic success rate of 85%-90%. However, 10%-20% of patients could not be cured by the current standard combination treatment. Recurrent ulcer bleeding, despite an initial successful hemostasis, is also a big problem for longer hospitalization stays, higher mortality, and higher complication rates, especially for malignant ulcer bleeding. How to manage all types of peptic ulcer bleeding and how to prevent early recurrent peptic ulcer bleeding remain unresolved clinical problems. Recently, several novel medications and endoscopic methods have been developed. Potassium competitive acid blockers have shown a stronger and longer acid suppression than PPI. Hemostatic powder spray and hemostatic gel emulsion are novel hemostatic weapons with emerging evidence, which are potential missing pieces of the puzzle. This literature review will go through the development of endoscopic hemostasis to the prospects of novel endoscopic treatments.

Clinicoetiological profile of patients with gastrointestinal bleed presenting to a tertiary care hospital in Kumaon Region of Uttarakhand

Background: Gastrointestinal (GI) bleed is a common cause of medical emergency resulting in significant morbidity and mortality. GI bleeding can be classified as upper (bleeding source proximal to the ligament of Treitz) and lower (bleeding source distal to the ligament of Treitz). Aims and Objectives: The present study was aimed to determine the current clinicoetiological profile of GI bleeding in Kumaon Region of Uttarakhand. Materials and Methods: All patients presented with GI bleed (GIB) to outpatient department and Emergency department or developed the GIB during hospitalization are managed in intensive care unit (preferably) and high-dependency unit. Results: Both upper and lower GI endoscopy were twice normal in 2.7% of patients (obscure bleeding). On upper GI endoscopy findings showing esophageal varices (45.83%), gastroesophageal varices (8.33%), isolated gastric varices (8.33%), gastric ulcer (8.33%), duodenal ulcer (6.25%), Mallory-Weiss tear (6.25%), erosive gastritis (6.25%), gastric antral vascular ectasia (4.16%), gastric carcinoma (4.16%), and Dieulafoy’s lesion (2.08%). Upper GIB (UGIB) had more mortality than lower GIB, among UGIB variceal bleed having higher mortality than non-variceal bleeding. Conclusion: Unlike the evidence from the west that peptic ulcer is the most common cause of upper gastrointestinal bleeding, we found varices as the common cause, followed by peptic ulcer and erosive gastritis. Hence, the variable spectrum of the etiology of the GIB seen in our country could represent either a true epidemiological difference or reflect skewed access to health care.