Cause Of Upper Gastrointestinal Bleeding Research Articles

Etiology of gastrointestinal bleeding in children referred to pediatric wards of Mashhad hospitals, Iran.

BackgroundGastrointestinal (GI) bleeding, which has several clinical manifestation and origins, is known as one of the most life-threatening events in children. Several etiologies have been suggested for GI bleeding.ObjectiveTo determine the most important causes of GI bleeding in children referred to Ghaem Hospital and Dr. Sheikh Hospital, Mashhad, Iran.MethodsIn this cross-sectional study, after obtaining written informed consent of their parents, 113 patients aging from newborn infants to 18-year-old children with GI bleeding admitted to Ghaem Hospital and Dr. Sheikh hospital were enrolled in this study from June 2012 to June 2014. After performing routine diagnostic and therapeutic procedures, a checklist containing all necessary information including demographic data, clinical history of patients, endoscopy and pathology findings, clinical and preclinical information were collected. The data were then analyzed using Statistical Package for the Social Sciences (SPSS) version 16.ResultsOf a total 113 study children, 61 (54%) were male and 52 (46%) were female. The results of this study showed that the most important causes of bleeding in upper GI among all admitted patients were prolapse gastropathy (18.6%), esophagitis (15.9%) and esophageal varices, gastritis, and coagulopathy (7.1% for each). The main causes of lower GI bleeding were polyp (32.5%), chronic nonspecific colitis (20.7%), and proctitis (18.2%).ConclusionFindings of this study indicated that prolapse gastropathy and esophagitis are more prevalent causes of upper GI bleeding. Furthermore, esophageal varices were more common in children older than 13 years. Polyp, chronic nonspecific colitis and proctitis are the most prevalent causes of lower GI bleeding.

Refractory Gave Treated with Radiofrequency: Two Cases of Complete Response

Gastric antral vascular ectasia (GAVE) is an uncommon cause of upper gastrointestinal bleeding. Up to date, standard of care of GAVE is endoscopic treatment with argon plasma coagulation (APC) or endoscopic band ligation (EBL). Despite good technical efficacy of these techniques, approximately two third of patients remain dependent on blood transfusions after therapy. One of the emerging and more promising endoscopic treatments for GAVE is radiofrequency ablation (RFA) with focal catheters (e.g. HALO90 and HALOULTRA).

Clinical features of hemobilia in unresectable pancreatic cancer (uPC).

247 Background: Hemobilia is a life-threatening, although rare event in uPC patient(pt)s. However, there are few reports about it. The purpose of this study was to identify it’s clinical features in uPC at our institute. Methods: Data of 2066 pts who received treatment for uPC between April 2008 and August 2017 were reviewed retrospectively from the electronic medical records. Hemobilia was determined when extravasation was detected from the biliary tree artery on contrast-enhanced computed tomography (CT) or angiography. Blood clot seen in the bile duct on endoscopy was also included. Pts whose bleeding was diagnosed due to tumor invasion of the stomach or duodenum by endoscopy were excluded. CT and angiography were reviewed by an experienced radiologist. Results: Eleven pts developed hemobilia; there were no pts before 2013. All of them received gemcitabine plus nab-paclitaxel (GnP) as first-line chemotherapy. Eight pts developed hemobilia during GnP, three had it after disease progression. Every pt had at least one symptom of Quinke’s triad; upper gastrointestinal hemorrhage (n = 8, 73%), biliary colic (n = 4, 36%), and jaundice (n = 6, 55%). The median time to hemobilia after the start of GnP was 198 days (range: 43-559 days). A covered self-expanding metal stent (cSEMS) was placed in the lower common bile duct in all pts. The median time to bleeding after cSEMS placement was 87 days (range: 30-467 days). Eight pts showed pseudoaneurysm(PA). In 7 of these pts, were diagnosed by CT, the remaining by interventional radiology(IR). IR was employed initially in 6 of the 8 pts, and hemostasis was successful in all. Two pts underwent cSEMS placement and was unsuccessful in both. Of these 2 pts, one underwent IR, with successful hemostasis. Of the remaining 3 pts, 2 pts had hemostasis without treatment, and one had cSEMS placement that was successful for hemostasis. Conclusions: In our study, hemobilia was only seen after 2014. Hemobilia developed after the start of GnP in all of the pts. Pts who showed PA, successful hemostasis was obtained in all cases that underwent IR. Hemobilia should be kept in mind as a cause of upper GI bleeding in uPC pts, especially those with a biliary stent and history of GnP. IR was effective for the management of hemobilia associated with PA.

The Importance of Endoscopy as a Useful Method for Diagnosis of Upper Gastrointestinal Bleeding in Children

Background: Upper gastrointestinal bleeding (UGIB) is recognized as a life-threatening emergency condition among children and parents, which requires prompt assessment. The purpose of this study was to determine the role of upper endoscopy in determining the cause of UGIB in a pediatric population. Methods: In this retrospective study performed at Ali-Ibn-Abi-Taleb hospital, records of all children with UGIB (below 14 years) were evaluated. Subjects with incomplete information were excluded from the study. Results: A total of 101 patients with the mean ± SD age of 6.8 ± 3.99 years were included in this study (45 females, 56 males). The clinical presentations included hematemesis in 77 (76%) cases, melena in 6 (5.9%) cases, and both in 18 (17.8) cases. The upper endoscopy showed a high diagnostic yield (90%) in determining the cause of UGIB. The most common source of bleeding was esophageal varices in 32 (31.7%) children, followed by peptic ulcer disease (n, 17; 16.8%), gastritis (n, 11; 10.9%), and hiatal hernia. No cause of UGIB was found in 10 (9.9%) cases. Conclusions: Esophageal varices and peptic ulcer disease were the most common causes of UGIB in our center. Considering the valuable role of endoscopy in the diagnosis and treatment of UGIB, early referral to a hospital with pediatric endoscopy is recommended.

Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children's Hospital Experience.

The aim of this study was to review the aetiology, presentation and management of these patients with upper gastrointestinal bleeding (UGIB) at a tertiary children’s unit in the United Kingdom. This was a retrospective single-institution study on children (<16 years) who presented with acute UGIB over a period of 5 years using known International Classification of Diseases (ICD) codes. A total of 32 children (17 males, 15 females) were identified with a total median age at presentation of 5.5 years. The majority (24/32) of patients presented as an emergency. A total of 19/32 presented with isolated haematemesis, 8/32 with isolated melaena and 5/32 with a combination of melaena and haematemesis. On admission, the mean haemoglobin of patients who presented with isolated haematemesis was 11 g/dL, those with isolated melaena 9.3 g/dL and those with a combination 7.8 g/dL. Blood transfusion was required in 3/19 with haematemesis and 3/5 with haematemesis and melaena. A total of 19/32 underwent upper gastrointestinal endoscopy. Endoscopic findings were oesophageal varices (5/19) of which 4 required banding; bleeding gastric ulcer (1/19) requiring clips, haemospray and adrenaline; gastric vascular malformation (1/19) treated with Argon plasma coagulation therapy; duodenal ulcer (3/19) which required surgery in two cases; oesophagitis (5/19); and gastritis +/− duodenitis (3/19). A total of 13/32 patients did not undergo endoscopy and the presumed aetiology was a Mallory–Weiss tear (4/13); ingestion of foreign body (2/13); gastritis (3/13); viral illness (1/13); unknown (2/13). While UGIB is uncommon in children, the morbidity associated with it is very significant. Melaena, dropping haemoglobin, and requirement for a blood transfusion appear to be significant markers of an underlying cause of UGIB that requires therapeutic intervention. A multi-disciplinary team comprising gastroenterologists and surgeons is essential.

Spectrum of upper gastrointestinal bleed in patients with cirrhosis of liver

Background &amp; Objectives:Acute upper gastrointestinal (UGI) bleeding is a serious medical problem in patients with cirrhosis of liver associated with high mortality. Gastro-oesophageal variceal bleed is the most common complication of portal hypertension in patient with liver cirrhosis. This study was undertaken to establish the causes of UGI bleed in cirrhosis, their relative incidences, clinical presentation , endoscopic findings, outcomes during hospitalization including rebleeding and mortality were studied.Materials &amp; Methods:One hundred and twenty patients with clinical features, sonological and endoscopic evidence of portal hypertension and cirrhosis of liver who presented with upper gastrointestinal bleed were included in the study. After haemodynamic stability, each patient underwent UGI endoscopy usually within 12 hours and the aetiology with diagnostic findings were documented. Results:Ruptured oesophageal varices was the most common cause of UGI bleed in cirrhotic patients. Non variceal causes of UGI bleed accounted for 33.3 % of cases. The majority of non variceal bleed was peptic ulcer disease and accounted for 19.2 % of total UGI bleed in liver cirrhosis. This was followed by portal hypertension gastropathy, erosive gastropathy, mallory-weiss tear and others.Conclusion:The most frequent causes of acute gastrointestinal bleeding in cirrhosis was oesophageal varices. Peptic ulcer disesase is also a common aetiology of UGI bleed in cirrhosis. Cirrhotic patients with variceal etiology have more chances of rebleeding and have higher mortality than those with non variceal aetiologies.

Hemosuccus Pancreaticus and Hematochezia: An Unusual Presentation of a Rare Disease

Gastrointestinal bleed (GIB) is a major reason of hospitalization and can lead to worsened morbidity and mortality. Hemosuccus pancreaticus (HP) is a rare cause of upper GIB observed in patients with chronic pancreatitis, pancreatic pseudocysts, or pancreatic tumors. Patients with HP usually present with intermittent epigastric pain and GIB, most commonly hematemesis or melena, but rarely, may have hematochezia. We present a patient with recurrent GIB episodes whose evaluation revealed HP. A 52-year-old gentleman with history of excessive alcohol use was evaluated for recurrent abdominal pain and hematochezia. He had undergone esophagogastroduodenoscopy (EGD), colonoscopy, deep anterograde and spiral retrograde endoscopies as well as two Meckel scans with negative evaluation. Finally, intra-operative enteroscopy revealed a few non-bleeding small angioectasias in the jejunum and ileum that were ligated. However, the patient presented again with hematochezia. Initial CT scan of the abdomen was concerning for chronic pancreatitis change and a hypervascular lesion at the junction of the body and tail of the pancreas. He had no prior history of acute pancreatitis. Subsequent CT angiography revealed a 7mm mid-splenic artery saccular aneurysm arising from the inferior wall of the splenic artery, abutting the tail of the pancreas with pancreatic duct dilatation. Selective angiography with embolization was performed at this lesion. The procedure was complicated by downstream migration of the coils into the splenic artery bifurcation resulting in segmental splenic infarction. He has had no further bleeding and his condition and hemoglobin have been stable since the procedure. Follow up endoscopic ultrasound (EUS) showed chronic pancreatitis changes, there was no mass lesion. GIB from HP usually results when a direct communication is established between the blood vessel and pancreatic duct as a result of erosion. Intermittent abdominal pain and GIB are hallmarks for this disease. Abdominal CT usually establishes the diagnosis but it can also be confirmed by MRCP, ERCP or intra-operatively. Angiography with coil embolization is the initial treatment which was also successful in our patient. Our patient was unique in that he presented with recurrent hematochezia, which is uncommon in this rare disorder. This case demonstrates that HP should be considered in patients with GIB, particularly in those with a pancreatic disorder and negative evaluation of more common causes.Figure: Angiogram of splenic artery revealing pseudoaneurysm off of the mid splenic artery.Figure: Angiogram of the splenic artery after successful coil embolization.Figure: CT angiogram reveals mid-splenic artery pseudoaneurysm.

Downhill Esophageal Varices: A Rare and Potentially Correctable Cause of Serious Gastrointestinal Bleeding

Instances of downhill esophageal varices are rare in the literature, and the optimal management strategy when they are found is not well known. In the reported cases, a catheter-associated thrombus of the upper venous system is often implicated as the cause of the varices, which then form due to collateral flow. We present the hospital course of a patient found to have downhill varices. A 65 year old female with history of stage IIIB colorectal cancer (status post right hemicolectomy with end ileostomy formation and curative chemotherapy; still with chest port) presented to our institution with several episodes of melena through her ostomy over the preceding day. She was hemodynamically stable on admission, and hemoglobin was 10.8 gm/dL (baseline 12.8 gm/dL). A CT of the chest with intravenous contrast was performed due to shortness of breath, and a large thrombus was seen involving the right innominate vein, superior vena cava, and azygos vein. The patient's chest port had retracted and now terminated in the superior vena cava. An esophagogastroduodenoscopy (EGD) was performed, and innumerable grade III varices (one with a white nipple sign; no active bleeding) were found in the proximal and mid esophagus; it was otherwise normal. Banding was not performed. Ileoscopy showed melena only. Three days later, interventional radiology performed a thrombectomy of the large venous clot and placed a superior vena cava stent to ensure continued flow. The chest port was removed. The patient was placed on therapeutic anticoagulation due to the stenting. Repeat EGD was performed due to a continued slow drift downward in hemoglobin. The EGD revealed only one small varix in the proximal esophagus (no high risk stigmata; no banding performed). The patient's hemoglobin stabilized, and patient had no further melena. She was discharged on a therapeutic dose of enoxaparin. The outcome in this case reinforces the notion that prompt revascularization should be a high priority in patients with downhill varices. Even though this patient received a procedure that required therapeutic anticoagulation only days after a variceal bleed, she is now at low risk for further bleeding, as her varices almost completely collapsed within one day of the intervention. This case highlights a rare but serious cause of upper gastrointestinal bleeding, and how prompt intervention can be a lasting solution.Figure: Esophagoscopy of the proximal esophagus demonstrating grade III varices with white nipple sign (arrow).Figure: Esophagoscopy after interventional radiology guided thrombectomy and stenting of the superior vena cava; no residual varices seen.

Portal Hypertensive Duodenopathy in Decompensated Liver Cirrhosis: A Cause of GI Bleeding

Alcoholic cirrhosis and non-alcoholic fatty liver disease on the continuous rise in the United States, there is also a congruent rise in portal hypertension. Far more familiar complications of portal hypertension include esophageal varices, ascites and hepatorenal syndrome. Portal hypertensive duodenopathy is a rare but known consequence of portal hypertension, which serves as a potentially devastating source of gastrointestinal (GI) bleeding. A 46 year old man with a past medical history of Liver Cirrhosis (MELD 24, child pugh class B) complicated by esophageal varices presented with abdominal pain and hematochezia for the past 3 days. He reported worsening ascites and generalized malaise. Patient also reported associated chills, shortness of breath, lightheadedness, and decreased appetite. He undergoes frequent paracentesis for refractory ascites, last presentation 1 month prior. Patient endorsed diet and medication compliance. Physical exam was significant for ascites, generalized abdominal tenderness, and splenomegaly without rebound or guarding. Scant blood noted on rectal exam. Laboratory findings revealed stable hemoglobin of 12.4 g/dL, hematocrit of 36.8 %, platelet of 83 K/UL, leukocytosis of 15.4 K/UL with 78% neutrophils and 16% bands, sodium of 130 mmol/L, ammonia of 83 Umol/L, alanine aminotransferase of 40 U/L, aspartate aminotransferase of 42 U/L and alkaline phosphatase of 127 U/L. INR was 2.02. Diagnostic paracentesis revealed serosanguinous fluid, PMN count of 686 cells/mm3 consistent with culture negative neutrocytic ascites. Blood cultures obtained revealed no growth of organisms. Patient completed course of intravenous (IV) Ceftriaxone therapy. Endoscopy performed revealed erosions, mucosal edema and erythema with minimal oozing of blood in the duodenum. Colonoscopy and video capsule endoscopy revealed no active bleeding. Patient was referred for evaluation for transugular intrahepatic portosystemic shunt (TIPS) amidst significant complications of portal hypertension. Management of portal hypertensive duodenopathy with acute bleeding is same as in patients with other causes of upper GI bleed. Endoscopic thermal coagulation could be effective if bleeding lesions are identified. Clinicians should consider TIPS as a management strategy in patients with other significant complications of portal hypertension.Figure: EGD picture of duodenum with snake skin like picture of portal hypertensive duodenopathy.Figure: EGD picture of duodenum with snake skin like picture of portal hypertensive duodenopathy.Figure: EGD picture of duodenum with snake skin like picture of portal hypertensive duodenopathy.

Orthotopic liver transplantation changes the course of gastric antral vascular ectasia: a case series from a transplant center

Gastric antral vascular ectasia (GAVE) is an important cause of upper gastrointestinal bleeding and anemia in patients with cirrhosis. The aim of our study was to evaluate the effect of orthotopic liver transplantation (OLT) on GAVE and associated anemia. We performed a chart review and identified all cirrhotic patients with GAVE who underwent OLT at the University Of Alabama at Birmingham between 2005 and 2013. Population's demographics, etiology of cirrhosis, comorbidities, presentation and treatment modalities of GAVE, endoscopic and histopathologic reports, hemoglobin values before and after transplant, and immunosuppressive regimens were collected. Twelve patients were identified, mean age 52.4±4.4 years; seven were men (58.3%); 11 (91.7%) were White; and 6 of 12 patients had biopsy-proven GAVE. The most common etiology of cirrhosis in the cohort was chronic hepatitis C and obesity was the most common chronic condition in 50 and 83.3%, respectively. Anemia resolution was observed in 9/12 (75%) patients who underwent OLT with an increase in hemoglobin from 8.1±2.4 (5.7-13.1) before transplant to 12.0±1.4 (10-15) after transplant (P<0.0001). Esophagogastroduodenoscopy after transplant was performed in all 12 (100%) patients. The mean time between transplant and post-OLT esophagogastroduodenoscopy was 13.8±18.28 (2-57) months; complete resolution of GAVE was observed in 10 (83.3%) patients, with resolving GAVE in one (8.3%) patient. GAVE is an important cause of anemia and upper gastrointestinal bleeding in patients with liver cirrhosis. Our findings show that liver transplantation can resolve GAVE and related anemia.

Schwannom des Magens: seltene Differenzialdiagnose einer akuten oberen gastrointestinalen Blutung

Schwannomas are benign tumors derived from Schwann cells and their typical site of origin is the subcutaneous tissue of the extremities. Gastrointestinal localization of Schwannomas is extremely rare and the stomach is the prevalent site. Gastric schwannomas primarily occur in the gastric submucosa and are usually asymptomatic.We present a rare case of a solitary gastric schwannoma in a 51-year old male, which initially manifested with hematemesis by acute upper gastrointestinal (GI) bleeding. The upper GI-Endoscopy revealed a gastric submucosal tumor, 7 cm in size, located in the proximal corpus and fundus. In the endoscopical Ultrasound (EUS-Examination), the lesion appeared to arise from the fourth proper muscle layer (Muscularis propria). The fourth layer origin and the isoechogenicity, as compared to the normal muscle layer, are endoscopic ultrasonographic characteristics of gastric schwannomas and help in distinguishing them from gastrointestinal tumors (GIST). Because of the unclear histological identity, the patient underwent a "rendezvous" endoscopic-laparoscopic surgical resection of the tumor in toto. The histomorphological features of the lesion and the strong expression of S100 in combination with absence of DOG1 expression indicated the diagnosis of gastric schwannoma. There was no evidence of malignancy. The postoperative course was uncomplicated.This is a very rare manifestation of gastric schwannoma, representing a rare differenzial diagnosis in a case of acute upper GI-Bleeding. Only 14 % of gastric schwanommas are presented with gastrointestinal bleeding, including mainly melena rather than hematemesis. This case is considered to be worthy of presentation owing to the rare and unusual cause of upper GI bleeding implied in it.

Clinical epidemiological characteristics and change trend of upper gastrointestinal bleeding over the past 15 years

To investigate the clinical epidemiology change trend of upper gastrointestinal bleeding (UGIB) over the past 15 years. Consecutive patients who was diagnosed as continuous UGIB in the endoscopy center of The First Affiliated Hospital of Sun-Yat University during the period from 1 January 1997 to 31 December 1998 and the period from 1 January 2012 to 31 December 2013 were enrolled in this study. Their gender, age, etiology, ulcer classification, endoscopic treatment and hospitalization mortality were compared between two periods. In periods from 1997 to 1998 and 2012 to 2013, the detection rate of UGIB was 9.99%(928/9 287) and 4.49%(1 092/24 318)(χ2=360.089, P=0.000); the percentage of male patients was 73.28%(680/928) and 72.44% (791/1 092) (χ2=0.179, P=0.672), and the onset age was (47.3±16.4) years and (51.4±18.2) years (t=9.214, P=0.002) respectively. From 1997 to 1998, the first etiology of UGIB was peptic ulcer bleeding, accounting for 65.2%(605/928)[duodenal ulcer 47.8%(444/928), gastric ulcer 8.3%(77/928), stomal ulcer 2.3%(21/928), compound ulcer 6.8%(63/928)],the second was cancer bleeding(7.0%,65/928), and the third was esophageal and gastric varices bleeding (6.4%,59/928). From 2012 to 2013, peptic ulcer still was the first cause of UGIB, but the ratio obviously decreased to 52.7%(575/1092)(χ2=32.467, P=0.000)[duodenal ulcer 31.9%(348/1092), gastric ulcer 9.4%(103/1092), stomal ulcer 2.8%(30/1092), compound ulcer 8.6%(94/1092)]. The decreased ratio of duodenal ulcer bleeding was the main reason (χ2=53.724, P=0.000). Esophageal and gastric varices bleeding became the second cause (15.1%,165/1 092, χ2=38.976, P=0.000), and cancer was the third cause (9.2%,101/1 092, χ2=3.352, P=0.067). The largest increasing amplitude of the onset age was peptic ulcer bleeding [(46.2±16.7) years vs. (51.9±18.9) years, t=-5.548, P=0.000), and the greatest contribution to the amplitude was duodenal ulcer bleeding [(43.4±15.9) years vs. (48.4±19.4) years, t=-3.935, P=0.000], while the onset age of esophageal and gastric varices bleeding [(49.8±14.1) years vs. (48.8±13.9) years, t=0.458, P=0.648] and cancer [(58.4±13.4) years vs. (58.9±16.7) years, t=-0.196, P=0.845] did not change significantly. Compared with the period from 1997 to 1998, the detection rate of high risk peptic ulcer rebleeding (Forrest stage I(a, I(b, II(a and II(b) increased (χ2=39.958, P=0.000) in the period from 2012 to 2013. From 1997 to 1998, 54 patients underwent endoscopic treatment, and the achievement ratio of hemostasis was 79.6% (43/54). From 2012 to 2013, 261 patients underwent endoscopic treatment and the achievement ratio of hemostasis was 96.9%(253/261), which was significantly higher (χ2=23.287, P=0.000). Compared to the period from 1997 to 1998, more patients with variceal bleeding or non-variceal bleeding received endoscopic treatment in time (39.0% vs. 70.3%, χ2=51.930, P=0.000; 3.6% vs. 15.6%, χ2=62.292, P=0.000, respectively), and higher ratio of patients staging Forrest stage I(a to II(b also received endoscopic treatment in the period from 2012 to 2013 [27.4%(26/95) vs. 68.5%(111/162), χ2=40.739, P=0.000]. More qualified endoscopic hemostatic techniques were used, containing thermocoagulation (0 vs. 15.2%, χ2=79.518, P=0.000), hemostatic clip (0 vs. 55.9%, χ2=20.879, P=0.000), hemostatic clip combined with thermocoagulation (4.3% vs. 16.4%, χ2=5.154, P=0.023), while less single injection was used (87.1% vs. 6.2%, χ2=10.420, P=0.001), and single spraying for hemostasis was completely abandoned in the period from 2012 to 2013. The ratio of inpatients undergoing reoperation decreased obviously in the period from 2012 to 2013 [9.3%(86/928) vs. 6.0%(65/1092), χ2=7.970, P=0.005], while no significant difference was found in mortality during hospitalization between two periods. Compared with the period from 1997 to1998, the mean onset age of UGIB increased, and the ratio of peptic ulcer bleeding decreased due to the reduction of duodenal ulcer bleeding, the detection rate of high risk peptic ulcer rebleeding increased, the cure rate of endoscopic treatment for UGIB increased, more reasonable and immediate hemostatic methods were used, but overall mortality did not change obviously in the period from 2012 to 2013.

Etiology and outcome in patients with upper gastrointestinal bleeding: Study on 4747 patients in the central region of Iran

Upper gastrointestinal bleeding (UGIB) is a threatening condition leading to urgent hospitalization. This study aims to investigate etiology and outcome in UGIB patients in Iran. Medical records of GIB patients admitted to Alzahra referral hospital (in Isfahan) during 2010-2015 were retrospectively reviewed for demographic data, comorbidities, history of smoking and taking non-steroidal anti-inflammatory drugs (NSAIDs), presenting symptoms, endoscopic findings, therapeutic endoscopy, blood products' infusion, surgical intervention, rebleeding, and mortality. A total of 4747 patients were enrolled in the study (69.2% men, mean age = 55.46 ± 21.98 years). Hematemesis was the most frequent presenting symptom (63.5%). Peptic ulcer (duodenal ulcer in most cases) was seen as the main reason for UGIB (42.4%). Rebleeding (present in 16.5% of patients) was found to be more frequent in patients with older age, presenting sign of hematochezia and hypotension, history of taking NSAIDs and smoking, presence of comorbidities, history of bleeding because of UGI tract neoplasm and esophageal varices, history of needing blood products' infusion, and history of therapeutic endoscopy or surgical intervention (P < 0.005). We found that mortality (5.5% in total) was also higher in the same group of patients that were seen to have a higher tendency for rebleeding (P < 0.005). Peptic ulcers are the most common cause of UGIB. Comorbidities, hemodynamic instability, high-risk endoscopic stigmata, history of smoking and taking NSAIDs, gastric and esophageal malignancies, may be important predisposing factors for rebleeding and mortality in patients with UGIB.

UPPER GASTROINTESTINAL BLEEDING;

Background: Upper gastrointestinal bleeding (UGIB) is a common medicalcondition requiring mostly hospitalization and resuscitation. Patients with upper GI bleedinghave high morbidity. The investigation of choice in upper GI bleeding is upper GI endoscopy,because endoscopy has good, the complication rate with endoscopy are low, anotheradvantage of using endoscopy is therapeutic interventions as well. The causes of upper GIbleeding are numerous most frequent causes being in decreasing order of frequency pepticulcer, esophageal varices, mallory-weis tears. Other causes include tumors, erosions andarterio-venous malformations.3 Objectives: To determine the endoscopic findings in patientspresenting with UGIB and frequency of various findings among these patients according togender and age in medical ward of Allied Hospital Faisalabad. Study Design: Retrospectivelyreviewed and analyzed. Setting: Medical Unit 2 of Allied Hospital Faisalabad. Period: 06 monthbetween January 2015 to June 2015. Methods: The record of 120 patients who underwentendoscopy for upper gastrointestinal bleeding. Results: Data was collected and entered onSPSS. Statistical data analysis was performed with chi-square. Statistical significance wasdetermined at P&lt; 0.05. Information obtained from upper gastrointestinal endoscopy werethen recorded according to age, gender and presented in form of tables. Conclusions: It hasbeen found that esophageal varices was the most commonest cause of upper gastrointestinalbleeding in the study probably due to the high prevalence of hepatitis infection and chronic liverdisease in our population.

Epidemiology of upper gastrointestinal bleeding and Helicobacter pylori infection: review of 3,488 Thai patients

Abstract Background The current epidemiology of upper gastrointestinal bleeding (UGIB) in Thailand is poorly understood and the reported prevalence of Helicobacter pylori infection is outdated. Objectives To investigate the etiologies of UGIB and prevalence of H. pylori infection in Thailand, including its association with UGIB. Methods We retrieved information regarding patients attending the endoscopic unit of King Chulalongkorn Memorial Hospital from June 2007 to January 2013. A database search using keywords “upper gastrointestinal bleeding” and “iron deficiency” was used. From 4,454 diagnoses, after exclusion criteria, 3,488 patients (2,042 male (58.5%) and 1,446 female (41.5%); mean age 63.3 ± 15.94 years, range 13–103 years) were included. Results The three most common causes of UGIB were peptic ulcer (38.2%), nonulcer-mucosal lesions (23.4%), and esophageal-related causes (20.4%). The 5 year-incidence of H. pylori was 25%–30%. The overall prevalence was 27%. The prevalence of H. pylori infection was found to decrease with age from 43.8% at &lt;40 years to 21.7% at &gt;79 years old. H. pylori infection was significantly associated with duodenal and gastroduodenal ulcers. Cirrhosis and nonulcer-mucosal lesions were significantly unrelated to H. pylori infection. Patients with concurrent cirrhosis with peptic ulcer were found to be negative for H. pylori infection. Conclusion Peptic ulcer is the leading cause of UGIB in Thailand. However, its incidence is declining. Patients who presented to hospital with UGIB were older, compared with those a decade ago. H. pylori infection plays an important role in UGIB and its incidence was stable during the past 5 years.

Etiological and Endoscopic Profile of Middle Aged and Elderly Patients with Upper Gastrointestinal Bleeding in a Tertiary Care Hospital in North India: A Retrospective Analysis.

Background:Upper gastrointestinal (GI) bleeding is a common medical emergency associated with significant morbidity and mortality. The clinical presentation depends on the amount and location of hemorrhage and the endoscopic profile varies according to different etiology. At present, there are limited epidemiological data on upper GI bleed and associated mortality from India, especially in the middle and elderly age group, which has a higher incidence and mortality from this disease.Aim:This study aims to study the clinical and endoscopic profile of middle aged and elderly patients suffering from upper GI bleed to know the etiology of the disease and outcome of the intervention.Materials and Methods:Out of a total of 1790 patients who presented to the hospital from May 2015 to August 2017 with upper GI bleed, and underwent upper GI endoscopy, data of 1270 patients, aged 40 years and above, was compiled and analyzed retrospectively.Results:All the patients included in the study were above 40 years of age. Majority of the patients were males, with a male to female ratio of 1.6:1. The most common causes of upper GI bleed in these patients were portal hypertension-related (esophageal, gastric and duodenal varices, portal hypertensive gastropathy, and gastric antral vascular ectasia GAVE), seen in 53.62% of patients, followed by peptic ulcer disease (gastric and duodenal ulcers) seen in 17.56% of patients. Gastric erosions/gastritis accounted for 15.20%, and duodenal erosions were seen in 5.8% of upper GI bleeds. The in-hospital mortality rate in our study population was 5.83%.Conclusion:The present study reported portal hypertension as the most common cause of upper GI bleeding, while the most common endoscopic lesions reported were esophageal varices, followed by gastric erosion/gastritis, and duodenal ulcer.

Upper Gastrointestinal Bleeding (UGB): Causes and Treatment

Aim: The upper gastrointestinal bleeding (UGB) are frequent reasons for urgent consultation. The aim of our study is to determine the causes of upper gastrointestinal Bleeding in patients in our department. Materials and Methods: A retrospective study over 6 years between June 2011 and March 2017 covering 683 patients with a Upper gastrointestinal bleeding collected at the Gastroenterology II department of the military hospital of Instruction Mohamed V Rabat Morocco. Results: The average age was 54 years, with a male dominance (75%). The causes of bleeding are dominated by gastroduodenal ulcers and rupture of oesophageal varices. The endoscopic hemostasis was performed in 22% of patients, ligation of esophageal varices in 13% of cases, adrenaline injection in 8%of cases, use of hemoclips in 2% of cases and argon plasma coagulation (APC) in 2% of cases. Conclusion: In our series Ulcerative pathology and portal hypertension are the main causes of upper gastrointestinal bleeding. The development of endoscopic hemostasis techniques has improved the prognosis of upper gastrointestinal bleeding.

Successful Treatment of Dieulafoy´s Gastric Lesion in a Critical Elderly Patient

Dieulafoy's lesion is a rare cause of upper gastrointestinal bleeding. Due to the exceptional nature of its diagnosis and severity of clinical presentation in the critically ill patients, brevity of the treatment is essential. This report describes the treatment of an elderly patient during his stay in the Intensive Care Unit.

Endoscopic ultrasonography-guided obliteration of the left inferior phrenic artery pseudoaneurysm bleed in a patient with alcoholic chronic pancreatitis

Background:Bleeding due to a pseudoaneurysm is a life-threatening condition in chronic pancreatitis. Pseudoaneurysm is usually obliterated by digital subtraction angiography (DSA) and embolization. We report a rare case of recurrent pesudoaneurysmal bleed from the left inferior phrenic artery which was obliterated by endoscopic ultrasound (EUS)-guided N-butyl 2-cyanoacrylate glue injection, after failed DSA.Case Report:A 43-year male, chronic alcoholic and smoker, was diagnosed as a case of alcoholic chronic pancreatitis based on imaging. He presented with massive upper gastrointestinal bleed (UGIB) with shock to emergency. His gastroduodenoscopy and colonoscopy were normal. Computed tomographic angiography revealed contrast extravasation from left inferior phrenic artery, but DSA was not technically possible. He had two more episodes of UGIB in 3 months’ duration. Percutaneous thrombin (500 units) was injected with subsequent thrombosed pseudoaneurysm on Doppler study. However, he had another episode of bleeding and an EUS examination showed large revascularized pseudoaneurysm (3.6 cm × 2.3 cm). It was obliterated with EUS-guided 3 mL N-butyl 2-cyanoacrylate glue (1:1 dilution with lipoidal) injection with 22-gauge EUS-guided fine needle aspiration needle. In the same session, two more glue injections completely obliterated the pseudoaneurysm.Conclusions:Left inferior phrenic artery pseudoaneurysm is a very rare cause of UGIB in chronic pancreatitis. Due to technical difficulty during DSA, it could be managed with EUS-guided N-butyl 2-cyanoacrylate glue injection.

Bleeding Peptic Ulcer - Tertiary Center Experience: Epidemiology, Treatment and Prognosis.

The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding (PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.