Diagnosis Of Acute Gastrointestinal Bleeding Research Articles

Outcomes of Acute Gastrointestinal Bleeding in Patients With COVID-19: A Case-Control Study.

BackgroundCoronavirus disease 2019 (COVID-19) patients are at higher risk of acute gastrointestinal bleeding (AGIB) due to higher use of steroids, mechanical ventilation, and use of anticoagulation. We performed this study to compare outcomes of AGIB in COVID-19-positive patients and those without COVID-19 and AGIB.MethodsThis was a case-control study including patients admitted from March 2020 to February 2021 with the diagnosis of AGIB. Patients were divided into two groups: COVID-19-positive and non-COVID-19 patients. Our primary outcomes were in-hospital or 30 days mortality and length of stay. Secondary outcomes were the rate of rebleeding, the need for intensive care unit (ICU) level of care, and the need for blood transfusion.ResultsEighteen COVID-19-positive patients and 54 matched non-COVID-19 patients were included. The COVID-19-positive patients less frequently had endoscopies performed (33.3% vs. 74.1%, P = 0.0059) and had greater steroid use (83.3% vs. 14.8%, P < 0.0001) compared to non-COVID-19 patients. ICU stays were more likely in the COVID-positive patients (odds ratio (OR): 20.41; 95% confidence interval (CI): 2.59 - 160.69; P = 0.004) as was longer hospital length of stay (OR: 1.08; 95% CI: 1.03 - 1.13; P = 0.002). Mortality, readmission within 30 days, need for blood transfusion, and having rebleeding during the admission did not differ for COVID-19 and non-COVID-19 patients.ConclusionCOVID-19 patients with AGIB are more likely to require ICU admission and had a longer length of stay. Despite the significantly lower rate of endoscopic procedures performed in patients with COVID-19, need for blood transfusion, mortality and rebleeding were not significantly different.

Risk Factors for 30 Days Readmission in Patients Admitted With Acute Gastrointestinal Bleeding

Introduction: 30-day hospital readmissions have a big burden on any healthcare institution, and is usually an indicator of poor-quality patient care. This study identifies factors associated with 30-day readmission of patients admitted with acute gastrointestinal bleeding (AGIB). Methods: From July 2013 to July 2016, 296 patients admitted with a diagnosis of AGIB were retrospectively reviewed. This includes patient admitted with acute variceal and non-variceal upper GI and lower GI bleeding. Clinical variables including 30-day mortality were then compared between the groups of patients who got readmitted within 30 days with those who did not get readmitted. Results: The overall rate of readmission among patients admitted with AGIB is 20% (60/296). The overall 30-day mortality associated with AGIB is 6.4% (19/298). 30-day mortality trended higher in patients who got readmitted (8.3% vs 5.9%). Length of stay also trended higher in patients who were readmitted (4.4 days vs 7.2 days, P=0.056). Past medical history of congestive heart failure [CHF] (30% vs 19.1%, P=0.06) and hypertension (66.9 vs 81.7%, P=0.026) were also present more in patients who got readmitted. Hemoglobin also trended on the lower side in patients who got readmitted (9.76 vs 10.57, P=0.06). No difference is found in other comorbidities including diabetes, afib, and coronary artery disease. Conclusion: Almost 15-20% of patients admitted for acute GI bleeding were readmitted within 30 days as per review of literature. In our study, rebleeding is the most common reason for readmission followed by dyspnea related to fluid overload. In our hospital, lower hemoglobin on presentation, longer duration of stay, CHF and hypertension are the risk factors associated with 30-day readmission. It is important to stratify patients on the basis of risk factors to prevent readmission associated with acute gastrointestinal bleeding.Table: Table. Results of Univariate Tests

Prognostic Significance of Cardiac Troponin in Acute Gastrointestinal Bleeding

Introduction: Acute gastrointestinal bleeding (AGIB) is responsible for over 300,000 hospitalizations annually. Cardiovascular-related deaths accounts for 30% of the patients surviving the initial episode of AGIB. The purpose of this study is to identify the impact of elevated troponin on short-term mortality and length of stay (LOS) of these patients. Methods: From July 2013 to July 2016, 290 patients admitted with a diagnosis of AGIB and who had cardiac troponin I measured within 24 hours of presentation were retrospectively reviewed. Clinical variables including 30-day mortality, 30-day readmission and LOS were then compared between the groups of troponin elevation and no troponin elevation. Results: The overall 30-day mortality among patients with AGIB was 6.5% (19/290). Cardiac troponin was elevated in 10% of patients (29/290). Among patients with normal troponin, 5% (13/261) died within 30 days. In patients with troponin elevation, 21% died in the same period (6/29), P=0.001. The LOS was also higher in patients with troponin elevation (4.88 vs 5.45, P=0.02). There was no difference in 30-day readmission among the two groups. Past history of Coronary artery disease, Congestive Heart Failure, Hypertension, aspirin use and elevated creatinine were more common in patients with troponin elevation troponin elevation. On multivariate analysis, troponin elevation on presentation is associated with increased mortality (Odds 5.50, [CI: 1.73-17.47], P=0.004). Conclusion: Cardiac troponin I is the sensitive marker for myocardial ischemia, especially in assessing acute coronary syndromes. Elevated troponin can occur in non-cardiac conditions including AGIB and represent cardiac injury. Diminished oxygen delivery secondary to anemia and hypotension and increased oxygen demand due to tachycardia are the main reasons for myocardial ischemia and subsequent troponin elevation in GI bleeding. The severity of AGIB is usually assessed by Rockall and Blatchford score, with higher scores associated with higher mortality. Given association of troponin with higher mortality in AGIB, it can be used as a biomarker to risk-stratify the patients on admission, especially in those with pre-existing cardiovascular disease as elevated levels are associated with poor outcomes and higher utilization of resources. This study suggest 30-day mortality and length of stay are higher among patients with troponin elevation.Table: Table. Results of Univariate Tests between Patients with troponin elevation and those with normal troponin

Sa1520 The Impact of Early Endoscopy on the Diagnosis of Acute Gastrointestinal Bleeding

Sa1520 The Impact of Early Endoscopy on the Diagnosis of Acute Gastrointestinal Bleeding

Capsule Endoscopy: Is it Really Helpful in the Diagnosis of Small Bowel Diseases?

Objective: To determine the diagnostic yield and safety of capsule endoscopy for small bowel diseases. Introduction: The small bowel evaluation for any pathology has always been a difficult task because both upper GI endoscopy and colonoscopy could not access this area and other radiological tools like barium studies and CT enteroclysis were less sensitive with associated risk of radiation exposure. Only Push enteroscopy could evaluate the small bowel effectively but was laborious and invasive. Capsule endoscopy was introduced in year 2000 and was accepted with great enthusiasm all over the world3. Now, during the past few years it has also been used for the diagnosis of acute gastrointestinal bleeding in emergency departments and results are quite encouraging 5,6. The procedure was introduced at Department of Gastroenterology-Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan in year 2009. Since then, it has been regularly used for investigation of small bowel abnormalities. Methods: Video Capsule Endoscopy (VCE) using GIVEN Imaging system was performed on 60 patients having various indications like obscure GI bleeding, undiagnosed iron deficiency anemia, abdominal pain and malabsorption. This was a retrospective analytic study carried out at the Department of Gastroenterology-Hepatology Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan from February 2009 to June 2014. Statistical Analysis was done using SPSS version 22. Results: Out of 60 patients, 41 (68.33%) were male, 19 (31.67%) were female. Mean age was 52 years with minimum 11 years and maximum of 85 years. No lesion was found on examination in 8.33% (n=5) patients while presence of blood in the gut resulted in poor visualization in 3.33% (n=2) patients. In remaining 88.34% (n=53) patients, the procedure detected various intestinal lesions. Our study detected presence of Angioectasias in 30.0% (n=18), visible vessels in 6.67% (n=4), strictures in 5.0% (n=3), small bowel ulcers in 10.0% (n=6), edema and erosions in 8.33% (n=5), loss of villi in 11.68% (n=7), intestinal worms in 3.33% (n=2), mass lesions in 8.33% (n=5) and Angioectasia with ulcers in 5.0% (n=3) of patients. The diagnosis in 3 patients was further verified by surgical operation, while enteroscopy was done in 2 patients for confirmation. Capsule impaction occurred in 2 patients. All images of Video Capsule Endoscopy (VCE) were of good quality. Conclusion: Capsule endoscopy is a safe and effective procedure with a good diagnostic yield and can be used routinely for the diagnosis of small bowel diseases.

Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis

To assess the diagnostic accuracy of computed tomography (CT) angiography in the evaluation of patients with an episode of acute gastrointestinal haemorrhage. Systematic review and meta-analysis to estimate pooled accuracy indices. A bivariate random effects model was adjusted to obtain a summary receiver-operating characteristic (sROC) curve and the corresponding area under the curve (AUC). Twenty-two studies were included and provided data on 672 patients (range of age 5-74) with a mean age of 65 years. The overall sensitivity of CT angiography for detecting active acute GI haemorrhage was 85.2 % (95 % CI 75.5 % to 91.5 %). The overall specificity of CT angiography was 92.1 % (95 % CI 76.7 % to 97.7 %). The likelihood ratios for positive and negative test results were 10.8 (95 % CI 3.4 to 34.4) and 0.16 (95 % CI 0.1 to 0.27) respectively, with an AUC of 0.935 (95 % CI 0.693 to 0.989). The sources of heterogeneity explored had no significant impact on diagnostic performance. CT shows high diagnostic accuracy and is an excellent diagnostic tool for detection and localising of intestinal bleeding sites. It is highly available, provides fast detection and localisation of the bleeding site, and is minimally invasive. • CT angiography is increasingly used for investigating severe gastrointestinal bleeding. • This systematic review and meta-analysis updates previous ones. • In patients with massive gastrointestinal bleeding, CT angiography/MDCT detects bleeding accurately. • CT angiography is useful in locating the bleeding site and determining appropriate treatment.

Akute gastrointestinale Blutung - Diagnose mit der Computertomographie

Computed tomography represents a fast, non-invasive and accurate imaging modality for the diagnosis of acute gastrointestinal bleeding by providing information about localization and source of bleeding. Owing to its robustness and wide availability, it has the potential to be the first line imaging test in patients with acute life-threatening bleeding, for helping in the planning of interventional or surgical procedures.

Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: A meta-analysis

To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springerlink and Scopus, from January 1995 to December 2009, were searched for studies evaluating the accuracy of CT angiography in diagnosing acute GI bleeding. Studies were included if they compared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute GI bleeding. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver-operating characteristic. A total of 9 studies with 198 patients were included in this meta-analysis. Data were used to form 2 x 2 tables. CT angiography showed pooled sensitivity of 89% (95% CI: 82%-94%) and specificity of 85% (95% CI: 74%-92%), without showing significant heterogeneity (chi(2) = 12.5, P = 0.13) and (chi(2) = 22.95, P = 0.003), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.9297. CT angiography is an accurate, cost-effective tool in the diagnosis of acute GI bleeding and can show the precise location of bleeding, thereby directing further management.

Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

The aim of the study was to carry out a systematic review determining the accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding. A search of published work in Medline and manual searching of reference lists of articles was conducted. Studies were included if they compared CT angiography to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute gastrointestinal bleeding. Eight published studies evaluating 129 patients were included. Data were used to form 2 x 2 tables. Computed tomography angiography showed pooled sensitivity of 86% (95% confidence interval 78-92%) and specificity of 95% (95% confidence interval 76-100%), without showing significant heterogeneity (chi(2) = 3.5, P = 0.6) and (chi(2) = 5.4, P = 0.6), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.93. Computed tomography angiography is accurate in the diagnosis of acute gastrointestinal bleeding and can show the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review because of the methodological limitations and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.

Current angiographic approach to diagnosis and therapy of acute gastrointestinal bleeding.

The author's current angiographic approach to the diagnosis and therapy of acute gastrointestinal (GI) bleeding is summarized and discussed. It is based on the authors' experience with diagnostic studies in more than 300 acute GI bleeders and the use of various angiotherapeutic techniques in 138 of them as well as the experience of others. A "moderately aggressive angiographic approach" is advocated for the diagnosis of acute GI bleeding in most patients with angiography used as needed after emergency endoscopy and preliminary medical therapy. Vasoconstrictive angiotherapy with selective intraarterial use of vasopressin is partially giving way to low dose, intravenous infusion of vasopressin and, where possible, to direct vascular occlusion. Selective transcatheter embolic occlusion of bleeding vessels is in indicated cases an accepted method for controlling arterial bleeding. Medical gelatin (Gelfoam) is the current authors' embolization material of choice. Selective variceal occlusion offers promising means for management of bleeding from gastroesophageal varices. Its possible combination with transcatheter intrahepatic portosystemic shunting might also provide non-surgical relief of portal hypertension.