Diagnosis Of Upper Gastrointestinal Bleeding Research Articles

Evaluation of Glaskow-Blatchford, Rockall Scores and Shock Index of Patients Admitted from the Emergency Department with A Diagnosis of Upper Gastrointestinal System Bleeding

Background: Risk scores and shock index used in upper gastrointestinal system (GSB) bleeding have an important place in determining the treatment and clinical course of the patient. The aim of this study is to evaluate the predicted success in mortality by analyzing shock indices together with Glasgow Blatchford Scoring (GBS) and Rockall Scoring (RS), whichare used in upper GI bleeding. Methods: This study was conducted with a retrospective analysis of patients who were hospitalized with a diagnosis of upper GI bleeding from the emergency department of a single-center secondary care health institution. For each patient, age, gender, treatment procedures performed in the emergency department or clinic, and endoscopy results were evaluated. Mortality and discharge status of the patients were compared with the scoring values. Result: 86 patients were evaluated in the study. The average age was 69.09±19.07 and the most applications were in the 61-79 age range (48.8%). The most common presenting complaints of the patients were bloody vomiting and black stools. On physical examination, melena was positive in 64% of the patients. 89.5% of the patients were treated in intensive care. The mortality rate was 10.5%. In patients with death, the shock index value was ≥0.75 in all patients and the average was 1.07. As a result of the study, it was seen that GBS, RS and shock index were successful in predicting mortality. Conclusion: Current scoring systems need to be developed in order to manage patients with upper GI bleeding, which is frequently seen in emergency departments today, more quickly and to reduce patient costs.

Non-variceal Upper Gastrointestinal Bleeding and Its Endoscopic Management.

Upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality. Clinical symptoms that patients may present with include: hematemesis, coffee-ground emesis, melena, and hematochezia. Clinical signs can range from tachycardia to shock. The anatomical landmark that differentiates upper gastrointestinal (GI) bleeds from lower bleeds is the ligament of Treitz. The first steps of treating a patient who presents with signs of UGIB are resuscitation with appropriate fluids and blood products as necessary. The consideration of endoscopy and the urgency at which it should be performed is also vital during initial resuscitation. Endoscopic therapy should ideally be performed within 24 hours of presentation after initial stabilization with crystalloids and blood products. Intravenous proton pump inhibitors are the mainstay in the initial management of upper GI bleeding from a non-variceal etiology, and they should be administered in the acute setting to decrease the probability of high-risk stigmata seen during endoscopy. Pro-kinetic agents can be given 30 minutes to an hour before endoscopy and may aid in the diagnosis of UGIB. There are 3 broad categories of endoscopic management for UGIB: injection, thermal, and mechanical. Each endoscopic method can be used alone or in combination with others; however, the injection technique with epinephrine should always be used in conjunction with another method to increase the success of achieving hemostasis. In this review article, we will review the steps of triage and initial resuscitation in UGIB, causes of UGIB and their respective management, several endoscopic techniques and their effectiveness, and prognosis with a primary focus limited to non-variceal bleeding.

Evaluation of clinical and laboratory parameters of patients with the diagnosis of upper gastrointestinal system bleeding

Aims: In this study, it was purposed to evaluate demographic, clinical, laboratory characteristics, bleeding etiologies, risk factors, comorbidity and mortality of the patients who were interned with the diagnosis of upper gastrointestinal system bleeding. Methods: In this study, 157 patients those hospitalized to Ministry of Health Beyoğlu Public Hospitals Association Gaziosmanpaşa Taksim Training and Research Hospital Internal Medicine Clinic with the diagnosis of upper gastrointestinal bleeding between 1 April 2014 and 1 April 2015 were evaluated retrospectively. Age, gender, duration of hospitalization, comorbidity, prescription story, need and amount of transfusion, endoscopic findings, hemoglobin (Hgb), blood urea nitrogen (BUN), urea, creatinine (Cr) values on admission, complication and mortality data were recorded. IBM SPSS (Statistical Package for Social Sciences) for MAC 21.0 program was used for statistical analysis in order to evaluate the data. Results: Patient were aged between 17 and 94 .The mean age was 59.04±20.55. 95 (68.35%) of patients were male and 44 (31.65%) were female with the male/female ratio of 2.15/1. While 64.75% of the patients in our study had at least one additional disease, no additional disease was detected in 35.25%. Endoscopic procedure was peformed 89.93% of patients for both diagnosis and treatment. Exitus was seen in 7 patients and mortality was detected as 5.04%. Median age of deceased patients was 75.28±15.39. Median age of surviving patients was 58.18±20.47. Conclusion: Our study revealed that upper GI bleeding is an important cause of mortality and morbidity despite advanced treatment options and intensive care conditions. The most important risk factors responsible for mortality are advanced age and the presence of comorbidities, as seen in our study.

The Predictive Value of Glasgow-Blatchford Score: The Experience of an Emergency Department.

Upper gastrointestinal bleeding (UGB) is a common emergency and a major cause of morbidity and mortality worldwide. An early and accurate assessment at admission is essential to estimate the severity of each case, assisting in the management of patients. The Glasgow-Blatchford score (GBS) is currently recommended for risk stratificationof UGBin the emergency department (ED), helping triage patients to in-hospital vs. ambulatorymanagement. The aim of this study was to test the validity of the GBS in an ED. Patients who presented tothe ED with a diagnosis of UGB between 2017 and 2018 were retrospectively analyzed. The mean GBS value of the 149 patients included in the study was 10.3. Of the patients, 4.3% had values ≤1 and 8.7% had values ≤3. The sensitivity and negative predictive value for intervention needs (98.9% and 91.7%) and complications in 30 days (100% and 100%) remained high with a threshold ≤3. In the receiver operating characteristic curves, GBS presented an area under the curve of 0.883 and 0.625, regarding the need for intervention and complications in 30 days, respectively. In our population, the threshold ≤2, and eventually ≤3, allows the identification of twice as many low-risk patients, manageable as outpatients, without significant increases in interventionneeds or complications in 30 days.

CLINICAL CHARACTERISTICS, SEVERITY, AND OUTCOME OF ACUTE UPPER GASTROINTESTINAL BLEEDING IN ELDERLY AND NON-ELDERLY PATIENTS IN A TERTIARY CARE HOSPITAL- A PROSPECTIVE OBSERVATIONAL STUDY

Introduction: Upper gastrointestinal bleeding (UGIB) is a common emergency that requires hospitalization, and is more prevalent in men and older individuals. Age and co-morbidities are important factors for high mortality in UGIB patients, and elderly patients have an increased risk of mortality and morbidity compared to younger individuals. The type of UGIB experienced can also vary based on age. The Aim and objectives: aim of this study was to examine and compare the clinical characteristics, severity, and outcome of UGIB in elderly individuals (aged 60 or older) and non-elderly individuals (aged under 60) in Assam, India. Materials And Methods: This was a prospective observational study conducted at Assam Medical College and Hospital between April 2022 and September 2022. The study included adult patients presenting with UGIB. Patients below 18 years of age and in-patients who developed UGIB during hospitalization were excluded. A diagnosis of UGIB was based on the history of hematemesis and/or melena. Relevant blood and radiological investigations were conducted for all patients. All patients underwent upper GI endoscopy (UGIE). Data on clinical proles, laboratory reports, transfused blood/blood products, endoscopic ndings and interventions, and subsequent outcomes were collected prospectively for analysis. Results And Discussion: A total of 60 patients were included in the study, with a mean age of 42 years and 78.33% of patients being male. Of the 60 patients, 70% were non-elderly and 30% were elderly. The proportion of patients with co-morbidities and the use of non-steroidal anti-inammatory drugs or oral anti-coagulants was higher in the elderly group. The commonest mode of presentation among non-elderly patients was isolated melena (55%), while haematemesis in association with melaena was more common among elderly patients (50%). The proportion of patients with tachycardia and hypotension was signicantly higher among the elderly group. Variceal bleeding was signicantly higher among the elderly group (50% vs. 25%). The Rockall score, a measure of the severity of UGIB, was higher in 25% of elderly patients compared to 12

Aorticoesophagal Fistula Combined with Upper Gastrointestinal Bleeding after Endovascular Dissection of Thoracic Aortic Aneurysm

Aortoesophageal fistula (AEF) is a relatively rare and potentially fatal disease. Secondary AEF is rare but is associated with serious complications and high mortality. There are rare cases of esophageal mediastinal fistula after descending aortic aneurysm stent implantation. We report the case of a 76-year-old man who had upper abdominal distension, without obvious inducement, for 3 months and felt fullness after a meal, accompanied by anorexia. A chest computer tomography (CT) examination of the abdomen was performed with the outside hospital. Descending thoracic aortic aneurysm was discovered and was treated with stent implantation. The patient was transferred to our hospital to continue treatment, mainly because of an esophageal mediastinal fistula. Finally, the thoracic aortic aneurysm was diagnosed as AEF after stent implantation, combined with the diagnosis of upper gastrointestinal bleeding. We hope that, through this case, we can explain the possible causes of bronchial mediastinal fistula after stent implantation of descending aortic aneurysm and the mechanism of upper gastrointestinal bleeding.

Role of Venous Lactate in Predicting Outcomes in Patients with Acute Upper Gastro-Intestinal Bleeding

Background: Several risk scores were clinically assessed for risk stratification of patients with UGIB including Glascow–Blatchford score (GBS) and Rockall score pre and post endoscopy. Many studies tried to detect value of lactate as a predictor of mortality but its role in association with other systems is not well defined. Objective: To deduct the role of lactate and other scoring systems in assessment of outcomes of UGIB. Patients and Methods: We conducted a prospective cohort study of patients admitted to ICU of Tropical Medicine Department, Zagazig University Hospitals through the period from December 2019 to March 2020 with a charted diagnosis of upper gastrointestinal bleeding (UGIB). Results: Regarding performance of GBS, Rockall score and lactate among the studied group, cutoff point of GBS was equal or less than 10.5 can be used as a predictor for recovery with sensitivity of 63.6%, specificity 100%. Cut off of Pre Rockall score was less than or equal to 4.5 can be used as a predictor for recovery with sensitivity of 60.6%, specificity of 80%. As regards venous lactate, cutoff point was equal to or less than 1.85 can be used as a predictor for recovery with sensitivity of 75.8% and specificity of 100%. Regarding lactate clearance, the cutoff point of equal to or more than 18.8% can be used as a predictor for active bleeding with sensitivity of 63.2% and specificity of 42%. Conclusion: Elevated venous lactate in association with GBS, Rockall scoring systems were found as independent predictor factors for ICU admission, transfusion, endoscopy, length of hospital stay and mortality in patients with acute UGIB.

Nonvariceal Upper Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding that is proximal to the ligament of Treitz is considered upper GI bleeding (UGIB). UGIB can be further divided into variceal and nonvariceal, differentiated by etiology, presentation, management, and mortality. This review of nonvariceal UGIB addresses the epidemiology, diagnosis, treatment (including endoscopic therapy), prognosis, and differential diagnosis. Recommendations presented are evidence based and consistent with consensus statements and society guidelines. Figures show stigmata of recent hemorrhage, endoscopic therapy, peptic ulcer disease, Mallory-Weiss syndrome, angiodysplasia, Dieulafoy lesion, and arterioenteric fistula. Tables list the manifestation of GI bleeding and the presumed source of the bleeding, clues in the symptom and presentation of the patient that may suggest the diagnosis, medical history and physical examination findings that can suggest a specific diagnosis, a comparison of different prognostic scoring systems, differential diagnosis of UGIB, various etiologies of peptic ulcer disease, and treatment regimens for Helicobacter pylori. This review contains 7 highly rendered figures, 10 tables, and 85 references

Nonvariceal Upper Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding that is proximal to the ligament of Treitz is considered upper GI bleeding (UGIB). UGIB can be further divided into variceal and nonvariceal, differentiated by etiology, presentation, management, and mortality. This review of nonvariceal UGIB addresses the epidemiology, diagnosis, treatment (including endoscopic therapy), prognosis, and differential diagnosis. Recommendations presented are evidence based and consistent with consensus statements and society guidelines. Figures show stigmata of recent hemorrhage, endoscopic therapy, peptic ulcer disease, Mallory-Weiss syndrome, angiodysplasia, Dieulafoy lesion, and arterioenteric fistula. Tables list the manifestation of GI bleeding and the presumed source of the bleeding, clues in the symptom and presentation of the patient that may suggest the diagnosis, medical history and physical examination findings that can suggest a specific diagnosis, a comparison of different prognostic scoring systems, differential diagnosis of UGIB, various etiologies of peptic ulcer disease, and treatment regimens for Helicobacter pylori. This review contains 7 highly rendered figures, 10 tables, and 85 references

The value of color Doppler ultrasound in the diagnosis of upper gastrointestinal hemorrhage in patients with liver cirrhosis.

The value of color Doppler ultrasound in the diagnosis of upper gastrointestinal hemorrhage in patients with liver cirrhosis.

Variceal and non-variceal upper gastrointestinal bleeding. Analysis of 249 hospitalized patients

Upper gastrointestinal bleeding (UGIB) is one of the main reasons of hospitalization due to gastrointestinal causes. Reported mortality rates range from 5 to 12%. To determine hospital mortality and associated risk factors in hospitalized patients with UGIB. To compare the clinical characteristics and outcomes of patients with variceal versus non-variceal UGIB. Review of medical records of 249 patients (62% males) discharged with the diagnosis of UGIB at a clinical hospital between 2015 to 2017. Demographic and clinical characteristics and adverse clinical outcomes (surgery, length of hospital stay and in-hospital mortality) were recorded. A comparative analysis between patients with Variceal and Non-variceal UGIB was carried out. Seventy two percent of UGIB were non-variceal (peptic ulcer in 44%). Two patients required surgery (both died). Median of length of hospital stay was seven days (interquartile range (IQR) 4-13). Overall hospital mortality was 13 and 4% in variceal and non-variceal UGIB, respectively (p = 0.024). The variables associated with mortality were: red blood cell transfusion (odds ratio (OR): 18.7, p < 0.01), elevated creatinine on admission (OR: 3.30, p = 0.03) and variceal bleeding (OR: 3.23, p = 0.02). Hospital mortality of UGIB remains high, especially in variceal UGIB. Elevated creatinine levels on admission, the need of transfusion of red blood cells and variceal etiology are risk factors for mortality.

Changes in mean platelet volume in the course of upper gastrointestinal bleeding

In this study, we retrospectively evaluated patients with upper gastrointestinal bleeding (UGB) who were followed up at our center over a 3 year period and aimed to determine the factors affecting mean platelet volume (MPV) in patients with UGB, temporal changes in MPV during UGB, and the relationship between MPV values and the severity of UGB. Patients and methods: A total of 170 patients who were hospitalized between January 2010 and December 2013 with a diagnosis of UGB, completed a 72-hour follow up, and had a baseline blood count performed within 6 months were evaluated retrospectively. Demographic, clinical, and laboratory data, along with MPV values at baseline, on admission, and at 4 hours, 1 day, 2 days, 3 days, and discharge, were evaluated. Number Cruncher Statistical System (NCSS) 2007 was used for statistical analyses. Results: Women and patients with comorbid diseases had higher baseline MPV values; this effect disappeared after admission for UGB and reappeared at discharge. MPV values were lowest at the start of the bleeding and significantly increased during the course of UGB. Baseline MPV and MPV at discharge values were similar. There was no statistically significant relationship between any MPV measurement and transfusion amount. Conclusion: The effects of gender and comorbid diseases were negated by the presence of UGB and returned after UGB was controlled. MPV levels exhibited temporal changes during the course of UGB, indicating that MPV can be used as a marker; however, no statistical relationship was found between temporal MPV values and transfusion amount, a marker for UGB severity.

Case Report: Gastric Mucormycosis- a rare but important differential diagnosis of upper gastrointestinal bleeding in an area of Helicobacter pylori endemicity

A 57 years female from the hills of Nepal presented with upper gastrointestinal bleeding with gastric ulcer evident on endoscopy. Though initially treated with Helicobacter pylori ( H. pylori) eradication therapy alone, biopsy later on revealed both mucormycosis and H. pylori infection. She was then treated with antifungals liposomal amphotericin B followed by posaconazole which led to complete recovery. Mucormycosis is a rare but life-threatening fungal disease of immunocompromised host though our patient was immunocompetent. If recognized and treated at early stage, as in our patient, prognosis is good. A high index of suspicion is required for considering this disease in H. pylori endemic regions such as Nepal, and is crucial for early recognition and treatment.

Aortoenteric Fistula with Duodenal Graft Material Migration Resulting in Gastrointestinal Bleeding

Introduction: Aortoenteric fistula (AEF) is an abnormal connection between the aorta and the gastrointestinal tract. AEF is a rare but life-threatening condition that requires emergent intervention. It usually results from a compression of an abdominal aortic aneurysm (AAA) or after an aortic surgery. Case summary: A 78-year-old male with a history of abdominal aortic dissection status post repair and mechanical aortic valve on chronic warfarin, presented to the emergency department (ED) with upper abdominal and lower back pain, black tarry stool and one episode of hematochezia. While in the ED, he had an episode of hematemesis and was noted to be hypotensive, so he was admitted to the intensive care unit. A Computed tomography (CT) scan of the abdomen and pelvis with contrast showed a calcified aortic plaque with surrounding soft tissue thickening and abutting of the second part of the duodenum, concerning of abdominal aortic dissection without contrast leak (Figure 1). Gastroenterology team performed an emergent Esophagogastroduodenoscopy (EGD), which showed blood in the fundus and an ulcer like lesion in the third portion of the duodenum with a graft material concerning for aorto-enteric fistula (Figure 2). Vascular surgery took the patient emergently to the operating room and performed an endovascular abdominal aortic aneurysm repair to control the acute bleeding. The plan was to do a definitive repair of the aorta and the aortoenteric fistula once he is more stable. Two days later the patient underwent removal of the aortic graft, duodenal diverticulectomy and duodenotomy repair, and replacement of abdominal aortic graft with HEMASHIELD?graft. The graft was found to be infected, so infectious disease team recommended discharging him home on intravenous IV antibiotics for 6 weeks. On follow up the patient was recovering well without any further GI bleeding. Discussion: Aortoenteric fistulae are uncommon but associated with high mortality. It should be considered in the differential diagnosis of upper gastrointestinal bleeding, especially in patients who have an aortic aneurysm or had a repair of an aortic disease.2996_A Figure 1. A: CT scan of the abdomen and pelvis showing calcified aortic plaques, B: CT scan of the abdomen and pelvis showing aotoenteric fistula.2996_B Figure 2. A: An EGD showing blood in the fundus, B: EGD showing an ulcer in the third part of the duodenum with graft material.

Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department

Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient’s emergency visit. Objective: The purpose of this study is to investigate the efficacy of “Glasgow-Blatchford scale + lactate levels” to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department. Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated. Results: A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p &lt; 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(–) GBS(+), lactate(+) GBS(–), and lactate(–) GBS(–) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p &lt; 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p &lt; 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above. Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish “modified Glasgow-Blatchford scale.” In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.

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.

VKORC1-1639 G&gt;A Polymorphism and the Risk of Non-Variceal Upper Gastrointestinal Bleeding

Background &amp; Aims: The mutations in the gene that encodes vitamin K epoxide reductase (VKOR) enzyme are responsible for low levels of vitamin K. The purpose of this study was to evaluate whether the presence of the VKORC1 -1639 G&gt; A polymorphism is a risk factor for non-variceal upper gastrointestinal bleeding (UGIB) in patients without concomitant therapy with vitamin K antagonists.Methods: This case-control study comprised 163 consecutive patients diagnosed with UGIB and 178 controls, in whom the diagnosis of UGIB was excluded. The following data were recorded: age, gender, alcohol consumption, smoking, history of UGIB, nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin consumption. Genetic analysis included genotyping for the VKORC1 -1639 G&gt;A polymorphism.Results: History of UGIB (OR 3.463, CI95% 1.463-8.198, p=0.005), smoking (OR 2.498, CI95% 1.358-4.597, p=0.003), alcohol consumption (OR 3.283, CI95% 1.796-6.000, p&lt;0.001), use of NSAIDs (OR 4.542, CI95% 2.502-8.247, p&lt;0.001) or of low-dose aspirin (OR 2.390, CI95% 1.326-4.310), and the VKORC1 -1639 G&gt; A AA genotype (OR 1.364, CI95% 0.998-1.863, p=0.05) were associated with an increased risk of UGIB. The risk of UGIB was analyzed in patients with genotype AA who used aspirin or NSAIDs. The genotype AA has not kept its status of independent risk factor (p=0.3). In subjects with NSAIDs/aspirin therapy and genotype AA there was a two times higher chance of UGIB compared to those under NSAIDs/aspirin therapy alone (OR 7.6 vs. 3.6, p&lt;0.001).Conclusion: Patients with non-variceal UGIB caused by the use of NSAIDs or low-dose aspirin are more frequent carriers of the VKORC1 -1639 G&gt;A AA genotype, as compared to those without UGIB.

VKORC1-1639 G>A Polymorphism and the Risk of Non-Variceal Upper Gastrointestinal Bleeding.

The mutations in the gene that encodes vitamin K epoxide reductase (VKOR) enzyme are responsible for low levels of vitamin K. The purpose of this study was to evaluate whether the presence of the VKORC1 -1639 G> A polymorphism is a risk factor for non-variceal upper gastrointestinal bleeding (UGIB) in patients without concomitant therapy with vitamin K antagonists. This case-control study comprised 163 consecutive patients diagnosed with UGIB and 178 controls, in whom the diagnosis of UGIB was excluded. The following data were recorded: age, gender, alcohol consumption, smoking, history of UGIB, nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin consumption. Genetic analysis included genotyping for the VKORC1 -1639 G>A polymorphism. History of UGIB (OR 3.463, CI95% 1.463-8.198, p=0.005), smoking (OR 2.498, CI95% 1.358-4.597, p=0.003), alcohol consumption (OR 3.283, CI95% 1.796-6.000, p<0.001), use of NSAIDs (OR 4.542, CI95% 2.502-8.247, p<0.001) or of low-dose aspirin (OR 2.390, CI95% 1.326-4.310), and the VKORC1 -1639 G> A AA genotype (OR 1.364, CI95% 0.998-1.863, p=0.05) were associated with an increased risk of UGIB. The risk of UGIB was analyzed in patients with genotype AA who used aspirin or NSAIDs. The genotype AA has not kept its status of independent risk factor (p=0.3). In subjects with NSAIDs/aspirin therapy and genotype AA there was a two times higher chance of UGIB compared to those under NSAIDs/aspirin therapy alone (OR 7.6 vs. 3.6, p<0.001). Patients with non-variceal UGIB caused by the use of NSAIDs or low-dose aspirin are more frequent carriers of the VKORC1 -1639 G>A AA genotype, as compared to those without UGIB.

Upper Gastrointestinal Bleeding and the Importance of an Early Endoscopic Study for Diagnosis: A Retrospective Study

Objectives: Determine if the time of early endoscopy modifies the patients evolution and hospitalization stay in patients with upper gastrointestinal bleeding. Design: A retrospective and transversal study. Setting: Primary care Hospital, in Tegucigalpa, Honduras. Participants we review a total of 115 medical records with diagnosis of upper gastrointestinal bleeding who attended the Emergency unit of the Social Security Institute Hospital in Tegucigalpa MDC Period from January 1 to December 31 of 2011. Results: We registered 115 patients with diagnosis of upper gastrointestinal bleeding of whom 92.17% underwent upper endoscopy study. Early endoscopy was performed within 24 hours in 10.38% of patients, in this group the average hospitalization stay was 3.1 days. Early endoscopy within the first 24 hours significantly reduced (p=0.0001) hospitalization stay. The mean length of hospital stay was 4.74 days. The main etiology of upper gastrointestinal bleeding was non-variceal 64.1%. Peptic ulcer disease type Forrest III (clean base ulcer) was the most frequent in 77.78%. The mean hospitalization stay in patients with peptic ulcer disease type Forrest III was 4.6 days. No endoscopy study was performed in 9 patients of whom all died because of hemodynamic instability and lack of an emergency endoscopy unit in the hospital. Conclusion: Early endoscopy determines the patient’s evolution and hospitalization stay.

The Use of Tranexamic Acid for Upper Gastrointestinal Bleeding by Medical and Surgical Intensivists: A Single Center Experience.

BackgroundTranexamic acid (TXA) may be beneficial in the management of upper gastrointestinal bleeding (UGIB). We sought to investigate how frequently intensivists at our academic institution use TXA for patients with UGIB, and to investigate whether the utilization rate of TXA differs between surgical and medical intensivists, and provide an updated literature review on the subject.MethodsWe performed a retrospective cohort study of patients admitted for UGIB to the surgical intensive care unit (SICU) and the medical intensive care unit (MICU) at our academic healthcare facility (University of Florida Health - Shands Hospital) from January 1, 2013 to December 31, 2016. The patients were categorized as receiving or not receiving TXA. The overall utilization rate of TXA was calculated, and the utilization rates for the MICU and SICU were compared using a two-sample test for equality of two proportions with continuity correction.ResultsThe study cohort included a total of 1,829 patients with a diagnosis of UGIB. Of those, 988 were treated in the MICU and 841 were treated in the SICU. Of the 988 patients in the MICU, six received TXA (0.61%), while 10 (1.19%) of the 841 patients in the SICU received TXA. The overall utilization rate of TXA was 0.87%. The odds of receiving TXA in the SICU were 1.97 times greater than in the MICU (odds ratio (OR): 1.97, 95% confidence interval (CI): 0.74 - 5.2, P = 1.83).ConclusionsOur study suggests that TXA may be underused in the management of UGIB, and that the utilization rate does not differ significantly between surgical and medical intensivists.