Etiology Of Bleeding Research Articles

Placental abruption and hemorrhage-review of imaging appearance.

Placental and periplacental bleeding are common etiologies for antepartum bleeding. Placental abruption complicates approximately 1% of pregnancies and is associated with increased maternal, fetal, and neonatal morbidity and mortality. This article reviews the normal placental appearance on ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) and then discusses the different morphological appearance of placental and periplacental hematomas along with their mimics. Hematomas are classified based on the location as retroplacental, marginal subchorionic, preplacental (subamniotic), or intraplacental. Placenta-related bleeding is a common finding during first trimester ultrasound and its detection can help triage the pregnant females into low- and high-risk groups. This article reviews placenta related bleeding in the setting of trauma. Trauma can complicate pregnancy with potential severe maternal and fetal outcomes. CT is usually performed as part of the trauma workup and it can be challenging for placental evaluation. MRI can characterize the age of the hematomas and can differentiate hematomas from tumors.

Transcatheter embolization of acute non-variceal gastrointestinal hemorrhage.

To determine the efficacy and safety of transcatheter embolization of nonvariceal gastrointestinal hemorrhage. Descriptive analytical study. Radiology Department, The Aga Khan University Hospital, Karachi, Pakistan, from October 1999 to August 2004. The study included 27 patients who underwent angiography for suspected gastrointestinal hemorrhage. The presumptive diagnosis was based on the findings of endoscopy in 08 patients, scintigraphy in 05 patients and on clinical findings only in 14 patients. Nine patients had gastroduodenal hemorrhage, 04 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Five patients had comorbidities. One patient had uremia, 2 had hepatitis C, 1 had cirrhosis and 1 had coagulopathy. Technical success, clinical success, complications and patient survival were assessed. Nine patients had upper gastrointestinal hemorrhage, 4 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Etiology of bleeding was known in 15 patients and unknown in 12 patients. Clinical success was achieved in 23 (85.18%) of 27 patients. Two patients had early rebleeding. One of these was managed surgically and recovered. The other had severe coagulopathy and was unfit for surgery. Two patients had bowel infarction, one of these was managed surgically and recovered and the other died of complication of procedure. One patient had small splenic infarcts and was managed conservatively. Overall 85.18% success was achieved for the embolization procedure. Two of 27 patients died. One patient died because of recurrence of bleeding and other died because of infarction of right hemi-colon which occurred as complication of embolization. Transcatheter embolization is effective and safe in patients with nonvariceal gastrointestinal hemorrhage.

The Natural History of Gastrointestinal Bleeding in Patients without an Obvious Source

With the advent of proton pump inhibitors and H. Pylori treatment, the old dogma "the most common cause of lower GI bleeding is upper GI bleeding" may no longer be valid. We sought to determine the most common causes of GI bleeding in patients without an obvious source and their clinical outcomes. We queried our hospital database for GI hemorrhage during 2015, excluding patients with obvious sources such as hematemesis or anal pathology. We collected data from patients with GI bleeding defined as bright red blood per rectum, melena, or a positive fecal occult blood test. The primary endpoints were etiology of GI bleed, amount of transfusions required, and types of interventions performed. Ninety-three patients were admitted with GI bleeding as defined previously: mean age was 74 years and mean hemoglobin was 8.2. Seventy-four per cent received blood transfusions with an average of 2 units transfused per patient; 22 per cent received 3 or more units of blood. The etiology of bleeding was 17 per cent upper GI source, 15 per cent lower GI source, and in 68 per cent, the source remained unknown. Bleeding stopped spontaneously in 86 per cent of patients and 9 per cent died. Endoscopy was performed in 71 per cent, but only 6 per cent underwent therapeutic endoscopic intervention. No patient had surgical or interventional radiologic procedures related to their GI bleed. Gastrointestinal bleeding, without an obvious source on presentation, rarely requires operative intervention or interventional radiologic procedure. Blood transfusions were not predictive of the need for therapeutic endoscopic intervention which was required in only 6 per cent of patients.

Role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding

Background: Abnormal uterine bleeding is a bleeding from uterine compose that is abnormal in volume, regularity and/or timing that has been present for the majority of the last 6 months. Evaluation of women with abnormal uterine bleeding should comprise history taking, systemic and local examination, laboratory investigations, imaging and different diagnostic procedures including hysteroscopy. Aim of the Work: to assess the accuracy of hysteroscopy in the diagnosis of the cause of bleeding in women with abnormal uterine bleeding. Patients and Methods: This prospective observational study was conducted on 114 patients attended the Early Cancer Detection Unit, Faculty of Medicine, Ain Shams University between July 2017 and April 2018, to assess the role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding. Results: Hysteroscopy had a sensitivity of 91.9%, specificity of 86.5%, positive predictive value of 93.2%, and negative predictive value of 84.2% and diagnostic accuracy of 90.1% for diagnosing the etiology of abnormal uterine bleeding. Conclusion: Hysteroscopy has a definitive role in evaluating patients with abnormal uterine bleeding especially with patient with thick endometrium, in any age group. Hysteroscopy is a safe and reliable procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value and negative predictive value and the results of hysteroscopy are immediately available. Hysteroscopy and histopathology complement each other in evaluating patients with abnormal uterine bleeding for accurate diagnosis and further treatment.

Role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding

Background: Abnormal uterine bleeding is a bleeding from uterine compose that is abnormal in volume, regularity and/or timing that has been present for the majority of the last 6 months. Evaluation of women with abnormal uterine bleeding should comprise history taking, systemic and local examination, laboratory investigations, imaging and different diagnostic procedures including hysteroscopy. Aim of the Work: to assess the accuracy of hysteroscopy in the diagnosis of the cause of bleeding in women with abnormal uterine bleeding. Patients and Methods: This prospective observational study was conducted on 114 patients attended the Early Cancer Detection Unit, Faculty of Medicine, Ain Shams University between July 2017 and April 2018, to assess the role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding. Results: Hysteroscopy had a sensitivity of 91.9%, specificity of 86.5%, positive predictive value of 93.2%, and negative predictive value of 84.2% and diagnostic accuracy of 90.1% for diagnosing the etiology of abnormal uterine bleeding. Conclusion: Hysteroscopy has a definitive role in evaluating patients with abnormal uterine bleeding especially with patient with thick endometrium, in any age group. Hysteroscopy is a safe and reliable procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value and negative predictive value and the results of hysteroscopy are immediately available. Hysteroscopy and histopathology complement each other in evaluating patients with abnormal uterine bleeding for accurate diagnosis and further treatment.

Resuscitative endovascular balloon occlusion of the aorta for non-traumatic intra-abdominal hemorrhage.

Hemorrhagic shock is the second leading cause of death in blunt trauma and a significant cause of mortality in non-trauma patients. The increased use of resuscitative endovascular balloon occlusion of the aorta (REBOA) as a bridge to definitivecontrol for massive hemorrhage has provided promising results in the trauma population. We describe an extension of this procedure to our hemodynamically unstable non-trauma patients. This is a retrospective review of patients requiring REBOA for end stage non-traumatic abdominal hemorrhage from our tertiary care facility. After excluding patients with trauma, supradiaphragmatic bleed and thoracic/abdominal aortic aneurysms, demographics, etiology of bleed, REBOA placement specifics, complications and outcomes were reviewed. From August 2013 to August 2016, 11 patients were identified requiring REBOA placement for hemodynamic instability from non-traumatic abdominal hemorrhage. Average patient age was 54.9 (SD 15.2). Sixty-four percent suffered cardiac arrest prior to REBOA, with mean shock index of 1.29. Average time from diagnosis of shock (MAP ≤ 65) or signs of bleeding to placement of REBOA was 177min. The leading etiologies of hemorrhage were ruptured visceral aneurysm and massive upper gastrointestinal bleed. REBOA was placed by both acute care and vascular surgeons. The procedure was mainly completed in the operating room in 82% of the patients and at the bedside in 18%. One patient expired before operative repair. Definitive surgical control of the source of bleeding was obtained by open surgical approach (n = 6) and combined surgical and endovascular approach (n = 4). In-hospital survival was 64%. There were no local complications related to REBOA placement. Similar to the trauma population, REBOA is an adjunctive technique for proximal control of bleeding as well as resuscitation in end stage non-traumatic intra-abdominal hemorrhage. We propose an algorithmic approach to REBOA use in this population and a larger prospective review is necessary to determine both the timing of REBOA placement and which non-traumatic patients may benefit from this technique. V. Brief report.

GASTRODUODENAL BLEEDINGS IN PATIENTS WITH THE PATHOLOGY OF CENTRAL NERVOUS SYSTEM

The article presents a brief overview of local and foreign literature sources and reflects some of the issues of the etiology and pathogenesis of bleeding from the upper gastrointestinal tract in patients with acute vascular pathology of CNS and modern minimally invasive methods of hemostasis.

Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report

BackgroundPrimary aortoduodenal fistula (ADF) is a rare cause of gastrointestinal (GI) bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA) can be used to detect primary ADF. Open surgery or endovascular aortic repair (EVAR) for ADF with bleeding will improve the survival rate.Case presentationWe report a rare case of AAA complicating ADF with massive GI bleeding in a 73-year-old Taiwanese man. He presented with abdominal pain and tarry stool for 5 days and an initial upper GI endoscopy at a rural hospital showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9 g/dl from 12 g/dl occurred the next day. He was referred to our hospital for EVAR and primary closure of fistula defect due to massive GI bleeding with shock from ADF caused by AAA. Diagnosis was made by CTA of aorta.ConclusionsA timely and accurate diagnosis of primary ADF may be challenging due to insidious episodes of GI bleeding, which are frequently under-diagnosed until the occurrence of massive hemorrhage. Clinical physicians should keep a high index of awareness for primary ADF, especially in elderly patients with unknown etiology of upper GI bleeding with or without a known AAA.

Timing of onset of gastrointestinal bleeding in the ICU: Protocol for a preplanned observational study.

Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm. For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding. This is a protocol and statistical analysis plan for a preplanned exploratory substudy of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) randomized clinical trial, comparing intravenous pantoprazole (40mg once daily) with placebo in 3350 acutely ill adult ICU patients. We will describe baseline characteristics and assess the time to onset of the first clinically important episode of GI bleeding accounting for survival status and allocation to SUP or placebo. In addition, we will describe differences in therapeutic and diagnostic procedures used in patients with clinically important gastrointestinal bleeding according to early vs late bleeding and 90-day vital status. The study outlined in this protocol will provide detailed information on patient characteristics and the timing of onset of gastrointestinal bleeding in the patients enrolled in the SUP-ICU trial. This may provide additional knowledge and incentives for future studies on which patients benefit from SUP.

A survey on rectal bleeding in children, a report from Iran

Background/aim: Studies on the epidemiology of rectal bleeding in children are limited in Iran. Our aim was to assess etiologies of rectal bleeding in children in Iran. Materials and methods: We enrolled 730 children with rectal bleeding. All the patients underwent colonoscopy, and 457 were further evaluated with histopathology. Results: According to colonoscopy and histopathology, respectively, inflammatory bowel disease (IBD) (29.4%, 15.8%), nodular hyperplasia (NH) (24.9%, 10%), and juvenile polyposis (JP) (12.6%, 9.9%) were the most common causes of rectal bleeding. Other conditions were solitary rectal ulcer (5.3%), chronic colitis (4.6%), allergic colitis (3.3%), focal colitis (1.3%), and infectious colitis (1.1%). In colonoscopy, there were no significant differences in the distribution of pathologies regarding sex, while the youngest and oldest mean ages were found for patients with NH (4.6 ± 3.9 years, P < 0.0001) and those with normal appearance (8.1 ± 4.4 years, P < 0.0001) respectively. Based on histopathologic reports, the youngest patients were diagnosed with infectious colitis (4.6 ± 2.8 years), while patients with chronic colitis were the oldest (9.2 ± 4.6 years, P = 0.003). Conclusion: JP, NH, and IBD constituted the most common etiologies of rectal bleeding in our patients. It is recommended to perform a complete diagnostic approach to accurately assess rectal bleeding in children.

Inter-institutional analysis demonstrates the importance of lower than previously anticipated dose regions to prevent late rectal bleeding following prostate radiotherapy

PurposeTo investigate whether inter-institutional cohort analysis uncovers more reliable dose–response relationships exemplified for late rectal bleeding (LRB) following prostate radiotherapy. Material and methodsData from five institutions were used. Rectal dose–volume histograms (DVHs) for 989 patients treated with 3DCRT or IMRT to 70–86.4 Gy@1.8–2.0 Gy/fraction were obtained, and corrected for fractionation effects (α/β = 3 Gy). Cohorts with best-fit Lyman–Kutcher–Burman volume-effect parameter a were pooled after calibration adjustments of the available LRB definitions. In the pooled cohort, dose–response modeling (incorporating rectal dose and geometry, and patient characteristics) was conducted on a training cohort (70%) followed by final testing on the remaining 30%. Multivariate logistic regression was performed to build models with bootstrap stability. ResultsTwo cohorts with low bleeding rates (2%) were judged to be inconsistent with the remaining data, and were excluded. In the remaining pooled cohorts (n = 690; LRB rate = 12%), an optimal model was generated for 3DCRT using the minimum rectal dose and the absolute rectal volume receiving less than 55 Gy (AUC = 0.67; p = 0.0002; Hosmer–Lemeshow p-value, pHL = 0.59). The model performed nearly as well in the hold-out testing data (AUC = 0.71; p < 0.0001; pHL = 0.63), indicating a logistically shaped dose–response. ConclusionWe have demonstrated the importance of integrating datasets from multiple institutions, thereby reducing the impact of intra-institutional dose–volume parameters explicitly correlated with prescription dose levels. This uncovered an unexpected emphasis on sparing of the low to intermediate rectal dose range in the etiology of late rectal bleeding following prostate radiotherapy.

4:21 PM Abstract No. 110 ■ FEATURED ABSTRACT Safety and efficacy of transcatheter arterial embolization for upper gastrointestinal bleeding at a tertiary care center: a contemporary review

To evaluate the safety and efficacy of transcatheter arterial embolization in the management of nonvariceal upper gastrointestinal bleeding (UGIB). All patients who underwent transcatheter arterial embolization intervention for UGIB at a single institution from September 2011 to October 2016 were included in this retrospective study. The rates of technical and clinical success, ischemic complications, in-hospital mortality, and recurrent bleeding were determined. Technical success was defined as the absence of angiographic signs of hemorrhage at the conclusion of the procedure. Clinical success was defined as technical success without major complication or recurrent bleeding within 30 days of embolization. Additionally, the etiology of bleeding, outcomes of preprocedure endoscopic intervention, imaging concordance, and embolic material used were evaluated. 109 UGIB transcatheter arterial embolization procedures were performed on 101 patients over this time period. 61 embolizations (56%) were performed for positive angiographic findings, and 48 embolizations (44%) were performed empirically. The most commonly identified etiologies included duodenal ulcer (22%), gastric cancer (14.7%), pancreatic cancer (6.4%), and Dieulafoy lesions (7.3%). 79 cases underwent endoscopy prior to embolization. A CT angiogram was performed in 13 cases and was concordant with the angiogram performed during embolization 84.6% of the time. A nuclear medicine study was performed in 6 cases and was concordant with the angiogram performed during embolization 83.3% of the time. Embolic material used included coils only (56.9%), Gelfoam only (7.3%), particles only (6.4%), liquid embolic only (5.6%), or a combination of the above (23.9%). For all cases evaluated, the clinical success, ischemic complications, recurrent bleeding, and in-hospital mortality were 67%, 0%, 33%, and 33.7%, respectively. Modern equipment and techniques for transcatheter arterial embolization have maximized technical success rates and minimized ischemic complications, but clinical success rates remain similar to historical controls.

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.

Etiology of gastrointestinal bleeding in patients on dual antiplatelet therapy.

Dual antiplatelet therapy (DAPT) is associated with an increased risk of gastrointestinal (GI) bleeding and is thought to cause upper gastrointestinal bleeding (UGIB). However, recent reports indicate that the incidence of lower gastrointestinal bleeding (LGIB) in patients on DAPT may be increasing. We aimed to compare the endoscopic findings and etiology of GI bleeding between patients on DAPT compared with those not on DAPT. This was a retrospective, single-center, case-control study. Cases were 114 consecutive patients admitted with a first episode of GI bleeding while on DAPT who underwent detailed GI evaluation. We chose 114 controls who had GIB but were not on DAPT. There was no significant difference in the incidence of UGIB or LGIB between the two groups (UGIB: 53.5% vs 51.3% and LGIB: 46.5% vs 48.7%, P = 0.10) or within groups (DAPT: 53.5% vs 46.5%, P = 0.30 and controls: 51.3% vs 48.7%, P = 0.80). Although the DAPT group had a lower prevalence of the usual UGIB risk factors, it had a higher likelihood of bleeding from varices or upper GI inflammation [odds ratio (OR) 3.54, 95% confidence interval (CI) 0.14-92.3; OR 13.98, 95% CI 1.40-140.36]. No etiology of bleeding was identified in a higher percentage of patients on DAPT than those who were not (22.8% vs 5.3%). In patients with GI bleeding, the incidences of UGIB and LGIB are similar irrespective of their DAPT use.

Intensive care needs and predictors of in hospital mortality following spontaneous intracranial hemorrhage in children - A ten year single centre retrospective study

Objective: To study the clinical profile, intensive care needs and predictors of in hospital mortality in children with Spontaneous Intracranial Hemorrhage (SICH). Material and methods: Retrospective observational study in a tertiary care pediatric intensive care unit (PICU) of a teaching and referral hospital where 105 children aged > 1 month to 12 years with SICH admitted between January 2009 and May 2018 were assessed for in-hospital mortality as primary outcome. Survivors and non-survivors were compared to determine predictors of outcome. Results: The median (IQR) age of study subjects was 6 (2.25, 70) months, with 76 (72.4%) boys. Altered sensorium (n=87, 82.9%) and seizures (n=73, 69.5%), and pallor (n=66, 62.9%) and bulging anterior fontanelle (n=52, 49.5) were common presenting symptoms and signs respectively. Median (IQR) Glasgow Coma Scale (GCS) at admission was 10 (6,13) with features of herniation in 27 (25.7%). Arteriovenous malformation was the commonest cause of bleed among older children whereas late hemorrhagic disease of newborn was predominant cause among infants. Commonest site of bleed was intracerebral (n=47, 44.8%) followed by subdural (n=26; 24.8%). Sixteen (15.2%) children died during hospital stay. On univariate analysis, GCS<8, higher PRISM-III (>20), need for intubation at admission, development of shock and Acute kidney injury (AKI) during hospital stay and refractory status epilepticus requiring thiopentone coma were found to be significant predictors of mortality. Focal seizures were however associated with better survival [OR 0.12; 95% CI:0.03-0.47; p-0.002]. Age, site or etiology of bleed did not affect outcome. On multivariable analysis, progression to AKI [OR 5.86; 95% CI:1.53-22.4; p-0.01] predicted poor outcome. Conclusions: Etiology of SICH varies with age. Age or site of bleed did not predict outcome. Refractory status requiring thiopentone and development of MODS (shock, AKI) were associated with poor outcome.

Clinical approach to the patient with acute gastrointestinal bleeding.

Gastrointestinal bleeding (GIB) is a very common condition at all ages, with high rates of morbidity and mortality, especially in case of acute presentation. The optimal management of acute GIB requires a timely overview of vital signs and clinical presentation to stabilize the patient if necessary and set up the most adequate diagnostic and therapeutic approach, based on the suspected etiology. Endoscopy plays a major role both in diagnosis and treatment of acute GIB, as allows the application of several hemostasis techniques during the diagnostic session, which should preferably be performed within 24 hours from the acute event. The hemostasis technique should be chosen based on type, etiology of the bleeding and the operator preference and expertise. Nevertheless, several challenging cases need the cooperation of radiology especially in the diagnostic phase, and even in the therapeutic phase for those bleedings in which medical and endoscopic techniques have failed. Imaging diagnostic techniques include mainly CT angiography, scintigraphy with labeled erythrocytes and arteriography. This last technique plays also a therapeutic role in case arterial embolization is needed. Only those patients in which the previous techniques have failed, both in diagnosis and treatment, are candidates for emergency surgery. (www.actabiomedica.it)

Transabdominal and transvaginal ultrasonographic evaluation in the measurement of endometrial thickness in patients with abnormal uterine bleeding

Background: Abnormal uterine bleeding is a common complaint in women of all ages for which they consult their gynecologist and is the direct cause of a significant health-care burden for women. It affects 10%–30% of reproductive age women and 50% of perimenopausal women. The most probable etiology of abnormal uterine bleeding relates to the patients' reproductive age, as does the likelihood of serious endometrial pathology. Imaging plays a pivotal role in resolving these common complaints in practice. Study Design: This study is of 50 women presenting/referred with abnormal uterine bleeding in the department of radiodiagnosis of our hospital. They underwent both transabdominal and transvaginal ultrasonography for the evaluation of endometrial thickness and also to look for the presence of other pelvic pathologies. Results and Conclusion: In our study of 50 patients, transabdominal and transvaginal ultrasonography did not yield a significant difference in the measurement of endometrial thickness. However, both had a complimentary role in better diagnosing pelvic pathologies and eliminating the use of invasive procedures for diagnosing cases of abnormal uterine bleeding.

Epidemiology of obscure gastrointestinal bleeding in China: A single‐center series and comprehensive analysis of literature

To determine the etiologies of obscure gastrointestinal bleeding (OGIB) in a Chinese population using a retrospective case series and a systematic analysis of the literatures on OGIB in Chinese patients. A large enteroscopy database in a tertiary endoscopic center was searched to identify patients with OGIB from 2010 to 2016. The patients' characteristics and diagnostic findings were collected and analyzed. A comprehensive search of the literature was carried out to harvest all relevant studies published from 2004 to 2016. In total, 708 patients were included in the case series. The most common causes of OGIB were inflammatory diseases (36.3%), non-small bowel lesions (10.2%) and neoplasms (10.0%). A systematic analysis of the literatures included 39 studies providing relevant data for 3145 patients with a pooled detection rate of 84.2%. Inflammatory lesions (27.4%), neoplasms (18.5%), vascular lesions (16.1%) and diverticula or intestinal duplication (11.9%) were the most common causes of OGIB. Inflammatory lesions, neoplasms, vascular lesions and diverticula or intestinal duplication are the most common in Chinese OGIB patients, while in pediatric patients diverticula or intestinal duplication, vascular lesions and Crohn's disease are prevalent. Furthermore, the etiologies of OGIB distribute differently across different areas in China.

Sevelamer-Associated Rectosigmoid Ulcers in an End-Stage Renal Disease Patient

Sevelamer carbonate is a commonly prescribed anion-exchange resin administered orally to prevent hyperphosphatemia in patients with chronic kidney disease. We present a rare case of a 33-year-old man with end-stage renal disease and diabetic gastroparesis on sevelamer carbonate, who presented with hematochezia and was found to have rectosigmoid ulcers induced by sevelamer crystals. His hematochezia resolved after switching from sevelamer carbonate to lanthanum carbonate. Clinicians and pathologists must be aware of the possibility of drug-induced mucosal ulceration associated with sevelamer use as a potential etiology of a gastrointestinal bleed.

The role and importance of antiagregan, anticoagulant drugs in the etiology of upper gastrointestinal system bleeding in elderly

The role and importance of antiagregan, anticoagulant drugs in the etiology of upper gastrointestinal system bleeding in elderly