Gastric Bleeding Research Articles

Examining the Frequency of Second Endoscopy and Its Effect on Patient Outcomes With Upper Gastrointestinal Bleeding in Southeast of Iran.

This study investigated the frequency and impact of repeat endoscopy in patients with acute upper gastrointestinal bleeding (AUGIB) in a referral hospital in Southeast Iran. A cross-sectional descriptive-analytical study was conducted on the records of 190 patients who underwent endoscopy for AUGIB in 2019. The study compared the demographic and clinical characteristics, outcomes, and treatments of patients who had a second endoscopy (n=64) with those who did not (n=126). The data were analyzed with SPSS software, and a P value less than 0.05 was considered significant. The results showed that repeat endoscopy was not significantly associated with age, gender, initial symptoms, bleeding site, first endoscopy time, or disease outcome. However, repeat endoscopy was significantly associated with higher bleeding severity, different wound types, different bleeding causes, longer hospital stay, and different treatments in the first endoscopy. The main reasons for repeat endoscopy were poor visibility and recurrent bleeding. The majority of repeat endoscopies were performed within 2 days of the first one. Most patients who had a second endoscopy did not receive any treatment, and those who did received combined thermal and epinephrine injections. The study concluded that routine second endoscopy is not necessary for all patients with AUGIB, but it may be beneficial for some cases. Further research is needed to clarify the indications and timing of repeat endoscopy in AUGIB.

SCT-I10A combined with a bevacizumab biosimilar (SCT510) versus sorafenib in the first-line treatment of advanced hepatocellular carcinoma: A randomized phase 3 trial.

4092 Background: Hepatocellular carcinoma (HCC) is a significant health concern in China, and it has been a leading cause of cancer-related deaths. Immunotherapy combined with anti-vascular growth therapy is the first recommended therapy. In this study, we evaluated the safety and efficacy of SCT-I10A (an anti-programmed death 1 [PD-1] monoclonal antibody) combined with SCT510 (a bevacizumab biosimilar) compared to sorafenib as the first-line treatment for advanced HCC. Methods: In this open-label, multicenter, phase 3 trial (NCT04560894) conducted in China, patients with advanced HCC who had not received prior system therapy were enrolled and randomly assigned (2:1) to receive SCT-I10A (200 mg every three weeks [Q3W]) plus SCT510 (a bevacizumab biosimilar, 15 mg/kg Q3W) or sorafenib (400 mg orally twice daily) until no clinical benefit or unacceptable toxicity. Randomization was stratified by ECOG performance status (0 vs. 1), baseline alpha-fetoprotein level (<400ng/ml vs. ≥400ng/ml), macrovascular invasion or extrahepatic metastasis (yes vs. no). The co-primary endpoints were overall survival (OS) and progression-free survival (PFS) as assessed by the blinded independent central review (BICR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 in the full analysis set. Results: At the data cutoff for the interim analysis (November 2, 2023), a total of 346 patients were enrolled and received at least one dose (SCT-I10A plus SCT510 group, n=230; sorafenib group, n=116), and the median follow-up was 19.7 months. The SCT-I10A plus SCT510 group exhibited a significantly longer median OS than that in the sorafenib group (22.1 vs. 14.2 months, hazard ratio [HR] 0.60; 95% confidence interval [CI]: 0.44, 0.81; p=0.0008). Median PFS was prolonged significantly in the SCT-I10A plus SCT510 group compared to the sorafenib group (7.1 vs. 2.9 months; HR 0.50; 95%CI: 0.38, 0.65; p<0.0001). The objective response rate (ORR) was higher in the SCT-I10A plus SCT510 group (32.8% [75/229]) than in the sorafenib group (4.3% [5/116]). Grade ≥3 treatment-related adverse events (TRAEs) were observed in 42.6% (98/230) of patients in the SCT-I10A plus SCT510 group and 33.6% (39/116) of patients in the sorafenib group. The most common grade ≥3 TRAE was hypertension (SCT-I10A plus SCT510 group vs. sorafenib group: 7.8% [18/230] vs. 4.3% [5/116]). Three drug-related deaths (unknown cause, hemorrhage intracranial, or upper gastrointestinal hemorrhage in 1 patient each) occurred and were related to SCT510. Conclusions: The combination of SCT-I10A and SCT510 showed substantial clinical advantages and an acceptable safety profile in patients with advanced HCC, thereby supporting its suitability as a first-line treatment option for HCC. Clinical trial information: NCT04560894 .

Timing It Right: Endoscopic Necrosectomy for Infected Necrotizing Pancreatitis

AbstractThe endoscopic step-up drainage approach involving initial drainage followed by, if required, direct endoscopic necrosectomy (DEN) is the preferred management approach for symptomatic pancreatic necrotic collections. However, limited data suggests that immediate DEN during initial stent placement may hasten clinical recovery by quicker resolution of systemic inflammatory response. However, because of concerns about adverse effects, especially gastric perforation and bleeding, most endoscopists prefer delayed DEN. In this news and views, we discuss a recently published randomized controlled trial that compared upfront necrosectomy at the index intervention versus as a step-up for patients with infected necrotizing pancreatitis.

Endoscopy for acute upper gastrointestinal bleeding: a protocol for systematic review and network meta-analysis of randomized controlled trials

Background: Previous studies have reached mixed conclusions regarding the timing of endoscopic approaches for managing individuals with acute upper gastrointestinal bleeding (AUGIB). Therefore, the authors performed a protocol for systematic review and meta-analysis to assess the efficacy of various timing endoscopic approaches in managing individuals with AUGIB. Methods: The authors will search multiple databases, including PubMed, Embase, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database, WHO International Clinical Trials Registry Platform, and Chinese Clinical Trial Register. The search will cover the entire duration, starting from the establishment of these databases until July 2023. The selection criteria will focus on randomized controlled trials that assess the efficacy of endoscopy with varying timing in managing patients with AUGIB. The primary outcomes will include primary hemostasis and inpatient death. The secondary outcomes will include recurrent bleeding, need for surgical intervention, admission to the ICU, blood transfusion needs, and duration of hospitalization. Two reviewers will select the studies, extract data, and assess the risk of bias. A Bayesian approach will be used to conduct a network meta-analysis. Results: The results of this systematic review and meta-analysis will be published in peer-reviewed journals. Conclusion: This network meta-analysis provides comprehensive evidence of different timing endoscopic approaches for managing individuals with AUGIB.

Parvimonas micra Bacteremia: A Rare Complication After Esophagogastroduodenoscopy for Upper Gastrointestinal Bleeding

ABSTRACT Parvimonas micra bacteremia is rarely encountered in clinical practice. When it is, patients usually have underlying periodontal disease or colorectal carcinoma. To the best of our knowledge, this is the first case of P. micra bacteremia in a patient without the predisposing risk factors listed above. We postulate that this occurred because of translocation across an interrupted gut-blood barrier in the setting of an acute upper gastrointestinal bleed. We present this case to highlight the importance of identifying and treating P. micra bacteremia because it can prevent commonly encountered sequelae of untreated bacteremia and improve outcomes.

Meta-analysis: Over-the-scope clips in patients at high risk of re-bleeding following upper gastrointestinal tract bleeding.

Acute non-variceal upper gastrointestinal bleeding (UGIB) is challenging in patients at high risk of re-bleeding in whom standard endoscopic treatment (ST) has limited effectiveness. Over-the-scope clips (OTSC) have shown promise in these patients although their precise role remains uncertain. To confirm the role of OTSC in patients with UGIB at high risk of re-bleeding. We systematically searched CENTRAL, MEDLINE and Embase from January 1st, 1970 to April 24, 2024 for randomised controlled trials (RCTs) comparing OTSC and ST in acute non-variceal UGIB with high re-bleeding risk. The GRADE framework assessed evidence certainty, while trial sequential analysis (TSA) controlled random errors and evaluated conclusion validity. We analysed four RCTs (319 patients); pooled risk ratio (RR) for clinical success at initial endoscopy favoured OTSC (RR = 1.30, 95% CI = 1.08-1.56, p = 0.006, I2 = 58%, moderate certainty of evidence). TSA showed the desired sample size was 410 and the cumulative Z curve crossing the trial sequential monitoring boundary. The pooled RR for re-bleeding within 30 days favoured OTSC (RR = 0.53, 95% CI = 0.30-0.94, p = 0.03, I2 = 0%, moderate certainty of evidence). There was no significant difference in 30-day mortality, or length of hospital or ICU stay. Moderate certainty evidence supports OTSC as a superior initial treatment for acute non-variceal UGIB with high re-bleeding risk. Further large-scale studies are needed to confirm OTSCs' role by exploring other prognostic outcomes and assessing cost-effectiveness and potential complications.

Phellodendron chinense C.K.Schneid: An in vitro study on its anti-Helicobacter pylori effect

Ethnopharmacological relevancePhellodendron chinense C.K.Schneid(P. chinense Schneid) is known in TCM as Huang Bo, is traditionally used to support gastrointestinal function and alleviate stomach-related ailments, including gastric ulcer bleeding and symptoms of gastroesophageal reflux disease. Helicobacter pylori (H. pylori) is classified by the WHO as a Group 1 carcinogen. However, the specific activity and mechanism of action of P. chinense Schneid against H. pylori infection remain unclear. It has been noted that Huangjiu processing may alter the bitter and cold properties of P. chinense Schneid, but its effect on antimicrobial activity requires further investigation. Additionally, it remains uncertain whether berberine is the sole antimicrobial active component of P. chinense Schneid. Aim of studyThis study aims to elucidate the anti-H. pylori infection activity of P. chinense Schneid, along with its mechanism of action and key antimicrobial active components. Materials and methodsPhytochemical analysis was carried out by UPLC-MS/MS. HPLC was employed to quantify the berberine content of the extracts. Antimicrobial activity was assessed using the micro broth dilution method. Morphology was observed using SEM. The impact on urease activity was analyzed through in vitro urease enzyme kinetics. RT-qPCR was employed to detect the expression of virulence genes, including adhesin, flagellum, urease, and cytotoxin-related genes. The adhesion effect was evaluated by immunofluorescence staining and agar culture. ResultsP. chinense Schneid exhibited strong antimicrobial activity against both antibiotic-sensitive and resistant H. pylori strains, with MIC ranging from 40 to 160 μg/mL. Combination with amoxicillin, metronidazole, levofloxacin, and clarithromycin did not result in antagonistic effects. P. chinense Schneid induced alterations in bacterial morphology and structure, downregulated the expression of various virulence genes, and inhibited urease enzyme activity. In co-infection systems, P. chinense Schneid significantly attenuated H. pylori adhesion and urease relative content, thereby mitigating cellular damage caused by infection. Huangjiu processing enhanced the anti-H. pylori activity of P. chinense Schneid. Besides berberine, P. chinense Schneid contained seven other components with anti-H. pylori activity, with palmatine exhibiting the strongest activity, followed by jatrorrhizine. ConclusionsThis study sheds light on the potential therapeutic mechanisms of P. chinense Schneid against H. pylori infection, demonstrating its capacity to disrupt bacterial structure, inhibit urease activity, suppress virulence gene transcription, inhibit adhesion, and protect host cells. The anti-H. pylori activity of P. chinense Schneid was potentiated by Huangjiu processing, and additional components beyond berberine were identified as possessing strong anti-H. pylori activity. Notably, jatrorrhizine, a core component of P. chinense Schneid, exhibited significant anti-H. pylori activity, marking a groundbreaking discovery.

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

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

Ankaferd blood stopper: A novel additional strategy for less experienced gastroenterologists in gastrointestinal bleeding treatment.

The Ankaferd Blood Stopper (ABS) proves effective in managing various bleedings, particularly in surgical and dental procedures. This study assesses ABS efficacy endoscopically by less-experienced endoscopists for non-variceal upper gastrointestinal bleeding (NVUGB). Between 2016 and 2021, our hospital's Gastroenterology Department Endoscopy Unit conducted a retrospective data analysis of 653 patients who underwent endoscopy for NVUGB. The study included 202 patients who underwent endoscopic interventions performed by endoscopists with less than 3 years of experience. Based on the method used for endoscopic hemostasis, we classified those treated with ABS (either alone or as a second method) as group 1. In contrast, we classified patients treated with non-ABS hemostatic methods into Group 2. The study included 202 patients, with 96 (47.52%) in Group 1 and 106 (52.48%) in Group 2. All patients in Group 1 achieved bleeding control, while 4 patients in Group 2 initially did not achieve bleeding control; however, bleeding control was subsequently established following ABS administration. After 1 month of follow-up, mortality occurred in 3 out of 202 patients (1.48%), and all these cases were in Group 2. There is a significant difference in the need for blood transfusion between the groups (P < .001). Regarding the bleeding source, bulbus ulcer and gastric cancer were more prevalent in Group 2. On the other hand, although statistical significance was not reached in the comparison of rebleeding rates between groups, numerically, a higher incidence of recurrent bleeding was observed in Group 2 (Group 1: 3 [3.1%], Group 2: 8 [7.5%]; P = .167). Additionally, a similar relationship was noted among intensive care admissions (Group 1: 5 [5.2%]; Group 2: 7 [6.6%]; P = .675). In the group that used ABS, there were significantly higher rates of hypotension, tachycardia, syncope, and the need for transfusion than in the other group. In medical practice, this distinction often stems from the shared preference of clinicians to use ABS as a salvage method in cases of more severe bleeding. Considering all the findings, it is evident that using ABS through endoscopy in cases of NVUGIB significantly improves procedural success, irrespective of the endoscopist's experience level.

Acute Upper Gastrointestinal Bleeding in Post COVID-19 Patients Receiving Direct Oral Anticoagulants as Thromboprophylaxis

Acute Upper Gastrointestinal Bleeding in Post COVID-19 Patients Receiving Direct Oral Anticoagulants as Thromboprophylaxis

Sepsis as a Potential Risk Factor for Upper Gastrointestinal Bleeding in Critically Ill Patients: A Systematic Review and Meta-analysis.

Purpose: Sepsis is a common and critical condition in intensive care units (ICUs) known to complicate patient outcomes. Previous studies have indicated an association between sepsis and various ICU morbidities, including upper gastrointestinal bleeding (UGIB). However, the extent of this relationship and its implications in ICU settings remain inadequately quantified. This study aims to elucidate the association between sepsis and the risk of UGIB in ICU patients. Methods: A comprehensive meta-analysis was conducted, encompassing nine studies with a total of nearly 9000 participants. These studies reported events for both sepsis and nonsepsis patients separately. Pooled odds ratios (ORs) were calculated to assess the risk of UGIB in septic versus nonseptic ICU patients. Subgroup analyses were conducted based on age and study design, and both unadjusted and adjusted ORs were examined. Results: The pooled OR indicated a significant association between sepsis and UGIB (OR = 3.276, 95% CI: 1.931 to 5.557). Moderate heterogeneity was observed (I² = 43.9%). The association was significant in adults (pooled OR = 4.083) but not in children. No difference in association was found based on the study design. Unadjusted and adjusted ORs differed slightly, indicating the influence of confounding factors. Conclusion: This meta-analysis reveals a significant association between sepsis and an increased risk of UGIB in ICU patients, particularly in adults. These findings highlight the need for vigilant monitoring and proactive management of septic ICU patients to mitigate the risk of UGIB. Future research should focus on understanding the underlying mechanisms and developing tailored preventive strategies.

Recurrent Brunneroma: A Rare Cause of Duodenal Obstruction

Abstract Brunneroma, also known as Bruner’s gland adenoma or hamartoma, is a rare benign tumor of the duodenum. It is usually asymptomatic and sometimes presents with an upper gastrointestinal (UGI) bleed or obstruction. The majority of the cases are detected incidentally during endoscopy for UGI bleeding and may require endoscopic excision. Here, we attempt to highlight a case of recurrent large Brunneroma in a 52-year-old male and reassess the representative features that surgeons need to be aware of. We had to go for a major surgical intervention to relieve the duodenal obstruction.

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.

Upper gastrointestinal bleeding as a warning sign of gastrointestinal cancer

BackgroundUpper gastrointestinal bleeding (UGIB) is a prevalent etiology for hospital admissions on a global scale. However, the significance of UGIB as a warning sign of gastrointestinal (GI) cancer is frequently disregarded due to its uncommon and atypical symptoms. MethodsIn the Kailuan study, participants diagnosed with UGIB were assigned as the case group and were randomly matched in a 1:4 ratio with a control group of comparable age and sex from 2006 to 2018 in Tangshan. The statistical analysis included a total of 1250 UGIB patients and 5000 individuals without UGIB. The impact of UGIB on cancer incidence was evaluated using a Cox proportional hazards model, enabling the investigation of both site-specific and time-dependent effects of UGIB on cancer incidence. ResultsThe mean age of the patients was 60.91 ± 13.08 years. Over an average follow-up period of 8.92 years, there were 102 cases of cancer in the UGIB group and 210 cases in the non-UGIB group. The results of the Cox model analysis indicated that the strength of association between UGIB and cancer depends on specific cancer site. Excluding patients with follow-up periods of less than 1, 3, and 5 years weakened the associations between UGIB and GI cancer in sensitivity analysis. ConclusionUGIB may serve as a sign of occult cancer, necessitating thorough evaluation of middle-aged and elderly patients presenting with this warning symptom to detect the possibility of missing a cancer diagnosis.

Risk factors and outcomes of peptic ulcer bleed in a Pakistani population: A single-center observational study

BACKGROUND Peptic ulcer disease (PUD) remains a significant healthcare burden, contributing to morbidity and mortality worldwide. Despite advancements in therapies, its prevalence persists, particularly in regions with widespread nonsteroidal anti-inflammatory drugs (NSAIDs) use and Helicobacter pylori infection. AIM To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal (GI) bleeding in Pakistani population. METHODS This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022. Data on demographics, symptoms, length of stay, mortality, re-bleed, and Forrest classification was collected. RESULTS The mean age of patients was 53 years, and the majority was men (68.3%). Hematemesis (82.4%) and epigastric pain (75.4%) were the most common presenting symptoms. Most patients (73.2%) were discharged within five days. The mortality rates at one week and one month were 10.6% and 14.8%, respectively. Re-bleed within 24 h and seven days occurred in 14.1% and 18.3% of patients, respectively. Most ulcers were Forrest class (FC) III (72.5%). Antiplatelet use was associated with higher mortality at 7 and 30 d, while alternative medications were linked to higher 24-hour re-bleed rates. NSAID use was associated with more FC III ulcers. Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality. CONCLUSION Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding, while alternative medicines are associated with early rebleeding.

Evaluating the Accuracy, Comprehensiveness, and Validity of ChatGPT Compared to Evidence-Based Sources Regarding Common Surgical Conditions: Surgeons' Perspectives.

This study aims to assess the accuracy, comprehensiveness, and validity of ChatGPT compared to evidence-based sources regarding the diagnosis and management of common surgical conditions by surveying the perceptions of U.S. board-certified practicing surgeons. An anonymous cross-sectional survey was distributed to U.S. practicing surgeons from June 2023 to March 2024. The survey comprised 94 multiple-choice questions evaluating diagnostic and management information for five common surgical conditions from evidence-based sources or generated by ChatGPT. Statistical analysis included descriptive statistics and paired-sample t-tests. Participating surgeons were primarily aged 40-50 years (43%), male (86%), White (57%), and had 5-10 years or >15 years of experience (86%). The majority of surgeons had no prior experience with ChatGPT in surgical practice (86%). For material discussing both acute cholecystitis and upper gastrointestinal hemorrhage, evidence-based sources were rated as significantly more comprehensive (3.57 (±.535) vs 2.00 (±1.16), P = .025) (4.14 (±.69) vs 2.43 (±.98), P < .001) and valid (3.71 (±.488) vs 2.86 (±1.07), P = .045) (3.71 (±.76) vs 2.71 (±.95) P = .038) than ChatGPT. However, there was no significant difference in accuracy between the two sources (3.71 vs 3.29, P = .289) (3.57 vs 2.71, P = .111). Surveyed U.S. board-certified practicing surgeons rated evidence-based sources as significantly more comprehensive and valid compared to ChatGPT across the majority of surveyed surgical conditions. However, there was no significant difference in accuracy between the sources across the majority of surveyed conditions. While ChatGPT may offer potential benefits in surgical practice, further refinement and validation are necessary to enhance its utility and acceptance among surgeons.

The efficacy of sclerotherapy as the initial treatment in patients with bleeding from Dieulafoy's lesion of the upper gastrointestinal tract.

Dieulafoy's lesion (DL) is a rare and important cause of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), however, there is a lack of clear guidelines focus on the endoscopic hemostasis treatment for DL. Sclerotherapy, as the ANVUGIB guideline recommended endoscopic hemostasis method, is widely used in clinical practice. The aim of this study is to investigate the efficacy of sclerotherapy as the initial treatment for Dieulafoy's lesion of the upper gastrointestinal tract (UDL). Patients with UDL who underwent the ANVUGIB standard endoscopic hemostasis between April 2007 and January 2023 were enrolled. The endoscopic therapy method was left to the discretion of the endoscopist. In total, 219 patients were finally obtained, with 74 (33.8%) receiving sclerotherapy and 145 (66.2%) receiving other standard endoscopic therapy. The rebleeding within 30days was significantly lower in the sclerotherapy group compared to the other standard group (5.8% vs. 16.8%, p = 0.047). There were no significant differences between the two groups in terms of successful hemostasis rate (93.2% vs. 94.5%, p = 0.713), median number of red blood cell transfusions (3.5 vs. 4.0 units, p = 0.257), median hospital stay (8.0 vs. 8.0days, p = 0.103), transferred to ICU rate (8.1% vs. 6.2%, p = 0.598), the need for embolization or surgery rate (12.2% vs. 9.7%, p = 0.567) and 30-day mortality (0 vs. 2.1%, p = 0.553). In addition, we found no difference in efficacy between sclerotherapy alone and combination (3.1% vs. 8.1%, p = 0.714). Further analysis revealed that thermocoagulation for hemostasis was associated with a higher rate of rebleeding (28.6% vs. 3.1%, p = 0.042) and longer hospital stay (11.5 vs. 7.5days, p = 0.005) compared to sclerotherapy alone. Sclerotherapy represents an effective endoscopic therapy for both alone and combined use in patients with upper gastrointestinal Dieulafoy's lesion. Therefore, sclerotherapy could be considered as initial treatment in patients with bleeding of UDL.

Upper Gastrointestinal Bleeding in the Emergency Department of Ibn Sina Hospital in Rabat: Etiological, Endoscopic, Therapeutic and Evolutive Aspects

Introduction: Upper gastrointestinal bleeding (UGIB) is defined as a bleeding from a lesion in the digestive tract located upstream of the duodenojejunal angle of Treitz. It is a medical emergency with a mortality ranging from 2 to 10%. The aim of the study is to investigate the main etiologies of upper gastrointestinal bleeding in our setting, and specify the main endoscopic findings, therapeutic approaches, and evolutive aspects. Materials and methods: A prospective, descriptive study conducted over an eight month period from May 1st to December 1st, including 50 adult patients admitted for UGIB who underwent conclusive esophagogastroduodenoscopy (EGD). We collected data about patients demographics, comorbidities, clinical presentaiton, physical examination findings, laboratory data, EGD results, therapeutic procedures and patient outcomes. Results: UGD represented 0.5% of emergency admissions, with a mean age of 61.22 years and no gender predominance. The main risk factors were related to the use of anticoagulants and/or antiplatelet agents, a history of chronic liver disease, chronic gastritis, and alcohol and tobacco use. Patients presented with hematemesis, melena, or both. EGD was performed in all patients, the main etiologies were peptic ulcer disease, vatical pathology and peptic pathology. Endoscopic treatment was performed in 38% patients, surgery was required in one case. Red blood cell transfusion was necessary in 83% patients. A favorable outcome was observed in 84% patients, while 16% patients died because of hemorrhagic shock, cardiogenic shock, and one case of multiple myeloma. Conclusion: UGIB remans a common medical and surgical emergency in our setting. The etiologies are dominated by peptic ulcer disease. EGD is the key investigation, with a diagnostic, therapeutic, and prognostic interest. The outcome was generally favorable in our study, except for 16% of cases who resulted in death. Preventive measures are essential.

Widespread use of proton pump inhibitors or potassium-competitive acid blocker has changed the status of gastrointestinal bleeding in patients with ischemic heart disease: real-world data from high volume centers

BackgroundAlthough proton pump inhibitors (PPIs) or potassium-competitive acid blocker (PCAB) are useful in peptic ulcer prevention, their efficacy in preventing other gastrointestinal bleeding remains unclear. This study aimed to identify the status of gastrointestinal bleeding in the modern era when PPIs are widely used.MethodsThis study included patients who underwent percutaneous coronary intervention (PCI) between 2018 and 2019 at two high-volume centers. Patients were categorized based on whether they experienced gastrointestinal bleeding within 2 years of PCI into groups A (patients who experienced gastrointestinal bleeding within 2 years after PCI) and B (patients who did not experience gastrointestinal bleeding).ResultsGroups A and B included 21 (4.1%) and 494 (95.9%) patients, respectively (a total of 515 patients). Age at the initial PCI (77.8±2.4 and 72.0±0.5 years in groups A and B, respectively; p = 0.02), weight (53.8±3.2 and 61.8±0.7 kg in groups A and B, respectively; p = 0.01), and concomitant warfarin use (14.3% and 2.0% in groups A and B, respectively; p = 0.0005) were significantly different between the groups. The high bleeding risk rate (90.5% and 47.6% in groups A and B, respectively; p = 0.0001) was significantly different between the groups. A total of 95.9% of patients were taking PPIs or PCAB without significant differences between the groups. However, only one patient, who was taking steroids, had a gastric ulcer during PCAB treatment.ConclusionsAcid-related upper gastrointestinal bleeding is largely controlled by PPIs in post-PCI patients. Furthermore, the risk factors for non-acid-related bleeding include older age, lower weight, and concomitant warfarin use.

Frequency of Different Causes of Upper GI Bleed Using Endoscopic Procedure

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