Gastrointestinal System 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.

A case of Osler-Weber-Rendu syndrome, diagnosed at geriatric age, presenting with gastrointestinal bleeding, telangiectasias, and asymptomatic liver and lung angiodysplasia

Abstract Background Osler-Weber-Rendu syndrome (OWRS) is an autosomal dominant disease with recurrent epistaxis, mucocutaneous telangiectasias, and arteriovenous malformations. Its clinical presentation ranges from simple skin lesions to life-threatening complications. When the diagnosis of the disease is delayed, it can be mortal and have high morbidity. This case is presented because OWRS is rare, and although she has all the features of the disease, she was diagnosed in the geriatric age group. Case presentation A 72-year-old female patient who applied to the emergency department with the complaint of melena was diagnosed with upper gastrointestinal system bleeding. Gastroscopy revealed angiodysplasia in the bulb. Colonoscopy was normal. She had telangiectasias on her face, maxilla, nose, tongue and lips. She also had recurrent epistaxis and a family history. Thorax CT showed aneurysmatic vascular malformations in the lung. Abdominal MRI revealed vascular malformations in the liver. Brain MRI was normal. The patient was diagnosed with OWRS according to the Curaçao diagnostic criteria because of telangiectasia in the mouth, nose, and face, angiodysplasia in the gastric bulb, aneurysmatic vascular dilatation in the lung, vascular pathologies in the liver, and a history of epistaxis and telangiectasia in the patient’s family members. Conclusion This patient is presented because OWRS is rare, and although she has all the features of the disease, she was diagnosed in the geriatric age group. Clinicians should be aware of this rare disease. Especially in the elderly, when angiodysplasia causing gastrointestinal bleeding is detected, it should be considered in the differential diagnosis that this may be an OWSR case.

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.

Gastrointestinal sistem kanaması sebebiyle yatan hastalarda akılcı ilaç kullanımı ve geleneksel tamamlayıcı tıp kullanımının incelenmesi

AIM: The aim of this study was to determine the knowledge levels of rational drug use, the attitudes to traditional and complementary medicine, and the relationship between these in patients admitted to the Internal Medicine Clinic because of gastrointestinal system bleeding. 
 METHOD: This descriptive, cross-sectional study was conducted with 124 patients hospitalised in the Internal Medicine Clinic of a training and research hospital with a diagnosis of gastrointestinal bleeding between 01.06.2022 and 01.10.2022.
 An Information Form including demographic and clinical characteristics, the Rational Drug Use Scale (RDUS), and the Complementary, Alternative, and Conventional Medicine Attitudes Scale (CACMAS) were applied to the patients. The data obtained were analyzed statistically using SPSS vn. 23.0 software. 
 RESULTS: For the whole sample of patients hospitalised with a diagnosis of gastrointestinal system bleeding, the mean RDUS points were determined to be 19.8±4.17 and the mean total CACMAS points were 96.76±15. In the subscales of the CACMAS, the mean points were determined to be 28.15±9.42 for philosophical congruence with complementary medicine, 23.23±10.39 for dissatisfaction with conventional medicine, and 45.38±8.18 for holistic balance. 
 The RDUS points were found to be significantly higher in females (20.33±4.37, p:0.04), patients with a good income status (22.17±4.02, p:0.03) and those who did not use painkillers (21.21±4.00, p:0.01) compared to other subgroups. The CACMAS subscale mean points for philosophical congruence with complementary medicine were determined to be significantly higher in males (29.77±9.52, p:0.03), patients who were single (36.33±9.06, p:0.002), and those who used anticoagulants (32.95±10.77, p: 0.04). The dissatisfaction with conventional medicine subscale points were determined to be significantly higher in females (26.04±9.74, p: 0,03), patients with a low income (30±15.17, p: 0.03) and those who used painkillers (26±10.67, p:0.01), and the holistic balance points were determined to be significantly higher in females (47.24±7.33, p: 0.02) and those who used medication regularly (46.49±8.34, p:0.02) compared to other sub-groups. A statistically significant negative correlation was found between rational drug use and dissatisfaction with conventional medicine (r=-0.381, p

Real-world experience with CLAIRYG® 50 mg/mL (intravenous immunoglobulin) in children under 12 years with primary immunodeficiency or immmune thrombocytopenia: a post-approval safety study.

This study presents the results of a real-life, multicenter, prospective, post-approval safety evaluation of Clairyg® 50 mg/mL, a 5% intravenous immunoglobulin (IVIg) liquid, in 59 children (aged < 12 years) with primary immunodeficiency diseases (PID) (n = 32) or immune thrombocytopenia (ITP) (n = 27) in France. The primary objective of the study was to assess the safety and tolerability of Clairyg®, recording all serious and non-serious adverse events (AEs), whether related (rAEs) or not related to the product. Secondary objectives aimed at evaluating the administration of Clairyg® under routine conditions and the available efficacy data to better document the benefit/risk ratio in this pediatric population. An exploratory objective was added to evaluate the potential factors associated with the occurrence of rAEs. Patients received Clairyg® according to the approved dosage under normal conditions of prescriptions over a median follow-up period of 11.8 months. A total of 549 infusions (PID: n = 464 and ITP: n = 85), were administered, of which 58.8% were preceded by premedication. The most frequent rAEs were headache, vomiting, and pyrexia in both indications. Most of them were considered non-serious and mild or moderate in intensity. A severe single rAE was observed (aseptic meningitis) in a 4-year-old girl presenting with chronic ITP. The exploratory multivariate analysis of potential co-factors showed that the occurrence of rAEs is significantly linked to high IVIg doses and possibly to female gender. The annualized rate of serious bacterial infections was 0.11 for patients with PID. For patients with ITP, 74.1% experienced at least one bleeding episode during the follow-up, mostly a cutaneous one, and none had gastrointestinal, genitourinary, or central nervous system bleeding. Clairyg® was well tolerated and allowed for control of serious bacterial infection in PID and serious bleeding in ITP, which are the main complications in these respective pediatric disorders. No new safety signal was detected in children less than 12 years-old in real-life conditions of use.

Effectiveness of Combination of Pharmacological Treatment and Endoscopic Band Ligation in Active Esophageale Varicos Bleeding

Acute gastrointestinal system bleeding in cirrhotic patients is one of the emergencies of gastroenterology that requires rapid and careful intervention. For this reason, patients who are thought to have esophageal variceal bleeding should be referred to a center that is adequately equipped for follow-up and treatment. There are studies supporting that current approaches to the treatment of esophageal variceal bleeding have a positive effect on life expectancy. Volume replacement is an important condition in the general approach to esophageal variceal bleeding. It is recommended to maintain hemodynamic stability and keep the hemoglobin level at approximately 8 g/dL. Additionally, it is thought that prophylactic antibiotic usage in gastrointestinal system bleeding of cirrhotic patients reduces the risk of bacterial infection and has a positive effect on life expectancy. In addition to these approaches, there are also specific measures for the control of esophageal variceal bleeding and the prevention of early recurrence of these bleedings. Pharmacological treatment for esophageal variceal bleeding can be started as soon as variceal bleeding is considered, even before upper gastrointestinal system endoscopy. Similar efficacy was demonstrated in a meta-analysis of 15 studies comparing emergency sclerotherapy and pharmacological therapy (vasopressin±nitroglycerin, terlipressin, somatostatin, octreotide). In the treatment of esophageal variceal bleeding, the combination of pharmacological and endoscopic treatment seems to be the most appropriate option. A meta-analysis of 8 studies compared the combination of endoscopic treatment [(sclerotherapy or endoscopic band ligation (EBL)] with endoscopic, pharmacological treatment) for acute variceal bleeding. Combination of endoscopic and pharmacological treatment was found superior in terms of bleeding control and risk of recurrence. In this study, we evaluated the efficacy of combination of pharmacological and endoscopic band ligation in patients who admitted to the hospital with esophageal variceal bleeding.

Endoscopic findings are not different in patients with upper gastrointestinal bleeding with COVID-19

Background and Aims: Coronavirus disease-2019 is an emerging disease of global public health concern. We aimed to evaluate the demographic data, clinical properties, risk factors and endoscopy findings of coronavirus disease-2019 patients with upper gastrointestinal system bleeding. Materials and Method: Patients who underwent endoscopy for upper gastrointestinal bleeding between July 2, 2020 and January 29, 2021 and were diagnosed with severe acute respiratory syndrome coronavirus-2 confirmed by polymerase chain reaction were included in the study. In this retrospective study patients with gastrointestinal bleeding were compared as 1:2 case-control. Coronavirus disease-2019 patients who underwent endoscopy for upper gastrointestinal bleeding and the control group were compared retrospectively in terms of demographic data, comorbid diseases, bleeding symptom, drugs administered, laboratory parameters, time between bleeding symptom and endoscopy, endoscopy findings, gastrointestinal bleeding treatment, and mortality rates. Results: Forty Covid-19 patients (23 males, mean age ± SD, 65.92 ± 12.97) and 80 non-Covid-19 control patients (43 males, mean age ± SD, 66.17 ± 15.61) who underwent endoscopy for upper gastrointestinal bleeding were compared. The most common bleeding symptom was melena in both groups (50% vs 60%). Hospitalization in intensive care unit (47.5% vs 20%, P = 0.004) and need for mechanic ventilation (22.5% vs 5%, p = 0.006), use of corticosteroids were more common in coronavirus disease-2019 group (30% vs. 2.5%, p = 0.000). The need for erythrocyt replacement were not different between the groups [median (min - max) 1.5 (0 - 13) vs 0.5 (0 - 22), p = 0.397]. Use of low molecular weight heparin was statistically more common in coronavirus disease-2019 group (32.5% vs 5%, p=0.00). Time elapsed until the performance of endoscopy in terms of hours was significantly longer in coronavirus disease-2019 group (62.97 ± 84.59 vs. 21.85 ± 33.91, p = 0.006). The most common endoscopic finding was gastroduodenal ulcer in both groups. No significant differences were seen in terms of rebleeeding rates. Mortality rate was statistically higher in coronavirus disease-2019 group (37.5% vs 8.8%, p = 0.000). Conclusions: Until more precise guidelines for the management of gastrointestinal bleeding in COVID-19 patients are developed, a case-by-case decision should be made on whether to perform endoscopy and the timing of the procedure, after multidisciplinary assessments are made in terms of patient status, response to medical therapy, treatment resources, and assessment of risks.

Timing of Colonoscopy for Hemodynamically Stable Patients With Acute Lower Gastrointestinal Bleeding.

The detection rate of the etiology of the lower gastrointestinal system (GIS) hemorrhage has been low, although urgent colonoscopy has been performed. Even if the etiology has been specified, the possibility of rebleeding is uncertain. Furthermore, adequate bowel cleansing required for colonoscopy cannot be achieved in emergency situations, so the procedure may fail. The aim of this study is to compare the etiological diagnoses of patients with lower GIS bleeding after bowel preparation at their first hospitalization and after discharge. Patients who were hemodynamically stable after upper GIS bleeding were identified and divided into 2 groups. Colonoscopy was performed in the first group of patients at their first hospitalization. The second group of patients was called again for colonoscopy within 2 weeks after discharge. Patients were classified according to their age, gender, bleeding etiology, whether complete colonoscopy procedure was possible (The cecum was intubated, and the bowel cleansing was sufficient to evaluate the intestinal mucosa), and whether the colonoscopic intervention was performed. The rate of patients who are hemodynamically stable and require emergency intervention at their first hospitalization is 5%. The colonoscopy repeat rate is 70% for the first hospitalization group, and the patients with no findings despite the second colonoscopy at a rate of 50% are re-evaluated electively. Our study suggests that colonoscopy should be performed in elective conditions after a complete bowel cleansing in hemodynamically stable patients.

Validation of the Japan score in patients with upper gastrointestinal system bleeding and comparison with other scores

Validation of the Japan score in patients with upper gastrointestinal system bleeding and comparison with other scores

Mallory-Weiss Syndrome in Pregnancy

Mallory-Weiss syndrome (MWS), which is characterized by bleeding due to mucosal rupture at the gastroesophageal junction, accounts for 1% to 4% of cases with upper gastrointestinal system (GIS) bleeding. Mallory-Weiss tear (MWS) is characterized by longitudinal mucosal lacerations (intra-mural dissection) in the distal esophagus and proximal stomach. These tears usually result from a sudden increase in intra-abdominal pressure. During pregnancy, MWS can develop because of hyperemesis gravidarum in the first trimester, and the volume of bleeding is such that it can be controlled through spontaneous hemostasis. However, reports of third trimester pregnancies complicated by MWS are rare

Retrospective Analyses of the Utility of Glasgow-Blatchford and Rockall and Pre-Rockall Scoring Systems in Patients Admitted to the Emergency Department with Upper Gastrointestinal System Bleeding

Retrospective Analyses of the Utility of Glasgow-Blatchford and Rockall and Pre-Rockall Scoring Systems in Patients Admitted to the Emergency Department with Upper Gastrointestinal System Bleeding

Analysis of Patients With Acute Upper Gastrointestinal System Hemorrhage Applying to Kahramanmaras Sutcu Imam University Medical Faculty Emergency Department

AbstractObjective: Gastrointestinal system bleeding is a health problem with a high life-threatening potential that is frequently encountered in emergency departments in hospitals. This study was planned to determine the etiologic causes, clinical findings, endoscopic findings, and prognosis in patients admitted to our emergency department and diagnosed with upper gastrointestinal system bleeding.Material and Methods: The files of the patients admitted to emergency department due to upper gastrointestinal system bleeding were retrospectively reviewed. Demographic data, clinical characteristics, etiological causes, laboratory and endoscopic results of 31 patients were reviewed. In statistical evaluation, Student t test, One way ANOVA test and SPSS 20.0 package program was used. p&amp;lt;0.05 was considered statistically significant.Results: Hematemesis was the most common reason for admission. As a result of the endoscopic procedure performed on the patients, erosive gastritis was found most frequently. 16.1% of the patients underwent sclerotherapy, and other patients underwent medical treatment. 83.9% of the patients were discharged, however, 16.1% of them died.Conclusion: Analgesics of the non-steroidal anti-inflammatory drugs group and the drugs of the antiaggregant group play a significant role in upper gastrointestinal system bleeding. The drug use should be carefully investigated especially in the elderly population with a history of comorbidities, and the possibility of gastrointestinal system bleeding should not be forgotten while prescribing analgesics. Mortality is high in patients with upper gastrointestinal system bleeding, the treatment should be initiated quickly, and endoscopy should be planned as soon as possible.

Evaluation of the Sheffield score, clinical characteristics, and the therapeutic approach in children with upper gastrointestinal system bleeding.

Unlike adults, there is no valid and reliable scoring system for upper gastrointestinal system bleeding (UGB) in children. The Sheffield scoring system, which is awaiting confirmation, is the single scoring system which can be predictive for children who require high-risk, endoscopic therapeutic intervention. The aim of this study was to evaluate the efficacy of the Sheffield scoring system, the clinical characteristics of patients, and the treatments applied. Evaluation was made of a total of 86 children with UGB who underwent esophagogastroduodenoscopy and for whom the Sheffield score was calculated. The decision for therapeutic intervention was made according to the clinical status independently of the score. The demographic data of the patients, clinical symptoms and findings, risk factors, and treatments were examined retrospectively. The Sheffield score was calculated as ≤8 in 67.4% of the patients and >8 in 32.6%. Endoscopic hemostatic intervention was applied to 15.1% of the patients. The rate of therapeutic endoscopy was significantly high in the high-score group. In 11 patients with Sheffield score >8, the bleeding was brought under control with octreotide treatment administered before endoscopy and no invasive intervention was applied. The sensitivity and specificity of the Sheffield score were determined to be at a good level in the prediction of the requirement for therapeutic endoscopy and octreotide treatment. The Sheffield score can reliably predict the need for endoscopic treatment with high sensitivity and specificity. In children with a high score, the need for an invasive intervention can be reduced with the administration of vasoactive treatment before esophagogastroduodenoscopy. The Sheffield score can thus be of guidance in the determination of the need for vasoactive treatment.

Using the Charlson comorbidity index as a prognostic factor of lower gastrointestinal system bleeding: the experience of a tertiary center

Introduction: Lesions in the gastroinestinal (GI) tract that are distal to the Treitz ligament are what cause the lower gastrointestinal bleeding (LGB) system. The purpose of this study was to investigate and compare the Charlson Comorbidity Index (CCI), mortality rates, length of hospital stays, need for intensive care, need for blood products, and surgical rates in patients with acute LGB. Material and Method: Retrospective research was done on patients who had lower GI bleeding and had been seen in our gastroenterology clinic between 2015 and 2021. We looked into the impact of CCI on patients' follow-up after LGB. Results: The mean age of the 210 patients who had lower GI bleeding was 67.70±13.67 years. For all of the patients, the median CCI value was 4.00. (2.00-5.00). While 16 study participants (group 1) passed away, 194 participants (group 2) were released from the hospital. The variance in the median CCI values between the two groups was statistically significant (p&amp;gt;0.001). The results of a multivariate logistic regression analysis revealed that CCI was a reliable predictor of mortality (p&amp;gt;0.001). Conclusion: It was found that CCI was an accurate predictor of mortality. CCI ought to be regarded as a crucial factor in the treatment of patients who are bleeding from their lower gastrointestinal tract.

The Prognostic Role of In-Hospital Mortality Predictors and De Ritis Ratio in Patients with Upper Gastrointestinal System Bleeding

Objective: We aimed to evaluate the prognostic significance of the aspartate aminotransferase(AST) / alanine aminotransferase (ALT) named as (De Ritis) ratio in patients hospitalized in the intensive care unit with the diagnosis of upper gastrointestinal (GI) bleeding. Method: We retrospectivelyanalyzed the clinical and laboratory data of 243 patients admitted with upper GI bleeding to the intensive care unit of our tertiary hospital between January 2018 and April 2022. The potential prognostic parameters between survivors and non-survivors groups and then between low De Ritis and High De Ritis groups were compared. The effect of the De Ritis ratio on in-hospital mortality was investigated by logistic regression analysis. Results: Of the two hundred andforty-three patients hospitalized with upper GI bleeding, 65.8% were male. The mean age of the patients was 68.6±11.56. The cut-off value for low and high De Ritis groups was selected as 1.57,which value seperated second tertile and third tertile of the patient population.İn hospital mortality rate was 13.1%. While albumin level was higher in the low De Ritis group, ALT, AST, and INR values were higher in the high De Ritis group. No statistically significant correlation was found between these two groups in terms of mortality. Moreover, De Ritis ratio did not show a significant difference between survivors and non-survivors (p=0.058). Conclusion: It was concluded that the rate of De Ritis is not an independent predictive factor for mortality in patients with upper GI bleeding. But, more prospective and randomized studies are needed to evaluate clearly the prognostic value of the De Ritis ratio in upper GI bleeding patients. Keywords: De Ritis ratio, aspartate aminotransaminase, alanineaminotransaminase, upper gastrointestinal bleeding, mortality

The Prognostic Role of In-Hospital Mortality Predictors and De Ritis Ratio in Patients with Upper Gastrointestinal System Bleeding

Material-Method: In our tertiary hospital's intensive care unit, we studied the clinical and laboratory records of 243 patients who had been admitted with upper GIS bleeding between January 2018 and April 2022. Results: Patients with upper gastrointestinal haemorrhage who were hospitalised were 65.8% male (M/F: 56/22). Mean age was 68.611.56 years old. One cutoff value was determined for the De Ritis ratio: 1.54. The mortality rate within the hospital was 13.1%.. Conclusion: Our results showed for the first time that the De Ritis ratio was not associated with in-hospital mortality in GI bleeding but further large clinical studies are needed to examine this issue.

Effectiveness of Clinical Scoring Systems in Duration of Hospital Stay, Transfusion Need and Prediction of Re-Bleeding in Patients Admitted to the Emergency Department for Upper Gastrointestinal System Bleeding

Objective: Upper gastrointestinal system (UGIS) bleeding is a life-threatening abdominal emergency. Numerous scoring systems have been developed to identify patients who may develop mortality due to UGIS bleeding. We aimed to determine the effectiveness of the Glasgow Blatchford Score (GBS), Rockall score (RS), and AIMS 65 score in predicting the length of hospital stay, re-bleeding, and transfusion need. Material and Methods: It was carried out retrospectively by recording the parameters and clinical scoring systems collected from the archive files and epicrisis information of the patients with the pre-diagnosis of UGIS hemorrhage. Results: Sixty-three (67.7%) of 93 patients were male. Four patients (4.3%) needed intensive care, and in-hospital mortality occurred in 4 (4.3%) patients. Mortality was observed in 7 patients (7.5%), and recurrent UGIS bleeding was observed in six patients (6.5%). A statistically significant difference was found in AIMS 65 and Rockall scores in predicting -intensive care needs (p<0.05). There was no statistically significant difference between clinical scoring systems in predicting in-hospital mortality and re-bleeding the UGIS at 3-month follow-up. A statistically significant difference was observed with the AIMS 65 score in predicting mortality at a 3-month follow-up (p<0.05). Conclusion: While there was no statistically significant difference between GBS, RS, and AIMS 65 scores in predicting in-hospital mortality and 3-month re-bleeding, RS and AIMS 65 scores can be used to predict ICU need in the emergency department due to UCIS bleeding. The AIMS 65 score can also be used to predict 3-month mortality.

Gastrointestinal kanamayla taburcu olan hastalarda anemi prevalansı ve klinik yaklaşım

Background and Aims: Acute gastrointestinal system hemorrhages are frequent, and anemia is frequently seen in patients with acute gastrointestinal system bleeding after hospital discharge. Studies intended for patient follow-ups after discharge and anemia treatment are limited, and this topic has no guidelines. This study aimed to evaluate anemia prevalence and clinical approach in patients with acute gastrointestinal system bleeding after hospital discharge and during 3 months of follow-up. Materials and Method: This study retrospectively evaluated 197 patients with acute gastrointestinal system bleeding who were treated at our hospital between January 2017 and May 2018. Upon discharge, anemia was accepted as hemoglobin levels of &amp;lt; 13 g/dL in men and 12 g/dL in women according to the World Health Organization criteria. Results: Of these patients, 129 underwent upper gastrointestinal endoscopy; 3 enteroscopy; 45 lower gastrointestinal endoscopy; 8 upper and lower gastrointestinal endoscopy; 2 upper, middle, and lower gastrointestinal endoscopies; and 10 did not undergo endoscopy. Additionally, 69 patients underwent therapeutic endoscopic treatments. The mean hospitalization duration was 10 ± 13.84 days, and 67% of patients had erythrocyte transfusion with a mean value of 3.5 ± 5.89 units during hospitalization. The mean hemoglobin rate was 9.85 ± 1.67 g/dL upon hospital discharge. Of the patients, 92.4% (female: 91.1%, male: 93.2%; upper gastrointestinal bleeding: 93.9%, middle gastrointestinal bleeding: 100%, lower gastrointestinal bleeding: 86.8%) had anemia upon hospital discharge and 9.7% underwent iron deficiency treatment. Of all 197 patients, 33% were evaluated 3 months after discharge from the hospital and 80% of these patients have ongoing anemia. Conclusions: Anemia frequency is high when patients with acute gastrointestinal system bleeding are discharged. Most patients are discharged without receiving a prescription for anemia. In the follow-up, control applications are inadequate and anemia persists in patients. A wider range of patient studies on the treatment application and adherence, as well as guidelines from the consensus body on this issue, is necessary.

Coats plus syndrome: a rare cause of severe gastrointestinal tract bleeding in children \u2013 a case report

BackgroundCoats plus syndrome, cerebroretinal microangiopathy with calcifications and cysts, is a rare disease with autosomal recessive pattern occurring due to a mutation in CTC1, encoding conserved telomere maintenance component 1, gene. Besides retinal involvement, abnormalities in brain and osteopenia, serious life-threatening bleeding in gastrointestinal tract and portal hypertension can be observed.Case presentationA 6-year-old girl with Coats plus syndrome presented to the pediatric emergency department with vomiting blood and blood in stool. An upper and lower gastrointestinal endoscopy revealed esophageal varices and vascular telangiectasia in the pyloric antrum, duodenum, and colon. She received palliative care and the bleeding was stopped after receiving intravenous octreotide. She then was followed in the pediatric gastroenterology, neurology, and ophthalmology clinics. She was later hospitalized and admitted to the intensive care unit as she continued to have intermittent gastrointestinal system bleeding. She eventually died due to severe gastrointestinal system bleeding.ConclusionsCoats plus syndrome can lead to life-threatening gastrointestinal bleeding and portal hypertension. As Coats plus syndrome is quite rare, there is little published data on this syndrome. This report presents a case of Coats plus syndrome as a rare cause of gastrointestinal bleeding and portal hypertension.

Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study.

Many scoring systems for predicting mortality, rebleeding and transfusion needs among patients with upper gastrointestinal bleeding (UGIB) have been developed. However, no scoring system can predict all these outcomes. To show whether the perfusion index (PI), compared with the Rockall score (RS), helps predict transfusion needs and prognoses among patients presenting with UGIB in emergency departments. In this way, critical patients with transfusion needs can be identified at an early stage. Prospective cohort study in an emergency department in Turkey, conducted between June 2018 and June 2019. Patients' demographic parameters, PI, RS, transfusion needs and prognosis were recorded. A total of 219 patients were included. Blood transfusion was performed in 174 patients (79.4%). The PI cutoff value for prediction of the need for blood transfusion was 1.17, and the RS cutoff value was 5. The area under the curve (AUC) value for PI (AUC: 0.772; 95% confidence interval, CI: 0.705-0.838; P < 0.001) was higher than for RS (AUC: 0.648; 95% CI: 0.554-0.741; P = 0.002). 185 patients (84.5%) were discharged, and 34 patients (15.5%) died. The PI cutoff value for predicting mortality was 1.1, and the RS cutoff value was 7. The AUC value for PI (AUC: 0.743; 95% CI: 0.649-0.837; P < 0.001) was higher than for RS (AUC: 0.725; 95% CI: 0.639-0.811; P < 0.001). PI values for patients admitted to emergency departments with UGIB on admission can help predict their need for transfusion and mortality risk.