Non-variceal Upper Gastrointestinal Bleeding Patients Research Articles

Proton pump inhibitor therapy after transcatheter angiography in refractory nonvariceal acute upper gastrointestinal bleeding patients: a cohort study.

Transcatheter angiography (TA) could help to diagnose and treat refractory nonvariceal upper gastrointestinal bleeding (NVUGIB). Proton pump inhibitors (PPIs) are the key medication for reducing the rebleeding rate and mortality and are usually continued after TA. It is unknown whether high-dose PPIs after TA are more effective than the standard regimen. We retrospectively collected data from patients who received TA because of refractory NVUGIB from 2010 to 2020 at West China Hospital. 244 patients were included and divided into two groups based on the first 3 days of PPIs treatment. All baseline characteristics were balanced using the inverse probability of treatment weighting method. The 30-day all-cause mortality, rebleeding rate and other outcomes were compared. The propensity score matching method was also used to verify the results. There were 86 patients in the high-dose group and 158 in the standard group. The average daily doses of PPI were 192.1 ± 17.9mg and 77.8 ± 32.0mg, respectively. Cox regression analysis showed no difference in the 30-day all-cause mortality (aHR 1.464, 95% CI 0.829 to 2.584) or rebleeding rate (aHR 1.020, 95% CI 0.693 to 1.501). There were no differences found in red blood cell transfusion, hospital stay length and further interventions, including endoscopy, repeating TA, surgery and ICU admission. The results were consistent in the subgroup analysis of patients with transcatheter arterial embolization. In refractory NVUGIB patients who received TA, regardless of whether embolization was performed, high-dose PPI treatment did not provide additional benefits compared with the standard regimen.

Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding

Background: Non-variceal upper gastrointestinal bleeding (UGIB) is a common case of emergency in daily clinical practice with a fairly high mortality rate. The use of tranexamic acid, which has been recommended in managing trauma bleeding, may serve as an alternative pharmacological therapy to manage bleeding in non-variceal UGIB. This evidence-based case report aims to evaluate the impact of tranexamic acid on managing bleeding, risk of mortality, and thromboembolic event in non-variceal UGIB patients.Methods: A systematic literature search was conducted on 4 databases: CDSR, EMBASE, PubMed, and Scopus for meta-analyses. Studies were selected based on inclusion and exclusion criteria formulated a-priori with subsequent critical appraisal according to the OCEBM critical appraisal tools. Result: Meta analyses by Kamal, et al (2020) and Twum-Barimah, et al (2020) were included in our report. Kamal, et al shows no significant difference in mortality in tranexamic acid use compared to placebo (RR 0.84; 95%CI 0.63–1.11; I2=2%). Similarly, although Twum-Barimah reported tranexamic acid reduced risk of mortality compared to placebo (RR 0.45; 95%CI 0.23–0.88; p=0.02; I2 = 0%), none of the RCTs included shows significant result when observed individually. In addition, Kamal, et al also reported increased risk of vein thromboembolic events in high-dose tranexamic acid administration (RR 2.21; 95%CI 1.32–3.69; I2=0%) compared to low-dose administration, in UGIB patients.Conclusion: Tranexamic acid is not recommended to be used in managing bleeding in patients non-variceal UGIB patients and may increase the risk of thromboembolic event.

Value of multidetector computed tomography angiography in severe non-variceal upper gastrointestinal bleeding: a retrospective study in a referral bleeding unit.

Non-variceal upper gastrointestinal bleeding is a common gastroenterological emergency associated with significant morbidity and mortality. Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment. As historically played a limited role in the diagnosis of acute non-variceal upper gastrointestinal bleeding, multidetector-row computed tomography angiography is emerging as a promising tool in the diagnosis of non-variceal upper gastrointestinal bleeding, especially for severe cases. However, to date, evidence concerning the role of multidetector-row computed tomography angiography in the non-variceal upper gastrointestinal bleeding diagnosis is still lacking. The purpose of this study was to retrospectively investigate the diagnostic performance of emergent multidetector-row computed tomography angiography performed prior to any diagnostic modality or following urgent upper endoscopy to identify the status, the site, and the underlying etiology of severe non-variceal upper gastrointestinal bleeding. Institutional databases were reviewed in order to identify severe acute non-variceal upper gastrointestinal bleeding patients who were admitted to our bleeding unit and were referred for emergent multidetector-row computed tomography angiography prior to any hemostatic treatment (< 3h) or following (< 3h) endoscopy, between December 2019 and October 2022. The study aim was to evaluate the diagnostic performance of multidetector-row computed tomography angiography to detect the status, the site, and the etiology of severe non-variceal upper gastrointestinal bleeding with endoscopy, digital subtraction angiography, surgery, pathology, or a combination of them as reference standards. A total of 68 patients (38 men, median age 69years [range 25-96]) were enrolled. The overall multidetector-row computed tomography angiography sensitivity, specificity, and accuracy to diagnose bleeding status were 77.8% (95% CI: 65.5-87.3), 40% (95% CI: 5.3-85.3), and 75% (95% CI: 63.0-84.7), respectively. Finally, the overall multidetector-row computed tomography angiography sensitivity to identify the bleeding site and the bleeding etiology were 92.4% (95% CI: 83.2-97.5) and 79% (95% CI: 66.8-88.3), respectively. Although esophagogastroduodenoscopy is the mainstay in the diagnosis and treatment of most non-variceal upper gastrointestinal bleeding cases, multidetector-row computed tomography angiography seems to be a feasible and effective modality in detecting the site, the status, and the etiology of severe acute non-variceal upper gastrointestinal bleeding. It may play a crucial role in the management of selected cases of non-variceal upper gastrointestinal bleeding, especially those clinically severe and/or secondary to rare and extraordinary rare sources, effectively guiding timing and type of treatment. However, further large prospective studies are needed to clarify the role of multidetector-row computed tomography angiography in the diagnostic process of acute non-variceal upper gastrointestinal bleeding.

Nonvariceal upper gastrointestinal bleeding in COVID-19 patients: insights from the National Inpatient Sample

Background This retrospective study, conducted using the U.S. National Inpatient Sample (NIS), examines the outcomes and management of nonvariceal upper gastrointestinal bleeding (NVUGIB) in COVID-19 patients and identifies predictive factors to enhance patient prognosis. Methods We analyzed the 2020 U.S. NIS data involving adult patients (≥18 years) admitted with NVUGIB and categorized them based on the presence of COVID-19. Primary and secondary outcomes, NVUGIB-related procedures, and predictive factors were evaluated. Results Of 184,885 adult patients admitted with NVUGIB, 1.6% (2990) had COVID-19. Patients with NVUGIB and COVID-19 showed higher inpatient mortality, acute kidney injury, need for intensive care, and resource utilization metrics. Notably, there was a lower rate of early esophagogastroduodenoscopy (EGD). Multivariate logistic regression revealed conditions like peptic ulcer disease, mechanical ventilation, and alcohol abuse as significant positive predictors for NVUGIB in COVID-19 patients, whereas female gender and smoking were negative predictors. Conclusion Our findings suggest that COVID-19 significantly increases the risk of mortality and complications in NVUGIB patients. The observed decrease in early EGD interventions, potentially contributing to higher mortality rates, calls for a review of treatment strategies. Further multicenter, prospective studies are needed to validate these results and improve patient care strategies.

Hemospray Versus Conventional Therapy for Non-variceal Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis.

Hemospray (TC-325; Cook Medical, Winston-Salem, NC) has been used effectively in hemostasis in non-variceal upper gastrointestinal (GI) bleeding. Current guidelines suggest using Hemospray as a temporizing measure or adjunct technique. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Hemospray as a modality for primary hemostasis. We searched MEDLINE, CENTRAL, and CINAHL (Cumulative Index of Nursing and Allied Health Literature) databases from inception to August 1, 2022. Three independent reviewers performed a comprehensive review of all original articles describing the application of Hemospray as the primary method of hemostasis in non-variceal upper GI bleeding patients. Three reviewers independently reviewed and abstracted data and assessed study quality using the Cochrane risk of bias tool. Primary outcomes were (1) primary hemostasis rate, (2)rebleeding rate until hospital discharge or death, (3)need for surgery, and (4) overall mortality rate. Of the 211 studies identified, 146 underwent title and abstract review, and four were included in the systematic review. Pooled results from 303 patients showed that compared to standard of care, Hemospray has significantly higher odds of primary hemostasis (OR: 3.48, 95% CI: 1.09-11.18, p = 0.04). There was no statistically significant difference in terms of rebleeding rates (OR: 0.79, 95% CI: 0.24-2.55, p = 0.69), need for surgery (OR: 1.62, 95% CI: 0.35-7.41, p = 0.54), or overall mortality (OR: 1.08, 95% CI: 0.56-2.08, p = 0.83). This systematic review and meta-analysis provethat Hemospray is a better modality of primary hemostasis in non-variceal upper GI bleeding when used as a primary method. At the same time, there is no significant difference in complications, including rebleeding, need for surgical intervention, and all-cause mortality.

Recurrent Non-Variceal Upper Gastrointestinal Bleeding among Patients Receiving Dual Antiplatelet Therapy.

Patients undergoing dual antiplatelet therapy (DAPT) may experience recurrent gastrointestinal bleeding (GIB). We investigated the clinical characteristics and risk factors for recurrent non-variceal upper gastrointestinal bleeding (NVUGIB) in patients who had experienced NVUGIB while receiving DAPT. We enrolled patients diagnosed with NVUGIB while receiving DAPT between 2006 and 2020. Definite bleeding was confirmed by esophagogastroduodenoscopy in all NVUGIB patients. A total of 124 patients were diagnosed with NVUGIB while receiving DAPT. They were predominantly male (n = 103, 83.1%), bleeding mostly from the stomach (n = 94, 75.8%) and had peptic ulcers (n = 72, 58.1%). After the successful hemostasis of NVUGIB, 36 patients (29.0%) experienced at least one episode of recurrent upper GIB, 19 patients (15.3%) died, and 7 (5.6%) patients had a bleeding-related death. Multivariate analysis showed that age was a significant factor for re-bleeding (odds ratio [OR], 1.050; 95% confidence interval [CI]: 1.001-1.102; p-value: 0.047), all-cause mortality (OR, 1.096; 95% CI: 1.020-1.178, p = 0.013), and re-bleeding-related mortality (OR, 1.187; 95% CI: 1.032-1.364, p-value: 0.016). In Kaplan-Meier analysis, the cumulative probabilities of re-bleeding, death, and bleeding-related death were significantly higher in patients aged 70 and older (p = 0.008, <0.001, and 0.009, respectively). Clinicians should be cautious about re-bleeding and mortality in elderly patients who experience NVUGIB while receiving DAPT.

Development of a model for predicting acute cerebral infarction induced by non-variceal upper gastrointestinal bleeding

ObjectiveTo evaluate the risk factors for acute cerebral infarction(ACI) in patients with non-variceal upper gastrointestinal bleeding(NVUGIB), and construct a model for predicting ACI in NVUGIB patients. MethodsA model for predicting ACI induced by NVUGIB was established on the basis of a retrospective study that involved 1282 patients who were diagnosed with NVUGIB in the emergency department and Gastroenterology Department of Nanchang University Affiliated Ganzhou Hospital from January 2019 to December 2021. Receiver operating characteristic (ROC) curves were drawn to evaluate the sensitivity and specificity of the model and CHA2DS2-VASc score to predict ACI. Delong’s test was used to compare AUCs of the present score and the CHA2DS2-VASc score. ResultsThere were 1282 patients enrolled in the study, including 69 in the ACI group and 1213 in the non-ACI group. Multivariate analysis revealed that hypertension, diabetes, red blood cell (RBC) transfusion, mechanical ventilation, D-dimer, rate pressure product (RPP), somatostatin and mean platelet volume (MPV) were factors associated with ACI induced by NVUGIB. A model based on the eight factors was established, Logit(P)= 0.265 + 1.382 × 1 + 1.120 × 2 + 1.769 × 3 + 0.839 × 4–1.549 × 5–0.361 × 6 + 0.045 × 7 + 1.158 × 8(or 1.069 ×9) (X1, hypertension=1; X2, diabetes=1; X3, RBC transfusion=1; X4, mechanical ventilation=1; X5, somatostatin=1; X6, MPV(fL); X7, D-dimer(ng/l); X8, low RPP= 1; X9, high RPP = 2). The area under ROC curve of the model was 0.873, the sensitivity and specificity were 0.768 and 0.887, respectively. The area under ROC curve of CHA2DS2-VASc score was 0.792, the sensitivity and specificity were 0.728 and 0.716, respectively. Delong’s test showed the area under ROC curve of the present study was significantly larger than that of CHA2DS2-VASc score. ConclusionsHypertension, diabetes, RBC transfusion, mechanical ventilation, D-dimer, RPP, somatostatin and MPV were factors associated with ACI induced by NVUGIB. A model constructed based on these factors showed excellent prediction of ACI, and was superior to CHA2DS2-VASc score. However, this needs to be further validated by multi-center study with a larger sample size.

Impact of COVID-19 infection on patients admitted with nonvariceal upper gastrointestinal bleeding: an analysis from the National Inpatient Sample

Background Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a medical emergency that has significant morbidity and mortality. The available data about the impact of COVID-19 infection on mortality in patients with NVUGIB is limited. Methods We identified all hospitalizations with a principal diagnosis of NVUGIB in 2020. The baseline characteristics and clinical outcomes of patients with COVID-19 infection were compared to those without COVID-19 infection. Results NVUGIB patients with COVID-19 infection had higher mortality (5% vs 2%, P < 0.0001), a longer mean length of stay (6.85 vs 4.48 days, P < 0.0001), and a lower rate of esophagogastroduodenoscopy utilization (40% vs 51%, P < 0.0001) than those without COVID-19 infection. Multivariate logistic regression analysis showed that COVID-19 infection was associated with a higher mortality rate (odds ratio 2.2, 95% confidence interval, 1.4–3.4). Conclusions COVID-19 infection is an independent predictor of mortality in adults hospitalized with NVUGIB.

Outcomes of Nonvariceal Upper Gastrointestinal Bleeding in Patients With Cirrhosis: A National Analysis.

We sought to evaluate hospital outcomes of cirrhosis patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). NVUGIB is common in patients with cirrhosis. However, national outcome studies of these patients are lacking. We utilized the 2014 Nationwide Readmission Database to evaluate NVUGIB in patients with cirrhosis, further stratified as no cirrhosis (NC), compensated cirrhosis (CC), or decompensated cirrhosis (DC). Validated International Classification of Diseases, Ninth Revision, Clinical Modification codes captured diagnoses and interventions. Outcomes included 30-day readmission rates, index admission mortality rates, health care utilization, and predictors of readmission and mortality using multivariable regression analysis. Overall, 13,701 patients with cirrhosis were admitted with NVUGIB. The 30-day readmission rate was 20.8%. Patients with CC were more likely to undergo an esophagogastroduodenoscopy (EGD) within 1 calendar day of admission (74.1%) than patients with DC (67.9%) or NC (69.4%). Patients with DC had longer hospitalizations (4.1d) and higher costs of care ($11,834). The index admission mortality rate was higher in patients with DC (6.2%) than in patients with CC (1.7%, P<0.001) or NC (1.4%, P<0.001). Predictors of 30-day readmission included performing an EGD >1 calendar day from admission (OR: 1.21; 95% CI, 1.00 to 1.46) and DC (OR: 1.78; 95% CI, 1.54 to 2.06). DC was a predictor of index admission mortality (OR: 3.68; 95% CI, 2.67 to 5.05). NVUGIB among patients with DC is associated with higher readmission rates, mortality rates, and health care utilization compared with patients with CC and NC. Early EGD is a modifiable variable associated with reduced readmission rates. Early identification of high-risk patients and adherence to guidelines may improve clinical outcomes.

Risk Assessment in Non-Variceal Upper Gastrointestinal Bleeding: A Comprehensive Review of Scoring Systems

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a critical medical emergency with significant morbidity and mortality rates. The primary cause of NVUGIB is peptic ulcers. Proper risk assessment is vital for the efficient management of NVUGIB patients, impacting both clinical decisions and healthcare resources. Established scoring systems like the Rockall score (RS), Glasgow-Blatchford score (GBS), and AIMS65 have been instrumental in guiding clinical decisions. Their strengths, limitations, and areas of application are discussed. The emerging ABC score, with its potential to outperform existing systems, is highlighted, emphasizing its relevance in both upper and lower GI bleedings. However, The ABC score, though promising, necessitates further research for broader clinical adoption.

Analysis of the patients with nonvariceal upper gastrointestinal bleeding and comparison of Rockall and Glasgow-Blatchford scores.

Nonvariceal upper gastrointestinal bleeding (UGB) has important morbidity and mortality. Predicting high-risk patients for mortality and rebleeding is necessary for a treatment plan. In the present study, we aimed to define the epidemiological and etiological characteristics of patients presenting with nonvariceal UGB and to observe mortality and morbidity rates. We also aimed to compare Rockall and Glasgow-Blatchford scoring systems in predicting rebleeding and mortality. Subjects presenting with nonvariceal UGB over a 3-year period were included. Demographic characteristics, symptoms, and signs on physical examination, laboratory data, endoscopic signs and diagnosis, interventions during hospitalization and follow-up period were recorded. Glasgow-Blatchford and Rockall scores were calculated for every participant at the first day of the admission. A total of 709 patients were enrolled in the study. A total of 490 of them (69.1%) were men. The mean age of the women and men was 60.7±1.2 and 58.6± 0.7 years, respectively. Melena was the most common presenting symptom. Duodenal ulcer (31%), gastric ulcer (20.7%), and erosive disease (17.6%) were the most common causes of bleeding. History of use of aspirin and/or nonsteroidal anti-inflammatory drug use were present in 63.7% of the subjects. All patients were followed up for 30th-day mortality. Overall, rebleeding and mortality rates were 11% and 7%, respectively. A Rockall score greater than 6 was the most important predictor of mortality (odds ratio:39.1) and rebleeding (odds ratio:4.7). Nonvariceal UGB patients with a Rockall score greater than 6 should undergo aggressive endoscopic treatment and inpatient care.

Results of therapeutic endoscopy in non-variceal upper gastrointestinal bleeding at Hue University of Medicine and Pharmacy Hospital

Background: Upper gastrointestinal bleeding is a frequent emergency in Viet Nam, most of them are non-variceal gastrointestinal bleeding. Despite of many improvements in diagnosis and management, the mortality rate of upper gastrointestinal bleeding is still significant high. In recent years, many endoscopic hemostasis techniques improved the prognosis of this emergency. This study was aimed at: 1. Describing characteristics and the endoscopic lesions in patients with non-variceal upper gastrointestinal bleeding. 2. Assessing efficacy of some endoscopic hemostasis techniques in non-variceal upper gastrointestinal bleeding. Subject and methods: Interventional study concludes 161 non-variceal upper gastrointestinal bleeding patients, 179 therapeutic upper endoscopy to get hemostasis in Gastroenterology - Endoscopy Center, Hue University of Medicine and Pharmacy Hospital from 11/2017 to 8/2020. Result: Mean age of the patients: 55.0 ± 17.3, minimum: 12, maximum: 94. Male/female ratio: 2.6. Positions of lesions: 10.6% in esophagus, 41.6% in stomach, 47.8% in duodenum. Causes of bleeding: peptic ulcer diseases (82.0%), esophago-gastric junction tear (9.9%), angiodysplasia (5.6%), and others (2.5%). Successful rate of initiating endoscopic hemostasis: 100%, permanent endoscopic hemostasis: 98.8%; recurrent bleeding rate: 4.3%, endoscopic hemostasis failure: 1.2%; operation rate: 1.2%. Conclusion: Endoscopic hemostasis techniques showed good safety and efficacy, failure and operation rate are very low. Key words: non-variceal upper gastrointestinal bleeding, endoscopic hemostasis

S710 Hyperthyroid State Is Associated with Reduced Mortality in Patients Admitted for Nonvariceal Upper Gastrointestinal Bleeding

Introduction: Through an uncertain mechanism, previous animal models proved that thyroid hormones act on mucosal lesions and reduce the formation of gastric stress ulcers. In this study, authors aim to investigate the influence of hyperthyroid state on outcomes of patients with non-variceal upper gastrointestinal bleeding (NVUGIB). Up to our knowledge, such association have never been studied in literature before. Methods: This is a retrospective cohort examining data from the National Inpatient Sample (NIS) Database of the years 2016 to 2019. Using ICD-10 codes, authors identified hyperthyroid and non-hyperthyroid patients who were principally hospitalized for NVUGIB. Univariate and Multivariate logistic regression analysis was performed to determine the risk of mortality and in-hospital complications. Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant with p-value < 0.05. Results: A total of 1,638,754 patients were identified with a principal diagnosis of non-variceal UGIB, among those 7,205 (0.43%) had a history of hyperthyroidism. Study groups baseline comorbidities are illustrated in Figure. After running a multivariate logistic analysis for inpatient mortality, patients with non-variceal UGIB and hyperthyroidism had a 38% reduction in risk of mortality (OR 0.62, 95% CI 0.40 – 0.97, P= 0.039) compared to non-hyperthyroid subjects. In term of secondary outcomes, both groups had no difference in risk of sepsis (OR 0.74, 95% CI 0.50 – 1.09, P= 0.135), hypovolemic shock (OR 1.03, 95% CI 0.74 – 1.43, p=0.853), acute kidney injury (OR 1.06, 95% CI 0.92 – 1.21, p=0.394), acute respiratory failure (OR 0.73, 95% CI 0.54 – 1.00, p=0.050), acute coronary syndrome (OR 1.27, 95% CI 0.95 – 1.71, p=0.097) and In-hospital cardiac arrest (OR 0.62, 95% CI 0.17 – 2.17, p=0.457). Length of stay (aMD 0.33 days, 95% CI -0.09– 0.77, p=0.124) and charges of care (aMD 6146$, 95% CI -852.3– 13145, p=0.085) were not affected by hyperthyroid state as well. Conclusion: Interestingly, our analysis concludes that hyperthyroid state can influence the mortality of patient with non-variceal UGIB. This beneficial effect is likely related to the modulatory effect of thyroid hormones on the responsiveness of the gastrointestinal mucosa to stress. Further studies are needed to investigate and confirm the clinical impact of thyroid state on the outcomes of patients with gastrointestinal bleeding.Figure 1.: Baseline comorbidities of NVUGIB patients stratified by past history of Hyperthyroidism.

Clinical Management of Non-Variceal Upper Gastrointestinal Bleeding

Non-variceal upper gastrointestinal bleeding (NVUGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of varices. As a common clinical problem, NVUGIB entails a heavy burden on the healthcare system. In addition to endoscopic hemostasis, evaluation and treatment before and after endoscopy are also of critical importance for the clinical management of NVUGIB patients. In recent years, based on the rapid development of endoscopic technology and clinical management of NVUGIB, the research evidence and clinical guidelines have been updated internationally, while some clinical decisions remain controversial. In this article, we mainly reviewed and discussed the current status of NVUGIB patient management before, during, and after endoscopy, aiming to deepen the understanding of the disease for clinicians, and to promote standardized management of patients with NVUGIB.

Does off-hours endoscopic hemostasis affect outcomes of nonvariceal upper gastrointestinal bleeding?

Aim: Different researches showed controversial results about the 'off-hours effect'in nonvariceal upper gastrointestinal bleeding (NVUGIB). Materials & methods: A total of301 patients with NVUGIB were divided into regular-hours group and off-hours group based on when they received endoscopic hemostasis, and the relationship of the clinical outcomes with off-hours endoscopic hemostasis was evaluated. Results: Patients who received off-hours endoscopy were sicker and more likely to experience worse clinical outcomes. Off-hours endoscopic hemostasis was a significant predictor of the composite outcome in higher-risk patients (adjusted OR: 4.63; 95% CI: 1.35-15.90). However, it did not associate with the outcomes in lower-risk patients. Conclusion: Off-hours effect may affect outcomes of higher-risk NVUGIB patients receiving endoscopic hemostasis (GBS ≥12).

How does cirrhosis impact mortality, morbidity, and resource utilization in non-variceal upper gastrointestinal bleeding? A nationwide analysis.

Upper gastrointestinal bleeding is common in liver cirrhosis patients. Studies have described the prognostic impact of liver disease in non-variceal upper gastrointestinal bleeding (NVUGIB), but a direct subgroup comparison is lacking using a large database. To study the impact of NVUGIB on hospital-based outcomes in patients with cirrhosis. This is a retrospective study using Nationwide Inpatient Sample (NIS) employing International Classification of Diseases (ICD-10) codes for adult patients with a primary diagnosis of NVUGIB. Mortality, morbidity, and resource utilization were compared. Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student's t-test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses. Of 107,001,355 discharges, 957,719 had a diagnosis of NVUGIB. Of those, 92,439 had cirrhosis upon admission. NVUGIB patients with cirrhosis had higher adjusted odds of mortality and intensive care unit (ICU) admission than patients without cirrhosis (adjusted odds ratio (AOR) for mortality 1.31, p < 0.001, ICU admission AOR = 1.29, p < 0.001). NVUGIB patients with cirrhosis had shorter length of stay (LOS) by 0.44 days (p < 0.001), greater hospital costs per day ($3114 vs. $2810, p < 0.001), and lower odds of acute kidney injury (AOR = 0.81, p < 0.001). In addition, the cirrhotic patients had higher odds of receiving endoscopic therapy (AOR = 1.08, p < 0.001). There was no difference between the 2 groups' requirements of packed red blood cell transfusion, parenteral nutrition, hypovolaemic shock, and endotracheal intubation. We also identified novel independent predictors of mortality from NVUGIB in cirrhosis patients. Cirrhosis presents greater mortality and morbidity burden and greater healthcare resource utilization from NVUGIB.

S665 AIMS65 Score Predicts ICU Admission and Prolonged Length of Stay in Patients with Non-Variceal Upper Gastrointestinal Bleed on Dual Anti-Platelet Therapy

Introduction: ICU admission and prolonged length-of-stay (PLOS) is associated with increased resources need, healthcare cost and poorer outcomes for the patients. There is a paucity of predictive parameters to assess ICU admission and PLOS in non-variceal upper gastrointestinal bleeding (NVUGIB) patients taking dual antiplatelet therapy (DAPT). Methods: A retrospective chart review was done for all consecutive adult patients between 2015-2020 who presented with NVUGIB on DAPT (aspirin, clopidogrel; aspirin, ticagrelor; aspirin, prasugrel) to Allegheny Health Network and underwent endoscopy. Patients who had DAPT held as per ASGE guidelines were excluded from the study. An exploratory analysis was done to assess predictive ability of four GI bleeding risk scores [Glasgow Blatchford score (GBS), AIMS65, qSOFA and Rockall] to predict ICU admission and prolonged Length of Stay (PLOS). PLOS was defined as ≥5 days based on institutional experience in NVUGIB patients. Logistic regression was used to identify variables independently associated with ICU admission and PLOS and estimate their odds ratios and 95% CI. P value < 0.05 was considered as the level of significance. Results: 75 patients (M: F 53:22), mean age±S.D. 70.1±11.2 years, meeting inclusion criteria were included for final analysis. 22/75 (29%) patients had ICU admission. AIMS65 and qSOFA predicted ICU admission (Table 1A). Sensitivity, specificity, PPV, NPV and accuracy of AIMS65 and qSOFA for ICU admission has been shown in Table 1B. Median LOS was 6; IQR=8 (range 2-43) days. 47/75 (63%) patients had PLOS. GBS and AIMS65 predicted PLOS (Table 1A). Sensitivity, specificity, PPV, NPV and accuracy of GBS and AIMS65 for PLOS has been shown in Table 1B. Conclusion: AIMS65 is a simple scoring system, originally developed to predict mortality in patients with UGIB. This study provides preliminary evidence for the use of AIMS65 to predict longer LOS and ICU admission in patients with NVUGIB taking DAPT which may help resource allocation and prognostication. However, the study needs to be validated in a larger study population before it can be used in clinical practice.Table 1.: Comparison of Inpatient Outcomes of NVUGIB Patients.

Outcomes of Non-Variceal Upper Gastrointestinal Bleed Stratified by Hospital Teaching Status: Insights From the National Inpatient Sample.

BackgroundNon-variceal upper gastrointestinal bleeding (NVUGIB) is a significant cause of mortality and morbidity in the USA. Currently, there are limited data on the inpatient outcomes of patients admitted with a diagnosis of NVUGIB stratified according to teaching hospital status. We analyzed data from the National Inpatient Sample (NIS) intending to evaluate these outcomes.MethodsWe queried the NIS 2016 and 2017 databases for NVUGIB hospitalizations by teaching hospital status. The primary outcome was inpatient mortality while secondary outcomes were rate of endoscopy for hemostasis, rate of early endoscopy (endoscopy in 1 day or less), mean time to endoscopy, rate of complications including acute kidney injury (AKI), acute respiratory failure (ARF), need for blood transfusion, development of sepsis, need for endotracheal intubation and mechanical ventilation as well as healthcare utilization.ResultsThere were over 71 million weighted discharges in the combined 2016 and 2017 NIS database. A total of 94,900 NVUGIB cases were identified with 63.4% admitted in teaching hospitals. The in-hospital mortality for patients admitted with an NVUGIB in teaching hospitals was 1.98% compared to 1.5% in non-teaching hospitals (adjusted odds ratio (aOR): 1.38, 95% confidence interval (CI): 1.08 - 1.77, P = 0.010) when adjusted for biodemographic and hospital characteristics as well as comorbidities. Patients admitted with a diagnosis of NVUGIB in teaching hospitals had a 10% adjusted increased odds of getting endoscopy for hemostasis (27.0% vs. 24.5%, aOR: 1.10, 95% CI: 1.02 - 1.19, P = 0.016) compared to patients in non-teaching hospitals. There was, however, no difference in early endoscopy between the two groups.ConclusionPatients admitted at teaching hospitals for an NVUGIB had worse outcomes during hospitalizations including mortality, median length of stay, and total hospital charges when compared to NVUGIB patients managed at non-teaching hospitals.

How Can Patient’s Risk Dictate the Timing of Endoscopy in Upper Gastrointestinal Bleeding?

Introduction: Although upper gastrointestinal bleeding (UGIB) management has improved substantially in the last decades, there is still much controversy regarding the optimal timing for performance of endoscopy. Recent guidelines suggest performing an early endoscopy within 24 h of nonvariceal UGIB (NVUGIB) presentation, although its impact on patients with different bleeding risks remains unclear. Aim: To evaluate the impact of performing endoscopy within 24 h on NVUGIB outcomes and to compare it in patients with lower-risk vs. higher-risk bleeding. Methods: This is a retrospective cohort study including consecutive patients undergoing upper endoscopy for suspected NVUGIB over 4 years. Demographic, clinical, biochemical, endoscopic, and outcome data were collected. Lower-risk bleeding was defined as a Glasgow-Blatchford score (GBS) <12 and higher-risk bleeding was defined as a GBS ≥12. Results: A total of 298 patients with suspected NVUGIB were included, 55% of whom had higher-risk bleeding. Endoscopy was performed within 24 h in 62.1% of the patients. In lower-risk bleeding patients, performance of endoscopy within 24 h was associated with a higher need for endoscopic treatment (OR = 2.6; 95% CI 1.2–5.7; p = 0.004), a lower 30-day mortality (OR = 0.41; 95% CI 0.27–0.63; p = 0.03), and a lower need for transfusion (OR = 0.58; 95% CI 0.36–0.92; p = 0.02). In higher-risk bleeding patients, there were no statistically significant differences in NVUGIB outcomes in performing endoscopy within 24 h. Conclusion: Endoscopy within 24 h of presentation was associated with a lower need for transfusion, a higher need for endoscopic treatment, and a lower 30-day mortality in lower-risk NVUGIB patients. Thus, performing endoscopy within the first 24 h of presentation can have a positive impact on NVUGIB outcomes even in lower-risk bleeding.

Non-variceal Upper Gastro-intestinal Bleeding in Patients of Liver Cirrhosis

Aim: To determine the frequency of non-variceal upper gastro-intestinal bleeding (NVUGIB) in patients of liver cirrhosis. Methods: A total number of 136 patients of liver cirrhosis having upper GI bleeding who presented in medical emergency of Nishtar Hospital Multan were included in this cross-sectional analysis. Gastric Endoscopy was done all patients to determine the presence of NVUGIB in all patients. Data regarding patient’s age, Body mass index (BMI), gender and duration of upper GI bleed was also collected. Results: Mean age was 47.23±9.45 years. Mean body mass index (BMI) was 24.94±3.35 kg/m2. Mean duration of upper UGIB was 3.45±3.03 months. There were 94(69.12%) male and 42(30.88%) female patients. NVUGIB was found in 76(55.88%). There was a significant association of age with NVUGIB. In patients of age 20-49 years, NVUGIB was found in 47(62.7%) patients. In having age 49-65 years, NVUGIB was found in 29(47.5%) patients. Conclusion: NVUGIB in patients with liver cirrhosis is very common and it is more common in younger age patients. So diagnostic endoscopy should be done in liver cirrhosis patients presenting with upper GI bleeding in emergency departments. This will aid in proper diagnosis and in deciding the appropriate treatment in these patients. Keywords: Non-variceal upper gastro-intestinal bleeding, liver cirrhosis, Hepatitis