Prognosis Of Upper Gastrointestinal Bleeding Research Articles

Predictive factors and prognosis of upper gastrointestinal bleeding in gastric cancer: A large population-based study (UGIB-GC trial).

Gastric cancer remains the fourth leading cause of cancer-related death worldwide. Significant number of gastric cancer patients presented with bleeding. This study aimed to identify risk factors and overall survival rates of bleeding gastric cancer patients. This retrospective cohort study was conducted between 2007-2022 at tertiary care center in Thailand. Clinical information, endoscopic findings and histological type were extensively reviewed and were compared between bleeders and non-bleeders. Patients were monitored for at least 5 years. There were 20,981 patients who underwent upper gastrointestinal endoscopy during study period. Total of 201 gastric cancer patients were included in this study, 21 were excluded due to incomplete medical records. 180 gastric cancer patients were included with mean age of 60.5±14.3 years. There were 65 (36.1%) patients with gastrointestinal bleeding. Hypertension and chronic kidney disease were significantly more common in bleeders than non-bleeders (43.1% vs 23.5%, OR2.51, 95%CI 1.14.-5.52, p = 0.022; and 16.9% vs 5.2%, OR2.00, 95%CI 1.56-6.63, p = 0.025, respectively). current H. pylori infection was also significantly more common in bleeders than non-bleeders (84.6% vs. 55.7%, OR 4.39, 95%CI 1.90-10.12, p<0.001). Median overall survival of bleeders was significantly lower than non-bleeders (7±0.93 vs 10±2.10 months, p = 0.001). Bleeding gastric cancer was not an uncommon condition. Majority of patients presented at advanced stage with grave prognosis. Male gender, hypertension, chronic kidney disease, and current H. pylori infection were reliable predictors for bleeding. Early diagnosis and prompt treatment are the key to improve clinical outcome.

Implementation of new techniques in the management of upper gastrointestinal bleeding

Background: In recent years, many endoscopic hemostasis techniques helped to improve the prognosis of upper gastrointestinal bleeding. It includes: esophageal band ligation and Histoacryl injection in variceal upper GI bleeding; dilute adrenalin injection, hemoclipping, argon plasma coagulation and Hemospray in non-variceal upper GI bleeding. But domestic studies about these techniques’ efficacy are limited. Objectives: 1. To describe characteristics of patients and endoscopic lesions in upper GI bleeding. 2. To assess the efficacy of some endoscopic hemostasis techniques in upper GI bleeding. Subject and methods: Interventional study concluded 346 upper GI bleeding patients, 365 therapeutic upper endoscopy to get hemostasis in Gastroenterology - Endoscopy Center, Hue University of Medicine and Pharmacy Hospital from 11/2017 to 4/2022. Result: Mean age of patients is 55.6 ± 17.9, minimum is 9, maximum is 95. Male/female ratio is 2.5. The causes of bleeding: esophageal varices 35.5%, gastric varices 4.3%, peptic ulcer diseases 50.9%, esophago-gastric junction tear 5.5%, angiodysplasia 2.6%, and others 1.2%. Hemostatic techniques: esophageal band ligation 33.7%, Histoacryl injection 4.1%, hemoclipping 52.6%, dilute adrenalin injection 15.9%, APC 7.9%, Hemospray 0.8% and others 0.3%. Successful rate of initiating endoscopic hemostasis is high (100%), permanent hemostasis is high (99.1%); recurrent bleeding rate is low (2.3%), endoscopic hemostasis failure is low (0.9%); operation rate is low (0.9%). Conclusion: Endoscopic hemostasis techniques showed good safety and efficacy, failure and operation rate are very low. Using new techniques in case of failure of traditional techniques was beneficial and safe Key words: upper gastrointestinal bleeding, endoscopy

AIMS65 predicts prognosis of patients with duodenal ulcer bleeding; a comparison with other risk-scoring systems.

Duodenal ulcer bleeding has a higher risk of mortality than bleeding from other portions of the gastrointestinal tract. AIMS65 is an effective risk-scoring system to predict prognosis of upper gastrointestinal bleeding and can be easily calculated without endoscopic findings. In this study, we investigate the usefulness of AIMS65 to predict prognosis of patients with duodenal ulcer bleeding. Two hundred and fifty-five patients with endoscopically diagnosed duodenal ulcer bleeding at Kurashiki Central hospital from July 2007 to June 2017 were studied. We compared AIMS65, Glasgow Blatchford score (GBS), admission Rockall, and full Rockall scoring systems for predicting in-hospital mortality by calculating area under the receiver operating characteristic curve (AUROC). In-hospital mortality due to duodenal ulcer bleeding occurred in 17 (6.7%). Scores of all scoring systems were significantly higher in patients with in-hospital mortality than in patients without it. AUROC values for predicting in-hospital mortality was 0.83 in AIMS65, 0.74 in GBS, 0.76 in admission Rockall score, and 0.82 in full Rockall score, a statistically insignificant difference among the systems. In AIMS65, score more than or equal to 2 was an optimal value to predict in-hospital mortality, with sensitivities of 88.2% and specificities of 59.7%, respectively. AIMS65 predicted in-hospital mortality of patients with duodenal ulcer bleeding as accurately as did other scoring systems. Given its simplicity of calculation, AIMS65 may be a more clinically practical system in the management of bleeding duodenal ulcer patients.

Upper Gastrointestinal Bleeding (UGB): Causes and Treatment

Aim: The upper gastrointestinal bleeding (UGB) are frequent reasons for urgent consultation. The aim of our study is to determine the causes of upper gastrointestinal Bleeding in patients in our department. Materials and Methods: A retrospective study over 6 years between June 2011 and March 2017 covering 683 patients with a Upper gastrointestinal bleeding collected at the Gastroenterology II department of the military hospital of Instruction Mohamed V Rabat Morocco. Results: The average age was 54 years, with a male dominance (75%). The causes of bleeding are dominated by gastroduodenal ulcers and rupture of oesophageal varices. The endoscopic hemostasis was performed in 22% of patients, ligation of esophageal varices in 13% of cases, adrenaline injection in 8%of cases, use of hemoclips in 2% of cases and argon plasma coagulation (APC) in 2% of cases. Conclusion: In our series Ulcerative pathology and portal hypertension are the main causes of upper gastrointestinal bleeding. The development of endoscopic hemostasis techniques has improved the prognosis of upper gastrointestinal bleeding.

Prognosis of Upper Gastrointestinal Bleeding of the Outpatients with the Peptic Ulcer Was Superior to That of the Hospitalized Patients, but Did Not Depend on the Visiting Time to the Hospital in Japan

Prognosis of Upper Gastrointestinal Bleeding of the Outpatients with the Peptic Ulcer Was Superior to That of the Hospitalized Patients, but Did Not Depend on the Visiting Time to the Hospital in Japan

Endoscopic evaluation in upper gastrointestinal bleed

Background: Gastrointestinal bleeding is one of the few frightening things that the patient experiences, which can indicate simple, benign, complex or malignant disorders and can end in disaster if proper steps are not taken to identify the source of bleeding and treat it. Aim was to study the role of oesophagogastroduodenoscopy in diagnosis, management and prognosis of upper gastrointestinal bleeding and see the aetiology and age sex incidence. Methods: The study was conducted on 200 patients, presenting with haematemesis and melaena or history of same and Endoscopy was done using Fujinon 200 Videoendoscope (that consist of end viewing endoscope, videoprocessor and monitor). Results: Upper gastrointestinal bleeding was 4.5 times more common in males than in females and the mean age in this series was 40 years. Most common cause of upper gastrointestinal bleeding was found to be secondary to oesophageal varices (About 90%), peptic ulcers (6%) and 4% secondary to mucosal erosions. About 22% of patients had both haematemesis and melaena, 28% had hypotension and 70% had tachycardia at the time of presentation. 54% of them had hemoglobin value less than 8 gm% and they were given blood transfusion as per requirement Conclusions: Oesophagogastroduodenoscopy plays a major role in diagnosis, management and prognosis of upper gastrointestinal bleeding and its importance cannot be replaced by other imaging modalities.

Influence of Weekend Versus Weekday Admissions on the Prognosis of Upper Gastrointestinal Bleeding Caused by Portal Hypertension: Post hoc Analysis of a Prospective Study

Nahon, Stéphane MD*; Pariente, Alexandre MD†; Pauwels, Arnaud MD‡; Boruchowicz, Arnaud MD§ for a Group of Investigators of the ANGH (Association Nationale des Gastroentérologues des Hôpitaux Généraux) Author Information

The Prognosis of Upper Gastrointestinal Bleeding in Very Elderly Patients Is the Same As That of Younger Ones: Results of a French Prospective Multicenter Study of the ANGH Group

The Prognosis of Upper Gastrointestinal Bleeding in Very Elderly Patients Is the Same As That of Younger Ones: Results of a French Prospective Multicenter Study of the ANGH Group

Acute Upper Gastrointestinal Bleeding in Patients With Liver Cirrhosis and in Noncirrhotic Patients

To assess epidemiologic features and predictive factors of mortality of acute upper gastrointestinal bleeding (UGIB). During a 6-month period, a prospective population-based study including all the UGIB occurring in a geographic area of 3 million people was conducted. Data from cirrhotic patients were compared with those of noncirrhotic patients. A total of 2,133 UGIB were recorded, 21.9% in cirrhotic patients (n = 468). Endoscopic hemostasis was performed in 46.5% and 8.3% in cirrhotic and noncirrhotic patients, respectively (P < 0.001). Mortality during hospitalization was 23.5% in cirrhotic patients and 11.2% in noncirrhotic patients (P < 0.001). Six independent predictive factors of mortality were observed in both patient groups: a prothrombin level less than 40%, an UGIB occurring in inpatients, a concomitant digestive carcinoma, a hematemesis revealing the UGIB, a recent use of steroid drugs, and age over 60 years. Four other predictive factors of mortality were also identified in noncirrhotic patients. Although epidemiologic features, clinical course, management, and prognosis of UGIB were quite different in cirrhotic and noncirrhotic patients, the majority of predictive factors of mortality were the same in both patient groups. These data underline the major role of debilitated status and hepatic failure in the prognosis of UGIB in cirrhotic patients.

Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding

In 277 consecutive episodes of suspected upper gastrointestinal bleeding, lesions bearing stigmata of recent haemorrhage (stigmata) were found by endoscopy in 110 (47%) out of 233 patients who were judged to have bled; 78 (33%) had lesions without stigmata, and in 45 (19%) no lesion was seen. Results in 176 entirely unselected admissions for upper gastrointestinal bleeding were similar.Forty-eight chronic duodenal and 41 chronic gastric ulcers were identified by endoscopy. Stigmata were found in 27 (56%) and 33 (80%) of these cases respectively. Sixteen patients had multiple lesions, and in 12 (75%) the presence of stigmata permitted diagnosis of the source of the haemorrhage. Stigmata were more likely to be seen in cases of duodenal ulcer, Mallory-Weiss lesions, and oesophageal varices when endoscopy was performed within 12 hours of bleeding, but were as common in cases of gastric ulcer after longer intervals.In the absence of stigmata one out of 21 patients with duodenal ulcer had further haemorrhage and one other needed emergency surgery; no patient with gastric ulcer had further haemorrhage or needed emergency surgery. In contrast, when stigmata were present 15 of the 27 patients with duodenal ulcer (56%) had further haemorrhage and 17 (63%) needed emergency surgery; of the 33 patients with gastric ulcer, 10 (30%) had further haemorrhage and 15 (45%) required emergency surgery. Superficial mucosal lesions may have been the source of haemorrhage when an ulcer unmarked by stigmata was seen at endoscopy. Stigmata were superior to any other single factor or combination of factors in predicting rebleeding and the need for emergency surgery.