Source Of Gastrointestinal Bleeding Research Articles

Treatment of a Cushing's ulcer in a 7-y.o. child after a tumor (medulloblastoma) removal in ventricle IV

BACKGROUND: Cushing's ulcer is a stress ulcer in the stomach or duodenum which basic etiological factor is increased intracranial pressure. The increased intracranial pressure is caused, most often, by intracranial neoplasms, cranial-cerebral injury or previous neurosurgical interventions. Cushing's ulcers are usually solitary and deep, often complicated with recurrent gastrointestinal bleedings and less often with perforations. In cases of suspected perforation in a complex anatomical localization (posterior wall of the duodenum), the method of choice according to the world literature is computed tomography with intravenous contrast. Subsequently, after brief preoperative preparation, indications for laparoscopy or laparotomy with subsequent ulcer closure are determined. In the absence of free gas in the abdominal cavity, the "gold standard" for diagnosis and treatment is esophagogastroduodenoscopy. During esophagogastroduodenoscopy, it is necessary to visualize the source of gastrointestinal bleeding and determine if it is ongoing. In cases of ongoing gastrointestinal bleeding, endoscopic hemostasis is performed. If it is not possible to establish the source of bleeding and/or if local hemostasis attempts are unsuccessful, endovascular arterial embolization is recommended. If all minimally invasive methods are ineffective, radical methods such as laparoscopy or laparotomy with visualization of the source of bleeding, cessation of bleeding, and ulcer closure are employed. Clinical Case Description. This clinical case demonstrates the severity and unpredictability of the clinical course of Cushing's ulcer complicated by gastrointestinal bleeding. The patient underwent multiple hemostatic procedures through esophagogastroduodenoscopy and arterial embolization. However, despite all minimally invasive treatment methods, the patient's condition required radical surgical treatment. CONCLUSION: There is no information in the world literature about the algorithm for managing recurrent gastrointestinal bleeding in the context of Cushing's ulcer. The authors recommend to covert to more radical treatment only after all minimally invasive techniques turned to be ineffective.

Clinical Predictors of Gastrointestinal Bleeding Source before Computed Tomography Angiography.

Acute gastrointestinal bleeding (GIB) is a commonly encountered medical emergency. In cases of negative endoscopic evaluations, computed tomography angiography (CTA) is usually the next diagnostic step. To date, data regarding positive CTA examinations are lacking. We aimed to assess the clinical and laboratory parameters that predict a positive CTA examination, as demonstrated by the extravasation of contrast material into the bowel lumen. We performed a single-center retrospective study, including all patients who were admitted with GIB and who underwent CTA. Analysis was performed to compare patients' characteristics, and logistic regression was used to explore parameters associated with a positive CTA. We included 154 patients. Of them, 25 patients (16.2%) had active GIB on CTA vs. 129 patients (83.8%) who did not. On univariate analysis, several parameters were positively associated with active GIB, including congestive heart failure (OR 2.47, 95% CI 1.04-5.86, p = 0.04), warfarin use (OR 4.76, 95% CI 1.49-15.21, p = 0.008), higher INR (OR 1.33, 1.04-1.69, p = 0.02), and low albumin level (OR 0.37, 95% CI 0.17-0.79, p = 0.01). On multivariate logistic regression analysis, only high INR (OR 1.34, 95% CI 1.02-1.76, p = 0.03) and low albumin (OR 0.3, 95% CI 0.12-0.7, p = 0.005) kept their positive association with active bleeding, while a high ASA score was negatively associated with an active GIB. We could identify high INR and low albumin as strong predictors of active GIB, as demonstrated by positive CTA. On the other hand, comorbid patients classified by a high ASA score did not experience a higher rate of active GIB.

S3359 Varices at Choledochojejunostomy Site as the Elusive Gastrointestinal Bleeding Source in a Post-Whipple Patient

S3359 Varices at Choledochojejunostomy Site as the Elusive Gastrointestinal Bleeding Source in a Post-Whipple Patient

Percutaneous left atrial appendage closure in patients with gastrointestinal bleeding associated with oral anticoagulants

Introduction Percutaneous left atrial appendage closure (LAAC) has shown non-inferiority compared to oral anticoagulation (OAC) in preventing atrial fibrillation (AF)-related stroke. The objective of this study was to assess whether LAAC reduces the incidence of gastrointestinal bleeding (GIB) and/or chronic anaemia associated with OAC, as well as the consumption of healthcare resources. Materials and Methods Prospective, single-center study from 2016 to 2022, LAAC was performed. Clinical, analytical and healthcare resource consumption data were collected (endoscopies, blood transfusions, hospital admissions) prior and 6 months after LAAC. Results 43 patients were included, with an average age of 77.6 years. LAAC indication was upper, low and obscure GIB in 7 (16%), 8 (19%) and 28 patients (65%) respectively. GIB source was intestinal angiodysplasias in 27 patients (63%), occult origin in 12 (28%), and others (antral vascular ectasia, portal hypertension gastropathy, etc.) in 4 patients (9%). The mean number of packed red blood cells per patient before LAAC was (mean ± SD) 7.29 ± 5 vs 0.42 ± 1.3 (p < 0.001); endoscopic procedures were 4.34 ± 2.85 vs 0.27 ± 0.76 (p < 0.001); and hospitalizations 2.67 ± 2.14 vs 0.03 ± 0.17 (p < 0.001), with a hospital stay of 21.5 ± 17.3 vs 0.09 ± 0.5 days (p < 0.001) at 6 months post-intervention. Haemoglobin value increased from 8.1 ± 1.2g/dl to 12.4 ± 2.2g/dl (p < 0.001) at 6 months. No thromboembolic events were registered during a median follow-up of 16.6 months (range 6–65). Conclusions LAAC could be a safe and effective alternative to OAC in patients with non-valvular AF presenting significant, recurrent or potentially unresolvable GIB. This intervention also leads to important savings in the consumption of healthcare resources.

S2581 Colonic Dieulafoy’s Lesions: An Elusive Source of Gastrointestinal Bleeding

Introduction: Dieulafoy’s lesions (DL) are abnormally dilated submucosal vessels, protruding out of minute erosions in the gastrointestinal (GI) mucosa. They are responsible for less than 2% of acute GI bleeding and are relatively rare to find in the colon. While recent advances in endoscopy allow for better detection of DL, subtle intermittently bleeding lesions may easily be overlooked. Thus, DL can be challenging to diagnose, and its true incidence remains unknown. In this series, we present three cases of GI bleeding due to colonic DL. Case Description/Methods: Case 1: A 42-year-old woman with renal disease on hemodialysis presented with one month of generalized weakness, melena, and a three-point hemoglobin drop from baseline. During esophagogastroduodenoscopy, she developed acute onset hematochezia and hemorrhagic shock. A small focus of active extravasation at the hepatic flexure was identified on CT angiography but subsequent angiography performed by interventional radiology was negative for active extravasation. On colonoscopy, an actively bleeding DL in the hepatic flexure was identified. Two hemostatic clips (HC) were successfully placed with no further bleeding. Case 2: A 66-year-old man with congestive heart failure, admitted with cardiogenic shock developed intermittent episodes of hematochezia requiring packed red blood cells (pRBC). On colonoscopy, he was found to have an actively bleeding DL at the cecum. Despite four HC and hemostatic spray, his bleeding persisted, and he underwent successful embolization, guided by clip location. Case 3: A 90-year-old man with coronary artery disease presented with two weeks of melena and a four-point hemoglobin drop from baseline. He was transfused three units of pRBC and on colonoscopy, an actively bleeding DL was found at the hepatic flexure. Three HC were placed with cessation of bleeding. Discussion: Colonic DL, although rare, can cause life-threatening GI hemorrhage. Patients may be asymptomatic or present with melena, hematochezia, or bright red blood per rectum. At present, endoscopy is the preferred diagnostic modality for DL followed by angiography. The endoscopic management of colonic DL primarily involves epinephrine injection, clipping, and/or laser coagulation to achieve hemostasis. Interventional radiology or surgical intervention may be required in severe or refractory cases. It is imperative to maintain a high index of suspicion for colonic DL to arrive at an accurate diagnosis and initiate prompt treatment (Figure 1).Figure 1.: (A) Case 1 Colonic DL in the hepatic flexure (B) Case 1 post-clipping (C) Case 2: Colonic DL in the caecum (D) Case 2 post clipping (E) Case 3 Colonic DL in the hepatic flexure (F) Case 3 post clipping.

Intravascular papillary endothelial hyperplasia in the cecum: a case report

Background Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor, is a benign, non-neoplastic vascular lesion that is characterized by reactive proliferation of papillary endothelial cells associated with a thrombus. These lesions typically develop in the vascular regions of the head and neck, oral cavity, or extremities; however, other organ systems have been affected. IPEH in the gastrointestinal tract is rare, with only a few cases reported to date. Thus, the pathogenesis and clinical features of IPEH in the gastrointestinal tract are not entirely understood. Moreover, the local excision of certain subtypes of IPEH can be curative; this makes timely diagnosis essential. We present the case of a patient with IPEH in the cecum that was discovered while investigating the cause of severe anemia.Case presentationA 29-year-old woman visited a general practitioner (GP) with the complaint of abdominal pain. She was diagnosed with acute appendicitis and was prescribed antibiotics. After treatment, her abdominal pain disappeared. However, she was found to be severely anemic (hemoglobin level, 6.5 g/dl). To determine the cause of her anemia, the GP referred her to our hospital for further examination and treatment. Computed tomography scan revealed cecal wall thickening. Further, a lower gastrointestinal endoscopy revealed a 2-cm raised mass-like lesion in the cecum. This lesion was pathologically identified as an inflammatory granuloma. The cause of her anemia was determined to be bleeding from the lesion in the cecum. She underwent laparoscopic ileocecal resection.Histopathological examination of the surgical specimen revealed a spongy structure comprising many small papillary fibrous tissues lined by a typical monolayer endothelium. Further, immunohistochemical analysis showed that the cells of the endothelium monolayer expressed CD31, CD34. The Ki-67 labeling index was < 1%. Based on these findings, the lesion was identified as an IPEH in the cecum. The patient’s postoperative course was uneventful, and there was no evidence of recurrence during the 1.3 years of follow-up.Conclusions IPEH rarely arises within the abdominal cavity. Surgery remains the only treatment for IPEH and is associated with an excellent prognosis and a low recurrence rate. More aggressive lesions such as angiosarcoma should be excluded when considering the histologic diagnoses of IPEH, and expert pathologic review is vital. This is the first report of IPEH occurring in the cecum and represents a novel cause of gastrointestinal bleeding which the clinician should consider when evaluating a patient with atypical or difficult gastrointestinal bleeding sources.

Annals for Educators - February 2022.

Annals for Educators - February 2022.

Dieulafoy Lesion as a Source of Bleeding: A Report of Two Clinical Cases

Summary Dieulafoy’s lesion is a rare source of gastrointestinal bleeding. It can be found anywhere in the gastrointestinal tract, but is most commonly seen in the proximal third of the stomach. It is a submucosal artery, adjacent to the mucosal surface, with no evidence of superficial ulcers. Lesions are routinely diagnosed and treated endoscopically. Their frequency is currently not well known, because as Dieulafoy lesions can be easily missed during endoscopy, and bleeding lesions are sometimes misidentified. In this article, we describe two cases of bleeding from the upper gastrointestinal tract, manifested by hematemesis and melena. Bleeding was successfully managed endoscopically by means of injection of adrenaline solution and application of an endoscopic hemoclip.

Abstract 9779: The Utility of Endoscopic Screening in Mitigating the Risk of Gastrointestinal Bleeding After Left Ventricular Assist Device Placement. A Retrospective Chart Review Study

Introduction: Left ventricular assist device (LVAD) is a lifesaving bridge to transplantation or destination therapy for patients with end-stage heart failure. More than one-third of patients suffer from gastrointestinal (GI) bleeding within one year of placement. We investigated the yield and safety of endoscopic screening for potential sources of GI bleeding before LVAD insertion. Hypothesis: Endoscopic screening prior to LVAD placement does not necessarily reduce the risk of GI bleed post LVAD. Methods: We performed a retrospective chart review study of patients at Saint Luke’s Mid America Heart Institute who underwent continuous-flow LVAD implantation from 2010 to 2020. Study participants were categorized based on whether or not they underwent screening endoscopy prior to LVAD implantation. Patients were followed for one year after implantation, and outcomes were collected to determine the yield and safety of these procedures. A multivariable logistic regression analysis was performed using SPSS® controlling for the following confounding factors: age, gender, race, and history of GI bleeding. Results: Among 205 patients with an LVAD, 169 patients were included in the study after excluding those with lack of data or those lost to follow up. 68 (40.23%) patients who received pre-LVAD screening by either upper and/or lower endoscopies, and 42 (24.85%) patients who had post-LVAD GI bleed. Patients who underwent pre-LVAD screening had similar rates of GI bleeding after LVAD compared to those who were not screened (odds ratio 1.66, 95% CI 0.648-4.264, P=0.2). Moreover, in patients with post LVAD GI bleed, endoscopy findings were typically different than those pre LVAD. No complications to the endoscopic interventions were reported. Conclusions: While endoscopic screening appears to be safe in patients before LVAD implantation, it had no association with GI bleeding risk or etiology after LVAD.

A sinister source of gastrointestinal bleeding treated by transhepatic splenic varix embolization in a paediatric patient: a case report

A sinister source of gastrointestinal bleeding treated by transhepatic splenic varix embolization in a paediatric patient: a case report

Gastrointestinal bleeding and endoscopic findings in critically and non-critically ill patients with corona virus disease 2019 (COVID-19): Results from Lean European Open Survey on SARS-CoV-2 (LEOSS) and COKA registries.

BackgroundCorona virus disease 2019 (COVID‐19) patients are at increased risk for thromboembolic events. It is unclear whether the risk for gastrointestinal (GI) bleeding is also increased.MethodsWe considered 4128 COVID‐19 patients enrolled in the Lean European Open Survey on SARS‐CoV‐2 (LEOSS) registry. The association between occurrence of GI bleeding and comorbidities as well as medication were examined. In addition, 1216 patients from COKA registry were analyzed focusing on endoscopy diagnostic findings.ResultsA cumulative number of 97 patients (1.8%) with GI bleeding were identified in the LEOSS registry and COKA registry. Of 4128 patients from the LEOSS registry, 66 patients (1.6%) had a GI bleeding. The rate of GI bleeding in patients with intensive care unit (ICU) admission was 4.5%. The use of therapeutic dose of anticoagulants showed a significant association with the increased incidence of bleeding in the critical phase of disease. The Charlson comorbidity index and the COVID‐19 severity index were significantly higher in the group of patients with GI bleeding than in the group of patients without GI bleeding (5.83 (SD = 2.93) vs. 3.66 (SD = 3.06), p < 0.01 and 3.26 (SD = 1.69) vs. 2.33 (SD = 1.53), p < 0.01, respectively). In the COKA registry 31 patients (2.5%) developed a GI bleeding. Of these, the source of bleeding was identified in upper GI tract in 21 patients (67.7%) with ulcer as the most frequent bleeding source (25.8%, n = 8) followed by gastroesophageal reflux (16.1%, n = 5). In three patients (9.7%) GI bleeding source was located in lower GI tract caused mainly by diverticular bleeding (6.5%, n = 2). In seven patients (22.6%) the bleeding localization remained unknown.ConclusionConsistent with previous research, comorbidities and disease severity correlate with the incidence of GI bleeding. Also, therapeutic anticoagulation seems to be associated with a higher risk of GI bleeding. Overall, the risk of GI bleeding seems not to be increased in COVID‐19 patients.

Provocative mesenteric angiography for localizing ambiguous gastrointestinal hemorrhage

Objectives: Five percent of patients with recurrent gastrointestinal (GI) hemorrhage have indeterminate origin by radiological and endoscopic examinations. To improve diagnostic accuracy and therapeutic embolization, the technique of provocative mesenteric angiography (PMA) has been developed. It involves the addition of pharmacologic agents to standard angiographic protocols to induce bleeding. Material and Methods: This is an institutional review board-approved, retrospective study of 20 patients who underwent PMA between 2014 and 2019. All patients had clinical evidence of GI hemorrhage without a definite source. PMA consisted of anticoagulation with 5000 units of heparin and selective transcatheter injection of up to 600 μg of nitroglycerine, followed by slow infusion of up to 24 mg of tissue plasminogen activator into the arterial distribution of the highest suspicion mesenteric artery. Results: Among the 20 patients who underwent PMA, 11/20 (55%) resulted in angiographically visible extravasation. Of these 11 patients, nine patients underwent successful embolization with coil or glue and were discharged upon achieving hemodynamic stability. Two patients spontaneously stopped bleeding. In our series, PMA resulted in the successful treatment of 9/20 (45%) patients with recurrent hemorrhage. No procedure-associated complications were reported with these 20 patients during the procedure and their course of hospitalization. Conclusion: In our experience, PMA is an effective and safe approach in localizing and treating the source of GI bleeding in about half of patients with an otherwise unidentifiable source.

Gastrointestinal Bleeds.

Gastrointestinal Bleeds.

PuraStat in gastrointestinal bleeding: results of a prospective multicentre observational pilot study

BackgroundA recently developed haemostatic peptide gel for endoscopic application has been introduced to improve the management of gastrointestinal bleeding. The aim of this pilot study was to evaluate the feasibility, safety, efficacy and indication profiles of PuraStat in a clinical setting.MethodsIn this prospective observational multicentre pilot study, patients with acute non-variceal gastrointestinal bleeding (upper and lower) were included. Primary and secondary application of PuraStat was evaluated. Haemoglobin, prothrombin time, platelets and transfusion behaviour were documented before and after haemostasis. The efficacy of PuraStat was assessed during the procedure, at 3 days and 1 week after application.Results111 patients with acute gastrointestinal bleeding were recruited into the study. 70 percent (78/111) of the patients had upper gastrointestinal bleeding and 30% (33/111) had lower gastrointestinal bleeding. After primary application of PuraStat, initial haemostatic success was achieved in 94% of patients (74/79, 95% CI 88–99%), and in 75% of the patients when used as a secondary haemostatic product, following failure of established techniques (24/32, 95% CI 59–91%). The therapeutic success rates (absence of rebleeding) after 3 and 7 days were 91% and 87% after primary use, and 87% and 81% in all study patients. Overall rebleeding rate at 30 day follow-up was 16% (18/111). In the 5 patients who finally required surgery (4.5%), PuraStat allowed temporary haemostasis and stabilisation.ConclusionsPuraStat expanded the therapeutic toolbox available for an effective treatment of gastrointestinal bleeding sources. It could be safely applied and administered without complications as a primary or secondary therapy. PuraStat may additionally serve as a bridge to surgery in order to achieve temporary haemostasis in case of refractory severe bleeding, possibly playing a role in preventing immediate emergency surgery.

Gastrointestinal Stromal Tumor: An Uncommon but Serious Cause of Gastrointestinal Bleeding

Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract that can sometimes present as a gastrointestinal bleeding source. This report describes a patient presented with upper GI bleeding secondary to a gastric GIST, which was initially detected on endoscopy. The patient underwent surgical resection of the tumor and was started on adjuvant chemotherapy with imatinib. The patient’s postoperative course was complicated by an esophageal leak requiring re-exploratory laparotomy and esophageal stent placement. The stent was removed 5 weeks later and the patient remained stable for discharge after 60 days of inpatient care. J Med Cases. 2021;12(2):74-78 doi: https://doi.org/10.14740/jmc3631

S3457 Unusual Gastrointestinal Manifestation of Fabry Disease

INTRODUCTION: Fabry’s disease (FD) is a rare lysosomal storage disease caused by an X-linked deficiency of α-galactosidase A, resulting in intracellular accumulation of glycolipids, globotriaosylceramide (Gb3) in various tissues. Primarily affecting the skin (angiokeratomas), kidney (proteinuria and renal failure), heart (cardiomyopathy and arrhythmias), nervous system (acroparaesthesia, and autonomic neuropathy). Gastrointestinal (GI) manifestations are common and include diarrhea, nausea, abdominal pain, early satiety, and diverticular disease typically attributed to enteric neuropathy and myopathy caused by the accumulation of (Gb3). CASE DESCRIPTION/METHODS: A 69-year-old male with a past medical history of FD on agalsidase-β bi-weekly infusion, chronic intermittent diarrhea, autonomic neuropathy, chronic kidney disease, and atrial fibrillation on Coumadin, presented with hematochezia, four hours from his presentation, associated with blood clots, lightheadedness, diaphoresis, and near syncope. At presentation, vitals were stable, the abdomen was soft and non-tender, digital rectal exam was remarkable for scant bright red blood, and guaiac positive stool. Routine laboratory testing was significant for 8.7 g/dl decreased from baseline 13 gm/dL, BUN 61 mg/dL, Creatinine 2.57 mg/dL, lactic acid 3.9 mg/dL, INR 3.8. Therapy initiated with oral vitamin K and fresh frozen plasma for reversal of Coumadin effect. With further bloody bowel movements, hemoglobin dropped to 6.8 gm/dL requiring blood transfusion. Tagged RBC scan was negative for active bleeding, esophagogastroduodenoscopy (EGD) showed mild non-bleeding erythematous antral gastropathy, colonoscopy revealed normal mucosa without a source of bleeding. In a few days hematochezia resolved, the patient tolerated oral intake, Coumadin was resumed, and the patient was discharged home with plans for virtual capsule endoscopy as an outpatient. DISCUSSION: Gastrointestinal bleeding is a rare manifestation of FD. Cutaneous angiokeratomas are vascular lesions caused by upper dermal vessels ectasia, affect 70% of FD patients. The absence of a clear source of GI bleeding in this case on EGD, increase the likelihood of mucosal angiokeratomas bleeding in the small intestine. Mucosal angiokeratomas have been reported as a cause of life-threatening GI bleeding, which can be found anywhere in the GI tract mucosa. Given the high likelihood of arrhythmias requiring anticoagulation in FD, physicians should be more vigilant of the possibility of severe GI bleeding.

Features of the diagnostics and treatment of a rare source of small bowel bleeding — venous malformations of the small bowel with Blue rubber bleb nevus syndrome (Bean’s syndrome)

The aim of the study is to demonstrate the possibilities of enteroscopy in diagnostics of rare source of small bowel bleeding in patient with blue rubber blue nevus syndrome.A 31-years old patient with severe anemia from the early age applied to our Hospital to diagnose the source of gastrointestinal bleeding. Previously performed EGD and colonoscopy didn’t reveal any sources of bleeding. Scintigraphy detected the signs of ongoing intestinal bleeding. Endoscopic methods (videocapsule and balloon-assisted enteroscopy) revealed multiple venous malformations of small bowel, as the source of gastrointestinal bleeding of «unknown source». The patient was performed surgery — resection of segments of small bowel with malformations. The diagnosis was verified morphologically. Postoperative period was without complications. For the first time in several years the patient had a fully restored level of hemoglobin.

Pediatric upper gastrointestinal bleeding in children: etiology and treatment approaches

Objective: Upper gastrointestinal bleeding (UGB) is one of the most important and serious cause of emergency admission in childhood. The aim of the study was to evaluate the etiological factors and the treatment approaches in patients with UGB. Methods: In this retrospective study, children with UGB admitted to emergency clinics of Istanbul Health Sciences University Kanuni Sultan Suleyman Research and Training Hospital, Istanbul Bakirkoy Sadi Konuk Research and Training Hospital and Diyarbakir Children’s Hospital were evaluated between January 2014 and August 2017. Results: Of the 198 children, 14.6% had non-steroid anti-inflammatory drug (NSAID) history, and 12.6% had chronic liver disease. We detected esophagitis, esophagus varices and peptic ulcer with upper gastrointestinal endoscopic evaluation (47%, 11.1%, 18.1%, respectively). Helicobacter pylori was found in 61.6% of patients. Endoscopic therapeutic procedures (band ligation therapy, sclerotherapy, and adrenaline injection) were appied in 11.1% of patients. Eighty-four (42.4%) patients were hospitalized, and erythrocyte transfusion (ET) was ordered in 29 (14.6%) patients. Conclusion: Approximately in 20% of the pediatric patients, the source of gastrointestinal bleeding is the upper gastrointestinal system. The cause of UGB varies with age. Appropriate diagnostic and therapeutic approaches are very important for management and to reduce mortality.

Risk factors for bleeding from gastrointestinal angiodysplasia: acase-control study in patients with bleeding and non-bleeding angiodysplasia.

Angiodysplasia (AD) is a common source of gastrointestinal bleeding. Yet, little is known about factors forwarding bleeding in these vascular malformations. The presented study aims to determine risk factors for bleeding that occurs only in patients with symptomatic, but not with asymptomatic, AD. Case-control study in patients with AD and either a positive or a negative history of gastrointestinal bleeding in Munich, Germany. Groups were compared by clinical, laboratory, and endoscopic features. 80 patients with (58, f 31, med. age 72) or without bleeding AD (22, f 12, med. age 61) were included. Bleeding from AD was significantly associated with the total number of AD (OR 1.4 (95 % CI 1.1-1.7) p = 0.01) and closure time in PFA/collagen-epinephrine test (OR 1.0 (95 % CI 1.0-1.0) p < 0.01). The total number of AD correlated significantly with age (r = 0.36; p = 0.01). AD were mainly detected in the upper small intestine (> 30 %). Although patients with aortic stenosis suffered not significantly more frequently from bleeding from AD, they demonstrated a loss of high molecular multimers of VWF. The amount of AD is clearly correlated to the age of the patient. A higher number of ADs and inhibition of primary hemostasis increase the risk of bleeding.

Study of the benefit of blood urea nitrogen/creatinine ratio and some other parameters to detect site, cause, and severity of gastrointestinal hemorrhage noninvasively

Background and aim Gastrointestinal (GI) bleeding is a common medical condition that may lead to emergent endoscopy. The aim of our study was to design pre-endoscopic scores for GI bleeding to clarify the source of GI bleeding, to differentiate variceal and nonvariceal cases, and to identify complications and high-risk patients requiring urgent clinical management. Patients and methods One hundred patients with hematochezia or melena were enrolled in this study. Blood urea nitrogen (BUN)/creatinine ratio score, upper GI bleeding etiological score, C-WATCH score, and Glasgow-Blatchford score (GBS) were calculated. Upper GI endoscopy was performed by the consultant within 72 h, and lower endoscopy was done if indicated. Results This prospective study was done on 83 patients presented with upper gastrointestinal tract (GIT) bleeding and 17 patients presented with lower GIT bleeding. BUN/creatinine ratio was significantly higher in upper than lower GIT bleeding (P=0.019). Sensitivity of upper GI score was 45%, specificity was 86.96%, positive predictive value was 90.0%, and negative predictive value was 37.7%, with accuracy of 81.6%. Sensitivity and specificity of C-WATCH score were 38.33 and 78.26, respectively, and for GBS were 61.6 and 69.5%, respectively. Conclusion BUN/creatinine ratio had higher effectiveness in detecting upper than lower GI bleeding. Upper GI etiological score was significantly higher in diagnosis of variceal bleeding than nonvariceal bleeding. GBS is highly sensitive but not specific to anticipate complications of upper GIT bleeding; however, C-WATCH score can anticipate severity and complications of upper GI bleeding.