Variceal Upper Gastrointestinal Bleeding Research Articles

Observation on the Clinical Effect of Emergency Interventional Therapy on Acute Severe Non- Variceal Upper Gastrointestinal Bleeding

Objective: To observe the clinical effect of emergency interventional therapy for patients with acute severe non-variceal upper gastrointestinal bleeding. Methods: 78 patients with acute severe non-variceal upper gastrointestinal bleeding who were treated in the General Hospital of the Eastern Theater Command from May 2020 to May 2023 were randomly divided into two groups according to different treatment plans. The study group underwent emergency upper gastrointestinal angiography and interventional embolization therapy, the control group was treated with esomeprazole; the clinical data related to the two groups were compared, including the total effective rate of treatment, blood pressure stabilization time, bleeding control time, etc. Results: The effective rate of clinical treatment in the study group was 97.44%, which was higher than that in the control group, which was 79.49% (P < 0.05). Both were significantly shorter (P < 0.05); the 7 d rebleeding rate and 30 d rebleeding rate of the study group were lower than those of the control group (P < 0.05); the 7 d and 30 d mortality rates of the two groups after treatment were compared, and the comparative study group was lower, but there was no significant difference (P > 0.05). Conclusion: Emergency interventional therapy can control bleeding more quickly, shorten bleeding control time and complete hemostasis time, shorten blood pressure stabilization time and abdominal pain relief time, and reduce rebleeding rate in patients with acute severe non-variceal upper gastrointestinal bleeding.

Clinical Outcomes of Older Patients with Non-Variceal Upper Gastrointestinal Bleeding Taking Anti-Thrombotic or Non-Steroidal Anti-Inflammatory Agents.

Non-variceal upper gastrointestinal bleeding is a well-established complication of non-steroidal anti-inflammatory drugs and anti-thrombotics. Both medication groups are frequently used by older populations and increase the incidence of non-var- iceal upper gastrointestinal bleeding; however, their impact on etiology and outcomes of non-variceal upper gastrointestinal bleeding has not been well defined. We aimed to compare the etiology and outcomes of non-variceal upper gastrointestinal bleeding in older patients who use anti-thrombotics and non-steroidal anti-inflammatory drugs or do not use either of them. This is a single-center prospective study of patients older than 65 years with non-variceal upper gastrointesti- nal bleeding. Endoscopic findings, laboratory values, blood transfusion, endoscopic treatment, re-bleeding, and 30-day mortality rates were recorded. A total of 257 patients (median age 77.7 ± 8.2, 59% male) were included. Re-bleeding occurred in 25 (10%) and the 30-day mortality rate was 40 (16%). There was no statistically significant difference between patients using anti-thrombotics, non-steroidal anti-inflammatory drugs or non-users for blood transfusion (P = .46), endoscopic hemostasis (P = .39), re-bleeding (P = .09), and 30-day mortality (P = .45). Peptic ulcer was the most common etiology in all groups (124, 48%). Although the incidence of peptic ulcer was similar between drug users and anti-thrombotic users (P = .75), the incidence of peptic ulcer was significantly higher in patients using non-steroidal anti-inflammatory drugs than in patients who did not use drugs (P = .05). When the patients were analyzed as using anti- thrombotic drugs or non-steroidal anti-inflammatory drugs or neither, no statistically significant difference was found between ulcer location, ulcer number, and ulcer size. Non-variceal upper gastrointestinal bleeding increasingly occurs in older populations with several comorbidities; non- steroidal anti-inflammatory drugs or anti-thrombotics do not seem to change the clinical outcomes among older patients with non- variceal upper gastrointestinal bleeding.

Influence of COVID-19 on Patients with Esophageal Varices under Prophylactic Endoscopic Band Ligation Therapy

Background and Objectives: Endoscopic band ligation (EBL) plays a critical role in patients with clinically significant portal hypertension, as variceal eradication (VE) is essential to prevent further variceal upper gastrointestinal bleeding (GI). The emergence of COVID-19 has led to a dramatic reduction in endoscopic activity. Our study aimed to evaluate the effect of COVID-19 on VE, GI, and 6-month mortality of patients treated with prophylactic EBL therapy. In addition, our goal was to identify the risk factors for our proposed outcomes. Methods: A single-center retrospective cohort study included patients with esophageal varices treated with prophylactic EBL therapy between 2017 and 2021. To demonstrate the impact of COVID-19 on two independent groups on prophylactic EBL therapy with 1 year of follow-up, March 2019 was selected as the cut-off date. Clinical, laboratory, and endoscopic data were recovered from electronic reports. Results: Ninety-seven patients underwent 398 prophylactic EBL sessions, 75 men (77.3%) with mean age 59 ± 12 years. Most achieved VE (60.8%), 14.4% had GI bleeding post-therapy, and 15.5% died at 6 months. The rate of variceal obliteration was significantly lower in the pandemic group (40.9% vs. 77.4% in the pre-pandemic group, p = 0.001). Mean number of EBL sessions and pandemic group were independently associated with incomplete VE, while MELD-Na, portal vein thrombosis and failed VE were identified as risk factors associated with mortality at 6 months. Conclusions: Almost 60% of patients in the pandemic group failed to eradicate esophageal varices. Failure to achieve this result conferred a higher risk of GI bleeding and death at 6 months, the latter also significantly associated with the MELD-Na score and portal vein thrombosis. Our study is among the first to demonstrate the impact of COVID-19 in patients receiving prophylactic EBL therapy.

LOXYTOCINE: ALTERNATIVE THERAPEUTIQUE DANS LES HEMORRAGIES DIGESTIVES HAUTES VARIQUEUSES A ANTANANARIVO (MADAGASCAR)?

Aim: The aim of the study is to assess the effect of oxytocin on the hemodynamic status of patients with variceal upper digestive hemorrhage becausethe main principle of the management of this pathology is hemodynamic optimization through vasoconstrictors (octreotide, somatostatin, ...), that are not available in Madagascar. Materials and Methods: A descriptive and monocentric, retrospective study was carried out in University Hospital J. R. Andrianavalona, for a period of 60 months (2010 to 2014).Patients with known variceal upper gastrointestinal bleeding were included. Correlations (Chi² or exact Fishers test, XLStat®10.0) between oxytocin use and hemodynamic parameters, therapeutics and mortality were performed. Results: A number of 175 patients aged 47.5 ± 13.6 years, predominantly male (sex ratio = 2.4) were studied. The admission pattern was dominated by the combination of hematemesis and melena (52.6%). The use of oxytocin had an impact on the decrease of hemodynamic parameters (p <0.05). This molecule limited perfusion and blood transfusion (p <0.001). The use of oxytocin had no impact on patient survival and death (18.3%) (p> 0.05). Conclusion: Because of the lack of main vasoactive drugs, oxytocin could be an alternative to vasoactive treatment in Antananarivo (Madagascar), without specific impact on the morbidity and mortality of upper gastrointestinal varicose bleedings.

The COVID-19 Infection Resulted Delayed Esophagogastroduodenoscopy in Patients Admitted with Variceal Bleeding: Hospital-Based Outcomes of a National Database.

During the COVID-19 pandemic in 2020, most healthcare services, including inpatient and outpatient procedures, got delayed. We reviewed the effect of COVID-19 infection on the timing of esophagogastroduodenoscopy (EGD) in variceal bleeding patients and analyzed the complications of delayed EGD. Using the National Inpatient Sample (NIS) 2020, we identified patients admitted for variceal bleeding with COVID-19 infection. We performed a multivariable regression analysis and adjusted it for patient and hospital-related variables. The International Classification of Disease Tenth Revision (ICD-10) codes were used for patient selection. We measured the effect of COVID-19 on the timing of EGD and further analyzed the effect of delayed EGD on hospital-based outcomes. A total of 49,675 patients diagnosed with variceal upper gastrointestinal bleeding were analyzed, out of which 915 (1.84%) were COVID-19 positive. Variceal bleeding patients who were COVID-positive had a significantly lower rate of EGD performed within the first 24 h of admission (36.1% vs. 60.6% p = 0.001) compared to the patients who tested negative for COVID-19. The performance of EGD within 24 h of admission resulted in a decrease in all-cause mortality by 70% (adjusted odds ratio (AOR) 0.30, 95% CI 0.12-0.76, p = 0.01) compared to EGD after 24 h. A significant decrease was noted in the odds of ICU admission rate (AOR 0.37, 95% CI 0.14-0.97, p = 0.04) in patients who got EGD within the first 24 h of admission. No difference in odds of sepsis (AOR 0.44, 95% CI 0.15-1.30, p = 0.14) and vasopressor use (AOR 0.34, 95% CI 0.04-2.87, p = 0.32) was seen in COVID positive vs. COVID negative group. The hospital mean length of stay (2.14 days, 95% CI 4.35-0.06, p = 0.06), mean total charges ($51,936, 95% CI $106,688-$2816, p = 0.06), and total cost (11,489$, 95% CI 30,380$-7402$, p = 0.23) was similar in both COVID-positive and -negative groups. In our study, we found that the presence of COVID-19 infection in variceal bleeding patients resulted in a significant delay in EGD compared to COVID-negative patients. This delay in EGD resulted in increased all-cause mortality and intensive care unit admissions.

30-day readmission rates among upper gastrointestinal bleeds: A systematic review and meta-analysis.

Upper gastrointestinal bleeding (UGIB) is a common emergency, with high rates of hospitalization and in-patient mortality compared to other gastrointestinal diseases. Despite readmission rates being a common quality metric, little data are available for UGIBs. This study aimed to determine readmission rates for patients discharged following an UGIB. Adhering to PRISMA guidelines, MEDLINE, Embase, CENTRAL, and Web of Science were searched to October 16, 2021. Randomized and non-randomized studies that reported hospital readmission for patients following an UGIB were included. Abstract screening, data extraction, and quality assessment were conducted in duplicate. A random-effects meta-analysis was performed, with statistical heterogeneity measured using I2 . The GRADE framework, with a modified Downs and Black tool, was used to determine certainty of evidence. Seventy studies were included of 1847 screened abstracted, with moderate interrater reliability. Within these studies, 4292714 patients were analyzed with a mean age of 66.6years, and 54.7% male. UGIB had a 30-day all-cause readmission rate of 17.4% (95% confidence interval [CI] 16.7-18.2%), stratification revealed a higher rate for variceal UGIB [19.6% (95% CI 17.6-21.5%)] than non-variceal [16.8% (95% CI 16.0-17.5%)]. Only one third were readmitted due to recurrent UGIB (4.8% [95% CI 3.1-6.4%]). UGIB due to peptic ulcer bleeding had the lowest 30-day readmission rate [6.9% (95% CI 3.8-10.0%)]. Certainty of evidence was low or very low for all outcomes. Almost one in five patients discharged after an UGIB are readmitted within 30days. These data should prompt clinicians to reflect on their own practice to identify areas of strength or improvement.

A63 TRENDS AND OUTCOMES OF LIVER DISEASE HOSPITALIZATIONS DURING THE CORONAVIRUS PANDEMIC IN THE UNITED STATES: A NATIONWIDE POPULATION-LEVEL ANALYSIS

Abstract Background The impact of the Coronavirus disease-2019 (COVID-19) pandemic on patients with liver disease is not well described at the population level in the United States. Purpose We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years. Method Using the National Inpatient Sample (2018-2020), we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality for liver-related indications including compensated cirrhosis, decompensated cirrhosis, alcohol-associated liver disease (ALD), alcohol-associated hepatitis (AH), hepatocellular carcinoma (HCC), and variceal upper gastrointestinal bleeding (VUGIB) using regression modeling. We also looked at the impact of the COVID-19 pandemic on liver transplantation rates. A p-value <0.05 was considered statistically significant. Result(s) Hospitalizations for both compensated and decompensated cirrhosis decreased in 2020 compared to 2019 (relative change [RC] of 1.5%, p <0.001, Table 1). Interestingly, hospitalizations for ALD and AH increased in 2020 compared to pre-pandemic years (ALD RC=15.5% and AH RC 17.0%; p<0.001). Despite the decrease in cirrhosis hospitalizations in 2020, all-cause inpatient mortality among patients with compensated cirrhosis increased from 30,135 in 2019 to 35,220 in 2020 (p<0.001) and from 22,850 in 2019 to 26,390 in 2020 among patients with decompensated cirrhosis (p<0.001). This was accompanied by a 27.8% increase in mortality for ALD (p=0.004) in comparison to pre-pandemic years. Corresponding to the peaks of the pandemic, we observed the fewest cirrhosis hospitalizations in April and December 2020 (Table 2), however, these months had the highest observed mortality rates (p-trend ≤ 0.004). Reassuringly, liver transplantation rates were not significantly impacted by the COVID-19 pandemic (p=0.51). Image Conclusion(s) Cirrhosis hospitalizations, in general, decreased in 2020 compared to pre-pandemic years but were associated with higher all-cause mortality rates particularly in the peak months of the COVID-19 pandemic (April and December 2020) possibly reflecting COVID-19 specific mortality. Alcoholic liver disease admissions also increased during the pandemic while liver transplantation rates were not significant impacted. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Identification of risk factors for upper gastrointestinal bleeding in intensive care unit patients (GIBICU study)

Background and goals Risk stratification for the need for therapeutic endoscopy and prediction of mortality in patients with upper gastrointestinal bleeding (UGIB) can be assessed by several scores. However, current scores are not validated for variceal bleeding and Intensive Care Unit (ICU) patients. The aim of this study was to evaluate potential parameters for the prediction of UGIB and patient outcomes. Patients and study methods In this monocenter retrospective observational study, data from all esophagogastroduodenoscopies (EGD) between November 2014 and February 2020 with suspected hemorrhage in our ICU were evaluated. Results Out of 345 included EGD, 42.3% of UGIB was diagnosed. 51.9% needed endoscopic intervention. Overall, 52.3% of included patients with UGIB died. Logistic regression showed that preceding variceal or non-variceal UGIB (p < .001), serum lactate (p = .001), heart rate (HR) (p = .005), and blood transfusions (p = .001) were significant predictors of UGIB. Previous UGIB (p < .001), male sex (p = .015), known varices (p < .001), serum albumin (p = .19) and use of catecholamines (p = .040) were significant predictors for the need of endoscopic intervention. Higher mortality was significantly associated with the usage of steroids (p < .001), malignant preconditions (p = .021), serum albumin (p = .020) and prolonged PTT (partial thromboplastin time) (p = .001). Conclusions We were able to identify additional parameters that had previously not been included in existing scores to predict the risk of UGIB, the need for therapeutic endoscopy and mortality in ICU patients. Therefore, an extension of these scores is necessary. Further validation of identified parameters in multicenter trials is needed to improve risk scores for ICU patients.

Sarcopenia, body composition and factors associated with variceal gastrointestinal bleeding and splenectomy in hepatosplenic schistosomiasis mansoni.

Sarcopenia is a common complication of cirrhosis and an important predictor of morbimortality. We aimed to determine the prevalence of sarcopenia and its associated factors in hepatosplenic schistosomiasis (HSS) as well as to evaluate whether muscle mass and function are associated with variceal upper gastrointestinal bleeding (VUGIB) and previous splenectomy in subjects without other liver diseases. We conducted a cross-sectional study including adults with HSS who underwent clinical, biochemical, anthropometric, muscle strength and physical performance evaluations and were submitted to bioelectrical impedance analysis and abdominal ultrasound. Sarcopenia was diagnosed according to the 2019 European consensus criteria. A total of 66 patients with HSS (62.1% male; mean age 48.8±8.6y) were included. Overall, six subjects (9.1%) were diagnosed with probable sarcopenia and none had confirmed sarcopenia. Fat-free body mass index (BMI) was independently associated with VUGIB (odds ratio 0.701 [95% confidence interval 0.51 to 0.96]; p=0.025). Compared with patients who did not undergo surgery, individuals who underwent esophagogastric devascularization combined with splenectomy (EGDS) had higher serum lipid levels, fat percentage and frequency of metabolic syndrome, with lower skeletal muscle mass index and hand grip strength. HSS mansoni seems not to cause sarcopenia. However, a lower fat-free BMI was associated with previous VUGIB and the subgroup of patients who underwent EGDS presented higher lipid levels, fat percentage and frequency of metabolic syndrome and lower muscle mass and function.

Comparison of outcomes between variceal and non-variceal gastrointestinal bleeding in patients with cirrhosis: Insights from a Nationwide Inpatient Sample.

Variceal upper gastrointestinal bleeding (VUGIB) occurs in patients with decompensated cirrhosis, but non-VUGIB (NVUGIB) is not uncommon. We compared the outcomes of VUGIB and NVUGIB in cirrhotic patients. This retrospective study used Nationwide Inpatient Sample employing International Classification of Diseases codes for adult NVUGIB and VUGIB patients. Mortality, morbidity, and resource utilization were compared. Analyses were performed using STATA; proportions and continuous variables were compared using Fisher's exact and Student's t-test, respectively. Confounding variables were adjusted using propensity matching, multivariate logistic and linear regression analyses. Of 2,166,194 cirrhotics, 92,439 had a diagnosis of NVUGIB and 17,620 VUGIB. VUGIB patients had higher rates of mortality [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.19-1.69], hemorrhagic shock (aOR 1.84, 95%CI 1.54-2.17) and intensive care unit admission (aOR 2.47, 95%CI 2.18-2.81), greater hospitalization costs ($16,251 vs. $12,295, P<0.001), more need for packed red blood cell transfusion (aOR 1.12, 95%CI 1.03-1.22) or endoscopic therapy (aOR 2.71, 95%CI 2.47-2.93), and a longer hospital stay compared to NVUGIB. However, NVUGIB had higher aOR of undergoing diagnostic endoscopy and radiography-guided vessel embolization. There were no differences in the rates of acute kidney injury between the 2 groups. Ascites and spontaneous bacterial peritonitis were independently associated with increased VUGIB mortality. VUGIB in patients with cirrhosis is associated with greater hospital costs, mortality, and morbidity burden than NVUGIB. This study provides updated and current knowledge of patient characteristics and differences in outcomes between VUGIB and NVUGIB, required to successfully address the healthcare delivery gaps.

P-EGS18 The outcomes of upper gastrointestinal bleeds with unsuccessful endoscopy in a district hospital with no interventional radiology

Abstract Background Acute upper gastrointestinal bleeding (UGIB) is a common emergency estimated to occur in 80 to 150 out of 100,000 people each year. First line management is endoscopy and pharmacological but those who fail this can pose a challenge. Current NICE guidelines recommend repeat endoscopy to patients who re-bleed, those unstable consider interventional radiology (IR) or emergency surgery. The estimated mortality rate is approximately 10%. This study was conducted to review our current surgical outcomes and whether referral for IR is appropriate and could reduce mortality. Methods Retrospective study of 11 patients who underwent surgery for refractory non- variceal UGIB between November 2015 and March 2021 with a mean age of 61. Data was collected from the electronic records. Results All patients underwent an emergency laparotomy, 82% had an ASA of 4 the remainder ASA 3, a mean NELA mortality of 31.1% and a mean Blatchford 11.1. The initial OGD was performed on the day of admission in 54% of patients. 45% during initial OGD became hemodynamically unstable and transferred to theatre, one patient re-bleed 3 days after and taken to theatre the remainder (45%) re-bleed and had a 2nd OGD. 2 patients unstable during OGD went to theatre, 3 re-bleed within 24hrs 1 within 48hrs and taken to theatre. Mortality rate was 27%, complication rate 45%, mean LOS 24.6. Conclusions These findings highlight the high rate of morbidity and mortality associated with surgical treatment for UBIB. A small number of cases occurred over 7 years requiring surgical intervention,45% had two OGD’s and 9% went on to have a 3rd. Was there a window of opportunity to use IR if it were available. Recent studies have shown that transcatheter arterial embolization is safer than surgical intervention in the high risk patient population and has a lower 30-d mortality rate.

Hepatic schistosomiasis, upper gastrointestinal bleeding, and health related quality of life measurements from the Albert Nile Basin

BackgroundHealth related quality of life measurements are vital elements of public health surveillance that uncover unmet health needs and predict the success of health interventions. We described health related quality of life measurements using the EuroQoL 5-dimension (EQ-VAS/EQ-5D) instrument and associated factors among patients with upper gastrointestinal bleeding (UGIB) and hepatic schistosomiasis at a rural health facility in the Albert Nile Basin, Uganda.Methods and materialsThis was a cross-sectional study at Pakwach Health Centre IV. Participants included adult inpatients and outpatients with a history of UGIB and ultrasound evidence of hepatic schistosomiasis. We evaluated and recorded each participant’s medical history, physical examination, laboratory tests results, ultrasound results, and endoscopy findings. We also recorded health related quality of life measurements using the EuroQoL 5-dimension instrument and derived disability weights from EQ-VAS and EQ-5D measurements. These were our dependent variables. Descriptive and inferential statistics were generated summarizing our findings.ResultsWe found 103 participants had a history of upper gastrointestinal bleeding and hepatosplenic schistosomiasis. Sixty percent were between the ages of 30–49 years, 59% were females, 74% were farmers, 92% had splenomegaly, 88% had varices at endoscopy, 22% were medical emergencies with acute variceal upper gastrointestinal bleeding, and 62% had anemia. Measures of the different dimensions of health from 101 participants with patient reported outcomes revealed 77 (76%) participants experienced problems in self-care, 89 (88%) participants reported anxiety or depression, and 89 (88%) participants experienced pain or discomfort. The median EQ-VAS derived disability weights and median EQ-5D index-derived disability weights were 0.3 and 0.34, respectively. Acute upper gastrointestinal bleeding, praziquantel drug treatment, and age by decade predicted higher EQ-VAS derived disability weights (p value < 0.05). Under weight (Body mass index ≤ 18.5), acute upper gastrointestinal bleeding, ascites, age by decade, female gender, and praziquantel drug treatment predicted higher EQ-5D index- derived disability weights (p value < 0.05).ConclusionAdult patients with upper gastrointestinal bleeding and hepatic schistosomiasis from this primary health facility experience poor health and considerable health loss. Several factors predicted increased health loss. These factors probably represent key areas of health intervention towards mitigating increased health loss in this population.

Luminal Clinical

Background and Aim: Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency and carries high morbidity and mortality. There are multiple risk factors for poorer outcomes, including malnutrition. Ascorbic acid is a water-soluble vitamin present in most plant foods. Dietary deficiency leads to scurvy, which may alter the natural history of UGIB through impaired tissue and mucosal integrity. Traditionally thought to be rare in developed countries, vitamin C deficiency (VCD) is now well described in patients with pneumonia, sepsis, and coronavirus disease 2019. There is a paucity of literature investigating the prevalence and clinical significance of VCD in patients with UGIB;interim findings reported by our group suggested a prevalence of >30%. The aim of this study was to establish the prevalence of VCD in patients presenting with UGIB and its association with clinical outcomes. Methods: We conducted a prospective cohort study of adult patients presenting with UGIB to two metropolitan tertiary hospitals in Melbourne, Australia, over a 12-month period (March 2020 to March 2021). Fasting vitamin C levels were obtained on admission. Patients were risk-stratified using the AIMS65 score, and baseline demographic data and outcomes were recorded. The primary outcome was the prevalence of VCD (serum vitamin C level < 23 μmol/L) and severe VCD (<12 μmol/L). Secondary outcomes included a composite endpoint of adverse events (AE), comprising inpatient death, intensive care unit (ICU) admission, rebleeding, surgery, angioembolization, or massive transfusion (≥4 units of red cells). Multivariate logistic regression was used to determine the association between vitamin C levels and the secondary endpoints. Subgroup analyses were performed in variceal and non-variceal UGIB and high-risk (AIMS65, ≥2) and low-risk (AIMS65, 0-2) UGIB. Results: A total of 227 patients were included. The median age was 65 years (IQR, 54-78), 145 (63.9%) were male, and the median AIMS65 score was 1 (IQR, 1-2). The etiology of UGIB was variceal bleeding in 20.3%, peptic ulcer disease in 44.1%, and other causes in 35.7%. The mean vitamin C level was 40 ± 26 μmol/L. In terms of patient outcomes, inpatient mortality was 4%, ICU admission occurred for 11.9%, and mean length of stay (LOS) was 7.7 ± 9.7 days. Red cell transfusion was required in 63.4% of patients, with a mean requirement of 2.2 ± 2.8 units. VCD was identified in 74 patients (32.6%), with severe deficiency in 32 (14.1%). VCD was associated with significantly higher in-hospital mortality (9.5% vs 1.3%, P = 0.01), prolonged LOS (10.8 vs 6.2 days, P < 0.01), rebleeding (17.6% vs 7.88%, P = 0.05), and a higher composite endpoint of AE (77% vs 54.9%, P < 0.01). On multivariate logistic regression, high-risk UGIB (odds ratio [OR], 3.24;95% CI, 1.42-7.42), VCD (OR, 2.28;95% CI, 1.11-4.71), and chronic liver disease (OR, 11.66;95% CI, 2.92-46.64) were all independently associated with the composite endpoint of AE. In subgroup analysis, VCD was associated with a significantly increased composite endpoint of AE in patients with non-variceal (74% vs 51%, P < 0.01) and low-risk (66% vs 44%, P = 0.04) UGIB. Conclusion: VCD is highly prevalent in patients with UGIB and associated with poorer outcomes, including higher mortality, rebleeding, and LOS. Interventional studies are required to determine the impact of early vitamin C supplementation on clinical outcomes.

Clinical outcomes in cirrhotics with variceal or nonvariceal gastrointestinal bleeding: A prospective, multicenter cohort study.

Upper gastrointestinal bleeding (UGIB) is associated with a distinct mortality in cirrhotics. We evaluated whether the rate of mortality and other outcomes differs between variceal and nonvariceal UGIB. This was a prospective, multicenter, cohort study on UGIB cirrhotics observed in 50 hospitals. Variceal or nonvariceal UGIB were diagnosed at endoscopy. The 6-week mortality rate, need of blood transfusion, intensive care unit (ICU) admission, radiologic or surgical intervention, rebleeding rate, and length of stay in hospital were the main clinical outcomes compared. Data were analyzed at univariate and multivariate analysis, and odds ratio (OR) with their 95% confidence interval (CI) was calculated. The study enrolled 706 cirrhotics, including 516 (73%) variceal and 190 (27%) nonvariceal UGIB. There were 78 (11%; 95% CI=8.7-13.4) deceases, without any difference between variceal (11.0%) and nonvariceal (11.0%) groups. Child-Pugh score C (OR: 6.99; 95% CI=2.58-18.95), and development of either hepatorenal syndrome (OR: 16.5; 95% CI=7.02-38.9) or hepatic encephalopathy (OR: 2.38; 95% CI=1.25-4.5) were independent predictors of mortality. Transfusions and onset of hepatic encephalopathy were significantly more frequent in variceal, whereas ICU admission rate was higher in nonvariceal bleedings. Overall, antibiotic prophylaxis was eventually administered in only 392 (55.5%) patients. Data found that the overall mortality rate in cirrhotics with UGIB seems to be reducing and that the value did not differ between variceal and nonvariceal types. Prevention of both hepatorenal syndrome and hepatic encephalopathy and implementation of antibiotic prophylaxis could improve survival in these patients.

Impact of Readmission for Variceal Upper Gastrointestinal Bleeding: A Nationwide Analysis.

Variceal upper gastrointestinal bleeding (VUGIB) is a common and potentially lethal complication of cirrhosis. Population-based data regarding hospital readmission and other outcomes in VUGIB are limited. In a large United States database of patients with VUGIB, we evaluated readmission rates, mortality rates, healthcare resource consumption, and identified predictors of readmission. The 2017 Nationwide Readmission Database using ICD-10 codes was used to identify all adult patients admitted for VUGIB. Primary outcomes were 30- and 90-day readmission rates. Secondary outcomes included mortality, healthcare resource consumption, and predictors of readmission. Multivariate regression analysis was used to adjust for potential confounders. In 2017, there were 26,498 patients with VUGIB discharged from their index hospitalization, and 24.7% were readmitted (all-cause) within 30-days and 41.5% within 90-days. Recurrent VUGIB accounted for 26.7% and 28.9% of 30- and 90-day readmissions, respectively. Compared to index admissions, 30-day readmissions were associated with higher mortality (4.3% vs. 6.4%, p < 0.01), increased mean hospital length of stay (5.6days vs. 4.5days, p < 0.01), and charges ($65,984 vs. $53,784, p < 0.01), with similar findings in 90-day readmissions. Factors associated with 30-day readmission included end-stage renal disease (HR 1.2, p < 0.05), chronic kidney disease (HR 1.31, p < 0.01), and acute kidney injury (HR 1.14, p < 0.05). Based on a nationwide cohort of hospitalized VUGIB patients, 25% were readmitted within 30-days and 42% within 90-days. Readmission was associated with increased mortality and healthcare consumption compared to the index admission. Additionally, acute and chronic renal injury were predictors of patients at high-risk for readmission.

EFFECT OF HELICOBACTER PYLORI INFECTION ON NON VARICEAL BLEEDING IN PATIENTS WITH LIVER CIRRHOSIS

Background: Variceal bleeding in chronic liver disease has been studied extensively. However, 30-40% of upper digestive hemorrhages in cirrhotic patients are non variceal (NVUGIB). Clinical features and endoscopic findings of this population have rarely been reported. Objective: To determine the prevalence of H. pylori infection in cirrhotic patients with non variceal upper gastrointestinal bleeding. Patients and methods: This was carried out at Hepatology, Gastroenterology and Infectious Diseases Department of Al-Azhar University Hospitals, and conducted on 150 patients infected by H. pylori From May 2019 till November 2019. Pateints were selected and divided into three equal groups: Group A: Patients with recent active bleeding (maximum within two days) of non variceal origin diagnosed endoscopically. Group B Matched cirrhotic patients without history of upper gastrointestinal bleeding, and group C Non-cirrhotic patients without history of upper gastrointestinal bleeding. Upper GI Endoscopy was done for all patients of the studied groups. Multiple biopsies were taken and H.pylori infection was determined by Histopathology. Results: The mean age of participants was 54.3 years. Males were 79 (52.6%) while females were 71 (47.3%). 58 of 150 patients (38.6%) were positive for H. pylori. there was no significant relation between H. pylori positivity and cause of cirrhosis. there was significant relation between H. pylori positivity and Sex of the studied cases. And there was high significant difference between the studied groups as regard H. pylori distribution. Conclusion: There was significant association between H. pylori infection and non variceal upper gastrointestinal bleeding. Eradication therapy has a role in reducing the incidence of NVUGIB in cirrhotic patients.

Endoscopic Utilization and Outcomes of Upper Gastrointestinal Bleeding in COVID-19: A Global Real-World Database Analysis

Introduction: Upper gastrointestinal bleeding (UGIB) events are increasingly recognized in the Coronavirus Disease-2019 (COVID-19) patients. The data about the rates of utilization of endoscopy and outcomes among these patients are scarce.Methods: All hospitalized COVID-19 patients with UGIB (hematemesis or melena or both) were studied from January 1, 2020, to September 1, 2020, from the TriNetX multicenter research network database. Patients were divided into two groups- patients who underwent any endoscopies (endoscopy group) and did not undergo endoscopy (non-endoscopy group). A subgroup analysis was performed for patients with variceal (V-UGIB) and non-variceal UGIB (NV-UGIB). Mortality and development of acute respiratory distress syndrome were the primary outcomes of the study. Secondary outcomes were cross-section imaging (CT scan of the abdomen) and mechanical ventilation.Results: A total of 3466 hospitalized COVID-19 had UGIB events from January 1, 2020, to September 1, 2020. 3.1% (3466/112,158). Only 51.1% of patients (1773/3446) underwent an endoscopy. The endoscopy group had a lower risk of mortality (risk ratio [RR] 0.63, 95%CI:0.52–0.77), and ARDS (RR 0.39, 95%CI:0.22–0.71). Rates of mechanical ventilation (RR 0.66, 95%CI:0.47–0.91) were lower, and the rate of CT scan utilization (RR 1.20, 95%CI:1.01–1.42) were higher in the endoscopy group. No differences in the outcomes were noted in V-UGIB and NV-UGIB groups.Conclusion: UGIB events in hospitalized adult COVID-19 patients was 3.1%. Endoscopy utilization in this cohort was associated with a significantly lower risk of mortality (37%) and ARDS (61%). Future prospective studies are needed to validate these findings.Funding Statement: None.Declaration of Interests: The authors have no commercial associations or sources of support that might pose a conflict of interest.Ethics Approval Statement: TriNetX has received a waiver from IRB since it does not contain any protected health information (PHI) or the HCO Information, and only includes aggregated counts and statistical summaries of de-identified information.

S0603 Acute, Chronic, and End-Stage Kidney Disease Are Independent Predictors of 30-Day Readmission in Patients With Variceal Upper Gastrointestinal Bleeding: Findings From a Nationwide Analysis

S0603 Acute, Chronic, and End-Stage Kidney Disease Are Independent Predictors of 30-Day Readmission in Patients With Variceal Upper Gastrointestinal Bleeding: Findings From a Nationwide Analysis

Prophylactic Antibiotics in Cirrhotic Patients With Upper Gastrointestinal Bleeding.

Cirrhotic patients often develop bleeding from gastric or esophageal varices that occur secondary to portal hypertension. Gastrointestinal (GI) bleeding is fatal in approximately 20% of these episodes and bacterial infections are an important contributor to this mortality. Patients with cirrhosis are also known to have impaired immune function and also at higher risk of translocation of bacteria from the gut into the bloodstream.1 Therefore, the administration of prophylactic antibiotics during the bleeding event might help prevent such infections.

Collateral Effect of Coronavirus Disease 2019 Pandemic on Hospitalizations and Clinical Outcomes in Gastrointestinal and Liver Diseases: A Territory-wide Observational Study in Hong Kong

Background The Coronavirus Disease 2019 (COVID-19) pandemic had a huge impact on healthcare systems globally. Decline in hospital admissions for common medical emergencies was observed. We investigated its collateral effect on hospitalizations and clinical outcomes in patients with gastrointestinal (GI) and liver diseases in Hong Kong. Methods We performed a territory-wide retrospective cohort study in Hong Kong from January 1, 2019, to May 31, 2020. Data were retrieved through Clinical Data Analysis and Reporting System. We included patients admitted to hospitals with top diagnoses of luminal GI cancers, pancreatico-hepatobiliary cancers, benign pancreaticobiliary disorders, liver diseases, non-infective enteritis and colitis, non-variceal and variceal upper gastrointestinal bleeding (UGIB). We excluded patient-based hospital admissions without emergency department attendance and length of stay equal to or shorter than one day. The primary endpoint was the total number of index hospital admissions related to these diagnoses at different time points. The secondary endpoints were in-hospital mortality, intensive care unit admission, elective or emergency operations and endoscopy. The COVID-19 period was defined as the time after the first local case in January 2020, week 4. Results We recorded a total of 195,867 hospital admissions related to GI diseases during the study period, and 125,049 of them were included in the final analysis. Comparing the same pre-COVID19 and COVID-19 periods, we observed a significant decline in the average number of hospitalizations for GI diseases (17.0% reduction, P Conclusions The number of hospitalizations related to GI diseases reduced drastically during the COVID-19 epidemic, yet no excessive in-hospital mortality was observed. More emergency endoscopies and operations were required, particularly for UGIB and benign pancreaticobiliary conditions.