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Results for “HEMORRHAGE, GASTROINTESTINAL”

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PubMed1998

The effectiveness of early endoscopy for upper gastrointestinal hemorrhage: a community-based analysis.

OBJECTIVES: The effectiveness of upper endoscopy in unselected patients with upper gastrointestinal hemorrhage has not been well studied. This study was undertaken to identify factors associated with the performance of early endoscopy (ie, within 1 day of hospitalization) and, after adjusting for these factors, to determine associations between early endoscopy and in-hospital mortality, length of stay, and performance of surgery. METHODS: Subjects in this observational cohort study were 3,801 consecutive admissions with upper gastrointestinal hemorrhage to 30 hospitals in a large metropolitan region. Demographic and clinical data were abstracted from hospital records. A multivariable model based on factors that potentially could relate to the decision to perform endoscopy was developed to determine the propensity (0 to 100%) for early endoscopy in each patient. RESULTS: Early endoscopy was performed in 2,240 patients (59%), and although it was not associated with mortality after adjusting for severity of illness among all patients, it was associated with a higher risk of death for patients in the lowest propensity group. Early endoscopy was associated with a lower likelihood of upper gastrointestinal surgery in all patients and in the two highest propensity groups and with a shorter length of stay in the entire cohort and in all subgroups. CONCLUSIONS: In the absence of specific contraindications, early endoscopy should be considered because of associated reductions in length of stay and surgical intervention. Further studies are needed to identify subgroups in whom the procedure may be associated with adverse effects on survival.

Adult↗
PubMed1999

Retrospective review of emergency department patients with non-variceal upper gastrointestinal hemorrhage for potential outpatient management.

OBJECTIVE: To determine the number of ED patients with non-variceal upper gastrointestinal hemorrhage (NVUGIH) who could have been managed as outpatients through application of previously developed clinical guidelines. METHOD: Descriptive study based on retrospective chart review of patients who presented with acute upper gastrointestinal hemorrhage (UGIH) to the ED of an urban teaching hospital from July 1 to December 31, 1996. Applying the clinical guidelines published by a health maintenance organization (HMO) group (no high-risk endoscopic features/varices/portal hypertensive gastropathy, no debilitation, no orthostatic vital sign change, no severe liver disease, no serious concomitant disease, no anticoagulation or coagulopathy, no fresh, voluminous hematemesis or multiple episodes of melena on the day of presentation, no severe anemia, and adequate home support), patients who could have been managed as outpatients after esophagogastroduodenoscopy (EGD) were identified and analyzed. RESULTS: 145 UGIH patients were seen in the ED, of whom 128 (88%) were admitted and 111 (77%) underwent EGD. 21 (19%) had varices, leaving 90 (81%) with NVUGIH. 18 of these 90 patients (20%, 95% CI = 12% to 28%) fulfilled guidelines for outpatient management and had the following characteristics with p < 0.05: younger age [mean 54.2+/-5.5 (SEM) vs 63.8+/-1.9 years], less transfusion (0.9+/-0.3 vs 3.7+/-0.4 units), and shorter length of stay (2.1+/-0.4 vs 5.3+/-0.7 days). None of the 18 outpatient management patients had any complications. CONCLUSION: In a non-HMO urban teaching hospital, 18 patients with NVUGIH met criteria for outpatient management in a six-month period and none developed a complication during a mean in-hospital stay of 2.1 days.

Ambulatory Care↗
PubMed1999

Acute major gastrointestinal hemorrhage in inflammatory bowel disease.

BACKGROUND: Acute major gastrointestinal hemorrhage is uncommon in inflammatory bowel disease. METHODS: We characterized the clinical features and course of such hemorrhage in patients at our institution from 1989 to 1996. RESULTS: Thirty-one patients had acute lower gastrointestinal bleeding from inflammatory bowel disease and one had upper gastrointestinal bleeding from duodenal Crohn's disease. Three patients had ulcerative colitis and 28 had Crohn's disease, representing 0.1% of admissions for ulcerative colitis and 1.2% for Crohn's disease. In addition, another patient bled from an ileal J-pouch. In patients with Crohn's disease, the site of bleeding was duodenal in 1, small intestinal in 9, ileocolonic in 8, and colonic in 10. All ulcerative colitis patients had pancolitis. Medical therapy was initiated in 27 patients, including endoscopic therapy in 3. Five patients underwent surgery immediately, and 7 medically treated patients eventually required surgery for ongoing or recurrent bleeding. CONCLUSIONS: Acute major gastrointestinal bleeding is uncommon in inflammatory bowel disease. Most cases are due to Crohn's disease, without a predilection for site of involvement. The presence of an endoscopically treatable lesion is uncommon, and surgery is required in less than half of cases during the initial hospitalization. Recurrent hemorrhage is not rare, and for these cases surgery may be the most appropriate treatment.

Acute Disease↗
PubMed1975

Intraarterial vasopressin in the treatment of upper gastrointestinal hemorrhage: a prospective, controlled clinical trial.

Intraarterial vasopressin has been reported to be effective in the treatment of massive upper gastrointestinal hemorrhage. A prospective, controlled clinical trial comparing conventional treatment with conventional therapy plus intraarterial vasopressin was undertaken. Sixty episodes of upper gastrointestinal hemorrhage were evaluated during a 40-month period; 32 received conventional and 28 conventional plus vasopressin therapy. The two groups of patients were similar in type and severity of their bleeding lesions and in their underlying diseases. Vasopressin was more effective in controlling hemorrhage from nonvariceal lesions (P less than 0.05) and from varices (P less than 0.01) than conventional therapy. Transfusion requirements were significantly reduced in those patients who received vasopressin. Paradoxically, survival was not affected by vasopressin administration. The failure of cessation of hemorrhage to improve survival is thought to be due to the degree of advancement of the underlying disease, to the torrential nature of the hemorrhage, to the frequency of recurrent hemorrhage, and to the use of intraarterial vasopressin in some patients in the conventional treatment group in whom conventional therapy had failed.

Adult↗
PubMed1987

Aggressive angiographic diagnosis in acute lower gastrointestinal hemorrhage.

To assess the value of recently developed aggressive pharmacologic angiographic techniques for the diagnosis of acute lower gastrointestinal hemorrhage, we reviewed our experience with 63 consecutive patients referred for angiography. Hemorrhage was severe as indicated by a mean blood transfusion requirement of 9.4 units. Extravasation of contrast (46%), or an obvious vascular abnormality suggestive of a bleeding site (32%), was identified in 78% of patients. Extravasation was seen more frequently in patients with greater than or equal to 3 units of transfusion (66%) than in those with less than 3 units of transfusion (17%, P less than 0.001). After the introduction of pharmacologic techniques using heparin, tolazoline, streptokinase, and indwelling arterial catheters, the percentage of studies with extravasation of contrast increased from 32 to 65% (P less than 0.01). Application of aggressive angiographic techniques increases the diagnostic yield of angiography in acute severe lower gastrointestinal hemorrhage while exposing the patient to modest increased procedure-related risks which can be accepted in selected patients.

Acute Disease↗
PubMed1990

[The blood urea nitrogen/creatinine ratio in localizing the bleeding site in pediatric patients with gastrointestinal hemorrhage].

The reliability of the blood urea nitrogen/creatinine (B/C) ratio in localizing the bleeding site in pediatric patients with gastrointestinal hemorrhages was evaluated retrospectively. Supplementary experiments on rats and rabbits were also conducted. The study population included 69 children ranging in age from 6 days to 16 years (mean age, 7y8m) with successful radiographic, endoscopic, and surgical identification of the bleeding site. Patients with renal disease, liver disease and coagulopathy were excluded. The upper gastrointestinal bleeding site was segregated from the lower one defined by the ligament of Treitz. For the 38 upper gastrointestinal bleeders, B/C values ranged from 7.8-69.0 (mean 28.8 +/- 15.4 SD). For the 31 lower gastrointestinal bleeders the values ranged from 4.3-28.5 (mean 18.9 +/- 6.9 SD). A significant difference between the two groups was noted after (p less than 0.01) analysis. No patients with lower gastrointestinal bleeding had values higher than 30. In the group of 17 bleeders with a value higher than 30, 8 patients were examined again from 2-5 days after they had been identified as having bleeding to prove that the bleeding had stopped. At the time of identification of no-bleeding, B/C values were calculated at under 30 in every patient. There was no significant correlation between Hb (g/dl) and B/C. With respect to our experiments on animals, the B/C ratio was evaluated in rats with gastric or small intestinal ulcers. Though B/C was 34.4 +/- 4.4 under normal conditions, it increased significantly to 114.0 +/- 8.8 in rats with gastrointestinal ulcers, while in those with small intestinal ulcers B/C did not increase significantly (40.3 +/- 12.3). Twenty ml of blood from ear veins of rabbits was infused into a) stomach b) small intestine (no-hemolysis blood) c) small intestine (hemolysis blood). For a) and c), B/C increased in a similar pattern. For b) the increase was small. Infusing 5 ml, 10 ml, and 15 ml of the whole blood into the stomach indicated that the volume of blood did not influence the change of B/C values, while the infusion of 3 ml of serum caused only a small increase. According to these studies the increase in the B/C ratio after upper gastrointestinal hemorrhage has been postulated to result from the procedure in which the hemorrhage blood is fragmented or hemolyzed by HCl and digestive enzymes in the gastric juices; and consequently the BUN in red blood cells as well as in serum is rapidly absorbed from the upper small intestine. Volume of blood has little influence upon B/C.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1997

[Argon plasma coagulation in endoscopic therapy of CREST syndrome associated upper gastrointestinal hemorrhage].

We report on the case of a 55-year-old patient suffering from progressive systemic sclerosis (PSS). The patient was sent to our department when clinical symptoms of an acute upper gastrointestinal hemorrhage occurred. Upper endoscopy showed a watermelon stomach and fresh blood in the stomach. The presence of teleangiectasias in the antrum could be proved histologically. Since the teleangiectasias found in the antrum were the only possible source of the hemorrhage three sessions of endoscopic argon plasma coagulation were performed. Macroscopically, a nearly complete disappearance of teleangiectasias could be achieved. After a follow-up of six months, there have been no clinical signs of another hemorrhage episode. This case shows that the existence of gastrointestinal teleangiectasias should be considered when chronic anemia or acute gastrointestinal hemorrhage occur in patients with PSS. Further it is demonstrated that even extended gastrointestinal teleangiectasias can be successfully treated by endoscopically performed argon plasma coagulation.

CREST Syndrome↗
PubMed2004

A case of Brunner's gland hamartoma presenting as obscure gastrointestinal hemorrhage.

Brunner's gland hamartomas are rare tumors of duodenum, they are often discovered incidentally during esophagogastroduodenoscopy or upper gastrointestinal series. These tumors arise mainly in the duodenal bulb and can present with gastrointestinal hemorrhage and intestinal obstruction. Most of Brunner's gland hamartomas are located within the range of the standard esophagogastroduodenoscope. However, they are rarely located below the third portion of duodenum. As well known, the small intestine, including the 4th portion of duodenum, jejunum, and ileum, is relatively inaccessible with routine endoscopy. Thus, the diagnosis of Brunner's gland hamartoma in these area can be delayed up to several months after onset of symptoms. We report a case of Brunner's gland hamartoma which was located in the fourth portion of the duodenum and presented as obscure gastrointestinal hemorrhage. Radiologic, surgical, and pathologic appearances are presented.

Brunner Glands↗
PubMed1992

Beta-adrenergic antagonists for primary prevention of gastrointestinal hemorrhage in patients with cirrhosis and esophageal varices.

The use of beta-adrenergic antagonists for primary prevention of gastrointestinal hemorrhage in patients with cirrhosis and esophageal varices is discussed. In five controlled trials, patients with cirrhosis and endoscopically proven esophageal varices were treated with either propranolol or nadolol in doses to reduce heart rate by 20-25% or in doses to decrease hepatic vein pressure by 25% of basal levels or to a level of less than 12 mm Hg. In two of three studies, investigators found that propranolol significantly reduced frequency of initial bleeding in patients with esophageal varices. In one of two studies, nadolol significantly decreased the risk of variceal bleeding in patients with cirrhosis; in the other study, a significant difference in the frequency of initial bleeding was found only among patients who were compliant with therapy. Only one of the five studies showed a significant difference in survival between the treatment group and the placebo group. Adverse effects of therapy included dizziness, fatigue, cardiac insufficiency, Raynaud's phenomenon, and risk of bleeding associated with propranolol withdrawal. Therapy with a nonselective beta-adrenergic antagonist should be considered for primary prevention of gastrointestinal hemorrhage in patients with cirrhosis and suspected or documented large varices; however, abrupt discontinuation of the medication is associated with risk of bleeding.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Superselective coil embolization in acute gastrointestinal hemorrhage: personal experience in 10 patients and review of the literature.

PURPOSE: To evaluate the safety and efficiency of microcoil embolization in upper and lower gastrointestinal hemorrhage. PATIENTS AND METHODS: Superselective microcoil embolization was performed in 10 patients (upper gastrointestinal bleeding, n = 3; lower gastrointestinal bleeding, n = 7) who had acute gastrointestinal hemorrhage. Embolization was performed as peripherally as possible with use of coaxial catheter systems. Embolization materials included microcoils (2-4 mm) alone (n = 5), microcoils and polyvinyl alcohol particles (355-500 microm) (n = 4), and microcoils and gelatin sponge particles (n = 1). RESULTS: Immediate hemostasis was achieved in eight patients. In two patients with dual blood supply of the bleeding site, significant reduction of hemorrhage resulted. In these two patients, it was technically impossible to place the coaxial catheter distally enough to allow safe embolization of both feeding vessels. No clinical signs of ischemia or infarction were observed after intervention. CONCLUSION: Microcoil embolization is a safe and efficient procedure for controlling acute lower gastrointestinal bleeding if performed in a superselective catheter position. In upper gastrointestinal bleeding, microcoil embolization is an established treatment and can be performed more proximally.

Acute Disease↗