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PubMed1984

Isolated duodenal varix: an unusual cause of gastrointestinal hemorrhage.

We have reported an unusual case of upper gastrointestinal hemorrhage due to an isolated varix involving the second portion of the duodenum. The varix originated directly from the inferior vena cava and did not communicate with the portal venous system. The diagnosis was made preoperatively by upper gastrointestinal endoscopy. Surgical resection of the varix and the involved portion of the duodenal wall proved curative.

Adult↗
PubMedDate not supplied

[Dieulafoy's lesion as a cause of massive gastrointestinal hemorrhage].

Dieulafoy's lesion also known as exulceration simplex with submucosal arterial malformation is a rare cause of massive upper gastrointestinal hemorrhage with high mortality. Surgery that has been considered as the preferred diagnostic and therapeutic option has been supplemented by endoscopy; gastroscopy may be a valid alternative for diagnosis and therapy. Between 1981 and 1988 we report 4 cases with massive upper gastrointestinal hemorrhage, haematemesis and hemodynamic decompensation consistent with Dieulafoy's lesion. In all patients emergency gastroscopy was performed, monopolar electrocoagulation was successfully applied in two patients. One patient died during surgery and another sixteen days after surgery from multiple organ failure. Rebleeding was seen in one of the coagulated patients, the site of bleeding was identified as Dieulafoy's lesion in three patients during the first endoscopy and was arterial spurting with normal surrounding gastric mucosa. All lesions were found in the upper third of the stomach. Diagnosis is not easy, especially when the bleeding is intermittent but once identified, endoscopic treatment should be attempted and if this fails surgery may be promptly performed with possible lowering of mortality.

Adult↗
PubMed1984

Angiographic diagnosis at gastrointestinal hemorrhage.

The position of angiography in the diagnosis of gastrointestinal hemorrhage is discussed on the basis of a series of 37 patients. In this series, there were angiographic signs of bleeding in 13 cases (35%). The largest group consisted of angiodysplasias. In 24 cases, angiography revealed no signs of bleeding. The cause of symptoms was discovered later in 17 of these cases. Hemorrhagic gastritis and ventricular ulcer were the main causes of bleeding in the latter group.

Adolescent↗
PubMed1995

[The value of diagnostic and interventional endoscopy in acute, non-varicose, upper gastrointestinal hemorrhage].

There is a broad consensus about the benefits of emergency endoscopy in the diagnosis and treatment of acute upper gastrointestinal bleeding. The Wels General Hospital is a large teaching hospital where all emergency endoscopies are performed by the staff of the First Department of Internal Medicine. The reports of 11,078 esophagogastro-duodenoscopies performed between November 1987 and February 1993 were scrutinized by the authors and 980 cases identified where a clinical diagnosis of suspected upper gastrointestinal hemorrhage had been made. All together 156 patients showed signs of active or recent bleeding on endoscopy (Forrest Ia, Ib, IIa) and were selected as database for this analysis. We identified 64 patients with duodenal ulcers, 43 patients with gastric ulcers and 15 patients with Mallory-Weiss-tears. Erosions, anastomotic ulcers, cancer and so called rare causes (Dieulafoy ulcers, mesenchymal tumors Hemobilia) were identified in 34 patients. Therapeutic endoscopy was performed in 69 patients (44.2%). For hemostatic therapy we used the injection method with epinephrine. 34 patients underwent surgical therapy (13 cases underwent emergency surgery). 10 of 156 patients 10 (6.4%) died secondary to their acute nonvariceal upper gastrointestinal hemorrhage.

Adult↗
PubMed1985

Risks of surgery for upper gastrointestinal hemorrhage: 1972 versus 1982.

A retrospective comparison was undertaken to determine if the risks of undergoing surgery for nonvariceal upper gastrointestinal hemorrhage had changed between 1972 and 1982. In 1982, patients were on the average 9 years older, there was a significant decrease in bleeding from duodenal ulcers compared with 1972 data, gastric ulcer rates remained unchanged, and diffuse gastritis occurred more frequently in 1982. Mortality and morbidity rates showed no significant differences; however, the patient population did change with the emergence of older patients, in whom bleeding developed after hospitalization for other reasons. These patients comprised 30 percent of the 1982 study population. If further improvements in surgical treatment of upper gastrointestinal hemorrhage are to occur, these patients must be identified and aggressively managed.

Adult↗
PubMed1992

Gastrointestinal hemorrhage in AIDS: arteriographic diagnosis and transcatheter treatment.

The usefulness of arteriography and transcatheter treatment was studied in nine patients with gastrointestinal hemorrhage and acquired immunodeficiency syndrome (AIDS). Selective arteriography was performed in all patients; transcatheter treatment was performed by means of embolotherapy or selective vasopressin infusion. Medical records were reviewed to determine the cause of hemorrhage and clinical outcome. Arteriography enabled identification of the site of hemorrhage in seven patients. Hemorrhage was caused by Kaposi sarcoma (n = 2), cytomegalovirus colitis (n = 1), lymphoma (n = 2), or unknown causes (n = 4). Neovascularity and dense parenchymal stain were present in patients with Kaposi sarcoma. Transcatheter treatment consisted of embolization (n = 3), vasopressin infusion (n = 2), or both (n = 1). Hemorrhage was controlled in six cases in which transcatheter treatment was administered. Complications included thrombosis of the femoral artery in a 7-month-old infant and formation of a pseudoaneurysm of the femoral artery, which was treated successfully with ultrasound-guided compression. In patients with AIDS and profuse gastrointestinal hemorrhage, arteriography often enables identification of a specific site of hemorrhage, which can be stopped with transcatheter treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Mechanism of upper gastrointestinal hemorrhage in Mediterranean spotted fever.

Gastrointestinal (GI) hemorrhage is not a common complication of Mediterranean spotted fever (MSF). We describe three MSF cases with upper digestive tract bleeding in patients from Salamanca (Spain) and the results of the histologic studies performed in two of them. Besides the classical clinical triad of the disease (fever, rash and lesion at the site of tick bite, 'tache noire'), these patients presented purpuric rash and hypoalbuminemia, previously identified in severe forms of the disease. The hemorrhagic complication occurred late in the course of the MSF (between 13 and 20 days after the onset of fever) and was the consequence of multiple acute superficial erosions of the gastric mucosa. The histologic substrate of these lesions was identified as a vasculitic process - characteristically lymphohistiocytic - affecting the small vessels of the gastric wall. Rickettsial vascular injury at this level of the digestive tract is histologically similar to that observed in other organs in patients with MSF and may manifest clinically as digestive tract bleeding.

Aged↗
PubMed1980

Regional enteritis with major gastrointestinal hemorrhage as the initial manifestation.

Four patients with massive gastrointestinal hemorrhage were found to have Crohn's ileitis. This prompted a five-year chart review of consecutive admissions for Crohn's enteritis; 60 patients were found whose disease was limited to the distal part of the ileum (and rarely the proximal part of the cecum). Eight (13%) of these patients were admitted because of major rectal bleeding, and in seven of the eight the hemorrhage was the initial manifestation of Crohn's disease. The mean age of the entire group was 30 years, with a mean age of 18.6 years in the eight bleeders. Crohn's ileitis should be considered in the differential diagnosis of massive rectal bleeding, especially in younger patients.

Adolescent↗
PubMed2002

Severe upper gastrointestinal hemorrhage in the newborn.

Three infants with severe upper gastrointestinal hemorrhage with esophagogastroduodenoscopic (EGD) findings were reported. The underlying conditions of these infants included Down's syndrome, hypoplastic left heart, and diaphragmatic hernia. The precipitating factors were identified in all cases, including prenatal stress, hypoxemia, prolonged ventilatory support, and gastroesophageal reflux. The EGD findings were composed of multiple gastric ulcers and a duodenal ulcer in the first 2 cases, whereas esophagitis and gastritis were noted in the last case. These ulcers were classified as secondary peptic ulcers. All cases responded well to medical treatment, including ranitidine, sucralfate, omeprazole, cisapride, and octreotide.

Acute Disease↗
PubMed1997

Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis.

PURPOSE: To determine the efficacy of somatostatin or octreotide for the treatment of acute nonvariceal upper gastrointestinal hemorrhage. DATA SOURCE: Database searches of English-language articles published between 1966 and 1996 and the bibliographies of all related articles and textbook chapters. STUDY SELECTION: Randomized clinical trials comparing somatostatin or octreotide with H2 blockers or placebo in patients with a clinical or endoscopic diagnosis of acute nonvariceal upper gastrointestinal hemorrhage. DATA EXTRACTION: Methods and quality of the studies were evaluated, and quantitative data on outcomes, including continued bleeding, rebleeding during the treatment period, need for surgery, and transfusion requirement, were extracted. DATA SYNTHESIS: Among 1829 patients from 14 trials, the relative risk (RR) for continued bleeding or rebleeding was 0.53 (95% CI, 0.43 to 0.63) in favor or somatostatin, with a number needed to treat (NNT) of 5. Among 7 investigator-blinded trials, the relative risk was 0.73 (CI, 0.64 to 0.81) and the NNT was 11. Somatostatin was efficacious for peptic ulcer bleeding (RR, 0.48 [CI, 0.39 to 0.59]; NNT, 4) and showed a trend toward efficacy for non-peptic ulcer bleeding (RR, 0.62 [CI, 0.39 to 1.002]). Although the overall results suggested a decreased need for surgery in the somatostatin group, a subgroup analysis of investigator-blinded trials revealed a more modest effect that was not statistically significant (RR, 0.94 [CI, 0.87 to 1.001]). CONCLUSION: Somatostatin may reduce the risk for continued bleeding from acutely bleeding peptic ulcer disease. Somatostatin may be useful either as an adjunct treatment before endoscopy or when endoscopy is unsuccessful, contraindicated, or unavailable.

Acute Disease↗
PubMed1986

Predictors of outcome in massive upper gastrointestinal hemorrhage.

We reviewed 100 consecutive cases of massive upper gastrointestinal hemorrhage (UGIH). The criteria for inclusion were a decrease in hematocrit greater than or equal to 6%, unstable vital signs, and greater than or equal to units of blood transfused (16 +/- 18 units, mean +/- SD). A multiple regression analysis of 96 variables was employed to determine the most accurate predictors of outcome. The overall mortality was 35%. Hospital status (whether the patient was an inpatient or outpatient when the UGIH began) showed a striking association with mortality (70% for inpatients vs. 22% for outpatients, p less than 0.001). Nonsurvivors also had a greater number of life-threatening diseases than survivors (1.4 +/- 1.1 vs. 0.3 +/- 0.5, p less than 0.001) and greater transfusion requirements (27 +/- 20 units vs. 10 +/- 13 units, p less than 0.001). Age, the presence of cirrhosis, and recent excessive alcohol intake were not important risk factors. At presentation, the most reliable predictor of a fatal outcome was the brevity of the interval between the onset of bleeding and the initiation of a medical work-up. The primary predictor when considering the entire hospitalization was the number of life-threatening diagnoses. Our data indicate that stratification for hospital status and for other potentially predictive risk factors should be incorporated in future trials of therapy for UGIH.

Aged↗
PubMed2002

Resource utilization for acute lower gastrointestinal hemorrhage: the Ontario GI bleed study.

OBJECTIVES: Acute lower gastrointestinal hemorrhage (LGIH) is a common indication for hospitalization. However, there are few published studies of related health care resource utilization. Resource utilization, length of stay (LOS) and direct medical costs were characterized in a cohort of patients admitted for nonmalignant LGIH to centres in Ontario. METHODS: Consecutive admissions for LGIH were identified at four Ontario hospitals. Profiles of resource utilization, LOS and estimates of direct medical costs were compiled through detailed chart review and adaptation of an administrative database. All centres were participants in the Ontario Case Cost Project. Linear regression models of log-transformed data were constructed to identify demographic variables predictive of LOS and case cost. RESULTS: Among 124 patients enrolled (mean age 58.8 years) the average case cost was dollars 4832 (SD dollars 7187) for 7.5 days in hospital (SD 12.0). Diverticular disease was the bleeding source most often identified (34.6%), followed by hemorrhoids (13.7%) and ischemic colitis (9.7%). Older age and comorbid illness, specifically coronary artery disease (CAD), were associated with both increased LOS and higher case cost in univariate regression analyses. Age persisted as the lone independent predictor of LOS in the multivariate model (P<0.05, R2=0.076), and age and CAD were both independent predictors of cost (P<0.05, R2=0.109) in a stepwise multiple linear regression analysis. Neither sex nor nonsteroidal anti-inflammatory drug use predicted LOS or cost. CONCLUSIONS: Admissions for acute LGIH are associated with significant resource utilization, particularly among elderly patients with CAD.

Acute Disease↗
PubMed1992

Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage.

To assess the efficacy of selective intestinal decontamination with norfloxacin in the prevention of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage, 119 patients were included in a prospective randomized study. Group 1 (n = 60) received norfloxacin orally or through a nasogastric tube, 400 mg twice daily for 7 days beginning immediately after emergency gastroscopy; group 2 (n = 59) was the control group. We found a significantly lower incidence of infections (10% vs. 37.2%; P = 0.001), bacteremia and/or spontaneous bacterial peritonitis (3.3% vs. 16.9%; P less than 0.05), and urinary infections (0% vs. 18.6%; P = 0.001) in patients receiving norfloxacin, as a consequence of decrease in the incidence of infections caused by aerobic gram-negative bacilli. The decrease in mortality observed in the treated group (6.6% vs. 11.8%) did not reach statistical significance. The cost for antibiotic treatment showed a 62% reduction in the treated group compared with the control group. The results show that selective intestinal decontamination with norfloxacin is useful in preventing bacterial infections in cirrhotics with gastrointestinal hemorrhage.

Adult↗
PubMed1986

Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization.

The results of selective intraarterial vasopressin-infusion therapy and embolization therapy were compared in two groups of patients with major gastrointestinal hemorrhage. The site of bleeding, clinical course, complications, and transfusion requirements were evaluated in each group. Intraarterial vasopressin infusion therapy resulted in successful control of hemorrhage in 16 (70%) of 23 patients. Four patients, however, rebled and an operation was necessary, reducing the overall success rate to 52% (12 of 23). In the group treated with embolization therapy, primary success was achieved in 17 (71%) of 24 patients. Four patients in whom initial embolization failed to control bleeding underwent repeat embolization and in all four permanent control of hemorrhage was obtained, producing an overall success rate of 21 (88%) of 24. Analysis of our results according to site of hemorrhage suggests that at certain sites embolization is a preferred method of treatment; embolization allows earlier control of gastrointestinal hemorrhage and a reduction in transfusion requirements.

Adult↗