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Results for “HEMORRHAGE, GASTROINTESTINAL”

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At least 271 records · Page 15Linked to original sources
PubMedDate not supplied

Percutaneous embolotherapy of lower gastrointestinal hemorrhage.

PURPOSE: To evaluate percutaneous embolotherapy in the treatment of lower gastrointestinal hemorrhage. MATERIALS AND METHODS: Twenty-one patients who underwent attempted percutaneous embolization for acute lower gastrointestinal bleeding between 1982 and 1997 were retrospectively studied. Hemorrhagic sites included jejunum (n = 4), ileum (n = 4), cecum (n = 4), and the remaining colon (n = 9). RESULTS: Embolization was not technically possible in four patients (19%). Hemostasis was achieved in 15 patients (71%) with prolonged hemostasis in 10 (48%). All embolizations distal to the cecum resulted in prolonged hemostasis. Three of four patients with jejunal bleeding had recurrent bleeding after apparent successful embolization. Only one of four cecal embolizations achieved prolonged cessation of bleeding. No ischemic complications were identified. CONCLUSION: Based on these data, it would appear that the risk of bowel ischemia/infarction in the lower gastrointestinal tract may not be as high as has been suggested. Two regions (cecum and proximal jejunum) were associated with poor results, suggesting these areas may not be as responsive to embolotherapy as other sites in the lower gastrointestinal tract.

Aged↗
PubMed1991

Factor XII and partial prekallikrein deficiencies in a dog with recurrent gastrointestinal hemorrhage.

Factor XII deficiency and impaired prekallikrein activity were diagnosed in a 1-year-old Chinese Shar Pei. The dog experienced repeated episodes of intestinal hemorrhage and diarrhea. Laboratory findings were compatible with blood loss (iron deficiency anemia and hypoproteinemia). Necropsy findings suggested mild infiltrative bowel disease that could have been responsible for the dog's diarrhea, but no explanation for the severe recurrent gastrointestinal hemorrhage could be found. Factor XII deficiency is uncommon in the dog and is not associated with hemorrhagic tendencies. The factor XII deficiency in this case may have contributed to the gastrointestinal hemorrhage.

Animals↗
PubMed2000

[Outpatient care of upper gastrointestinal hemorrhage not related to portal hypertension].

BACKGROUND: The handling of upper gastrointestinal hemorrhage (UGH) usually includes the hospitalization of all patients, regardless of severity and prognosis. The aim of this paper is to assess the security of the outpatient control of some UGH, after their assessment in the hospital emergency room. PATIENTS AND METHODS: Prospective cohort of 533 patients who attended over 1994 and 1995 hospital emergency room for an episode of UGH not linked to portal hypertension. After clinical and endoscopical assessment in the emergency department, 422 cases (79%) were admitted and 111 (21%) discharged for outpatient care. An analysis is presented of the characteristics of both groups, their clinical outcomes and a multivariate analysis to assess the factors associated with the decision to admit the patient. RESULTS: Outpatients were young, with less comorbidity and better haemodynamic status than hospitalized patients. Most of outpatient cases UGH was due to gastroduodenitis, oesophagitis and Mallory-Weiss syndrome, as opposed to the greater importance of peptic ulcer in those admitted. All outpatients presented clean lesions or haematic remains. 25 (5.9%) hospitalized patients presented rebleeding, vs. only 1 (0.9%) outpatient (p < 0.05). When more severity cases were excluded from hospital group, the differences were not significant. All cases with active bleeding, severe haemodynamic repercussion or without endoscopy were admitted. For the remainder, the decision to admit was associated with the presence of bleeding stigmata, haemodynamic repercussion, some causes of hemorrhage, older age, and urea levels. CONCLUSIONS: Although the scarce sample do not permit definitive conclusions, results guide towards that a substantial part of UGH not linked to portal hypertension may be monitored without hospitalizing the patient, thereby minimizing care costs and increasing the productive capacity of the hospital, without increasing risks for the patient.

Ambulatory Care↗
PubMed1997

[Chronic occult gastrointestinal hemorrhage].

Iron deficiency anemia is a common symptom of chronic occult gastrointestinal bleeding. There are numerous potential sources of gastrointestinal hemorrhage, most of which can be detected with the aid of endoscopy of the upper and lower digestive tract. Diagnostic procedures for the small bowel are less sensitive and usually more invasive. On the basis of the relevance of information they provide, the various diagnostic procedures and their indication in the diagnosis of iron deficiency anemia are critically reviewed, and a systematic diagnostic strategy developed.

Adult↗
PubMed1998

Early indicators of prognosis in upper gastrointestinal hemorrhage.

OBJECTIVE: Endoscopy allows accurate risk stratification of patients presenting with gastrointestinal bleeding; frequently, however, it is not immediately available. Initial management and triage of patients thus depends on nonendoscopic information. We sought to risk stratify patients with upper gastrointestinal bleeding using variables available on initial presentation (ie., before endoscopy). METHODS: A retrospective observational study was performed using data from 335 admissions with an initial diagnosis of upper gastrointestinal hemorrhage. All patients underwent endoscopy and were evaluated for an adverse outcome during their hospitalization. An adverse outcome was defined as death, the need for any operation, recurrent hematemesis, recurrent melena after initial clearing, or a hematocrit falling despite transfusion. RESULTS: Univariate analysis identified 17 distinct variables associated (p < 0.05) with an adverse outcome. A stepwise logistic regression identified five variables as independent predictors (p < 0.05) of an adverse outcome: an initial hematocrit <30%, initial systolic blood pressure < 100 mm Hg, red blood in the nasogastric lavage, history of cirrhosis or ascites on exam, and a history of vomiting red blood. We derived a decision rule based on patients having 0-5 of these independent predictors. This decision rule allowed identification of a large patient population with a <10% chance of an adverse outcome. CONCLUSION: Risk stratification is possible from information available at the time of initial presentation. If confirmed in other populations, these predictors can be used to identify patients who require a less intensive level of care.

Female↗
PubMed2005

Acute lower gastrointestinal hemorrhages in geriatric patients.

Age is a risk factor in acute lower gastrointestinal hemorrhages (LGIH). The objectives here were to analyze: (1) diagnostic and therapeutic handling, (2) related morbidity and mortality, (3) the indications for surgery, and (4) the evolution of acute LGIH in patients > or =80 years. Forty-three patients >80 years with acute LGIH were reviewed retrospectively. In 86% (n = 37) related comorbidities were found, in 9% (n = 4) there had been prior colorectal surgery, 19% (n = 8) were antiaggregated, and 7% (n = 3) were anticoagulated. One hundred thirty-two cases of acute LGIH in patients <80 years were used as a control group. Student's t test and the chi-square test were applied. On arrival at the emergency ward 11 cases (26%) had hemodynamic instability and 8 of these were stabilized using conservative measures. In 39 cases an endoscopy was performed, allowing for an etiological diagnosis in 59% (n = 23) of cases, above all in those carried out in an urgent or semiurgent way. The arteriography permitted an etiological diagnosis in two of the four cases in which it was carried out. In seven patients (16%) urgent surgery was indicated: three were hemorrhoidectomies, three were subtotal colectomies, and one was a resection of the small intestine. The morbidity rate was 10% (n = 4) in the patients who were not treated and 14% (n = 1) in those treated, with a mortality rate of 8% (n = 3) and 14% (n = 1), respectively. The rate of relapse of bleeding after discharge from hospital was 42% (n = 18), with nine of these needing to be readmitted into hospital. In comparison with the control group, they present a different bleeding etiology (diverticulosis as opposed to the benign anal-rectal and small intestinal pathology in the younger population; P = 0.017), surgery is indicated with less frequency (9 versus 33%; P = 0.007), and there is a higher relapse rate (42 versus 26%; P = 0.045). Acute LGIH in geriatric patients relents in most cases with the use of conservative measures, although there is a high percentage of related morbidity and mortality, and of relapse of bleeding.

Acute Disease↗
PubMed2004

Utility of proton pump inhibitors in the treatment of gastrointestinal hemorrhage.

Proton pump inhibitors inhibit gastric acid secretion thereby promoting the healing of peptic ulcers and decreasing the occurrence of gastrointestinal bleeding. An intravenous formulation of the PPI pantoprazole is now available in the United States. Some clinicians have prescribed this product after endoscopic hemostasis of acute upper gastrointestinal hemorrhage to prevent recurrence. Historically, the evidence is weak for the use of histamine H2-receptor antagonists in this role. Fifteen original studies on the use of intravenous proton pump inhibitors in this setting are reviewed. The evidence for their efficacy is similarly weak and does not justify the increased cost of their use in this setting. Larger, more definitive studies on proton pump inhibitors are needed to clarify their role in the control of acute upper gastrointestinal hemorrhage.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Helicobacter pylori causes gastrointestinal hemorrhage in patients with congenital bleeding disorders.

Helicobacter pylori (H. pylori) infection is associated with peptic ulcer disease and gastric cancer. The eradication of H. pylori is of special interest in patients with congenital bleeding disorders, for whom treatment of gastrointestinal hemorrhage with factor concentrates is costly. The prevalence of H. pylori varies between different populations and identification of high-risk subgroups may allow for more targeted screening and eradication of the infection. We performed a 5-year retrospective study of gastrointestinal bleeding, combined with screening and treatment for H. pylori and a long-term prospective follow-up in 168 Swedish and 23 Estonian patients with hemophilia or von Willebrand disease. The prevalence of seropositivity was lower in Sweden than in Estonia (28 versus 48%, p = 0.03), lower in native Swedes than in non-Nordic immigrants to Sweden (20 versus 76%, p = 0.0001) and lower in patients less than 40 years of age than older patients (16 versus 38%, p = 0.002). The incidence of gastrointestinal hemorrhages among the 35 Swedish patients with active H. pylori infection, confirmed by a urea breath test, was 6.0 per 100 patient-years before eradication therapy versus 1.7 during the prospective followup. A negative urea breath test one month after therapy always remained negative after one year. Screening, followed by treatment of all infected patients, yielded a reduction of direct costs over a 5-year period of 130 US-$ per screened patient. We conclude that screening and eradication therapy for infection with H. pylori in patients with congenital bleeding disorders is an effective and economic strategy.

Adolescent↗
PubMed1976

Intramural gastrointestinal hemorrhage. Clinical and radiographic manifestations.

The clinical and radiographic manifestations of intramural gastrointestinal hemorrhage are presented together with a review of the literature. The observations described are based on the analysis of 20 cases affecting different segments of the gastrointestinal tract. The pathologic process is induced principally by anticoagulant therapy, bleeding diathesis, or abdominal trauma and occurs as a localized, well-defined, intramural mass or as a more diffuse segmental involvement. The clinical features are nonspecific and can vary from mild crampy abdominal pain to severe shock. Other manifestations include rebound tenderness, muscle guarding, and small bowel obstruction. The duodenum and small bowel are the most frequent sites of involvement. The intestinal mucosal folds may be prominent, stretched, and sharply defined or completely affaced, accompanied by a smooth narrowing. There is rapid clinical and radiographic remission with conservative therapy. Intestinal perforations and fibrotic strictures resulting in small bowel obstruction are a rarity, observed only in the posttraumatic variety.

Abdominal Injuries↗
PubMedDate not supplied

Superselective transcatheter embolization for acute lower gastrointestinal hemorrhage after endoscopic mucosal resection: a report of 3 cases.

One of the most common complications related to endoscopic mucosal resection is hemorrhage; in almost every case, the bleeding is endoscopically managed, but some cases are unresponsive to the treatment. We have encountered three cases of endoscopically uncontrollable lower gastrointestinal hemorrhage after endoscopic mucosal resection in the colon which we successfully treated by urgent superselective transcatheter embolization. In our three cases, massive hemorrhage occurred immediately after endoscopic mucosal resection of a sessile polyp 25-40 mm in diameter, two cases in the ascending colon and one in the rectum. Although hemoclip placement was attempted in every case, hemostasis was not achieved. Emergency angiography disclosed massive extravasation of the contrast material in the colon. Hemostasis was achieved immediately after superselective transcatheter arterial embolizations with microcoils, with no observable ischemic complications and without the need of transfusions. In conclusion, superselective transcatheter embolization with microcoils should be considered a safe and efficient treatment option for endoscopically uncontrollable lower gastrointestinal hemorrhage occurring after endoscopic mucosal resection.

Aged↗
PubMed1985

Massive upper gastrointestinal hemorrhage from an arteriovenous malformation of the stomach.

Arteriovenous malformations of the stomach are rare; blood loss may be manifested either by chronic anemia or by massive recurrent hemorrhage. We report a patient with massive upper gastrointestinal hemorrhage from a gastric arteriovenous malformation. Emergency operation to control hemorrhage precluded the performance of angiography; diagnosis was made from the appearance of the lesion and dilatation of the veins draining the involved area. Complete operative excision of the lesion was curative.

Angiography↗
PubMed1979

[Possibilities of emergency endoscopy in the diagnosis and treatment of acute gastrointestinal hemorrhages].

The diagnostic and curative potentialities of the urgent endoscopy in acute gastrointestinal hemorrhages was assessed in 150 patients who were subjected to 208 examinations. The cause of hemorrhage was found out in 94,6%. An original method of sclerosing injections into hemorrhagic veins was used in patients with portal hypertension in order to stop the hemorrhage from varicose formations of the esophagus.

Adult↗