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PubMedDate not supplied

[Validation of the cedars-sinai score in the prediction of rebleeding and mortality in non variceal upper gastrointestinal hemorrhage].

INTRODUCTION: Upper gastrointestinal hemorrhage is a serious health problem with mortality rates that have remained unchanged for the last years in spite of improvements in management. OBJECTIVES: Validating the Cedars Sinai score for predicting rebleeding and mortality at the Arzobispo Loayza National Hospital. MATERIAL AND METHODS: Prospective longitudinal study in patients with upper gastrointestinal hemorrhage, collecting demographic, clinical and endoscopic data. The Cedars-Sinai score was applied in order to classify patients: low risk, medium risk and high risk. The final results were rebleeding and mortality. Calibration was done by X2, and the discrimination of the score was assessed by analysis of ROC curves. An area below the curve greater than 0.5 was considered good discrimination. RESULTS: We evaluated 143 patients, predominantly male (54.5%), the median age was 57.8. Melena (48.95%) and hematemesis (16.08) were the most frequent symptoms. Out of the total number of patients, 36.3% was taking some type of medication; NSAID's were taken by 55.7% and ACEI's by 25%. Associated comorbidity was found in 56.6%. The following diagnoses were made: gastric ulcer (32.15%), duodenal ulcer (30.75%), erosive hemorrhagic gastritis (20.3%), advanced gastric neoplasia (6.3%) and vascular lesions (4.9%). Rebleeding and mortality were 8.4% and 4.2%, respectively. The low risk group did not show any adverse events; the medium risk group, 7.25% and the high risk group, 13.2%. The areas under the curve were for rebleeding (0.79+/-0.13; p=0.01) and mortality (0.73+/-0.12; p=0.01) and considering both (0.66+/-0.12; p=0,034). CONCLUSIONS: This score is applicable in our environment and it is suitable for predicting rebleeding and mortality in patients with upper gastrointestinal hemorrhage, especially for mortality.

Adult↗
PubMed2005

Small bowel metastases from primary carcinoma of the lung: presenting with gastrointestinal hemorrhage.

Upper gastrointestinal system bleeding should be first taken into account when a patient complains of melena. On rare occasions, gastrointestinal bleeding may be due to primary or metastatic tumors of the gastrointestinal system. Here, we present a case in which the localization of bleeding was demonstrated by Tc-99m red blood cell labeled scintigraphy with the final diagnosis of metastases of non-small cell lung cancer to the small bowel.

Diagnosis, Differential↗
PubMed2001

Colonoscopic management of lower gastrointestinal hemorrhage.

Lower gastrointestinal bleeding is a common reason for hospitalization, especially among the elderly. Unlike that of upper gastrointestinal bleeding, the diagnostic and therapeutic approach to individuals with lower gastrointestinal bleeding is not well standardized. Recent reports indicate that early colonoscopy may be the best strategy to improve outcomes and reduce costs. However, good prospective, controlled data on the role of colonoscopy in the management of lower gastrointestinal bleeding are still required. Colonoscopy can establish a definite or probable diagnosis in greater than 80% of individuals with lower gastrointestinal bleeding. Based on the best available evidence, it appears that clinical and colonoscopic data may be combined in an effort to predict outcome and suggest optimal length of stay. It also appears that therapeutic colonoscopy can arrest or prevent bleeding in certain high-risk patients, offering the opportunity to change the natural history of the bleed.

Algorithms↗
PubMed1992

[Diagnostic procedures in acute gastrointestinal hemorrhage].

In gastrointestinal bleeding, the diagnosis is predominantly made by endoscopy. However, if the bleeding site is in a part of the intestine that cannot be reached by endoscopy, than the diagnosis is based on radiological and scintigraphic methods. In the past 5 years 35 patients with such cases of gastrointestinal bleeding had angiography and/or scintigraphy (n = 15) in our department. Based on our retrospective study of those cases, we advocate a management protocol for such patients based on the hemodynamic presentation.

Adolescent↗
PubMed1989

[Differential diagnosis of gastrointestinal hemorrhage].

Acute gastrointestinal bleeding is one of the classical emergency situations in medicine. Some 100 hospitalizations per 100,000 inhabitants per year are assumed. The mortality rate of gastrointestinal bleeding continues to be about 10 per cent. Those affected are in rate of gastrointestinal bleeding continues to be about 10 per cent. Those affected are in particular patients of more advanced age. The cardinal symptoms hematemesis, melena, hematochezia, stimulate a step-wise approach with parallel diagnosis and therapy. Emergency endoscopy does not result in any significant improvement in prognosis if the patients are considered overall. Only about 20 per cent of the referred patients, that is those with a persistent bleed, profit from the possibility of accurate endoscopic diagnosis. The techniques of endoscopic hemostasis are presently under discussion; in the case of inoperable patients they represent the sole possibility.

Diagnosis, Differential↗
PubMed1996

Low incidence of hemodynamic instability in patients with gastrointestinal hemorrhage.

Patients with gastrointestinal hemorrhage are frequently admitted to critical care units, in large part to be observed for signs of hemodynamic instability. All patients admitted with gastrointestinal bleeding to our medical intensive care unit over a 1-year period (n=108) were retrospectively reviewed to determine the incidence of hemodynamic instability. In an elderly patient population with predominantly nonvariceal bleeding, only 13% of those admitted had documented hypotension that led to an intervention. Only 7% had clinically significant hypotension after the first 5 hours of admission. Admission clinical criteria were analyzed by multivariate analysis but could not reliably predict patients at increased risk for hemodynamic instability. However, patients without significant comorbid illness who have been endoscopically shown to have a low-risk lesion can be considered for early transfer to a regular bed after a short period of close observation. This could lead to better resource utilization and cost savings without jeopardizing patient care.

Adult↗
PubMed1998

[Epidemiology of gastrointestinal hemorrhage].

We mentioned about epidemiology of gastrointestinal hemorrhage according to the clinical statistics. Most of recent reports has been investigated by emergency endoscopic examinations. Upper gastrointestinal hemorrhage was the most frequent and its clinical severity was severer than that of lower gastrointestinal hemorrhage. Hemorrhage from small intestine was rare, however they were mostly severe hemorrhage. Peptic ulcer was the most frequent disease as the upper gastrointestinal hemorrhage. Inflammation of colon was the most in the lower gastrointestinal hemorrhage. However, the varied diseases were recognized as origin of small intestinal hemorrhage, non epithelial tumor and inflammation were important.

Age Factors↗
PubMed1990

Multiple small-bowel carcinoids presenting with gastrointestinal hemorrhage: a case report.

Gastrointestinal hemorrhage from a small-bowel lesion can be a problem diagnostically and therapeutically. The authors present a case of multiple small-bowel carcinoids, which were the cause of multiple upper gastrointestinal hemorrhages over a 15-year period. Despite advances in endoscopy and diagnostic imaging, accurate localization and definitive diagnosis remain elusive in such cases. Optimal treatment depends on careful clinical evaluation and timely laparotomy.

Carcinoid Tumor↗
PubMed1991

A clinical study of acute gastrointestinal hemorrhage associated with various shock states.

Gastrointestinal hemorrhage from stress ulceration is a life-threatening complication in a critically ill patient. We retrospectively studied 471 patients admitted to the Department of Traumatology of our hospital who developed shock in their clinical course. Forty-two patients (8.9%) developed gastrointestinal hemorrhage, most within 1 wk (76.2%). The hemorrhage lesion usually was located in the corpus of the stomach. The mortality rate of the shock patients with gastrointestinal hemorrhage was 33.3% (14 of 42). Comparison of different types of shock showed that the incidence, severity, and mortality rates of gastrointestinal hemorrhage were significantly higher in septic shock patients than in hemorrhagic shock patients. These findings show the importance of preventive therapy against progression of early mucosal damage and development of gastrointestinal hemorrhage in shock patients, especially those with sepsis.

Acute Disease↗
PubMed2001

[Analysis of 136 children with gastrointestinal hemorrhage].

OBJECTIVE: To investigate the pathogeny of children with gastrointestinal hemorrhage, pathogeny distribution and the cause of misdiagnosis before gastrointestinal endoscopy check-up. METHODS: We detected 136 children suspected upper gastrointestinal hemorrhage (UGH) by gastrointestinal endoscopy and among them a few cases were diagnosed by celiotomy. RESULTS: One hundred and three cases of UGH, 7 cases of small intestine bleeding, and 4 cases of gulping blood syndrome were diagnosed; but the pathogeny of the other 22 cases was not clear. CONCLUSION: Gastric ulcer and duodenal ulcer are the common causes of gastrointestinal hemorrhage of elder children and inheriting alimentary canal abnormality leads to gastrointestinal hemorrhage of infants. Some children with bellyache were misdiagnosed as ascariasis or enterospasm. The endoscopy examination should carry on within 48 hours after the latest bleeding to reach the highest positive rate.

Adolescent↗
PubMed1998

Jejunal cirsoid aneurysm: a rare cause of massive lower gastrointestinal hemorrhage.

Diverticulosis and angiodysplasia are the most common causes of massive lower gastrointestinal hemorrhage. Lower gastrointestinal hemorrhage frequently resolves without determination of a definitive source. An uncommon cause of lower gastrointestinal tract hemorrhage is the small intestinal submucosal aneurysm. This poorly described entity, more commonly recognized as Dieulafoy's disease in the gastric mucosa, has been documented only rarely in the jejunum. We describe a case report of a 27-year-old man with a massive lower gastrointestinal hemorrhage. Diagnostic evaluation failed to identify the source on initial admission. The patient re-presented to the emergency room with recurrent bleeding, anemia, and hypotension. During a period of active bleeding, a number of diagnostic studies ultimately revealed the source to be the proximal jejunum. Inspection of the resected specimen identified a submucosal aneurysm on the mesenteric border. Histologic evaluation identified the pathologic entity as a cirsoid aneurysm.

Adult↗
PubMed2006

Impact of anticoagulation on rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage.

OBJECTIVE: Endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage achieves hemostasis in greater than 90% of patients, but up to 20% rebleed. The aim of this study was to determine the impact of anticoagulation on rebleeding in patients undergoing endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage. METHODS: Patients who underwent successful endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage between July 1, 1999, and June 30, 2004, at a large, tertiary care teaching hospital were identified. The primary outcome was rebleeding within 30 days. Secondary outcomes were transfusion requirement, length of stay, surgery, and mortality. Baseline data were analyzed using t-tests and chi(2) tests. Multivariable logistic and linear regression analyses were carried out to calculate the adjusted odds ratios for the international normalized ratio (INR) predicting the primary and secondary outcomes. The multivariable analyses controlled for: age, Charlson comorbidity index, antiplatelet agent use, postprocedure heparin use, postprocedure proton pump inhibitor use, hypotension, ulcer as the bleeding source, and active bleeding at endoscopy. RESULTS: The study included 233 patients. Forty-four percent of the patients had an INR >or=1.3. Ninety-five percent of the anticoagulated patients had an INR between 1.3 and 2.7. The rebleeding rate was 23% in the anticoagulated patients and 21% in the patients with INRs <1.3. On multivariable analyses, INR was not a predictor of rebleeding, transfusion requirement, surgery, length of stay, or mortality. CONCLUSIONS: Mild to moderate anticoagulation does not increase the risk of rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage, suggesting that endoscopic therapy is appropriate in these patients.

Aged↗
PubMedDate not supplied

Gastrointestinal hemorrhage after laparoscopic gastric bypass.

Gastrointestinal hemorrhage is a potential perioperative complication after Roux-en-Y gastric bypass. The surgeon performing laparoscopic gastric bypass should understand the need for early recognition and management of this complication, as it can be life-threatening. This paper discusses the incidence and clinical presentation of gastrointestinal hemorrhage, mechanisms for hemorrhage, management options, and possible methods of prevention.

Adult↗
PubMed1996

Causes of gastrointestinal hemorrhage in neonates and children.

The causes of gastrointestinal hemorrhage in children were detailed in 1964 by Spencer. We investigated the causes of gastrointestinal hemorrhage in 165 children seen at our institution over a 13-year period. The most common causes of gastrointestinal hemorrhage in the hospitalized patients were necrotizing enterocolitis (44%), anal fissures (23%), and guaiac-positive stools of unknown cause (16%). The mortality rate was 5.4%. Necrotizing enterocolitis was the most common cause of death. Only 16 patients required surgery. Gastrointestinal hemorrhage is an infrequent cause of mortality and morbidity in hospitalized pediatric patients.

Adolescent↗
PubMed1966

Hemorrhage during long-term anticoagulant drug therapy. II. Gastrointestinal hemorrhage.

Most of the gastrointestinal hemorrhages occurring during long-term anticoagulant drug therapy of 2,013 patients (reported in the literature) were caused by underlying lesions (44 to 77). Of the 44 lesions, only seven were diagnosed before treatment was started. Most of the episodes of hemorrhage occurred with the prothrombin activity at a so-called "safe" level. Closer investigation before the anticoagulant therapy was begun might have brought the underlying lesion to light.

Anticoagulants↗
PubMed1998

BUN/creatinine ratios: aid to decision making about delayed imaging in Tc-99m red blood cell scans for gastrointestinal hemorrhage.

In patients with gastrointestinal hemorrhage, delayed or late scans with Tc-99m labeled red blood cells are readily performed and have prognostic impact when early images are negative. Nevertheless, there have been no indicators for the likelihood of detecting bleeding on such images. In a review of all gastrointestinal bleeding scans over an 8-year period, 73 patients had delayed images (> 3 hours) following early negative exams. For these patients, determinations of serum blood urea nitrogen (BUN) and creatinine (Cr) were evaluated as the BUN/Cr ratio and were compared against delayed scan findings and confirmed diagnoses. Patients with significant renal failure were excluded from analysis. There were 34 late positive (46%) and 39 late negative (54%) studies. Mean BUN/Cr was 26.5 and 20.0 in patients with late positive and late negative scans, respectively (p < 0.05). Occurrence of late positive scans was 38% (19/50) for BUN/Cr < 25.0 vs. 65% (15/23) for BUN/Cr > 25.0 (p < 0.05). Patients with early negative images and a BUN/Cr ratio of 25 or greater have a greater likelihood of a positive delayed image. Late imaging should be encouraged in patients with elevated BUN/Cr and early negative scintigraphy.

Adult↗
PubMed2000

[Gastrointestinal hemorrhage of obscure origin].

Gastrointestinal bleeding of obscure origin consists of recurrent bouts of acute or chronic bleeding for which no definite source is discovered in routine endoscopic and barium contrast studies of the upper and lower gastrointestinal tracts. Usually its cause is angiodysplasia of the intestine, but many cases are due to tumors, mostly of the small bowel, which may be malignant. In patients under the age of 50, the proportion with malignancy is relatively high (up to 14%) as compared to older patients. We describe a 45-year-old woman who suffered from gastrointestinal bleeding for 3 years. The cause of bleeding was not found despite extensive work-up. In her last admission for acute gastrointestinal hemorrhage she was given a total of 30 units of blood. A tumor of the small intestine found by angiography was excised and found to be a stromal tumor of uncertain malignant potential. 1 year after operation she is asymptomatic without bleeding and her hemoglobin is stable without treatment.

Angiography↗