PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “HEMORRHAGE, GASTROINTESTINAL”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources
PubMed1996

Prophylaxis for stress-related gastrointestinal hemorrhage: a cost effectiveness analysis.

OBJECTIVE: To assess the cost-effectiveness of prophylaxis for stress-related gastrointestinal hemorrhage in patients admitted to the intensive care unit. DESIGN: Decision model of the cost and efficacy of sucralfate and cimetidine, two commonly used drugs for prophylaxis of stress-related hemorrhage. Outcome estimates were based on data from published studies. Cost data were based on cost of medications and costs of treatment protocols at our institutions. MEASUREMENTS AND MAIN RESULTS: The marginal cost-effectiveness of prophylaxis, as compare with no prophylaxis, was calculated separately for sucralfate and cimetidine and expressed as cost per bleeding episode averted. An incremental cost-effectiveness analysis was subsequently employed to compare the two agents. Sensitivity analyses of the effects of the major clinical outcomes on the cost per bleeding episode averted were performed. At the base-case assumptions of 6% risk of developing stress-related hemorrhage and 50% risk-reduction due to prophylaxis, the cost of sucralfate was $1,144 per bleeding episode averted. The cost per bleeding episode averted was highly dependent on the risk of hemorrhage and, to a lesser degree, on the efficacy of sucralfate prophylaxis, ranging from a cost per bleeding episode averted of $103,725 for low-risk patients to cost savings for very high-risk patients. The cost per bleeding episode averted increased significantly if the risk of nosocomial pneumonia was included in the analysis. The effect of pneumonia was greater for populations at low risk of hemorrhage. Assuming equal efficacy, the cost per bleeding episode averted of cimetidine was 6.5-fold greater than the cost per bleeding episode averted of sucralfate. CONCLUSIONS: The cost of prophylaxis in patients at low risk of stress-related hemorrhage is substantial, and may be prohibitive. Further research is needed to identify patient populations that are at high risk of developing stress-related hemorrhage, and to determine whether prophylaxis increases the risk of nosocomial pneumonia.

Anti-Ulcer Agents↗
PubMed2002

Lower gastrointestinal hemorrhage in African-American and Hispanic elderly patients.

OBJECTIVES: To investigate the frequency and etiology of lower gastrointestinal hemorrhage (LGIH) in African-American and Hispanic elderly patients and to determine its natural history and the risks and benefits of therapeutic interventions. SETTING: Inner-city community teaching hospital serving predominantly African-American and Hispanic populations. METHODS: Records of 236 patients, 65 to 103 years of age, with a diagnosis of LGIH were reviewed retrospectively, over a period of 7 years, (9 White and 6 Asian patients were excluded). RESULTS: In 21 patients, the source of bleeding was located in the upper gastrointestinal tract, and these patients were excluded from the study. The source of bleeding remained unidentified in 16 of 200 patients, and they were also excluded. Bleeding was so profuse in 19 patients that satisfactory endoscopy could not be performed and emergency angiography and/or surgery was required. Endoscopic results were available in 165 patients and included: internal hemorrhoids in 60 (active bleeding in 23) patients, diverticular bleeding in 55, angiodysplasia in 50, polyps in 37, cancer in 23, drug-induced (anti-coagulants, non-steroidal anti-inflammatory drugs) lesions in 20, ischemic colitis in 15, ulcerative colitis in 10, solitary rectal ulcer in 9, Crohn's disease in 8, and colonic varices in 6 patients. Forty-eight patients had more than one lesion. Endoscopic therapy was given to 101 patients and was helpful in stopping bleeding and/or delaying surgery in 69 patients. Overall, there were 43 deaths, mostly due to underlying multiple system disease. Mortality rates did not differ by race/ethnicity or gender. Older elderly (76-85 yrs.; P < 0.01) and (> 85 yrs.; P < 0.001) had higher mortality rates. None of the deaths were directly due to endoscopy. CONCLUSIONS: Despite the small number of patients, our study suggests that acute LGIH in African-American and Hispanic elderly patients is a common condition, with the potential to become a life-threatening event. All such patients should be offered the benefits of early endoscopy and therapeutic interventions, unless contraindicated by their advanced directives. A patient's advanced age should not be a deterrent to any of the diagnostic or therapeutic interventions.

Black or African American↗
PubMed1996

Management of angiogram positive lower gastrointestinal hemorrhage: long term follow-up of non-operative treatments.

After positive mesenteric angiography for massive lower gastrointestinal hemorrhage, one is faced with a localized bleeding site and the therapeutic options of embolization, vasopressin infusion, observation, or operation. This review was designed to determine long term outcomes of angiographically controlled bleeding. All cases of mesenteric angiography for hemorrhage performed over a twelve year period were reviewed, with focus on those treated non-operatively. A total of 37 patients had angiographically localized bleeding distal to the ligament of Treitz. Twenty-one patients were controlled with vasopressin, embolization, or spontaneous cessation. Only three patients had recurrent bleeding, at one month, one year, and eight years. No patients died from recurrent bleeding. Five patients died without any further bleeding; mean time to death was 2 years. Twelve patients had no further bleeding at a mean follow-up of 2.6 years. Bleeding controlled by any angiographic measure, was followed by recurrent bleeding in 14% without the need for operative intervention.

Angiography↗
PubMed2001

Upper gastrointestinal hemorrhage in African-American and Hispanic elderly patients.

OBJECTIVES: To investigate the frequency and etiology of upper gastrointestinal hemorrhage (UGIH) in African-American and Hispanic elderly patients, and to determine the risks and benefits of endoscopic intervention. SETTING: An inner-city county hospital serving predominantly African-American and Hispanic populations. METHODS: Records of 290 patients, 65 to 95 years of age, with diagnosis of UGIH, were reviewed retrospectively, 12 White and 8 Asian patients were excluded. RESULTS: Source of bleeding remained unidentified in 25 of 270 patients and they were also excluded. Endoscopic findings in 245 patients were: 59 gastric ulcers, 52 duodenal ulcers, 49 gastric erosions, 37 gastroesophageal varices, 25 Mallory Weiss tears, 15 angiodysplasias, 13 Dieulafoy's lesions, 12 portal hypertensive gastropathies, 8 esophageal cancers with bleeding, and 7 gastric cancers with bleeding; 32 patients had more than one lesion. Endoscopic therapy was administered to 159 patients, and was helpful in stopping bleeding and/or delaying surgery in 102 patients. Overall, there were 59 deaths, mostly due to underlying multiple system disease. There was no death directly due to endoscopy. CONCLUSIONS: Acute UGIH in African-American and Hispanic elderly patients is a serious condition, associated with significant morbidity and mortality. Benefits of endoscopy should be offered to all such patients, and endoscopy should not be withheld because of age alone.

Black or African American↗
PubMed2005

[Emergency surgery in severe lower gastrointestinal hemorrhage].

INTRODUCTION: There are no conclusive studies that would allow us to distinguish between patients with severe lower gastrointestinal hemorrhage (LGIH) who require emergency surgery and those who do not. The aim of the present study was to determine the clinical and epidemiological factors that would allow us to distinguish between severe LGIH requiring emergency surgery and self-limiting LGIH and to analyze the surgical management of these patients. MATERIAL AND METHODS: We reviewed 175 patients with LGIH (severe rectal bleeding with a decrease in hematocrit > or = 10 points or transfusion of at least three units of packed red blood cells) treated between 1980 and 2002 and selected 28 patients (16%) who required emergency surgery. The control group consisted of patients with LGIH who did not require surgery. Student's t-test and the Chi-squared test were used in the statistical analysis. RESULTS: Comparison of severe LGIH requiring emergency surgery with self-limiting LGIH revealed three variables that could serve as a guide to differentiating between these entities, namely: age less than 80 years (p = 0.013), the presence of hypotension on arrival at the emergency department (p < 0.0001), and cause of bleeding (p < 0.0001). Among patients requiring emergency surgery, the origin was ano-rectal in nine (32%) and consequently the approach used was perianal. In the remaining patients (n = 19) the abdominal approach was used. In 10 patients, etiologic diagnosis was not available before surgery and the source of bleeding was identified during the intervention in 6 of these patients. In the four remaining patients without etiological diagnosis before surgery, subtotal colectomy was performed. In the remaining patients, local resection of the affected area was performed (3 right hemicolectomies, 9 small bowel resections, and 3 resections of Meckel's diverticulum). Morbidity was 18% and mortality was 7%. CONCLUSION: Distinguishing between self-limiting LGIH and LGIH requiring emergency surgery is difficult. In our series, the only factors predictive of emergency surgery were hemodynamic instability on arrival at the emergency department and age less than 80 years. Cause of bleeding is not a predictive factor as it generally unknown at symptom onset.

Adult↗
PubMed1975

[Emergency esophagogastroduodenoscopy in the diagnosis of acute gastrointestinal hemorrhage].

It is reported that among 1383 endoscopies, performed in the clinic, 618--were defined as urgent ones for acute gastrointestinal hemorrhages. There were 470 male and 148 female patients, their age ranging from 14 to 93 years. 408 endoscopies were performed during the first 6 hours since patients' admission to the clinic, and 210--during the following 48 hours. Contraindications to an urgent exploration of patients in hemorrhage from upper portions of the digestive tract are determined.

Adolescent↗
PubMedDate not supplied

Physical activity and risk of severe gastrointestinal hemorrhage in older persons.

OBJECTIVE: To assess whether regular physical activity is associated with a decreased risk of severe gastrointestinal hemorrhage (GIH) in older persons. DESIGN: Cohort study with 3 years of follow-up. SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: A total of 8205 persons aged 68 years or older, yielding 22,277 person-years of follow-up. MEASUREMENTS: The occurrence of severe GIH was defined as either a hospital discharge diagnosis of gastrointestinal bleeding associated with blood transfusion or death during the hospital stay or a nonhospital death with mention of GIH on the death certificate. Physical activity was measured by self-reported frequency of walking, gardening, or doing vigorous physical activity. Those participants doing the activity three times per week or more were compared with the remaining participants. Adjusted relative risks (RRs) of GIH were controlled for age, gender, body mass index, blood pressure, chronic conditions, number of hospital admissions in the past year, and number and types of drugs taken. RESULTS: Severe GIH occurred in 241 participants (rate, 10.8 per 1000 person-years). After adjusting for potential confounding variables, the RRs and 95% confidence intervals (CIs) for severe GIH associated with walking, gardening, and vigorous physical activity were 0.6 (0.4 to 0.8), 0.8 (0.5 to 1.1), and 0.7 (0.4 to 1.2), respectively. The RR associated with a summary variable for the three activities was 0.7 (95% CI, 0.5 to 0.9). These results were consistent after stratifying on health status and disability or by excluding those who were not mobile, ie, not able to walk half a mile or climb a flight of stairs. CONCLUSIONS: Regular physical activity is associated with a decreased risk for severe GIH in older persons.

Age Factors↗
PubMed1956

Management of upper gastrointestinal hemorrhage.

In the past few years gastric resection has become the therapy of choice for patients with massive hemorrhage from duodenal ulcer. When this is done as an emergency procedure the ability of the surgeon is often taxed to the limit. Although sometimes easy, control is often extraordinarily difficult. Many important technical details must be considered in order to attain a successful outcome. This method of therapy has proved to be very satisfactory with patients who are in good condition for operation, and even in the poorer risks seen on ward service has resulted in a surgical mortality of only 7 per cent in all patients less than 60 years of age treated for this extremely severe type of hemorrhage. In the older age groups mortality rates still remain high.

Disease Management↗
PubMed1978

Acute upper-gastrointestinal hemorrhage. New observations on an old problem.

In a two-year period, 289 patients with acute upper-gastrointestinal hemorrhage were evaluated. The site of hemorrhage was proven by endoscopy in more than 90% of cases. The frequency of any particular bleeding site was characterized for several subgroups and was found to correlate with: (1) the severity of the bleeding episode; (2) the iatrotropic stimulus of hemorrhage, and (3) the history of ethanol consumption. No difference was found in the frequency of ulcer and acute mucosal lesions as sites of hemorrhage between patients who consumed aspirin and those who did not. A history of symptoms of peptic ulcer correlated with the presence of an ulcer as the bleeding site. It is possible that failure to identify important patient subgroups may be partially responsible for the disagreement between previous reports.

Alcohol Drinking↗
PubMed1988

Dieulafoy's lesion associated with truncus arteriosus type IV: an unusual cause of upper gastrointestinal hemorrhage.

Dieulafoy's lesion is an abnormal submucosal artery in the stomach characterized by massive and often fatal upper gastrointestinal hemorrhage. Diagnosis is usually made at operation, as endoscopy and arteriography frequently fail to identify the lesion. Embolization may be helpful, but surgery is generally the treatment of choice. We present the first reported case of Dieulafoy's lesion in a 17-yr-old boy with type IV truncus arteriosus. This congenital cardiac anomaly may have predisposed this patient to early manifestation of Dieulafoy's lesion, a rare and frequently unrecognized disorder.

Adolescent↗