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Results for “HEMORRHAGE, GASTROINTESTINAL”

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At least 649 records · Page 36Linked to original sources
PubMed1998

Gastrointestinal hemorrhage in patients with systemic sclerosis and CREST syndrome.

OBJECTIVES: Systemic sclerosis (SSc) and calcinosis, Raynaud's phenomenon, esophageal disease, sclerodactyly, telangiectasia (CREST) syndrome present distinctive microvasculature lesions that are thought to be responsible for tissue damage and disease progression. Involvement of the gastrointestinal tract may lead to the occurrence of profuse hemorrhage. We performed a study to assess the incidence and characteristics of gastrointestinal hemorrhage in a large group of patients with SSc and CREST syndrome. METHODS: We reviewed the medical records of 144 patients with SSc/CREST seen at our institution during the period 1985-1996. Endoscopic findings and clinical data were correlated. Data are expressed as means +/- SD. RESULTS: Twenty-two of 144 (15.2%) patients had at least one episode of gastrointestinal hemorrhage (16 women, 6 men; mean age, 59.4 +/- 17.6 yr). Eight patients (8/22; 36%) had multiple episodes and four (4/22; 18%) required chronic transfusion therapy. Mucosal telangiectasias were the most common cause of bleeding (9/22; 40.9%), followed by peptic ulcer disease (7/22; 31.8%) and erosive gastritis (3/22; 13.6%). Bleeding telangiectasias occurred in the entire gastrointestinal tract, including oral cavity (n = 1), esophagus (n = 1), stomach (n = 3), duodenum (n = 1), ileum (n = 1), cecum (n = 2), and colon (n = 2). Mortality was 22.7% in patients with gastrointestinal bleeding, compared with 7.3% in patients without bleeding. CONCLUSIONS: Patients with SSc/CREST syndrome are at risk of developing severe gastrointestinal hemorrhage. This complication is associated with frequent hospitalization, blood transfusions, and increased mortality. Mucosal telangiectasias are the most common source of bleeding. Appropriate endoscopic intervention is recommended in evaluating and preventing bleeding in patients with SSc/CREST.

Adolescent↗
PubMed1994

Upper gastrointestinal hemorrhage. Comparison of the causes and prognosis in primary and secondary bleeders.

BACKGROUND: Hemorrhage from the upper gastrointestinal (UGI) tract is defined as primary when it is the cause of admission to hospital and as secondary when it complicates the course of patients admitted to hospital for other causes. The objective of this study was to compare the background features, course, and outcome of patients with primary and secondary bleeding. METHODS: All patients who underwent upper endoscopy because of acute UGI bleeding during 1988-91 in a tertiary care university hospital were studied longitudinally. The background features of primary bleeders (n = 321) were compared with those of secondary bleeders (n = 125). From the primary bleeders, a group was matched to the secondary bleeders by age, sex, use of nonsteroidal anti-inflammatory drugs (NSAIDs), and liver disease. The laboratory and endoscopic findings, hospital course, and mortality were compared in the two groups. RESULTS: Secondary bleeders were on the average 5 years older than primary bleeders and were significantly more likely to have ischemic heart disease, chronic lung disease, and chronic renal failure. Use of corticosteroids, H2 blockers, antacids, and anticoagulants in this group was significantly more prevalent, whereas the use of NSAIDs was similar in the two groups. The case-control analysis showed a similar distribution of the causes of bleeding in the two groups. However, rebleeding, endoscopic hemostasis, and complications were more frequent in secondary bleeders. The mortality in secondary bleeders was 28%, compared with 10% in matched primary bleeders, for a relative risk of 3.8 (p = 0.0002). CONCLUSION: Secondary hemorrhage is associated with an increased mortality, which is related to the underlying diseases and not to a difference in the causes of bleeding.

Acute Disease↗
PubMed1985

Massive gastrointestinal hemorrhage cecal ulcers and salmonella colitis.

A 65-year-old man presented with massive lower gastrointestinal tract hemorrhage. Minimal changes were noted on sigmoidoscopy, no bleeding lesions were identified on arteriography or red blood cell scan, and barium enema examination demonstrated only diverticular disease and minimal cecal deformity, interpreted as secondary to a recent appendectomy. Colonoscopy demonstrated multiple deep cecal ulcers. These were presumed to be due to an infectious etiology, since the stools were culture-positive for Salmonella typhimurium. The hemorrhage stopped within 24 hours of treatment with Ampicillin, Flagyl, and Gentamicin. The patient has remained well over a 12-month follow-up period. Repeat colonoscopy demonstrated healing of the cecal ulcers and there was also clearing of the Salmonella from the stools. This case report serves to remind us of the different methods used to diagnose lower gastrointestinal tract hemorrhage, and the importance of considering infectious causes of colitis.

Aged↗
PubMed1991

[Changes in hemostasis indices in patients with gastrointestinal hemorrhages depending on treatment methods].

The dynamics of changes in some values of the hemostatic system was studied on days 1, 3, and 7 after gastrointestinal hemorrhage (GIH) of ulcerous etiology during enteral (administration of an electrolyte-monomer solution through a tube) and parenteral (traditional administration of infusion solutions) treatment. In operated on patients with enteral correction marked hyperfibrinogenemia was revealed, as well as diminished blood fibrinolytic activity, prolonged thrombin time, and a positive ethanol test, which indicates the predominance of hypercoagulation changes in the blood. Patients who were not subjected to operation but were given enteral correction had marked thrombocytopenia, reduced tolerance of plasma to heparin in all test periods tendency towards reduction of the fibrinogen content during the whole week after the hemorrhage in normal values of fibrinolytic activity, positive ethanol and protamine sulfate tests, which is evidence of hypocoagulation shifts in the hemostatic system. Reduction of the 4th thrombocytic factor, a tendency towards diminution of plasma tolerance to heparin, normal fibrinogen level, reduced blood fibrinolytic activity, and negative ethanol and protamine sulfate tests were revealed in patients who did not undergo operation and were given the traditional parenteral treatment, which reflects the compensatory character of the blood coagulation system response to rapidly developing blood loss. Disorders of the hemostatic system were more marked in patients with GIH who were not operated on and were given enteral correction, who require additional therapy.

Adult↗
PubMed2003

Impact of protocol-based guidelines on the management and outcome of acute upper gastrointestinal hemorrhage in a district general hospital.

A prospective audit of acute upper gastrointestinal (GI) hemorrhage was conducted between January and September 2000 at Frimley Park Hospital to determine the impact of introducing an upper GI bleeding protocol based on Rockall's initial risk scoring system. Fifty-seven patients and 52 patients were in the pre- and postprotocol phases of the study respectively. Fifty per cent (28) of the patients in the first phase and 40% (21) of the patients in the second phase belonged to the high risk group. In the preprotocol phase, endoscopy was performed in 86% (49) of cases with 60% of patients having an esophogastroduodenoscopy within 24 h. Thirty-three per cent of the high risk group failed to have an endoscopic examination within 24 h. Only two of 57 patients required surgery and the mortality was 14%. In the postprotocol phase, endoscopy was performed in 79% (42) of patients and 68% (36) patients had endoscopy within 24 h. Only four of 21 patients belonging to the high risk group had their endoscopy after 24 h of the admission. Patients were better monitored and mortality was reduced to 7.5%. Reduction of mortality from upper GI hemorrhage followed the introduction of an agreed protocol based on risk scoring.

Adolescent↗