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Results for “HEMORRHAGE, GASTROINTESTINAL”

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At least 865 records · Page 48Linked to original sources

PubMed1995

Triage considerations for patients with acute gastrointestinal hemorrhage admitted to a medical intensive care unit.

OBJECTIVE: To determine whether previously identified clinical criteria, available at the time of triage, can predict clinical outcomes for patients with acute gastrointestinal (GI) hemorrhage. DESIGN: An inception cohort study. SETTING: Barnes Hospital, an academic tertiary care center. PATIENTS: One hundred eight consecutive hospital admissions (103 patients) triaged to intensive care for GI hemorrhage. INTERVENTIONS: Prospective patient surveillance, data collection, and risk stratification using preselected clinical criteria and outcomes assessment. MEASUREMENTS AND MAIN RESULTS: Using clinical data available at the time of triage, 28 (25.9%) intensive care unit admissions were classified as low risk for having poor outcomes. There was no difference in the distribution of upper and lower GI tract sources of hemorrhage for the two risk groups (p = .310). Stigmata of recent hemorrhage were endoscopically identified for six (21.4%) of the low-risk patient admissions and for 16 (20.0%) of the high-risk patient admissions (p = .872). Patient admissions identified as low risk had significantly lower rates of recurrent GI hemorrhage (3.6% vs. 22.5%; p = .022), less acquired organ system derangements (1.0 +/- 0.3 vs. 1.5 +/- 1.0 organs; p < .001), shorter lengths of hospitalization (4.9 +/- 3.5 vs. 8.8 +/- 7.4 days; p < .001), required transfusion with fewer units of packed red blood cells (1.3 +/- 1.2 vs. 6.2 +/- 4.7 units; p < .001), and had a lower overall hospital mortality rate (0.0% vs. 21.3%; p = .008) compared with patient admissions identified as being high risk. CONCLUSION: These data suggest that objective clinical criteria, available at the time of triage determination, can be utilized to identify a low-risk group of patients with acute GI hemorrhage, having favorable outcomes and potentially no need for intensive care unit services.

Acute Disease↗

PubMed1982

Recurrent gastrointestinal hemorrhage: an unusual cause.

A young man presented with gastrointestinal bleeding which necessitated a partial gastrectomy. No lesion was discovered in the stomach or duodenum. Subsequently episodes of hemorrhage recurred. Barium studies and blood investigations failed to reveal the cause. The observation of skin lesions on the neck led to the diagnosis of pseudoxanthoma elasticum. The importance is stressed of examining the skin in any case of alimentary bleeding of obscure origin.

Adult↗

PubMed1987

Incidence, diagnosis, and natural course of upper gastrointestinal hemorrhage. Prognostic value of clinical factors and endoscopy.

Upper gastrointestinal bleeding is a common emergency, with a constant annual incidence of 90 patients per 100,000 population. Peptic ulcer marked by stigmata of hemorrhage is the commonest source of bleeding (51%), followed by varices (11%), esophagitis (10%), and erosions (5%). Most hemorrhages stop bleeding spontaneously (82%), whereas 18% present with major bleeding, mostly due to erosion of an artery in the ulcer base, requiring hemostatic intervention. Thirty per cent of the peptic ulcers bleed massively, constituting 89% of all major bleeds. Non-ulcer lesions rarely bleed massively (4%). Clinical factors including bleeding pattern before admission and endoscopically observed stigmata of hemorrhage including the visible vessel have been shown to be poor predictors of major hemorrhage. Hemodynamic monitoring remains the most reliable method for distinguishing between patients with major bleeding and need for emergency surgery and patients who will stop bleeding spontaneously.

Esophageal Diseases↗

PubMed2005

Risk of hospitalization with peptic ulcer disease or gastrointestinal hemorrhage associated with nabumetone, Arthrotec, diclofenac, and naproxen in a population based cohort study.

OBJECTIVE: To identify the unbiased differences in the risk of hospitalization with peptic ulcer disease (PUD) or gastrointestinal (GI) hemorrhage among populations using 4 nonsteroidal antiinflammatory drugs (NSAID): nabumetone, Arthrotec, diclofenac plus a cytoprotective agent dispensed separately (diclo+coRx), and naproxen. METHODS: A population based historical cohort study using linked data from provincial healthcare databases. The population of the province of Saskatchewan, Canada, entitled to drug plan benefits in 1995 was eligible (roughly 91% of 1 million people). Participants were identified if they filled a prescription for one of the 4 study NSAID (18,424 individuals). They were then followed for 6 months to determine outcomes. Logistic regression was used to produce estimates of the risk of admission to hospital with a primary diagnosis of PUD or GI hemorrhage associated with the study drugs unbiased by known confounders. RESULTS: Compared to Arthrotec the adjusted odds of hospitalization for PUD for participants taking nabumetone was 2.6 (95% CI 1.0-6.6), diclo+coRx 6.8 (95% CI 3.5-13.4), and naproxen 7.9 (95% CI 3.9-15.9). Compared to nabumetone the adjusted odds of hospitalization for PUD for participants taking diclo+coRx was 2.7 (95% CI 1.2-6.0) and naproxen 3.1 (95% CI 1.3-7.1). No significant differences were noted in terms of admissions for GI hemorrhage. CONCLUSION: Participants taking nabumetone and Arthrotec had significantly lower risk of hospitalization for PUD than those taking the other study drugs. Arthrotec was superior to nabumetone in a head to head comparison and especially when compared with the diclo+coRx and naproxen groups. No short term differences were seen in the rates of admission for GI hemorrhage. It appears that inherent gastroprotective strategies with Arthrotec and to a lesser extent with nabumetone do translate into decreased serious GI side effects at the population level in the short term.

Aged↗

PubMed1967