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Results for “HEMORRHAGE, GASTROINTESTINAL”

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PubMed1981

Clinical significance of erosive gastritis in patients with alcoholic liver disease and upper gastrointestinal hemorrhage.

Since, in many patients with alcoholic liver disease and upper gastrointestinal hemorrhage, varices and erosive gastritis frequently coexist, the purpose of this study was to assess the severity of hemorrhage, rebleeding and mortality rates when these lesions are present singly or concomitantly. In 104 patients not operated upon, 31 had both lesions present on endoscopic examination, and their clinical courses paralleled the severity of 29 patients who had bleeding varices as the sole finding. In 13 patients with alcoholic liver disease and upper gastrointestinal hemorrhage who were found to have erosive gastritis as the sole lesion, the clinical course was as benign as in 31 patients with ethanol-induced gastritis without liver disease, and their blood loss, rebleeding and mortality rates were significantly less than in patients with both varices and gastritis. It is concluded that the course and prognosis of upper gastrointestinal hemorrhage in patients with alcoholic liver disease and erosive gastritis is dependent upon the presence or absence of gastroesophageal varices.

Esophageal and Gastric Varices↗
PubMed1994

Disability and severe gastrointestinal hemorrhage. A prospective study of community-dwelling older persons.

OBJECTIVE: To describe the occurrence of severe gastrointestinal bleeding in community-dwelling older persons and to examine whether disability is a risk factor for this life-threatening condition independent of other known predictors. DESIGN: Prospective cohort survey. SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). PARTICIPANTS: 8205 persons age > or = 68 years. MEASUREMENTS: The hospital discharge diagnoses provided by the Medicare Provider Analysis and Review files and the death certificates were prospectively surveyed for 3 years. Those with at least 1 discharge diagnosis of gastrointestinal bleeding and who received a blood transfusion or died were identified as cases of severe gastrointestinal hemorrhage. Physical disability, cognitive function, smoking and alcohol intake habits, body mass index, blood pressure, chronic conditions, number of hospital admissions in past year and medications taken were assessed at baseline. RESULTS: The occurrence rate of severe gastrointestinal bleeding was 10.8 per 1000 person-years (241 events/22,277 person-years). In proportional hazards regression models, compared with no disability, > or = 1 disabilities in the Rosow-Breslau scale (RR = 2.1, 95% CI = 1.5-2.9), and > or = 1 ADLs limitations (RR = 3.1, 95% CI = 2.1-4.6) independently predicted gastrointestinal hemorrhage after adjusting for age, gender, body mass index, comorbidity, number of hospital admissions, blood pressure, intake of coumarin, corticosteroids, aspirin and other nonsteroidal anti-inflammatory drugs. CONCLUSIONS: In this prospective analysis, disability is an independent predictor of gastrointestinal hemorrhage. Further studies are needed to explain the mechanisms by which disability may cause gastrointestinal hemorrhage. Because physical disability is potentially modifiable, strategies to lower the risk of gastrointestinal bleeding should be evaluated.

Aged↗
PubMed1979

Clinical and pathologic studies of gastrointestinal hemorrhage in acute leukemia.

One hundred and sixty cases of acute leukemia observed at our Department between 1953 and 1977 were reviewed as to the presence and nature of the accompanying gastrointestinal hemorrhage. A massive gastrointestinal hemorrhage requiring blood transfusions occurred in 29 cases (18%). The most common lesion was hemorrhagic necrosis of the small intestines. There were three forms of hemorrhage: Type I: thrombocytopenia, hemorrhagic diathesis, diffuse hemorrhage of mucosa and submucosa, but no erosion nor ulceration. Type II: no specific pathologic findings. Diffuse hemorrhage, superficial erosions, bacterial and fungal invasions were observed. Type III: single and/or multiple ulcerations, necrosis and perforation of the small intestines and colon. Thrombocytosis was almost always present at the prebleeding phase in these cases. Intravascular microthrombi at the basis of ulceration were seen. Usually, more than one process were seen in each case. An appropriate approach to the severe gastrointestinal hemorrhage with a combination of anti-leukemic chemotherapy, anti-coagulant therapy, platelet transfusion, etc. would further add to the number of long-term survivors in acute leukemia.

Blood Platelets↗
PubMed1993

Spectrum of lower gastrointestinal hemorrhage: an endoscopic study of 166 patients.

BACKGROUND: The spectrum of lesions causing lower gastrointestinal hemorrhage shows marked geographic variation. The study was aimed to determine this spectrum in our region using endoscopic examination. METHODS: 166 patients presenting with lower gastrointestinal hemorrhage were investigated using colonoscopy as the first investigation. RESULTS: Lesions responsible for bleeding could be identified in 141 patients (84.9%). In 25 patients (15.1%), the etiology of bleed could not be determined either because of failure to identify a lesion (10 patients) or because of an incomplete examination (15 patients). Major causes of lower gastrointestinal bleeding included idiopathic ulcerative colitis (19.3%), acute colitis (12.0%), colonic polyps (10.2%), radiation colitis (9.0%), solitary rectal ulcer (7.8%), colonic carcinoma (7.2%), colonic tuberculosis (4.2%) and enteric fever (3.0%). CONCLUSION: Endoscopic examination is very useful in evaluating patients with lower gastrointestinal hemorrhage. The predominant causes of lower gastrointestinal bleeding in our experience are different from those reported from western countries.

Adolescent↗
PubMed2003

Meta analysis of propranolol effects on gastrointestinal hemorrhage in cirrhotic patients.

AIM: To assess the effects of propranolol as compared with placebo on gastrointestinal hemorrhage and total mortality in cirrhotic patients by using meta analysis of 20 published randomized clinical trials. METHODS: A meta analysis of published randomized clinical trials was designed. Published articles were selected for study based on a computerized MEDLINE and a manual search of the bibliographies of relevant articles. Data from 20 relevant studies fulfilling the inclusion criteria were retrieved by means of computerized and manual search. The reported data were extracted on the basis of the intention-to-treat principle, and treatment effects were measured as risk differences between propranolol and placebo. Pooled estimates were computed according to a random-effects model. We evaluated the pooled efficacy of propranolol on the risk of gastrointestinal hemorrhage and the total mortality. RESULTS: A total of 1,859 patients were included in 20 trials, 931 in the propranolol groups and 928 as controls. Among the 652 patients with upper gastrointestinal tract hemorrhage, 261 patients were treated with propranolol, and 396 patients were treated with placebo or non-treated. Pooled risk differences of gastrointestinal hemorrhage were -18 % [95 % CI, -25 %, -10 %] in all trials, -11 % [95 % CI, -21 %, -1 %] in primary prevention trials, and -25 % [95 % CI, -39 %, -10 %] in secondary prevention trials. A total of 440 patients died, 188 in propranolol groups and 252 in control groups. Pooled risk differences of total death were -7 % [95 % CI, -12 %, -3 %] in all trials, -9 % [95 % CI, -18 %, -1 %] in primary prevention trials, and -5 % [95 % CI, -9 %, -1 %] in secondary prevention trials. CONCLUSION: Propranolol can markedly reduce the risks of both primary and recurrent gastrointestinal hemorrhage, and also the total mortality.

Adrenergic beta-Antagonists↗
PubMed1998

Successful outpatient management of acute upper gastrointestinal hemorrhage: use of practice guidelines in a large patient series.

BACKGROUND: Acute upper gastrointestinal hemorrhage is a common reason for hospitalization. Clinical and endoscopic characteristics predict outcome. The aim of this study was to determine the characteristics and outcome of patients with acute upper gastrointestinal hemorrhage cared for without hospitalization. METHODS: One hundred seventy-six consecutive patients in a staff-model health maintenance organization were selected for outpatient care based on absolute endoscopic and non-absolute clinical criteria. Clinical and endoscopic characteristics, British national audit "risk scores," and rates of recurrent bleeding, hospitalization, and mortality were determined. RESULTS: Mean patient age (+/- SD) was 56.4 +/- 16.0 years, and 106 patients (60%) were men. One hundred one (57%) had endoscopy within 2 days of the onset of hemorrhage. The mean initial hemoglobin concentration was 11.7 +/- 2.3 mg/dL. Ninety-seven patients (55%) had a peptic ulcer, and 57 (32%) had a British risk score greater than 2. Hospitalization, recurrent bleeding, and mortality occurred in two (1%), one (1%), and zero (0%) patients, respectively, during 16.0 +/- 10.8 months of follow-up. CONCLUSIONS: Many patients with acute upper gastrointestinal hemorrhage can be safely treated as outpatients using endoscopic and clinical guidelines.

Acute Disease↗
PubMed1989

Gastrointestinal hemorrhage and the skin.

Cutaneous manifestations are often associated with disorders in which gastrointestinal hemorrhage is a major feature. These manifestations include vascular abnormalities, connective tissue disorders, gastrointestinal polyposis, vasculitis and its variants, Kaposi's sarcoma, and inflammatory bowel disease. Because such skin lesions often develop prior to gastrointestinal hemorrhage, they may prove helpful in making a definitive diagnosis before gastrointestinal blood loss becomes a major clinical problem.

Gastrointestinal Hemorrhage↗
PubMed2003

[Dieulafoy's disease as a cause of massive upper gastrointestinal hemorrhage].

Dieulafoy's disease is a rare cause of gastrointestinal hemorrhage. The cause of this disorder is not known exactly but it is generally characterized with massive hemorrhage from the abnormal submucosal vessels. Although abnormal submucosal vessels are mostly seen in stomach, they can also be seen in duedonum, jejunum or colon. In this report we presented a patient who developed massive gastrointestinal hemorrhage due to Dieulafoy disease.

Arteriovenous Malformations↗
PubMed1996

Gastrointestinal hemorrhage complicating aspirin therapy in acute Kawasaki disease.

Although gastrointestinal hemorrhage is a well-recognized complication of aspirin therapy, this side effect has not been previously reported in patients with Kawasaki disease (KD). We describe two children with typical KD who had massive gastrointestinal bleeding that required hospitalization and transfusion. Physicians caring for patients with KD should instruct parents on the signs and symptoms of aspirin toxicity. Fortunately, gastrointestinal hemorrhage appears to be a rare complication of salicylate therapy in patients with Kawasaki disease.

Acute Disease↗
PubMed1999

Polyarteritis nodosa presenting as massive upper gastrointestinal hemorrhage.

We report the first case of massive upper gastrointestinal hemorrhage as the initial presentation of polyarteritis nodosa (PAN), which is an uncommon form of systemic necrotizing vasculitis that may involve many organ systems and could affect any age group. Abdominal pain is the most common sign of gastrointestinal involvement. Gastrointestinal bleeding occurs less frequently in approximately 6% of cases. Reported cases of gastrointestinal hemorrhage have been in the form of coffee ground emesis, melena, or hematochezia. Such bleeding complications have resulted from ischemic ulceration or perforation of the small or large intestine. However, we are unaware of previous reports showing massive hematemesis to be the initial presentation of PAN.

Abdominal Pain↗
PubMed1978

Upper gastrointestinal hemorrhage: aggressive management decreases mortality.

In a retrospective study of 630 patients with upper gastrointestinal hemorrhage admitted to the Royal Victoria Hospital between 1963 and 1971, the overall mortality was 12.54%. Mortality increased in patients receiving more than 10 units of blood and in patients over 60 years of age. Mortality decreased in patients in whom the site of hemorrhage was known prior to operation. Early surgery for gastric ulcers and conservative therapy for acute gastric erosions reduced mortality. Therefore in 334 patients admitted to the Royal Victoria Hospital between 1973 and 1976 with upper gastrointestinal hemorrhage, an aggressive approach to diagnosis and management was emphasized. There was a significant decrease in patients with duodenal ulcers, acute gastric erosions, and gastric ulcers who received more than 10 units of blood. There was a significant increase in the use of endoscopy to establish the source of hemorrhage and a significant increase in the use of endoscopy to establish the source of hemorrhage and a significant decrease in the number of patients who did not have a diagnosis prior to operation. There was also a significant increase in early surgery for gastric ulcers. This regimen led to a significant decrease in mortality (6.69% vs. 12.54%). This report demonstrates that early diagnosis and management based on the lesion found reduces mortality from upper gastrointestinal hemorrhage.

Blood Transfusion↗