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[Role of endoscopy in the treatment of non-variceal upper gastrointestinal hemorrhage].

Over the past three decades important progress has been made in the diagnosis and treatment of non-variceal upper gastrointestinal bleeding. We discuss the endoscopic techniques available today in combination therapies. The data in the literature regarding endoscopic techniques are discordant and no single technique has proved statistically superior in the management of bleeding. We believe that the initial injection approach is still the procedure of choice, particularly when performed by less expert endoscopists.

Electrocoagulation↗
PubMed1989

[Diagnosis of the bleeding site in gastrointestinal hemorrhage by the determination of the serum urea and creatinine ratios].

Serum urea/creatinine (Ur/Cr) ratios were determined in patients showing massive gastrointestinal (GI) bleeding in order to evaluate the bleeding site. In 36 cases of upper GI bleeding, serum Ur/Cr ratios were 119.1 +/- 4.0. The ratios were 54.1 +/- 12.1 and 58.4 +/- 10.3 in 23 cases of lower GI bleeding and 50 control cases without GI bleeding, respectively. The ratio in the upper GI bleeding cases were significantly higher than those in the lower GI bleeding and the control cases. In all cases of upper GI bleeding, except for 6 cases in which blood volume flowed into the GI tract was small, the ratios were beyond 81. On the other hand, in the lower GI bleeding and the control cases, the ratios were all below 81. Values over 81 in serum Ur/Cr ratios in upper GI bleeding cases continued until the 3rd day after bleeding. These results indicate that determination of serum Ur/Cr ratios is a simple and useful procedure for diagnosis of the bleeding site in cases showing massive GI bleeding.

Adolescent↗
PubMed1999

[Patient with recurrent gastrointestinal hemorrhage in acquired von Willebrand disease].

A 61-year-old female without prior history of bleeding experienced several symptomatic episodes of gastrointestinal bleeding in the last few years. A source of gastrointestinal bleeding could not be found although several tests of occult blood in the stool were positive. Diagnostically, a significant deficiency of von Willebrand factor could be found due to a shortened half-life of the von Willebrand factor. This acquired von Willebrand factor deficiency most likely can be explained by an immunological mechanism (e.g. antibodies against von Willebrand factor). Neither an immunosuppressive therapy with steroids nor cyclophosphamide could normalize the von Willebrand factor and the bleeding continued. Only tranexamic acid (inhibiting fibrinolysis) could at last stop the symptomatic episodes of gastrointestinal bleeding despite the fact of decreasing von Willebrand factor.

Autoantibodies↗
PubMed1993

[Ultrasound imaging of mesenchymal small intestine tumors in diagnosis of unexplained gastrointestinal hemorrhage].

The presented case reports highlight the value of transabdominal ultrasound as a complementary and non-invasive diagnostic tool in unexplained gastrointestinal bleeding. Seven patients with intermittent melaena and/or chronic anaemia were examined. In all patients, diagnostic procedures like abdominal ultrasound, EGD, colonoscopy and enteroclysis were performed primarily and did not point to a bleeding source. Transabdominal bowel wall ultrasound discovered in all cases a round and smoothly delineated tumour of homogeneous and hypoechoic structure. The diagnosis was confirmed using selective angiography in three cases revealing a roundish hypervascular lesion. Fine-needle aspiration biopsy and re-endoscopy were used in two cases, respectively, to verify the diagnosis. Postoperative histology revealed a benign leiomyoma (n = 3), schwannoma (n = 2), lipoma (n = 1) and angiofibroma (n = 1) with vascular erosions. Transabdominal ultrasound can operate as a complementary imaging technique in case of gastrointestinal haemorrhage, if endoscopic procedures fail to identify the bleeding source in the upper gastrointestinal tract and large bowel.

Aged↗
PubMed1977

Advantage of intraarterial over intravenous vasopressin infusion in gastrointestinal hemorrhage.

Recent laboratory data have suggested equivalent therapeutic value of selective intraarterial or peripheral intravenous infusions of vasopressin in the control of gastrointestinal bleeding. However, recent experience in two clinical cases continues to support a therapeutic advantage of the selective intraarterial route and casts doubt on the applicability of the laboratory results to man. Until further data is accumulated, it is premature to discard the presumed therapeutic advantage of the selective intraarterial infusion of vasopressin.

Adult↗
PubMed1999

[Calcium inhibiting drugs and the risk of gastrointestinal hemorrhage. A pharmaco-epidemiologic case-non-case study].

Calcium antagonists were found to be associated with an increased risk of gastrointestinal haemorrhage (GIH) in hypertensive patients over 67 years old (Pahor et al. Lancet 1996; 347 : 1061). This unexpected result led us to investigate this question using the French pharmacovigilance system database. We use the case/non case methodology (Moore et al. Br J Pharmacol 1997; 44 : 513) where cases and non cases were both identified from the spontaneous adverse drug reaction (ADR) reporting database. Cases were reports of the reaction of interest (i.e. GIH as recorded in the database). Non cases were all reports of reactions other than being studied. Exposure was considered as the presence in a report of the drug of interest (calcium antagonists), whether or not it was suspected of causing the reaction. We calculated Odds ratios (OR) as the ratio of the Odds of the association of reports of GIH with calcium antagonists in cases and in non cases. Calcium antagonists included in the present study were dihydropyridines, diltiazem, verapamil and bepridil. Salicylates and non steroidal antiinflammatory drugs were used as positive controls. Among the 112,792 ADRs recorded in the database between January 1985 and December 1996, 864 (0.8%) were GIH. There was no association between GIH and the exposure to calcium antagonists whatever the class of the drugs (OR = 1.2, 95% CI: [0.9; 1.6]. A subgroup analysis among the GIH reported in patients over 65 years old (470 GIH from 37,462 ADRs) also failed to find any association (OR = 0.7, 95% CI: [0.5-1.0%]). The present results failed to confirm the hypothesis of an association between GIH and use of calcium antagonists.

Aged↗
PubMed1976

[Massive gastrointestinal hemorrhage following internal drainage of pancreatic pseudocysts].

In operative treatment of pancreatic pseudocysts by inner drainage there is a risk of massive gastrointestinal bleeding particularly following an anastomosis to the stomach. In 10 patients in whom cystogastrostomy or cystoduodenostomy had been performed elsewhere a second laparotomy was necessary because of acute bleeding. In one patient a cystadenoma of the pancreas had been anastomosed to the duodenum by mistake at the previous operation. The leak of obliteration of the cyst is suggested to be the most important factor in the pathophysiology of bleeding. Inner pseudocyst drainage in a disconnected small bowel loop therefore principally should be performed at the lowest point of the cyst. The indication for an inner cyst drainage, however, must be closely examined since simultaneous pathologic changes in the pancreas often justify a resection to remove the origin of the cyst and, further, averting the complications of an inadequate inner pancreatic cyst drainage.

Adult↗
PubMed1989

[Gastrointestinal hemorrhage in children against a background of viral and bacterial infections].

In the process of intensive therapy, 22 of 32 patients developed gastrointestinal bleeding against the background of acute virobacterial pneumonia. The degree of intoxication, hypoxia, impairment in the coagulative blood system, and the level of circulating immune complexes were the main factors, which defined severity of the state of a patient, massiveness of bleeding and outcome of the treatment. The bleeding developed, if the DIC-syndrome achieved the stage of consumptive coagulopathy, and the content of the middle molecular mass substances and circulating immune complexes exceeded 1.5-2-fold the age indices.

Child↗