Upper gastrointestinal(GI)hemorrhage presents a substantial clinical challenge.Initial management typically involves resuscitation and endoscopy within 24 h,although the benefit of very early endoscopy(<12 h)for hi...Upper gastrointestinal(GI)hemorrhage presents a substantial clinical challenge.Initial management typically involves resuscitation and endoscopy within 24 h,although the benefit of very early endoscopy(<12 h)for high-risk patients is debated.Treatment goals include stopping acute bleeding,preventing rebleeding,and using a multimodal approach encompassing endoscopic,pharmacological,angiographic,and surgical methods.Pharmacological agents such as vasopressin,prostaglandins,and proton pump inhibitors are effective,but the increase in antithrombotic use has increased GI bleeding morbidity.Endoscopic hemostasis,particularly for nonvariceal bleeding,employs techniques such as electrocoagu-lation and heater probes,with concerns over tissue injury from monopolar electrocoagulation.Novel methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have limitations.Currently,the first-line therapy includes thermal probes and hemoclips,with over-the-scope clips emerging for larger ulcer bleeding.The gold probe,combining bipolar electrocoagulation and injection,offers targeted coagulation but has faced device-related issues.Future advancements involve combining techniques and improving endoscopic imaging,with studies exploring combined approaches showing promise.Ongoing research is crucial for developing standardized and effective hemorrhage management strategies.展开更多
BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS ...BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS In this retrospective study,692 patients with UGIB were enrolled from two cen-ters and divided into a training(n=591)and a validation cohort(n=101).The clinical data were collected to develop new prognostic prediction models.The en-dpoint was compound outcome defined as(1)demand for emergency surgery or vascular intervention,(2)being transferred to the intensive care unit,or(3)death during hos-pitalization.The models’predictive ability was compared with previously esta-blished scores by receiver operating characteristic(ROC)curves.RESULTS Totally 22.2%(131/591)patients in the training cohort and 22.8%(23/101)in the validation cohort presented poor outcomes.Based on the stepwise-forward Lo-gistic regression analysis,eight predictors were integrated to determine a new post-endoscopic prognostic scoring system(MH-STRALP);a nomogram was de-termined to present the model.Compared with the previous scores(GBS,Rock-all,ABC,AIMS65,and PNED score),MH-STRALP showed the best prognostic prediction ability with area under the ROC curves(AUROCs)of 0.899 and 0.826 in the training and validation cohorts,respectively.According to the calibration cur-ve,decision curve analysis,and internal cross-validation,the nomogram showed good calibration ability and net clinical benefit in both cohorts.After removing the endoscopic indicators,the pre-endoscopic model(pre-MH-STRALP score)was conducted.Similarly,the pre-MHSTRALP score showed better predictive value(AUROCs of 0.868 and 0.767 in the training and validation cohorts,respectively)than the other pre-endoscopic scores.CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple,convenient,and accurate tools for prognosis prediction of UGIB,and may be applied for early decision on its management strategies.展开更多
BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distin...BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%.展开更多
Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bl...Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bleeding ulcers recommend a continuous infusion of proton pump inhibitors (PPI). However, studies comparing intermittent dosing of PPI therapy show that this regimen achieves similar clinical benefits. If the clinical efficacy remains equivalent, intermittent dosing will be more cost-effective for patients and the health care system. Our research study aims to analyze the comparative effectiveness of intermittent versus continuous PPI therapy after endoscopic treatment in patients with UGIB, focusing on such endpoints as rebleeding risk at 3-and 7-day mortality rates. Methods: Resources searched included MEDLINE, EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials databases from January 2010 through December 2023 with the inclusion of meta-analysis, systematic review, review, or ACG guideline recommendations. Results of the analysis show how recommendations regarding high vs. low PPI regimen changed over time: from no difference in regimen in 2010 to recommending continuous regimen in 2012 to declaring insufficient evidence between choosing one regimen over another in 2013 to determine that both regimens were comparable to each other in 2014-2018 and finally to recommending both regimens in 2021. To conclude, our review shows that in patients with bleeding ulcers and high-risk endoscopic findings, intermittent PPI therapy is non-inferior to continuous PPI infusion for three days, seven days bleeding risk or mortality rates;however, it remains challenging to determine the most optimal intermittent regimen due to heterogeneity of RCTs included in meta-analyses, and further trials will need to be performed.展开更多
BACKGROUND Upper gastrointestinal bleeding(UGIB)is defined as bleeding that occurs proximal to the ligament of Treitz and can sometimes lead to potentially serious and life-threatening clinical situations in children....BACKGROUND Upper gastrointestinal bleeding(UGIB)is defined as bleeding that occurs proximal to the ligament of Treitz and can sometimes lead to potentially serious and life-threatening clinical situations in children.Globally,the cause of UGIB differs significantly depending on the geographic location,patient population and presence of comorbid conditions.AIM To observe endoscopic findings of UGIB in children at a tertiary care center of Bangladesh.METHODS This retrospective study was carried out in the department of Pediatric Gastroenterology and Nutrition of Bangabandhu Shiekh Mujib Medical University,a tertiary care hospital of Bangladesh,between January 2017 and January 2019.Data collected from hospital records of 100 children who were 16 years of age or younger,came with hematemesis,melena or both hematemesis and melena.All patients underwent upper gastrointestinal endoscopy(Olympus CV 1000 upper gastrointestinal video endoscope)after initial stabilization.Necessary investigations to diagnose portal hypertension and chronic liver disease with underlying causes for management purposes were also done.RESULTS A total of 100 patients were studied.UGIB was common in the age group 5-10 years(42%),followed by above 10 years(37%).Hematemesis was the most common presenting symptom(75%)followed by both hematemesis and melena(25%).UGIB from ruptured esophageal varices was the most common cause(65%)on UGI endoscopy followed by gastric erosion(5%)and prolapsed gastropathy(2%).We observed that 23%of children were normal after endoscopic examination.CONCLUSION Ruptured esophageal varices were the most common cause of UGIB in children in Bangladesh.Other causes included gastric erosions and prolapsed gastropathy syndrome.展开更多
Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Gastroenterologists and other involved clinicians are generally assiste...Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Gastroenterologists and other involved clinicians are generally assisted by international guidelines in its management.However,NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines,with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and treatment.Conversely,the management of rare and extraordinary rare causes of NVUGIB is not covered by current guidelines.Given they are frequently lifethreatening conditions,all the involved clinicians,that is emergency physicians,diagnostic and interventional radiologists,surgeons,in addition obviously to gastroenterologists,should be aware of and familiar with their management.Indeed,they typically require a prompt diagnosis and treatment,engaging a dedicated,patient-tailored,multidisciplinary team approach.The aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.展开更多
Objective:This study aimed to establish a nomogram model to predict the mortality risk of patients with dangerous upper gastrointestinal bleeding(DUGIB),and identify high-risk patients who require emergent therapy.Met...Objective:This study aimed to establish a nomogram model to predict the mortality risk of patients with dangerous upper gastrointestinal bleeding(DUGIB),and identify high-risk patients who require emergent therapy.Methods:From January 2020 to April 2022,the clinical data of 256 DUGIB patients who received treatments in the intensive care unit(ICU)were retrospectively collected from Renmin Hospital of Wuhan University(n=179)and the Eastern Campus of Renmin Hospital of Wuhan University(n=77).The 179 patients were treated as the training cohort,and 77 patients as the validation cohort.Logistic regression analysis was used to calculate the independent risk factors,and R packages were used to construct the nomogram model.The prediction accuracy and identification ability were evaluated by the receiver operating characteristic(ROC)curve,C index and calibration curve.The nomogram model was also simultaneously externally validated.Decision curve analysis(DCA)was then used to demonstrate the clinical value of the model.Results:Logistic regression analysis showed that hematemesis,urea nitrogen level,emergency endoscopy,AIMS65,Glasgow Blatchford score and Rockall score were all independent risk factors for DUGIB.The ROC curve analysis indicated the area under curve(AUC)of the training cohort was 0.980(95%CI:0.962-0.997),while the AUC of the validation cohort was 0.790(95%CI:0.685-0.895).The calibration curves were tested for Hosmer-Lemeshow goodness of fit for both training and validation cohorts(P=0.778,P=0.516).Conclusion:The developed nomogram is an effective tool for risk stratification,early identification and intervention for DUGIB patients.展开更多
BACKGROUND:It is controversial whether prophylactic endotracheal intubation(PEI)protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding(UGIB).The study aimed to explore the...BACKGROUND:It is controversial whether prophylactic endotracheal intubation(PEI)protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding(UGIB).The study aimed to explore the predictive value of PEI for cardiopulmonary outcomes and identify high-risk patients with UGIB undergoing endoscopy.METHODS:Patients undergoing endoscopy for UGIB were retrospectively enrolled in the eICU Collaborative Research Database(eICU-CRD).The composite cardiopulmonary outcomes included aspiration,pneumonia,pulmonary edema,shock or hypotension,cardiac arrest,myocardial infarction,and arrhythmia.The incidence of cardiopulmonary outcomes within 48 h after endoscopy was compared between the PEI and non-PEI groups.Logistic regression analyses and propensity score matching analyses were performed to estimate effects of PEI on cardiopulmonary outcomes.Moreover,restricted cubic spline plots were used to assess for any threshold effects in the association between baseline variables and risk of cardiopulmonary outcomes(yes/no)in the PEI group.RESULTS:A total of 946 patients were divided into the PEI group(108/946,11.4%)and the non-PEI group(838/946,88.6%).After propensity score matching,the PEI group(n=50)had a higher incidence of cardiopulmonary outcomes(58.0%vs.30.3%,P=0.001).PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders(odds ratio[OR]3.176,95%confidence interval[95%CI]1.567-6.438,P=0.001).The subgroup analysis indicated the similar results.A shock index>0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI(P=0.015).The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index(OR 1.465,95%CI 1.079-1.989,P=0.014)and shock index>0.77(compared with shock index≤0.77[OR 2.981,95%CI 1.186-7.492,P=0.020,AUC=0.764]).CONCLUSION:PEI may be associated with cardiopulmonary outcomes in elderly and critically ill patients with UGIB undergoing endoscopy.Furthermore,a shock index greater than 0.77 could be used as a predictor of a worse prognosis in patients undergoing PEI.展开更多
The etiology of upper gastrointestinal bleeding(UGIB)varies by age,from newborns to adolescents,with some of the causes overlapping between age groups.While particular causes such as vitamin K deficiency and cow’s mi...The etiology of upper gastrointestinal bleeding(UGIB)varies by age,from newborns to adolescents,with some of the causes overlapping between age groups.While particular causes such as vitamin K deficiency and cow’s milk protein allergy are limited to specific age groups,occurring only in neonates and infants,others such as erosive esophagitis and gastritis may be identified at all ages.Furthermore,the incidence of UGIB is variable throughout the world and in different hospital settings.In North America and Europe,most UGIBs are nonvariceal,associated with erosive esophagitis,gastritis,and gastric and duodenal ulcers.In recent years,the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries.However,variceal bleeding still predominates in certain parts of the world,especially in South Asia.The most severe hemorrhage arises from variceal bleeding,peptic ulceration,and disseminated intravascular coagulation.Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients.Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings,the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIBincludes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability,followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis inthe pediatric population because some of them are unique to children. Endoscopic techniques are of significantdiagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally,surgical treatment is reserved for the most severe bleeding.展开更多
BACKGROUND: Currently, prophylactic antibiotics are recommended only for cirrhotic patients with acute upper gastrointestinal bleeding(AUGIB);however, the benefit for other AUGIB patients remains undetermined. We aime...BACKGROUND: Currently, prophylactic antibiotics are recommended only for cirrhotic patients with acute upper gastrointestinal bleeding(AUGIB);however, the benefit for other AUGIB patients remains undetermined. We aimed to compare the clinical outcomes between patients with AUGIB with and without prophylactic antibiotics to identify the population that requires this therapy.METHODS: Patients with AUGIB admitted between 1st January 2019 and 31st December 2021 in the Emergency Department of Peking Union Medical College Hospital were enrolled. Patients were divided into the antibiotic and non-antibiotic groups. The primary outcome was in-hospital mortality, and the secondary outcome was the onset of new infection. The risk factors for mortality and infection were analyzed, and stratification analysis of prophylactic antibiotics was performed. Continuous data were analyzed using the t-test or nonparametric rank sum test, and categorical data were analyzed using the Chi-square test or Fisher's exact test. Indicators with significant differences between the groups were included for logistic regression analysis. A P-value <0.05 was considered statistically significant. RESULTS: A total of 392 individuals were included, among them, 281 patients received prophylactic antibiotics, and 111 patients did not receive prophylactic antibiotics. The mortality rates were significantly lower in the antibiotic group than in the non-antibiotics group(6.41% vs. 17.12%, P=0.001). The risk factors for infection were varicose veins(P=0.045) and endotracheal intubation(P=0.005) in the prophylactic antibiotic group, and endoscopic treatment(P=0.010) in the non-prophylactic antibiotic group. Stratified analyses showed that patients with age ≥ 65 years, endotracheal intubation, endoscopic treatment, and AUGIB of variceal etiologies benefited from prophylactic antibiotics.CONCLUSION: AUGIB patients may benefit from prophylactic antibiotics to decrease mortality, especially those aged ≥ 65 years and those with endotracheal intubation, endoscopic treatment, and variceal etiologies.展开更多
BACKGROUND Massive intragastric clotting(MIC) makes endoscopic therapy difficult in patients with acute upper gastrointestinal bleeding. Literature data on how to address this problem are limited. Here, we report on a...BACKGROUND Massive intragastric clotting(MIC) makes endoscopic therapy difficult in patients with acute upper gastrointestinal bleeding. Literature data on how to address this problem are limited. Here, we report on a case of massive stomach bleeding with MIC that was successfully treated endoscopically using an overtube of singleballoon enteroscopy.CASE SUMMARY A 62-year-old gentleman with metastatic lung cancer was admitted to the intensive care unit due to tarry stools and hematemesis of 1500 mL of blood during hospitalization. Emergent esophagogastroduodenoscopy revealed massive blood clots and fresh blood in the stomach with evidence of active bleeding.Bleeding sites could not be observed even by changing the patient’s position and aggressive endoscope suction. The MIC was successfully removed using an overtube connected with a suction pipe, which was inserted into the stomach with an overtube of a single-balloon enteroscope. An ultrathin gastroscope was also introduced through the nose into the stomach to guide the suction. A massive blood clot was successfully removed, and an ulcer with oozing bleeding at the inferior lesser curvature of the upper gastric body was revealed, facilitating endoscopic hemostatic therapy.CONCLUSION This technique appears to be a previously unreported method to suction MIC out of the stomach in patients with acute upper gastrointestinal bleeding. This technique could be considered when other methods are not available or if they fail to remove massive blood clots in the stomach.展开更多
BACKGROUND The optimal timing of esophagogastroduodenoscopy(EGD)and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding(NVUGIB)remains an area of activ...BACKGROUND The optimal timing of esophagogastroduodenoscopy(EGD)and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding(NVUGIB)remains an area of active research.AIM To identify independent predictors of outcomes in patients with NVUGIB,with a particular focus on EGD timing,anticoagulation(AC)status,and demographic features.METHODS A retrospective analysis of adult patients with NVUGIB from 2009 to 2014 was performed using validated ICD-9 codes from the National Inpatient Sample database.Patients were stratified by EGD timing relative to hospital admission(≤24 h,24-48 h,48-72 h,and>72 h)and then by AC status(yes/no).The primary outcome was all-cause inpatient mortality.Secondary outcomes included healthcare usage.RESULTS Of the 1082516 patients admitted for NVUGIB,553186(51.1%)underwent EGD.The mean time to EGD was 52.8 h.Early(<24 h from admission)EGD was associated with significantly decreased mortality,less frequent intensive care unit admission,shorter length of hospital stays,lower hospital costs,and an increased likelihood of discharge to home(all with P<0.001).AC status was not associated with mortality among patients who underwent early EGD(aOR 0.88,P=0.193).Male sex(OR 1.30)and Hispanic(OR 1.10)or Asian(aOR 1.38)race were also independent predictors of adverse hospitalization outcomes in NVUGIB.CONCLUSION Based on this large,nationwide study,early EGD in NVUGIB is associated with lower mortality and decreased healthcare usage,irrespective of AC status.These findings may help guide clinical management and would benefit from prospective validation.展开更多
BACKGROUND Gastric cancer(GC)is a prevalent malignant tumor worldwide and ranks as the fourth leading cause of cancer-related mortality.Upper gastrointestinal bleeding(UGIB)is a frequent complication of GC.Radical gas...BACKGROUND Gastric cancer(GC)is a prevalent malignant tumor worldwide and ranks as the fourth leading cause of cancer-related mortality.Upper gastrointestinal bleeding(UGIB)is a frequent complication of GC.Radical gastrectomy and palliative therapy are widely used surgical procedures in the clinical management of GC.This study intends to probe the clinical efficacy and safety of radical gastrectomy and palliative therapy on the basis of exploratory laparotomy in patients with GC combined with UGIB,hoping to provide valuable information to aid patients in selecting the appropriate surgical intervention.AIM To investigate the clinical efficacy and safety of exploratory laparotomy^(+)radical gastrectomy and palliative therapy in patients with GC and UGIB combined.METHODS A total of 89 GC patients admitted to the First Affiliated Hospital of the University of South China between July 2018 and July 2020 were selected as participants for this study.The 89 patients were divided into two groups:radical resection group(n=46)treated with exploratory laparotomy^(+)radical gastrectomy and Palliative group(n=43)treated with palliative therapy.The study compared several variables between the two groups,including surgical duration,intraoperative blood transfusion volume,postoperative anal exhaust time,off-bed activity time,length of hospitalization,and incidence of complications such as duodenal stump rupture,anastomotic obstruction,and postoperative incision.Additionally,postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),and CD3^(+)/HLADR^(+)),immunoglobulin(IgG and IgM),tumor markers(CEA,CA199,and CA125),and inflammatory factors(IL-6,IL-17,and TNF-α)were assessed.The surgical efficacy and postoperative quality of life recovery were also evaluated.The patients were monitored for survival and tumor recurrence at 6 mo,1 year,and 2 years post-surgery.RESULTS The results indicated that the duration of operation time and postoperative hospitalization did not differ between the two surgical procedures.However,patients in the radical resection group exhibited shorter intraoperative blood loss,anus exhaust time,off-bed activity time,and inpatient activity time than those in the Palliative group.Although there was no substantial difference in the occurrence of postoperative complications,such as duodenal stump rupture and anastomotic obstruction,between the radical resection group and Palliative group(P>0.05),the radical resection group exhibited higher postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),etc.)and immunoglobulin levels(IgG,IgM)than the Palliative group,while tumor markers and inflammatory factors levels were lower than those in the radical resection group.Additionally,surgical efficacy,postoperative quality of life,and postoperative survival rates were higher in patients who underwent radical gastrectomy than in those who underwent palliative therapy.Moreover,the probability of postoperative tumor recurrence was lower in the radical gastrectomy group compared to the palliative therapy group,and these differences were all statistically significant(P<0.05).CONCLUSION Compared to palliative therapy,exploratory laparotomy^(+)radical gastrectomy can improve immune function,reduce the levels of tumor markers and inflammatory factors,improve surgical efficacy,promote postoperative quality of life recovery,enhance survival rates,and attenuate the probability of tumor recurrence.展开更多
Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which po...Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.展开更多
Non-variceal upper gastrointestinal bleeding(NVUGIB)is one of the challenging situations in clinical practice.Despite that gastric ulcer and duodenal ulcer are still the main causes of acute NVUGIB,there are other cau...Non-variceal upper gastrointestinal bleeding(NVUGIB)is one of the challenging situations in clinical practice.Despite that gastric ulcer and duodenal ulcer are still the main causes of acute NVUGIB,there are other causes of bleeding which might not always be detected through the standard endoscopic evaluation.Standard endoscopic management of UGIB consists of injection,thermal coagulation,hemoclips,and combination therapy.However,these methods are not always successful for rebleeding prevention.Endoscopic ultrasound(EUS)has been used recently for portal hypertension management,especially in managing acute variceal bleeding.EUS has been considered a better tool to visualize the bleeding vessel in gastroesophageal variceal bleeding.There have been studies looking at the role of EUS for managing NVUGIB;however,most of them are case reports.Therefore,it is important to review back to see the evolution and innovation of endoscopic treatment for NVUGIB and the role of EUS for possibility to replace the standard endoscopic haemostasis management in daily practice.展开更多
Objective:To observe the clinical effect of emergency interventional therapy for patients with acute severe non-variceal upper gastrointestinal bleeding.Methods:78 patients with acute severe non-variceal upper gastroi...Objective:To observe the clinical effect of emergency interventional therapy for patients with acute severe non-variceal upper gastrointestinal bleeding.Methods:78 patients with acute severe non-variceal upper gastrointestinal bleeding who were treated in the General Hospital of the Eastern Theater Command from May 2020 to May 2023 were randomly divided into two groups according to different treatment plans.The study group underwent emergency upper gastrointestinal angiography and interventional embolization therapy,the control group was treated with esomeprazole;the clinical data related to the two groups were compared,including the total effective rate of treatment,blood pressure stabilization time,bleeding control time,etc.Results:The effective rate of clinical treatment in the study group was 97.44%,which was higher than that in the control group,which was 79.49%(P<0.05).Both were significantly shorter(P<0.05);the 7 d rebleeding rate and 30 d rebleeding rate of the study group were lower than those of the control group(P<0.05);the 7 d and 30 d mortality rates of the two groups after treatment were compared,and the comparative study group was lower,but there was no significant difference(P>0.05).Conclusion:Emergency interventional therapy can control bleeding more quickly,shorten bleeding control time and complete hemostasis time,shorten blood pressure stabilization time and abdominal pain relief time,and reduce rebleeding rate in patients with acute severe non-variceal upper gastrointestinal bleeding.展开更多
Hypoxic-ischemic encephalopathy(HIE)occurs more in neonatal and rarely in adults.In adults,HIE is commonly caused by carbon monoxide(CO)poisoning,shock,cardiac arrest,respiratory depression,anesthesia and drug overdos...Hypoxic-ischemic encephalopathy(HIE)occurs more in neonatal and rarely in adults.In adults,HIE is commonly caused by carbon monoxide(CO)poisoning,shock,cardiac arrest,respiratory depression,anesthesia and drug overdose.[1–3]In patients with acute gastrointestinal bleeding,decreased circulating blood supply causes cerebral ischemia and hypoxia,leading to dizziness,syncope and even sudden death.However,these conditions are more common especially in elderly patients with cerebrovascular stenosis,acute massive blood loss,using hemostatic agents,and high-risk factors of cardiovascular and cerebrovascular disease.[4]Here,we reported a middle-aged male patient,who was diagnosed with HIE after upper gastrointestinal bleeding without these high-risk factors.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of liver disease globally with an estimated prevalence of 25%,with the clinical and economic burden expected to continue to increase.In the Unite...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of liver disease globally with an estimated prevalence of 25%,with the clinical and economic burden expected to continue to increase.In the United States,non-variceal upper gastrointestinal bleeding(NVUGIB)has an estimated incidence of 61-78 cases per 100000 people with a mortality rate of 2%-15%based on co-morbidity burden.AIM To identify the outcomes of NVUGIB in NAFLD hospitalizations in the United States.METHODS We utilized the National Inpatient Sample from 2016-2019 to identify all NVUGIB hospitalizations in the United States.This population was divided based on the presence and absence of NAFLD.Hospitalization characteristics,outcomes and complications were compared.RESULTS The total number of hospitalizations for NVUGIB was 799785,of which 6%were found to have NAFLD.NAFLD and GIB was,on average,more common in younger patients,females,and Hispanics than GIB without NAFLD.Interestingly,GIB was less common amongst blacks with NAFLD.Multivariate logistic regression analysis was conducted,controlling for the multiple covariates.The primary outcome of interest,mortality,was found to be significantly higher in patients with NAFLD and GIB[adjusted odds ratio(aOR)=1.018(1.013-1.022)].Secondary outcomes of interest,shock[aOR=1.015(1.008-1.022)],acute respiratory failure[aOR=1.01(1.005-1.015)]and acute liver failure[aOR=1.016(1.013-1.019)]were all more likely to occur in this cohort.Patients with NAFLD were also more likely to incur higher total hospital charges(THC)[$2148($1677-$2618)];however,were less likely to have a longer length of stay[0.27 d(0.17-0.38)].Interestingly,in our study,the patients with NAFLD were less likely to suffer from acute myocardial infarction[aOR=0.992(0.989-0.995)].Patients with NAFLD were not more likely to suffer acute kidney injury,sepsis,blood transfusion,intubation,or dialysis.CONCLUSION NVUGIB in NAFLD hospitalizations had higher inpatient mortality,THC,and complications such as shock,acute respiratory failure,and acute liver failure compared to those without NAFLD.展开更多
BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hosp...BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021.We calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts.We subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score performance.RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group.AIMS65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding group.However,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both populations.PERS score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical intervention.Addition of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of admission.CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population.PERS and GBS should be used to determine need for endoscopic and surgical intervention,respectively.Lactate can be used as an additional tool to risk scores for predicting inhospital mortality.展开更多
BACKGROUND Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding.Here,we report a case of fistula formation between the...BACKGROUND Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding.Here,we report a case of fistula formation between the esophagus and a nonaneurysmal right bronchial artery(RBA).CASE SUMMARY An 80-year-old woman with previous left pneumonectomy and recent placement of an uncovered self-expandable metallic stent for esophageal adenocarcinoma was admitted due to hematemesis.Emergent computed tomography showed indirect signs of fistulization between the esophagus and a nonaneurysmal RBA,in the absence of active bleeding.Endoscopy revealed the esophageal stent correctly placed and a moderate amount of red blood within the stomach,in the absence of active bleeding or tumor ingrowth/overgrowth.After prompt multidisciplinary evaluation,a step-up approach was planned.The bleeding was successfully controlled by esophageal restenting followed by RBA embolization.No signs of rebleeding were observed and the patient was discharged home with stable hemoglobin level on postoperative day 7.CONCLUSION This was a previously unreported case of an esophageal RBA fistula successfully managed by esophageal restenting followed by RBA embolization.展开更多
文摘Upper gastrointestinal(GI)hemorrhage presents a substantial clinical challenge.Initial management typically involves resuscitation and endoscopy within 24 h,although the benefit of very early endoscopy(<12 h)for high-risk patients is debated.Treatment goals include stopping acute bleeding,preventing rebleeding,and using a multimodal approach encompassing endoscopic,pharmacological,angiographic,and surgical methods.Pharmacological agents such as vasopressin,prostaglandins,and proton pump inhibitors are effective,but the increase in antithrombotic use has increased GI bleeding morbidity.Endoscopic hemostasis,particularly for nonvariceal bleeding,employs techniques such as electrocoagu-lation and heater probes,with concerns over tissue injury from monopolar electrocoagulation.Novel methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have limitations.Currently,the first-line therapy includes thermal probes and hemoclips,with over-the-scope clips emerging for larger ulcer bleeding.The gold probe,combining bipolar electrocoagulation and injection,offers targeted coagulation but has faced device-related issues.Future advancements involve combining techniques and improving endoscopic imaging,with studies exploring combined approaches showing promise.Ongoing research is crucial for developing standardized and effective hemorrhage management strategies.
基金Supported by Key Disciplines Group Construction Project of Shanghai Pudong New Area Health Commission,No.PWZxq2022-06Medical discipline Construction Project of Pudong Health Committee of Shanghai,No.PWYgf2021-02+1 种基金Joint Tackling Project of Pudong Health Committee of Shanghai,No.PW2022D08the Medical Innovation Research Project of the Shanghai Science and Technology Commission,No.22Y11908400.
文摘BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS In this retrospective study,692 patients with UGIB were enrolled from two cen-ters and divided into a training(n=591)and a validation cohort(n=101).The clinical data were collected to develop new prognostic prediction models.The en-dpoint was compound outcome defined as(1)demand for emergency surgery or vascular intervention,(2)being transferred to the intensive care unit,or(3)death during hos-pitalization.The models’predictive ability was compared with previously esta-blished scores by receiver operating characteristic(ROC)curves.RESULTS Totally 22.2%(131/591)patients in the training cohort and 22.8%(23/101)in the validation cohort presented poor outcomes.Based on the stepwise-forward Lo-gistic regression analysis,eight predictors were integrated to determine a new post-endoscopic prognostic scoring system(MH-STRALP);a nomogram was de-termined to present the model.Compared with the previous scores(GBS,Rock-all,ABC,AIMS65,and PNED score),MH-STRALP showed the best prognostic prediction ability with area under the ROC curves(AUROCs)of 0.899 and 0.826 in the training and validation cohorts,respectively.According to the calibration cur-ve,decision curve analysis,and internal cross-validation,the nomogram showed good calibration ability and net clinical benefit in both cohorts.After removing the endoscopic indicators,the pre-endoscopic model(pre-MH-STRALP score)was conducted.Similarly,the pre-MHSTRALP score showed better predictive value(AUROCs of 0.868 and 0.767 in the training and validation cohorts,respectively)than the other pre-endoscopic scores.CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple,convenient,and accurate tools for prognosis prediction of UGIB,and may be applied for early decision on its management strategies.
基金Supported by Xi’an Health Commission Residential Training Base Construction Project,No.2023zp09.
文摘BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%.
文摘Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bleeding ulcers recommend a continuous infusion of proton pump inhibitors (PPI). However, studies comparing intermittent dosing of PPI therapy show that this regimen achieves similar clinical benefits. If the clinical efficacy remains equivalent, intermittent dosing will be more cost-effective for patients and the health care system. Our research study aims to analyze the comparative effectiveness of intermittent versus continuous PPI therapy after endoscopic treatment in patients with UGIB, focusing on such endpoints as rebleeding risk at 3-and 7-day mortality rates. Methods: Resources searched included MEDLINE, EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials databases from January 2010 through December 2023 with the inclusion of meta-analysis, systematic review, review, or ACG guideline recommendations. Results of the analysis show how recommendations regarding high vs. low PPI regimen changed over time: from no difference in regimen in 2010 to recommending continuous regimen in 2012 to declaring insufficient evidence between choosing one regimen over another in 2013 to determine that both regimens were comparable to each other in 2014-2018 and finally to recommending both regimens in 2021. To conclude, our review shows that in patients with bleeding ulcers and high-risk endoscopic findings, intermittent PPI therapy is non-inferior to continuous PPI infusion for three days, seven days bleeding risk or mortality rates;however, it remains challenging to determine the most optimal intermittent regimen due to heterogeneity of RCTs included in meta-analyses, and further trials will need to be performed.
基金The study was reviewed and approved by the departmental Ethics Committee of the Department of Pediatric Gastroenterology and Nutrition of Bangabandhu Shiekh Mujib Medical University(Approval No.BSMMU/Ped.Gastro/2023/122).
文摘BACKGROUND Upper gastrointestinal bleeding(UGIB)is defined as bleeding that occurs proximal to the ligament of Treitz and can sometimes lead to potentially serious and life-threatening clinical situations in children.Globally,the cause of UGIB differs significantly depending on the geographic location,patient population and presence of comorbid conditions.AIM To observe endoscopic findings of UGIB in children at a tertiary care center of Bangladesh.METHODS This retrospective study was carried out in the department of Pediatric Gastroenterology and Nutrition of Bangabandhu Shiekh Mujib Medical University,a tertiary care hospital of Bangladesh,between January 2017 and January 2019.Data collected from hospital records of 100 children who were 16 years of age or younger,came with hematemesis,melena or both hematemesis and melena.All patients underwent upper gastrointestinal endoscopy(Olympus CV 1000 upper gastrointestinal video endoscope)after initial stabilization.Necessary investigations to diagnose portal hypertension and chronic liver disease with underlying causes for management purposes were also done.RESULTS A total of 100 patients were studied.UGIB was common in the age group 5-10 years(42%),followed by above 10 years(37%).Hematemesis was the most common presenting symptom(75%)followed by both hematemesis and melena(25%).UGIB from ruptured esophageal varices was the most common cause(65%)on UGI endoscopy followed by gastric erosion(5%)and prolapsed gastropathy(2%).We observed that 23%of children were normal after endoscopic examination.CONCLUSION Ruptured esophageal varices were the most common cause of UGIB in children in Bangladesh.Other causes included gastric erosions and prolapsed gastropathy syndrome.
文摘Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Gastroenterologists and other involved clinicians are generally assisted by international guidelines in its management.However,NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines,with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and treatment.Conversely,the management of rare and extraordinary rare causes of NVUGIB is not covered by current guidelines.Given they are frequently lifethreatening conditions,all the involved clinicians,that is emergency physicians,diagnostic and interventional radiologists,surgeons,in addition obviously to gastroenterologists,should be aware of and familiar with their management.Indeed,they typically require a prompt diagnosis and treatment,engaging a dedicated,patient-tailored,multidisciplinary team approach.The aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.
基金supported by Wuhan Scientific Research Project(No.EX20B05)National Nature Science Foundation of China(No.82000521).
文摘Objective:This study aimed to establish a nomogram model to predict the mortality risk of patients with dangerous upper gastrointestinal bleeding(DUGIB),and identify high-risk patients who require emergent therapy.Methods:From January 2020 to April 2022,the clinical data of 256 DUGIB patients who received treatments in the intensive care unit(ICU)were retrospectively collected from Renmin Hospital of Wuhan University(n=179)and the Eastern Campus of Renmin Hospital of Wuhan University(n=77).The 179 patients were treated as the training cohort,and 77 patients as the validation cohort.Logistic regression analysis was used to calculate the independent risk factors,and R packages were used to construct the nomogram model.The prediction accuracy and identification ability were evaluated by the receiver operating characteristic(ROC)curve,C index and calibration curve.The nomogram model was also simultaneously externally validated.Decision curve analysis(DCA)was then used to demonstrate the clinical value of the model.Results:Logistic regression analysis showed that hematemesis,urea nitrogen level,emergency endoscopy,AIMS65,Glasgow Blatchford score and Rockall score were all independent risk factors for DUGIB.The ROC curve analysis indicated the area under curve(AUC)of the training cohort was 0.980(95%CI:0.962-0.997),while the AUC of the validation cohort was 0.790(95%CI:0.685-0.895).The calibration curves were tested for Hosmer-Lemeshow goodness of fit for both training and validation cohorts(P=0.778,P=0.516).Conclusion:The developed nomogram is an effective tool for risk stratification,early identification and intervention for DUGIB patients.
基金supported by grants from the Ministry of Science and Technology of the People’s Republic of China(2020AAA0109605)the National Natural Science Grant of China(82072225,82272246)+2 种基金High-level Hospital Construction Project of Guangdong Provincial People’s Hospital(DFJHBF202104)Science and Technology Program of Guangzhou(202206010044)Leading Medical Talents in Guangdong Province of Guangdong Provincial People’s Hospital(KJ012019425)。
文摘BACKGROUND:It is controversial whether prophylactic endotracheal intubation(PEI)protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding(UGIB).The study aimed to explore the predictive value of PEI for cardiopulmonary outcomes and identify high-risk patients with UGIB undergoing endoscopy.METHODS:Patients undergoing endoscopy for UGIB were retrospectively enrolled in the eICU Collaborative Research Database(eICU-CRD).The composite cardiopulmonary outcomes included aspiration,pneumonia,pulmonary edema,shock or hypotension,cardiac arrest,myocardial infarction,and arrhythmia.The incidence of cardiopulmonary outcomes within 48 h after endoscopy was compared between the PEI and non-PEI groups.Logistic regression analyses and propensity score matching analyses were performed to estimate effects of PEI on cardiopulmonary outcomes.Moreover,restricted cubic spline plots were used to assess for any threshold effects in the association between baseline variables and risk of cardiopulmonary outcomes(yes/no)in the PEI group.RESULTS:A total of 946 patients were divided into the PEI group(108/946,11.4%)and the non-PEI group(838/946,88.6%).After propensity score matching,the PEI group(n=50)had a higher incidence of cardiopulmonary outcomes(58.0%vs.30.3%,P=0.001).PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders(odds ratio[OR]3.176,95%confidence interval[95%CI]1.567-6.438,P=0.001).The subgroup analysis indicated the similar results.A shock index>0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI(P=0.015).The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index(OR 1.465,95%CI 1.079-1.989,P=0.014)and shock index>0.77(compared with shock index≤0.77[OR 2.981,95%CI 1.186-7.492,P=0.020,AUC=0.764]).CONCLUSION:PEI may be associated with cardiopulmonary outcomes in elderly and critically ill patients with UGIB undergoing endoscopy.Furthermore,a shock index greater than 0.77 could be used as a predictor of a worse prognosis in patients undergoing PEI.
文摘The etiology of upper gastrointestinal bleeding(UGIB)varies by age,from newborns to adolescents,with some of the causes overlapping between age groups.While particular causes such as vitamin K deficiency and cow’s milk protein allergy are limited to specific age groups,occurring only in neonates and infants,others such as erosive esophagitis and gastritis may be identified at all ages.Furthermore,the incidence of UGIB is variable throughout the world and in different hospital settings.In North America and Europe,most UGIBs are nonvariceal,associated with erosive esophagitis,gastritis,and gastric and duodenal ulcers.In recent years,the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries.However,variceal bleeding still predominates in certain parts of the world,especially in South Asia.The most severe hemorrhage arises from variceal bleeding,peptic ulceration,and disseminated intravascular coagulation.Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients.Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings,the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIBincludes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability,followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis inthe pediatric population because some of them are unique to children. Endoscopic techniques are of significantdiagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally,surgical treatment is reserved for the most severe bleeding.
文摘BACKGROUND: Currently, prophylactic antibiotics are recommended only for cirrhotic patients with acute upper gastrointestinal bleeding(AUGIB);however, the benefit for other AUGIB patients remains undetermined. We aimed to compare the clinical outcomes between patients with AUGIB with and without prophylactic antibiotics to identify the population that requires this therapy.METHODS: Patients with AUGIB admitted between 1st January 2019 and 31st December 2021 in the Emergency Department of Peking Union Medical College Hospital were enrolled. Patients were divided into the antibiotic and non-antibiotic groups. The primary outcome was in-hospital mortality, and the secondary outcome was the onset of new infection. The risk factors for mortality and infection were analyzed, and stratification analysis of prophylactic antibiotics was performed. Continuous data were analyzed using the t-test or nonparametric rank sum test, and categorical data were analyzed using the Chi-square test or Fisher's exact test. Indicators with significant differences between the groups were included for logistic regression analysis. A P-value <0.05 was considered statistically significant. RESULTS: A total of 392 individuals were included, among them, 281 patients received prophylactic antibiotics, and 111 patients did not receive prophylactic antibiotics. The mortality rates were significantly lower in the antibiotic group than in the non-antibiotics group(6.41% vs. 17.12%, P=0.001). The risk factors for infection were varicose veins(P=0.045) and endotracheal intubation(P=0.005) in the prophylactic antibiotic group, and endoscopic treatment(P=0.010) in the non-prophylactic antibiotic group. Stratified analyses showed that patients with age ≥ 65 years, endotracheal intubation, endoscopic treatment, and AUGIB of variceal etiologies benefited from prophylactic antibiotics.CONCLUSION: AUGIB patients may benefit from prophylactic antibiotics to decrease mortality, especially those aged ≥ 65 years and those with endotracheal intubation, endoscopic treatment, and variceal etiologies.
基金Supported by Natural Youth Science Foundation of China,No.82104743Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Innovation Project,No KY2056.
文摘BACKGROUND Massive intragastric clotting(MIC) makes endoscopic therapy difficult in patients with acute upper gastrointestinal bleeding. Literature data on how to address this problem are limited. Here, we report on a case of massive stomach bleeding with MIC that was successfully treated endoscopically using an overtube of singleballoon enteroscopy.CASE SUMMARY A 62-year-old gentleman with metastatic lung cancer was admitted to the intensive care unit due to tarry stools and hematemesis of 1500 mL of blood during hospitalization. Emergent esophagogastroduodenoscopy revealed massive blood clots and fresh blood in the stomach with evidence of active bleeding.Bleeding sites could not be observed even by changing the patient’s position and aggressive endoscope suction. The MIC was successfully removed using an overtube connected with a suction pipe, which was inserted into the stomach with an overtube of a single-balloon enteroscope. An ultrathin gastroscope was also introduced through the nose into the stomach to guide the suction. A massive blood clot was successfully removed, and an ulcer with oozing bleeding at the inferior lesser curvature of the upper gastric body was revealed, facilitating endoscopic hemostatic therapy.CONCLUSION This technique appears to be a previously unreported method to suction MIC out of the stomach in patients with acute upper gastrointestinal bleeding. This technique could be considered when other methods are not available or if they fail to remove massive blood clots in the stomach.
文摘BACKGROUND The optimal timing of esophagogastroduodenoscopy(EGD)and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding(NVUGIB)remains an area of active research.AIM To identify independent predictors of outcomes in patients with NVUGIB,with a particular focus on EGD timing,anticoagulation(AC)status,and demographic features.METHODS A retrospective analysis of adult patients with NVUGIB from 2009 to 2014 was performed using validated ICD-9 codes from the National Inpatient Sample database.Patients were stratified by EGD timing relative to hospital admission(≤24 h,24-48 h,48-72 h,and>72 h)and then by AC status(yes/no).The primary outcome was all-cause inpatient mortality.Secondary outcomes included healthcare usage.RESULTS Of the 1082516 patients admitted for NVUGIB,553186(51.1%)underwent EGD.The mean time to EGD was 52.8 h.Early(<24 h from admission)EGD was associated with significantly decreased mortality,less frequent intensive care unit admission,shorter length of hospital stays,lower hospital costs,and an increased likelihood of discharge to home(all with P<0.001).AC status was not associated with mortality among patients who underwent early EGD(aOR 0.88,P=0.193).Male sex(OR 1.30)and Hispanic(OR 1.10)or Asian(aOR 1.38)race were also independent predictors of adverse hospitalization outcomes in NVUGIB.CONCLUSION Based on this large,nationwide study,early EGD in NVUGIB is associated with lower mortality and decreased healthcare usage,irrespective of AC status.These findings may help guide clinical management and would benefit from prospective validation.
文摘BACKGROUND Gastric cancer(GC)is a prevalent malignant tumor worldwide and ranks as the fourth leading cause of cancer-related mortality.Upper gastrointestinal bleeding(UGIB)is a frequent complication of GC.Radical gastrectomy and palliative therapy are widely used surgical procedures in the clinical management of GC.This study intends to probe the clinical efficacy and safety of radical gastrectomy and palliative therapy on the basis of exploratory laparotomy in patients with GC combined with UGIB,hoping to provide valuable information to aid patients in selecting the appropriate surgical intervention.AIM To investigate the clinical efficacy and safety of exploratory laparotomy^(+)radical gastrectomy and palliative therapy in patients with GC and UGIB combined.METHODS A total of 89 GC patients admitted to the First Affiliated Hospital of the University of South China between July 2018 and July 2020 were selected as participants for this study.The 89 patients were divided into two groups:radical resection group(n=46)treated with exploratory laparotomy^(+)radical gastrectomy and Palliative group(n=43)treated with palliative therapy.The study compared several variables between the two groups,including surgical duration,intraoperative blood transfusion volume,postoperative anal exhaust time,off-bed activity time,length of hospitalization,and incidence of complications such as duodenal stump rupture,anastomotic obstruction,and postoperative incision.Additionally,postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),and CD3^(+)/HLADR^(+)),immunoglobulin(IgG and IgM),tumor markers(CEA,CA199,and CA125),and inflammatory factors(IL-6,IL-17,and TNF-α)were assessed.The surgical efficacy and postoperative quality of life recovery were also evaluated.The patients were monitored for survival and tumor recurrence at 6 mo,1 year,and 2 years post-surgery.RESULTS The results indicated that the duration of operation time and postoperative hospitalization did not differ between the two surgical procedures.However,patients in the radical resection group exhibited shorter intraoperative blood loss,anus exhaust time,off-bed activity time,and inpatient activity time than those in the Palliative group.Although there was no substantial difference in the occurrence of postoperative complications,such as duodenal stump rupture and anastomotic obstruction,between the radical resection group and Palliative group(P>0.05),the radical resection group exhibited higher postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),etc.)and immunoglobulin levels(IgG,IgM)than the Palliative group,while tumor markers and inflammatory factors levels were lower than those in the radical resection group.Additionally,surgical efficacy,postoperative quality of life,and postoperative survival rates were higher in patients who underwent radical gastrectomy than in those who underwent palliative therapy.Moreover,the probability of postoperative tumor recurrence was lower in the radical gastrectomy group compared to the palliative therapy group,and these differences were all statistically significant(P<0.05).CONCLUSION Compared to palliative therapy,exploratory laparotomy^(+)radical gastrectomy can improve immune function,reduce the levels of tumor markers and inflammatory factors,improve surgical efficacy,promote postoperative quality of life recovery,enhance survival rates,and attenuate the probability of tumor recurrence.
文摘Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.
文摘Non-variceal upper gastrointestinal bleeding(NVUGIB)is one of the challenging situations in clinical practice.Despite that gastric ulcer and duodenal ulcer are still the main causes of acute NVUGIB,there are other causes of bleeding which might not always be detected through the standard endoscopic evaluation.Standard endoscopic management of UGIB consists of injection,thermal coagulation,hemoclips,and combination therapy.However,these methods are not always successful for rebleeding prevention.Endoscopic ultrasound(EUS)has been used recently for portal hypertension management,especially in managing acute variceal bleeding.EUS has been considered a better tool to visualize the bleeding vessel in gastroesophageal variceal bleeding.There have been studies looking at the role of EUS for managing NVUGIB;however,most of them are case reports.Therefore,it is important to review back to see the evolution and innovation of endoscopic treatment for NVUGIB and the role of EUS for possibility to replace the standard endoscopic haemostasis management in daily practice.
文摘Objective:To observe the clinical effect of emergency interventional therapy for patients with acute severe non-variceal upper gastrointestinal bleeding.Methods:78 patients with acute severe non-variceal upper gastrointestinal bleeding who were treated in the General Hospital of the Eastern Theater Command from May 2020 to May 2023 were randomly divided into two groups according to different treatment plans.The study group underwent emergency upper gastrointestinal angiography and interventional embolization therapy,the control group was treated with esomeprazole;the clinical data related to the two groups were compared,including the total effective rate of treatment,blood pressure stabilization time,bleeding control time,etc.Results:The effective rate of clinical treatment in the study group was 97.44%,which was higher than that in the control group,which was 79.49%(P<0.05).Both were significantly shorter(P<0.05);the 7 d rebleeding rate and 30 d rebleeding rate of the study group were lower than those of the control group(P<0.05);the 7 d and 30 d mortality rates of the two groups after treatment were compared,and the comparative study group was lower,but there was no significant difference(P>0.05).Conclusion:Emergency interventional therapy can control bleeding more quickly,shorten bleeding control time and complete hemostasis time,shorten blood pressure stabilization time and abdominal pain relief time,and reduce rebleeding rate in patients with acute severe non-variceal upper gastrointestinal bleeding.
基金supported by the Capital’s Funds for Health Improvement and Research(2022-1-2181)Group Medical Aid Project of the Tibet Autonomous Region Natural Science Foundation(XZ2020ZR-ZY28[Z])。
文摘Hypoxic-ischemic encephalopathy(HIE)occurs more in neonatal and rarely in adults.In adults,HIE is commonly caused by carbon monoxide(CO)poisoning,shock,cardiac arrest,respiratory depression,anesthesia and drug overdose.[1–3]In patients with acute gastrointestinal bleeding,decreased circulating blood supply causes cerebral ischemia and hypoxia,leading to dizziness,syncope and even sudden death.However,these conditions are more common especially in elderly patients with cerebrovascular stenosis,acute massive blood loss,using hemostatic agents,and high-risk factors of cardiovascular and cerebrovascular disease.[4]Here,we reported a middle-aged male patient,who was diagnosed with HIE after upper gastrointestinal bleeding without these high-risk factors.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of liver disease globally with an estimated prevalence of 25%,with the clinical and economic burden expected to continue to increase.In the United States,non-variceal upper gastrointestinal bleeding(NVUGIB)has an estimated incidence of 61-78 cases per 100000 people with a mortality rate of 2%-15%based on co-morbidity burden.AIM To identify the outcomes of NVUGIB in NAFLD hospitalizations in the United States.METHODS We utilized the National Inpatient Sample from 2016-2019 to identify all NVUGIB hospitalizations in the United States.This population was divided based on the presence and absence of NAFLD.Hospitalization characteristics,outcomes and complications were compared.RESULTS The total number of hospitalizations for NVUGIB was 799785,of which 6%were found to have NAFLD.NAFLD and GIB was,on average,more common in younger patients,females,and Hispanics than GIB without NAFLD.Interestingly,GIB was less common amongst blacks with NAFLD.Multivariate logistic regression analysis was conducted,controlling for the multiple covariates.The primary outcome of interest,mortality,was found to be significantly higher in patients with NAFLD and GIB[adjusted odds ratio(aOR)=1.018(1.013-1.022)].Secondary outcomes of interest,shock[aOR=1.015(1.008-1.022)],acute respiratory failure[aOR=1.01(1.005-1.015)]and acute liver failure[aOR=1.016(1.013-1.019)]were all more likely to occur in this cohort.Patients with NAFLD were also more likely to incur higher total hospital charges(THC)[$2148($1677-$2618)];however,were less likely to have a longer length of stay[0.27 d(0.17-0.38)].Interestingly,in our study,the patients with NAFLD were less likely to suffer from acute myocardial infarction[aOR=0.992(0.989-0.995)].Patients with NAFLD were not more likely to suffer acute kidney injury,sepsis,blood transfusion,intubation,or dialysis.CONCLUSION NVUGIB in NAFLD hospitalizations had higher inpatient mortality,THC,and complications such as shock,acute respiratory failure,and acute liver failure compared to those without NAFLD.
文摘BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021.We calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts.We subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score performance.RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group.AIMS65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding group.However,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both populations.PERS score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical intervention.Addition of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of admission.CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population.PERS and GBS should be used to determine need for endoscopic and surgical intervention,respectively.Lactate can be used as an additional tool to risk scores for predicting inhospital mortality.
文摘BACKGROUND Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding.Here,we report a case of fistula formation between the esophagus and a nonaneurysmal right bronchial artery(RBA).CASE SUMMARY An 80-year-old woman with previous left pneumonectomy and recent placement of an uncovered self-expandable metallic stent for esophageal adenocarcinoma was admitted due to hematemesis.Emergent computed tomography showed indirect signs of fistulization between the esophagus and a nonaneurysmal RBA,in the absence of active bleeding.Endoscopy revealed the esophageal stent correctly placed and a moderate amount of red blood within the stomach,in the absence of active bleeding or tumor ingrowth/overgrowth.After prompt multidisciplinary evaluation,a step-up approach was planned.The bleeding was successfully controlled by esophageal restenting followed by RBA embolization.No signs of rebleeding were observed and the patient was discharged home with stable hemoglobin level on postoperative day 7.CONCLUSION This was a previously unreported case of an esophageal RBA fistula successfully managed by esophageal restenting followed by RBA embolization.
