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Non Variceal Bleed

Alan N Barkun, Viviane Adam, Richard C K Wong
BACKGROUND & AIMS: Upper gastrointestinal bleeding is a common emergency and rebleeding is associated with an increased risk of death. Proper assessment of high-risk lesions and appropriate endoscopic hemostasis are required for the best outcomes. The endoscopic Doppler probe exam (DPE) allows for a more complete assessment of the stigmata of hemorrhage, providing better evaluation of the need for endoscopic hemostasis and determination of its completeness. We aimed to evaluate whether use of the DPE provides an additional advantage in cost and effectiveness compared with traditional endoscopic visual assessment (TEA) of high-risk stigmata in patients with non-variceal upper gastrointestinal bleeding...
February 14, 2019: Clinical Gastroenterology and Hepatology
Ali Akbar Hajiagha Mohammadi, Mohammad Reza Azizi
BACKGROUND AND STUDY AIMS: Acute upper gastrointestinal bleeding is one of the main causes of hospitalisation. The purpose of this study was to determine the prognostic factors in non-variceal upper gastrointestinal bleeding. PATIENTS AND METHODS: Clinical outcomes, demographic and laboratory variables of the subjects were collected from the HIS software and national code with the SQL format from three hospitals in Qazvin. The data were linked to the database software designed by the author...
February 12, 2019: Arab Journal of Gastroenterology: the Official Publication of the Pan-Arab Association of Gastroenterology
Antonio Tarasconi, Gian Luca Baiocchi, Vittoria Pattonieri, Gennaro Perrone, Hariscine Keng Abongwa, Sarah Molfino, Nazario Portolani, Massimo Sartelli, Salomone Di Saverio, Arianna Heyer, Luca Ansaloni, Federico Coccolini, Fausto Catena
Background: Nowadays, very few patients with non-variceal upper gastrointestinal bleeding fail endoscopic hemostasis (refractory NVUGIB). This subset of patients poses a clinical dilemma: should they be operated on or referred to transcatheter arterial embolization (TAE)? Objectives: To carry out a systematic review of the literature and to perform a meta-analysis of studies that directly compare TAE and surgery in patients with refractory NVUGIB. Materials and methods: We searched PubMed, Ovid MEDLINE, and Embase...
2019: World Journal of Emergency Surgery: WJES
Magnus Strøh Schmidt, Louise Preisler, Rasmus Fabricius, Peter Svenningsen, Jens Hillingsø, Lars Bo Svendsen, Martin Sillesen
INTRODUCTION: Treatment-requiring acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common, potentially life-threatening emergency. This study investigated whether hospital admittance volume of patients with NVUGIB was associated with reduced mortality, reduced lasting failure of haemostatic procedures defined as rate of re-endoscopy with repeated haemostasis intervention (ReWHI), transfusion requirements and conversion to surgery. METHODS: Data on Danish nationwide admissions of patients with acute NVUGIB from 2011-2013 were analysed to estimate 30-day mortality, re-bleeding (ReWHI), transfusion rates and rates of conversion to surgery...
February 2019: Danish Medical Journal
F Fabbian, U Fedeli, A De Giorgi, R Cappadona, M Guarino, M Gallerani, R Manfredini R De Giorgio
OBJECTIVE: The relationship between in-hospital mortality (IHM) and acute oesophageal variceal bleeding (AOEVB) has not been fully assessed. The aim of this study was to establish the association between sex and mortality for patients hospitalized with AOEVB. PATIENTS AND METHODS: We analyzed hospitalizations from the Italian Health Ministry database by identifying all patients discharged with AOEVB from January 2001 to December 2015. A total of 144,943 hospitalizations were for oesophageal varices, but only 24,570 emergency admissions with AOEVB coded as the primary or secondary diagnosis were included for analysis...
January 2019: European Review for Medical and Pharmacological Sciences
Frederik Nevens, Paulo Lisboa Bittencourt, Minneke J Coenraad, Huiguo Ding, Ming-Chih Hou, Pierre-François Laterre, Manuel Mendizabal, Nayeli Xochiquetzal Ortiz-Olvera, Julio D Vorobioff, Wenhong Zhang, Paolo Angeli
Cirrhosis is a serious and life-threatening condition which imposes a significant socioeconomic burden on affected individuals and healthcare systems. Cirrhosis can result in portal hypertension, which may lead to major complications, including acute variceal bleeding and hepatorenal syndrome. Without prompt treatment, these complications may be life-threatening. Over the past 2 decades, new treatment modalities and treatment strategies have been introduced, which have improved patients' prognosis, but the initial management of these severe complications continues to present a challenge...
January 25, 2019: Digestive Diseases and Sciences
Grace Lai-Hung Wong, Lilian Yan Liang, Raymond Kwok, Aric Josun Hui, Yee-Kit Tse, Henry Lik-Yuen Chan, Vincent Wai-Sun Wong
We previously demonstrated the possible non-inferiority of a screening strategy for varices guided by liver and spleen stiffness measurement (LSSM) compared to universal endoscopic screening in detecting clinically significant varices in patients with cirrhosis. We now report the long-term outcome of the patients recruited in this trial for incident variceal bleeding and other hepatic events. This was a prospective follow-up study of a non-inferiority, open-label, randomized controlled trial (NCT02024347) of 548 adult patients with known chronic liver diseases, radiological evidence of liver cirrhosis and compensated liver function...
January 25, 2019: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Roula Sasso, Don C Rockey
OBJECTIVE: The belief that cirrhotic patients are "auto-anticoagulated" often results in anticoagulation therapy being withheld in these patients. We aimed to understand patterns of use of anticoagulation and to determine the risk of bleeding complications in cirrhotic patient. METHODS: We retrospectively analysed 320 cirrhotic patients treated with anticoagulation therapy from July 15 ,2014 to January 30, 2018. We performed bivariate and multivariate analyses to identify risk factors for clinically relevant bleeding...
January 17, 2019: American Journal of Medicine
Durayd Alzoubaidi, Laurence B Lovat, Rehan Haidry
Acute upper gastrointestinal bleeding (AUGIB) is one of the most common medical emergencies in the UK. Despite advancement in technology the management of AUGIB remains a challenge. The clinical community recognise the need for improvement in the treatment of these patients. AUGIB has a significant impact on resources. Endoscopic therapy is the gold standard treatment. The mortality in AUGIB is rarely related to the presenting bleed but significantly associated with concurrent comorbidities. The cost of blood transfusion in the management of patients with AUGIB is significant and misuse of blood products has been documented nationally...
January 2019: Frontline Gastroenterology
(no author information available yet)
No abstract text is available yet for this article.
February 2019: Gut
Warren Chapman, Keith Siau, Fiona Thomas, Selvajothi Ernest, Shriya Begum, Tariq Iqbal, Neeraj Bhala
This article outlines latest evidence-based care for patients with acute upper gastrointestinal (GI) bleeding. It aims to help gastroenterology and general medical ward nurses plan nursing interventions and understand the diagnostic treatment options available. Acute upper GI bleeding can present as variceal or non-variceal bleeding and has a high death rate. Endoscopy is used for diagnosis and to provide therapy, prior to which the patient should be adequately resuscitated and assessed. Various therapies can be initiated at endoscopy, depending on the source of bleeding...
January 10, 2019: British Journal of Nursing: BJN
Bu-Shan Xie, Jia-Wei Zhong, An-Jiang Wang, Zhen-Dong Zhang, Xuan Zhu, Gui-Hai Guo
BACKGROUND: Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension (IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt (TIPS) plus embolization. CASE SUMMARY: A 46-year-old woman with anemia for two years was frequently admitted to the local hospital...
December 26, 2018: World Journal of Clinical Cases
Rita Jiménez Rosales, Juan Gabriel Martínez-Cara, Francisco Vadillo-Calles, Eva Julissa Ortega-Suazo, Patricia Abellán-Alfocea, Eduardo Redondo-Cerezo
BACKGROUND: upper gastrointestinal bleeding (UGIB) is one of the main causes of hospital admission in gastroenterology departments and is associated with a significant morbidity and mortality. Rebleeding after initial endoscopic therapy occurs in 10-20% of cases and therefore, there is a need to define predictive factors for rebleeding. AIM: the aim of our study was to analyze risk factors and outcomes in a population of patients who suffered a rebleed. METHODS: five hundred and seven patients with gastrointestinal bleeding were included...
December 10, 2018: Revista Española de Enfermedades Digestivas
Loren Laine
Current guidelines recommend cirrhotic patients undergo endoscopic screening for varices, unless patients have liver stiffness <20kPa and platelet count >150x109 /L1 . Screening for varices presumes we can offer an intervention to reduce risk of first variceal hemorrhage and, ideally, death. Because risk of bleeding increases with variceal size, guidelines recommend patients with medium-large esophageal varices receive endoscopic variceal band ligation (VBL), non-selective β-blockers (NSBB), or carvedilol as primary preventive therapy to reduce first variceal hemorrhage...
December 18, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Lubna Kamani, Baseer Sultan Ahmad, Muhammad Arshad, Pervez Ashraf
Objective: To determine the safety and efficacy of N-butyl 2-cyanoacrylate in bleeding gastric varices in children. Methods: This retrospective observational study was conducted in the Department of Gastroenterology and Pediatric Surgery in Liaquat National Hospital Karachi between January 2010 and January 2017. Gastric fundal varices were obliterated in pediatric population with single shot of N-butyl-2 Cyanoacrylate 0.50ml diluted with 0.50ml of Lipoidal with use of forward-viewing video endoscope with 22-gauge needle...
November 2018: Pakistan Journal of Medical Sciences Quarterly
Thomas Reiberger, Theresa Bucsics, Rafael Paternostro, Nikolaus Pfisterer, Florian Riedl, Mattias Mandorfer
Purpose of Review: The natural history and classification systems of small varices (≤ 5 mm in diameter) in cirrhotic patients with portal hypertension are summarized. Studies that assessed the course of and therapeutic intervention for small varices are discussed. Recent Findings: Current non-invasive methods show suboptimal sensitivity to detect small varices in patients with cirrhosis. Next to etiological therapy, hepatic venous pressure gradient (HVPG)-guided non-selective betablocker or carvedilol treatment has shown to impact on natural history of small varices...
2018: Current Hepatology Reports
Amol Agarwal, Petros Benias, Olaya I Brewer Gutierrez, Vivien Wong, Yuri Hanada, Juliana Yang, Vipin Villgran, Vivek Kumbhari, Anthony Kalloo, Mouen A Khashab, Philip Chiu, Saowanee Ngamruengphong
Background and study aims  Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown. Patients and methods  This is an international case series of patients who underwent endoscopic suturing for bleeding PUD. Primary outcome was rate of immediate hemostasis and rate of early rebleeding (within 72 hours). Secondary outcomes included technical success, delayed rebleeding (> 72 hours), and rate of adverse events (AEs)...
December 2018: Endoscopy International Open
Jeong-Ju Yoo, Young Chang, Eun Ju Cho, Ji Eun Moon, Sang Gyune Kim, Young Seok Kim, Yun Bin Lee, Jeong-Hoon Lee, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon
AIM: To examine the association between the timing of endoscopy and the short-term outcomes of acute variceal bleeding in cirrhotic patients. METHODS: This retrospective study included 274 consecutive patients admitted with acute esophageal variceal bleeding of two tertiary hospitals in Korea. We adjusted confounding factors using the Cox proportional hazards model and the inverse probability weighting (IPW) method. The primary outcome was the mortality of patients within 6 wk...
November 28, 2018: World Journal of Gastroenterology: WJG
Jitrapa Kerdsuknirun, Virunpat Vilaichone, Ratha-Korn Vilaichone
Objective: Hepatocellular carcinoma (HCC) is common cancer in ASEAN. Variceal bleeding (VB) is considered to be fatal complication of cirrhosis with HCC. However, limited studies were reported in ASEAN. Aim of this study was to evaluate overall survival rate and predictors of VB in HCC patients. Methods: We conducted a retrospective cohort study of HCC patients aged ≥15 years between January 2012-January 2016 and follow up through June 2016 at Thammasat University Hospital, Thailand. Clinical information and radiologic findings were collected from reviewing computer database of medical records...
November 29, 2018: Asian Pacific Journal of Cancer Prevention: APJCP
Asmaa Elzeftawy, Loai Mansour, Abdelrahman Kobtan, Heba Mourad, Ferial El-Kalla
BACKGROUND/AIMS: The development of esophageal varices (EV) and resultant bleeding are the most critical complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV. To find a non-invasive method for diagnosis of EV and to predict the bleeding risk is appealing and would decrease the cost and discomfort of upper endoscopy. The aim of our study was to evaluate the blood ammonia level as a predictor of the presence of EV and of a high risk of bleeding...
November 21, 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
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