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Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

World Journal of Gastroenterology 2009年第9期15卷 1099-1104页

作者： Supot Pongprasobchai Sireethorn Nimitvilai Jaroon Chasawat sathaporn manatsathit Division of Gastroenterology Department of Internal Medicine Siriraj Hospital Bangkok 10700 Thailand Department of Internal Medicine Siriraj Hospital Bangkok 10700 Thailand

AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS： Among 261 patients with UGIB, 47 （18%） had variceal and 214 （82%） had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease （OR 22.4, 95% CI 8.3-60.4, P 〈 0.001）, red vomitus （OR 4.6, 95% CI 1.8-11.9, P = 0.02）, and red nasogastric （NG） aspirate （OR 3.3, 95% CI 1.3-8.3, P = 0.011）. The UGIB Etiology Score was calculated from （3.1× previous diagnosis of cirrhosis or signs of chronic liver disease）＋（1.5× red vomitus）＋（1.2× red NG aspirate）, when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value （PPV）, and negative predictive value （NPV） in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in cases （46 variceal and 149 another set of 195 UGIB non-variceal bleeding）. The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION： The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

关键词： Non-variceal bleeding Predictor Score Upper gastrointestinal bleeding Upper gastrointestinal hemorrhage Variceal bleeding

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Yield,etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

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World Journal of Gastrointestinal Endoscopy 2013年第3期5卷 122-127页

作者： Supot Pongprasobchai Songla Chitsaeng Tawesak Tanwandee sathaporn manatsathit Udom Kachintorn Division of Gastroenterology Department of Internal MedicineSiriraj HospitalMahidol UniversityBangkok 10700Thailand

AIM:To investigate the yield,etiologies and impact of capsule endoscopy(CE) in Thai patients with obscure gastrointestinal bleeding(OGIB).METHODS:The present study is a retrospective cohort *** patients with OGIB who underwent CE in Siriraj Hospital,Bangkok,Thailand during 2005-2009 were included in the *** the patients' medical records and results of the CE videos were *** findings were classified as significant,suspicious/equivocal and *** of the lesions were located to duodenum,jejunum,jejunoileum,ileum and diffuse lesions by the localization device of the *** of CE on the patients' management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood ***' outcomes(rebleeding,persistent bleeding,anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the ***:Overall,there were 103 patients with OGIB included in the *** age of the patients was 64 ± 16 years(range 9-88 years) and 57 patients(55%) were *** of OGIB were overt in 80(78%) and occult in 23 patients(22%).The median time interval of CE after onset of OGIB was 10 d(range 1-180 d).The median time of follow-up was 19 mo(range 1-54 mo).Capsules reached caecum in 77 patients(74%) and capsule retention was found in 1 patient(1%).The diagnostic yield of CE revealed significant lesions in 37 patients(36%),suspicious/equivocal lesions in 15 patients(15%) and 51 patients(49%) had negative CE *** the significant lesions,the bleeding etiologies were small bowel ulcers in 44%,angiodysplasia in 27%,small bowel tumor in 13%,miscellaneous in 8% and active bleeding without identifiable causes in 8%.Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs(48%,P = 0.034),while patients with small bowel tumors were more commonly female(86%,P = 0.043) compared to the ot

关键词： Angiodysplasia Etiology Gastrointestinal Bleeding Obscure Capsule Endoscopy Outcome Small bowel ulcer Wireless

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