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Predictors of rebleeding and in-hospital mortality in patients with nonvariceal upper digestive bleeding

World Journal of Clinical Cases 2019年第18期7卷 2687-2703页

作者： Daniela Cornelia Lazar Sorin Ursoniu Adrian Goldis Department of Internal Medicine I University Medical ClinicUniversity of Medicine and Pharmacy "Victor Babes"Timisoara 300041Timis CountyRomania Department of Public Health and Health Management University of Medicine and Pharmacy "Victor Babes"Timisoara 300041Timis CountyRomania Department of Gastroenterology and Hepatology University of Medicine and Pharmacy "Victor Babes"Timisoara 300041Timis CountyRomania

BACKGROUND nonvariceal upper digestive bleeding (NVUDB) represents a severe emergency condition and is associated with significant morbidity and mortality. Despite a decrease in the incidence due to the widespread use of potent therapy with proton pump inhibitors as well as the implementation of modern endoscopic techniques, the mortality rate associated with NVUDB is still high. AIM To identify the clinical, biological, and endoscopic parameters associated with a poor outcome in patients with NVUDB to allow the stratification of risk, which will lead to the implementation of the most accurate management. METHODS We performed a retrospective study including patients who were admitted to the Gastroenterology Department of Clinical Emergency County Hospital Timisoara, Romania, with a diagnosis of NVUDB between 1 January 2008 and 31 December 2016. All the data were collected from the patient’s records, including demographic data, medication history, hemodynamic status, paraclinical tests, and endoscopic features as well as the methods of hemostasis, rate of rebleeding, need for surgery and death;we also assessed the Rockall score of the patients, length of hospitalization and associated comorbidities. All these parameters were evaluated as potential risk factors associated with rebleeding and death in patients with *** We included a batch of 1581 patients with NVUDB, including 523 (33%) females and 1058 (67%) males with a median age of 66 years. The main cause of NVUDB was peptic ulcer (73% of patients). More than one-third of the patients needed endoscopic treatment. Rebleeding rate was 7.72%;surgery due to failure of endoscopic hemostasis was needed in 3.22% of cases;the in-hospital mortality rate was 8.09%, and the bleeding-episode-related mortality rate was 2.97%. Although our predictive models for rebleeding and death had a low sensitivity, the specificity was very high, suggesting a better discriminative capacity for identifying patients with better out

关键词： nonvariceal upper digestive bleeding Risk factors Rebleeding Death Outcome

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Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting

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World Journal of Gastroenterology 2006年第48期12卷 7779-7785页

作者： Robert A Enns Yves M Gagnon Alan N Barkun David Armstrong Jamie C Gregor Richard N Fedorak RUGBE Investigators Group Division of Gastroenterology University of British Columbia Vancouver Canada Occam Research & Consulting Inc. VancouverCanada Department of Medicine Division of Gastroenterology McGill University and the McGill UniversityHealth Center Montreal Canada Division of Gastroenterology McMaster University Medical Centre Hamilton Canada Division of Gastroenterology University of Western Ontario London Canada Division of Gastroenterology University of Alberta Edmonton Canada 不详

AIM: To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death. METHODS: We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals. Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used χ2 goodness-of-fit tests to assess the degree of calibration, and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system. RESULTS: For rebleeding, the χ2 goodness-of-fit test indicated an acceptable fit for the model [χ2 (8) = 12.83, P = 0.12]. For surgical procedures [χ2 (8) = 5.3, P = 0.73] and death [χ2 (8) = 3.78, P = 0.88], the tests showed solid correspondence between observed proportions and predicted probabilities. The AUC was 0.59 (95% CI: 0.55-0.62) for the outcome of rebleeding and 0.60 (95% CI: 0.54-0.67) for surgical procedures, representing apoor discriminative ability of the scoring system. For the outcome of death, the AUC was 0.73 (95% CI: 0.69-0.78), indicating an acceptable discriminative ability. CONCLUSION: The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures.

关键词： Upper gastrointestinal bleeding nonvariceal Predictors Rockall Outcomes

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Portal hypertensive gastropathy:A systematic review of thepathophysiology,clinical presentation,natural history andtherapy

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World Journal of Hepatology 2016年第4期8卷 231-262页

作者： Mihajlo Gjeorgjievski Mitchell S Cappell Division of Gastroenterology and Hepatology William Beaumont HospitalRoyal OakMI 48073United States Oakland University William Beaumont School of Medicine Royal OakMI 48073United States

AIM: To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy(PHG) based on a systematic literature ***: Computerized search of the literature was performed via Pub Med using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS: PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without *** increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibilit

关键词： Portal hypertensive gastropathy Congestivegastropathy Portal hypertension Cirrhosis Cirrhotic Chronic liver disease nonvariceal upper gastrointestinalbleeding Esophageal varices Hepatic fibrosis

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