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upper gastrointestinal bleeding in Bangladeshi children:Analysis of 100 cases

World Journal of gastrointestinal Endoscopy 2024年第1期16卷 44-50页

作者： Md Wahiduzzaman Mazumder Md Benzamin Department of Pediatric Gastroenterology and Nutrition Bangabandhu Sheikh Mujib Medical UniversityDhaka 1000Bangladesh Department of Pediatric Gastroenterology and Nutrition Sylhet M A G Osmani Medical College HospitalSylhet 3100Bangladesh

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.

关键词： Bangladeshi Children Endoscopy upper gastrointestinal bleeding Esophageal varices

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MH-STRALP:A scoring system for prognostication in patients with upper gastrointestinal bleeding

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World Journal of gastrointestinal Surgery 2024年第3期16卷 790-806页

作者： Jun-Nan Hu Fei Xu Ya-Rong Hao Chun-Yan Sun Kai-Ming Wu Yong Lin Lan Zhong Xin Zeng Department of Gastroenterology Shanghai East HospitalTongji University School of MedicineShanghai 200120China Department of Gastroenterology Shanghai Changzheng HospitalNavy Military Medical UniversityShanghai 200003China

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.

关键词： upper gastrointestinal bleeding Prognosis prediction Retrospective study Nomogram Post-endoscopic model Pre-endoscopic model

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Advancements in hemostatic strategies for managing upper gastrointestinal bleeding: A comprehensive review

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World Journal of Gastroenterology 2024年第15期30卷 2087-2090页

作者： Ah Young Lee Joo Young Cho Division of Gastroenterology Department of Internal MedicineCha Gangnam Medical CenterCha University College of MedicineSeoul 06135Korea

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(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.

关键词： upper gastrointestinal bleeding Hemostasis Endoscopy Probe Spray Clip

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Comparative Analysis of Continuous versus Intermittent Proton Pump Inhibitor Therapy in Patients with upper gastrointestinal bleeding Due to Ulcers

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Open Journal of Gastroenterology 2024年第3期14卷 99-107页

作者： Abraamyan Feruza Misra P. Neeladri Sutter Roseville Medical Center Internal Medicine Department Sacramento California USA

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.

关键词： upper gastrointestinal bleeding PPI Continuous Intermittent Bolus Regimens Review

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Importance of risk assessment,endoscopic hemostasis,and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding

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World Journal of Clinical Cases 2024年第24期12卷 5462-5467页

作者： Rick Maity Arkadeep Dhali Jyotirmoy Biswas General Medicine Institute of Post Graduate Medical Education and ResearchKolkata 700020India Department of Gastroenterology Sheffield Teaching Hospitals NHS Foundation TrustNorthern General HospitalSheffield S57AUUnited Kingdom School of Medicine and Population Health University of SheffieldSheffield S102HQUnited Kingdom General Medicine College of Medicine and Sagore Dutta HospitalKolkata 700058India

Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)is a common medical emergency in clinical practice.While the incidence has significantly reduced,the mortality rates have not undergone a similar reduction in the last few decades,thus presenting a significant challenge.This editorial outlines the key causes and risk factors of ANVUGIB and explores the current standards and recent updates in risk assessment scoring systems for predicting mortality and endoscopic treatments for achieving hemostasis.Since ANUVGIB predominantly affects the elderly population,the impact of comorbidities may be responsible for the poor outcomes.A thorough drug history is important due to the increasing use of antiplatelet agents and anticoagulants in the elderly.Early risk stratification plays a crucial role in deciding the line of management and predicting mortality.Emerging scoring systems such as the ABC(age,blood tests,co-morbidities)score show promise in predicting mortality and guiding clinical decisions.While conventional endoscopic therapies remain cornerstone approaches,novel techniques like hemostatic powders and over-the-scope clips offer promising alternatives,particularly in cases refractory to traditional modalities.By integrating validated scoring systems and leveraging novel therapeutic modalities,clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with ANVUGIB.

关键词： Non-variceal upper gastrointestinal bleeding upper gastrointestinal bleeding gastrointestinal bleeding Risk stratification Risk assessment scores Prognostication Endoscopy Esophagogastroduodenoscopy Endoscopic hemostasis

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Application Effect of Staged Health Education in the Nursing Care of Patients with upper gastrointestinal bleeding

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Journal of Contemporary Educational Research 2024年第4期8卷 204-208页

作者： Zhe Chen Rui Cao Department of Gastroenterology Shaanxi Provincial People’s HospitalXi’an 710068Shaanxi ProvinceChina

Objective:To investigate the application effect of staged health education in the care of patients with upper gastrointestinal bleeding.Methods:This study takes health education in the care of patients with upper gastrointestinal bleeding as the main direction.160 patients with upper gastrointestinal bleeding who received treatment in our hospital were selected as samples,and the grouping software was used to divide them into the reference group and the study group,with 80 patients each.The reference group and the study group used routine health education and staged health education respectively.Relevant research data were recorded during the nursing process,analyzed,and used as research indicators.Results:The compliance behavior of the study group was higher than that of the reference group after the staged nursing care,and at the same time,the nursing care satisfaction of the study group was higher than that of the reference group(Pupper gastrointestinal bleeding not only enhances the degree of patient awareness and compliance but also improves nursing satisfaction,which is worthy of promotion and application.

关键词： Staged health education upper gastrointestinal bleeding Application effect

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upper gastrointestinal bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography during successful cardiopulmonary resuscitation:A case report

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World Journal of Clinical Cases 2022年第9期10卷 2954-2960页

作者： Miao-Miao Tang Deng-Feng Fang Bin Liu Department of Anesthesiology West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND In recent years,it has been recognized that transesophageal echocardiography(TEE)is of great value in resuscitation of cardiac arrest.However,its safety has rarely been reported.CASE SUMMARY We present a 59-year-old male patient scheduled to undergo cardiac surgery for rheumatic heart disease.upper gastrointestinal bleeding from a Mallory-Weiss tear appeared following cardiopulmonary resuscitation,TEE,and percutaneous cardiopulmonary bypass resuscitation when he suffered from aesthesia-related cardiac arrest.gastrointestinal injury was diagnosed promptly and treated effectively.However,the exact etiology of gastrointestinal injury was unclear;the interaction of closed-chest cardiac massage and the application of TEE may be involved as a most possible mechanism of injury.CONCLUSION Serious complications should be considered when TEE is used in patients with special pathophysiological conditions.

关键词： Transesophageal echocardiography upper gastrointestinal bleeding Cardiopulmonary resuscitation Mallory-Weiss tear Percutaneous cardiopulmonary bypass resuscitation Case report

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Cardiopulmonary prognosis of prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy

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World Journal of Emergency Medicine 2023年第5期14卷 372-379页

作者： Yufang Lin Fei’er Song Weiyue Zeng Yichi Han Xiujuan Chen Xuanhui Chen Yu Ouyang Xueke Zhou Guoxiang Zou Ruirui Wang Huixian Li Xin Li School of Biology and Biological Engineering South China University of TechnologyGuangzhou 510006China Department of Emergency Medicine Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhou 510080China Medical Big Data Center Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhou 510080China School of Medicine South China University of TechnologyGuangzhou 510006China Guangdong Cardiovascular Institute Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhou 510100China

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

关键词： Prophylactic endotracheal intubation upper gastrointestinal bleeding Cardiopulmonary outcomes eICU Collaborative Research Database

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Age-specific causes of upper gastrointestinal bleeding in children

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World Journal of Gastroenterology 2023年第47期29卷 6095-6110页

作者： Marija Kocic Petar Rasic Vuk Marusic Dragan Prokic Djordje Savic Maja Milickovic Ivana Kitic Tanja Mijovic Adrijan Sarajlija Department of Gastroenterology Hepatology and NutritionMother and Child Health Care Institute of Serbia“Dr.Vukan Cupic”Belgrade 11000Serbia Department of Abdominal Surgery Mother and Child Health Care Institute of Serbia“Dr.Vukan Cupic”Belgrade 11000Serbia Institute of Epidemiology Faculty of MedicineUniversity of BelgradeBelgrade 11000Serbia Faculty of Medicine University of BelgradeBelgrade 11000Serbia Pediatric Day Care Hospital Department Mother and Child Health Care Institute of Serbia“Dr.Vukan Cupic”Belgrade 11000Serbia Department of Abdominal Surgery Mother and Child Health Care Institute of Serbia“Dr.Vukan Cupic”Radoja Dakica 6-8Belgrade 11000Serbia

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.

关键词： upper gastrointestinal bleeding Age-specific Epidemiology Pediatric Unusual cause

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Rare causes of acute non-variceal upper gastrointestinal bleeding: A comprehensive review

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World Journal of Gastroenterology 2023年第27期29卷 4222-4235页

作者： Alberto Martino Marco Di Serafino Luigi Orsini Francesco Giurazza Roberto Fiorentino Enrico Crolla Severo Campione Carlo Molino Luigia Romano Giovanni Lombardi Department of Gastroenterology and Digestive Endoscopy AORN“Antonio Cardarelli”Naples 80131Italy Department of General and Emergency Radiology AORN“Antonio Cardarelli”Naples 80131Italy Department of Interventional Radiology AORN“Antonio Cardarelli”Naples 80131Italy Department of Oncology AORN“Antonio Cardarelli”Naples 80131Italy Department of Oncological Surgery AORN“Antonio Cardarelli”Naples 80131Italy Department of Pathology AORN“Antonio Cardarelli”Naples 80131Italy

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.

关键词： gastrointestinal bleeding upper gastrointestinal bleeding Non-variceal upper gastrointestinal bleeding Rare causes Vascular causes upper endoscopy

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