Impact of Ethnicity in Upper Gastrointestinal Hemorrhage

Wollenman, Casey S.; Chason, Rebecca D.; Reisch, Joan; Rockey, Don C.

doi:10.1097/mcg.0000000000000025

Cited by 24 publications

(28 citation statements)

References 22 publications

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“…It is a frequent cause of hospitalization, although a number of advances have been made in diagnosis and treatments. Studies from the United States indicated that hospitalizations for upper GI (UGI) hemorrhage in the early 1990s occurred at an annual incidence of ~100/100,000 population and were ~5 times more common than hospitalizations for lower GI hemorrhage (5)(6)(7)(8)(9). UGI hemorrhage usually causes fatalities in 6-14% of those it affects (9,10).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of gastrointestinal hemorrhage associated with pancreatic cancer: A retrospective review of 246 cases

Wang

Yuan

Liu

2015

Molecular and Clinical Oncology

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Abstract. While gastrointestinal (GI) hemorrhage is common in the general population, few studies have evaluated large numbers of GI hemorrhage patients with pancreatic cancer. The clinical features and potential risk factors of GI hemorrhage with pancreatic cancer was investigated in the present study and the effect of GI hemorrhage on survival rate was examined. Patients enrolled in the present study had pathologically proven pancreatic cancer, and received treatment between August 2006 and 2012. Their medical records were retrospectively reviewed. The data for the present study were obtained from a review of 246 patients with pancreatic cancer (average age, 63.4±10.92 years; 190 male cases, 56 female cases). In addition, 73 cases had stage I-II, 173 had stage III-IV, and only 67 cases (27.2%) were candidates for curative pancreatectomy. Among them, 32 cases (13.0%) were clinically diagnosed with GI hemorrhage. A total of 24 cases were male patients and the other 8 cases were female, the cases of hemorrhage history and alcoholism were 2 and 29 cases, respectively. The major initial clinical symptoms of GI hemorrhage included 18 patients with melena or blood stool (56.25%), 9 with haematemesis (28.13%), 3 with abdominal distention (9.37%) and 2 with stomach ache (6.25%). The independent risk factor for GI hemorrhage was tumor initial stage of IV. A continuous increase in carbohydrate antigen 19-9 (CA19-9) may be a warning of GI hemorrhage, particularly when it is >1,000 U/ml. The most frequent method of hemostasis was combination therapy (n=12, 37.5%). Only 3 cases (9.3%) of these 32 GI hemorrhage patients were blood stanched and only 10 patients (31.2%) received gastroscopy. The time from GI hemorrhage to fatality is extremely short (median 30 days, range from 1 h to 65 days), and the median overall survival time of the patients with GI hemorrhage was 9.0 months (range, 2.0-16.0 months) and was significantly shorter than that of patients without GI hemorrhage [14.5 months (range, 0.5-48.0 months)]. In conclusion, although GI hemorrhage was not common in patients with pancreatic cancer, it is critical. GI hemorrhage was controlled with endoscopic hemostasis. Clinicians should fully assess the risk factors of GI hemorrhage (such as alcohol, smoking, past hemorrhage history, initial stage, tumor location and CA19-9 level at diagnosis of pancreatic cancer) when the pancreatic cancer patients were on admission, particularly for patients of the late stage, preventive measures should be investigated to reduce suffering.

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Section: Introductionmentioning

confidence: 99%

Characteristics of gastrointestinal hemorrhage associated with pancreatic cancer: A retrospective review of 246 cases

Wang

Yuan

Liu

2015

Molecular and Clinical Oncology

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“…1 In studies done in Western population, as well as Southern and coastal India, peptic ulcer disease still constitutes the most common cause of upper gastrointestinal bleed. [2][3][4][5] Upper gastrointestinal endoscopy plays an important role in the diagnosis of etiology of bleed, stratification of patients according to the risk of rebleed based on the endoscopic stigmata and in treatment of such patients.…”

Section: Introductionmentioning

confidence: 99%

Utility of clinical and complete Rockall score in Indian patients with upper gastrointestinal bleeding

Sharma¹

2016

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Introduction: Acute upper gastrointestinal bleeding (AUGIB) is an important gastroenterological emergency. Role of Rockall score in stratification of risk of mortality and rebleeding in Indian patients is uncertain. Methods: This study was prospectively conducted on 175 consecutive patients admitted with AUGIB who were 18 years or above. The clinical Rockall score and complete scores calculated at admission and after endoscopy were analyzed for association with the outcome (rebleeding and mortality) for both variceal and non-variceal bleeding. Results: The mean age of the patients was 48.4±16.4 years and 78.9% were males. History of inake of NSAIDs in patients of AUGIB was present in 13.7% and of antiplatelets in 13.7%. Variceal bleed was the most common etiology (45.7%) followed by peptic ulcer disease (24.0%). Overall rates of surgery, rebleed and mortality were 6.9%, 22.9% and 20% respectively. Both clinical and complete Rockall risk scoring systems were useful tools for stratifying patients with AUGIB into high and low risk categories for mortality. However, for the prediction of rebleed, the complete Rockall scoring system was found to be better than the clinical scoring system. These scoring systems performed much better in predicting the outcomes in non-variceal bleed than in patients with variceal bleed. Multivariate analysis showed that patients with age ≥65 years and albumin <3 g/dl were at an increased risk of mortality. Conclusion: Rockall scoring can be used to stratify patients with AUGIB and is more useful in non-variceal bleeding.

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“…9 Our observation on racial differences may, but only in part, be explicable given that Hispanic patients are reported at higher risk of variceal re-bleeding, and in our population, there was a significant association between liver diseases with readmission. 10 In our cohort of patients, the presence of chronic comorbidity correlated with the likelihood of ED readmission with complications; specifically, the presence of chronic liver disease and chronic gastrointestinal disease were significantly associated with ED readmission. These observations are not surprising as comorbidities define medical frailty that in turn strongly influences anesthesia outcome.…”

Section: Discussionmentioning

confidence: 69%

“…We can only speculate that our observations may reflect true pathophysiological differences, socioeconomic stressors or cultural norms that impact communication, availability of alternative primary care support, and proximity to the institution where the procedure took place . Our observation on racial differences may, but only in part, be explicable given that Hispanic patients are reported at higher risk of variceal re‐bleeding, and in our population, there was a significant association between liver diseases with readmission …”

Section: Discussionmentioning

confidence: 75%

Pediatric elective therapeutic procedure complications: A multicenter cohort analysis

Attard

Miller

Walker

et al. 2019

J of Gastro and Hepatol

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Background and Aim Current understanding of specific, therapeutic procedure‐associated complications in pediatric patients remains limited. This study aims to determine the frequency of significant complications in pediatric age‐range subjects following the principal therapeutic endoscopic procedures. Methods This study used retrospective multi‐institutional, ICD‐9‐CM, Clinical Transaction Classification, and Current Procedural Terminology based database (Pediatric Hospital Information System) analysis. This study included demographic, chronic comorbidity, procedure type, and post‐procedure outcomes defined through mortality, unplanned direct admission, emergency room, and inpatient admission and inpatient therapeutic events. Results During the study period, 18 018 patients underwent therapeutic endoscopy; 132 required direct (0.16%) or emergency room/inpatient (0.58%) admission within 5 days following the procedure; mortality was 0.01%. Most (50.75%) complications presented on the day of or 1 day post‐procedure. Hispanic race and coexisting chronic comorbidities, especially gastrointestinal conditions, were identified risk factors for significant complications. Endoscopic dilatation and variceal ablation were most frequently associated with complications. Abdominal pain, gastrointestinal bleeding, and esophageal stricture were the most common diagnoses: 9.0% required intravenous antibiotics, 36.63% underwent chest imaging, 27.27% abdominal imaging, and 0.75% required blood transfusion. Readmission following esophageal dilatation was most likely to result in prolonged admission. Conclusion In the pediatric population undergoing therapeutic endoscopy in the ambulatory setting, significant postoperative complications resulting in unplanned admission are rare. Complications can be anticipated in medically frail patients especially with gastrointestinal chronic illness. Procedures involving variceal ablation and esophageal dilatation entail the highest risk.

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Impact of Ethnicity in Upper Gastrointestinal Hemorrhage

Cited by 24 publications

References 22 publications

Characteristics of gastrointestinal hemorrhage associated with pancreatic cancer: A retrospective review of 246 cases

Characteristics of gastrointestinal hemorrhage associated with pancreatic cancer: A retrospective review of 246 cases

Utility of clinical and complete Rockall score in Indian patients with upper gastrointestinal bleeding

Pediatric elective therapeutic procedure complications: A multicenter cohort analysis

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