Management of Patients With Upper Gastrointestinal Bleeding

Wallner, Grzegorz; Skoczylas, Tomasz; Lundell, Lars

doi:10.2478/v10035-007-0009-7

Cited by 2 publications

(3 citation statements)

References 43 publications

(45 reference statements)

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“…The resulting opinion of the advantages of emergency endoscopy in all of the patients presenting with UGIB is often disputed, and economic data clearly indicate that the cost of keeping an endoscopic team on call is high. Despite that fact, certain measurable advantages of early endoscopic treatment can be observed [ 6 , 11 ]. Our analysis has shown that the patients undergoing emergency endoscopy needed fewer blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

Nonvariceal upper gastrointestinal tract bleeding – risk factors and the value of emergency endoscopy

Wierzchowski

Dąbrowiecki²,

Szczęsny³

et al. 2013

aoms

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IntroductionUpper gastrointestinal tract bleeding (UGIB) remains a valid issue of modern medicine. The mortality and recurrence rates remain high and have not decreased as expected over the past decades. Aim of the study: to assess the treatment outcomes of nonvariceal UGIB depending on the timing of endoscopy (urgent vs. elective) and to perform an analysis of risk factors for death in patients with nonvariceal UGIB.Material and methodsComparative evaluation of treatment outcomes in two groups of patients. Group A consisted of patients undergoing elective endoscopy (n = 187). Group B consisted of patients undergoing emergency endoscopy (n = 295). Moreover, the influence of selected factors on the risk of death and bleeding recurrence was analyzed in the combined population of the two groups. This was done by constructing a logistic regression model and testing dependence hypotheses.ResultsIn group A the mortality rate was 9.1%, and the recurrence rate was 18.2%. In group B the values were 6.8% and 12.2%, respectively. No statistically significant difference was found (p = NS). In group B the number of surgical interventions, blood transfusions and intensive care admissions was significantly lower (p < 0.05). An analysis of the combined material showed that the factors which correlated with an elevated risk of death included: old age, hemodynamic state (shock), elevated Charlson Comorbidity Index score, hemoglobin concentration, bleeding from a malignant lesion, recurrent bleeding and the need for surgery (p < 0.05).ConclusionsThe use of emergency endoscopy improves the treatment outcomes in patients with UGIB, although no statistically significant decrease in the mortality and recurrence rates could be observed.

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Section: Discussionmentioning

confidence: 99%

Nonvariceal upper gastrointestinal tract bleeding – risk factors and the value of emergency endoscopy

Wierzchowski

Dąbrowiecki²,

Szczęsny³

et al. 2013

aoms

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“…Aggregated data analysis proves progressively improving outcomes of several therapies, including in UGIB. In many publications, age is referred to as a significant risk factor of mortality and recurrence of UGIB [2, 3, 13, 23]. The standard UGIB-management protocol that is sufficient in an average patient might be unsuitable (or less effective) in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical management of UGIB is reserved only for patients in whom endoscopic control of the bleeding has been unsuccessful [8–13]. In the last decade, such a combined approach has led to the reduction of UGIB-related mortality to 6-10% [9, 12].…”

Section: Introductionmentioning

confidence: 99%

Urgent endoscopy in elderly patients with non-variceal upper gastrointestinal bleeding.

Wierzchowski¹,

Dąbrowiecki²,

Szczęsny³

2012

Videosurgery and Other Miniinvasive Techniques

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IntroductionAge of the patient is an important prognostic factor in patients with non-variceal upper gastrointestinal bleeding (UGIB). Despite that fact, current treatment algorithms do not differentiate UGIB management according to the patient's age.AimTo compare treatment outcomes in patients below and above 75 years of age, treated for UGIB with urgent endoscopy.Material and methodsProspective analysis of treatment outcomes in 295 patients with non-variceal UGIB divided into two age groups (group A < 75 years of age, group B > 75 years of age). Urgent endoscopy (up to 3 h since admission) was performed in 292 patients. The groups were compared in regards to the duration of symptoms, previous UGIB, presence of factors predisposing to UGIB (NSAIDs, peptic ulcer disease, liver cirrhosis, and previous gastrointestinal surgery), haemodynamic state and haemoglobin (Hb) levels on admission. We analysed the causes of UGIB, severity of UGIB on the Forrest scale, type of endoscopic bleeding control method, and co-morbidities with use of the Charlson Co-morbidity Index (CCI). Treatment outcomes were assessed in regard of mortality rate, UGIB-recurrence rate, duration of hospital stay, amount of transfused blood products and the requirement of intensive therapy unit (ITU) or other departments’ admissions. Patients were followed until their discharge home.ResultsMortality rate was 6.8% (group A vs. B: 3.5% vs. 18.7%; p = 0.001). Upper gastrointestinal bleeding recurrence was noted in 12.2% of patients (group A vs. B: 12.5% vs. 10.9%; p = 0.73). 2.4% of patients required surgery for UGIB (group A vs. B: 1.7% vs. 4.7%; p = 0.16). Patients in group B required ITU admission more frequently (group A vs. B: 1% vs. 4.7%; p < 0.01). The mean hospital stay (4.3 days) and the mean number of transfused packed red blood cells (PRBCs) (2.35 Units) did not differ between the groups. Patients in group B used NSAIDS much more frequently, more often had hypovolaemic shock and had a higher CCI score.ConclusionsUrgent endoscopy is an important and broadly accepted method of treatment of UGIB. Despite strict adherence to the modern UGIB-treatment algorithms, mortality remains high in the elderly. Thus, these patients need particular attention. The presented study indicates that the standard management might not be sufficient in elderly patients.

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Management of Patients With Upper Gastrointestinal Bleeding

Cited by 2 publications

References 43 publications

Nonvariceal upper gastrointestinal tract bleeding – risk factors and the value of emergency endoscopy

Nonvariceal upper gastrointestinal tract bleeding – risk factors and the value of emergency endoscopy

Urgent endoscopy in elderly patients with non-variceal upper gastrointestinal bleeding.

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