Outcomes in patients with acute upper gastrointestinal bleeding following changes to management protocols at an Australian hospital

Abstract

Background and Aim Upper gastrointestinal bleeding (UGIB) has a high mortality rate and requires efficient and directed acute management. This project aimed to assess patient outcomes following changes to UGIB management protocols at Northern Hospital, Victoria, Australia. Changes involved streamlining management under a single inpatient unit, earlier endoscopy, blood transfusion thresholds, and risk stratification. Methods This was a cohort study of 400 patients aged ≥18 years admitted to Northern Hospital who underwent endoscopy for acute UGIB. Data of preprotocol changes (Group 1) and prospectively postprotocol changes (Group 2) were collected retrospectively. Primary outcomes were inpatient mortality, rebleeding, radiologic or surgical intervention, and endoscopic reintervention. Secondary outcomes included length of stay (LOS) ≥4 days and blood units transfused. Univariate analyses were conducted comparing groups and associations between variables and outcomes, followed by multivariate analyses for each outcome. Results There was no difference in mortality on multivariate analysis ( P = 0.95). Rebleeding reduced by 4% (adjusted odds ratio [AOR] 0.48; P = 0.03), LOS ≥4 days reduced by 15.1% (AOR 0.46; P < 0.00) and median blood units transfused decreased with adjusted incidence rate ratio of 0.81 ( P = 0.00). Early endoscopy (i.e. ≤12 h) for all patients increased by 15% ( P < 0.00) and there were 12% more high‐risk patients (i.e. Glasgow–Blatchford score ≥ 12) in Group 2 ( P = 0.01). Conclusion Following changes to UGIB protocols at this Australian hospital, endoscopic times decreased with reductions in rebleeding, LOS ≥4 days, and blood transfusion rates. These findings demonstrate improved outcomes after the implementation of new treatment targets focusing on streamlined care of patients presenting with UGIB.

Low-FODMAP diet on postprandial distress syndrome type of functional dyspepsia with mixed type of irritable bowel syndrome patient: A case report

“…Functional gastrointestinal disorders (FGIDs) are common unexplained gastrointestinal symptoms that are thought to arise from different locations of the digestive tract. Two of the recognized diseases are functional dyspepsia and irritable bowel syndrome (IBS) [1]. Functional dyspepsia is a complex collection of symptoms from the gastroduodenal part of the digestive tract and includes pain or burning sensation in the epigastrium, a feeling of fullness after eating, or an early feeling of fullness [2].…”

Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding

“…In addition, if the patient is receiving antiplatelet agents or has coagulopathy, endoclips are safer than thermal coagulation because they cause less tissue damage. [5] Several recent studies have demonstrated that large amounts of epinephrine injections are superior to small amounts of injections in recurrent bleeding in peptic ulcers. These studies suggest that local tamponade has the greatest effect on continuous hemostasis, and that larger volumes of epinephrine injection may prevent re-bleeding.…”

“…Mechanical compression of the hemorrhaging vessel in peptic ulcer is the key factor for achieving initial hemostasis. In addition, if the patient is receiving antiplatelet agents or has coagulopathy, endoclips are safer than thermal coagulation because they cause less tissue damage [5] . Several recent studies have demonstrated that large amounts of epinephrine injections are superior to small amounts of injections in recurrent bleeding in peptic ulcers.…”

Functional gastrointestinal disorders among healthcare professionals—hidden in plain sight?

“…Adding further perspective to these observations, in this issue of JGH Open , Nagarethinam et al report a cross‐sectional survey assessing the prevalence and associations of FGIDs among HCPs from a tertiary Australian hospital setting 8 . Between January 2017 and June 2018, 274 HCPs were surveyed, and data were collected for demographics, medical role, work hours, sleep habits, stress levels (frequency and severity), and dietary factors.…”

“…Adding further perspective to these observations, in this issue of JGH Open , Nagarethinam et al report a cross‐sectional survey assessing the prevalence and associations of FGIDs among HCPs from a tertiary Australian hospital setting. 8 Between January 2017 and June 2018, 274 HCPs were surveyed, and data were collected for demographics, medical role, work hours, sleep habits, stress levels (frequency and severity), and dietary factors. Risk factors for FGIDs and their symptoms based on the Rome III criteria were assessed using a self‐report questionnaire (FGID‐Q), and quality of life (QoL) was assessed for its impact on work, leisure, relationships, and social activities.…”