Risk factors of the rebleeding according to the patterns of nonvariceal upper gastrointestinal bleeding

Nam, Ji Hyung; Jeon, Tae Joo; Cho, Jae Hee; Kim, Jae Hak

doi:10.5152/tjg.2017.17066

Cited by 9 publications

(13 citation statements)

References 24 publications

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“…Nam ve ark., [18] yaptığı araştırmada ülsere hastalar içerisinde en sık Forrest tip 2a (%49,5) olguları tespit edilmiştir. Bu klinik incelemede Forrest tip 3 olguları değerlendirmeye alınmamıştır.…”

Section: Yöntemunclassified

“…Araştırmamızda ülserler arasında genel olarak Forrest tip 3 en sık görülen ülser tipidir. Sadece riskli grup olarak kabul edilen ülserler dikkate alındığında çalışmamızda Nam ve ark., [18] bulduğu sonuçlara benzer olarak en sık Forrest tip 2a (riski yüksek) ülser olgularına rastlanılmıştır. Bununla birlikte çalışma sonuçlarımız riskli grup ile riskli olmayan grup arasında hematolojik değerleri arasında herhangi bir istatistiksel farklılık ortaya koyamamıştır.…”

Section: Yöntemunclassified

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Üst Gastrointestinal Sistem Kanamalarında Endoskopik Tanılara ve Forrest Ülser Gruplarına Göre Kan Üre Nitrojen ve Hematolojik Parametrelerin Önemi

İrak¹

2022

iksstd

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Objective: We aimed to investigate the cause and frequency of hemorrhage at the time of diagnosis of gastrointestinal bleeding in a gastroenterology clinic and analyzed the differences between some hematological parameters and blood urea nitrogen between ulcer and non-ulcer bleeding groups. Method:We retrospectively reviewed the data of 372 upper gastrointestinal bleeding patients who were followed between 2009 and 2021. Patients were classified as ulcerated and non-ulcerated hemorrhagic groups. The ulcerated patients were further grouped as high-risk and low-risk subjects. Among patient ÖZ Amaç: Bu çalışmada, bir gastroenteroloji kliniğine üst gastrointestinal kanama ile başvuran hastaların kanama nedenleri ve sıklıkları incelendi. Ayrıca, ülser ve ülser dışı kanama grupları arasında hematolojik parametreler ile üre azotu arasındaki farklılıkların incelenmesi amaçlandı.Yöntem: Çalışmada 2009-2021 yılları arasında 372 üst gastrointestinal kanama hastalarının verileri retrospektif olarak incelendi. Hastalar ülsere bağlı ve bağlı olmayan kanamalı gruplar olarak analiz edildi ve bunlar da yüksek ve düşük riskli olarak sınıflandırıldı. Bu gruplarda ayrıca lenfosit, hematokrit, beyaz küre, nötrofil, trombosit, midplatelet volüm (MPV), kırmızı küre dağılım genişliği (RDW) ile kan üre azotu (BUN) arasındaki farklılığın analizleri yapıldı.Bulgular: Endoskopik olarak en sık kanama nedeni peptik ülserdir. Peptik ülser olguları arasında en sık Forrest 3 grubu kanama nedeni olarak ortaya çıktı (%33,1). Peptik ülserin olduğu grupta lenfosit düzeyleri istatistiksel olarak anlamlı derecede yüksekti (p<0,0001). Ülser olmayan grupta RDW istatistiksel olarak daha yüksek oranda bulundu (p<0,0001). Yüksek riskli ülser grubundaki hastaların BUN değerleri düşük riskli gruba göre daha yüksek bulundu. Olgularda beyaz küre, nötrofil, hematokrit ve MPV ile kan üre değerleri arasında korelasyon ilişkisi tespit edildi. Hastanın yaşı ile nötrofil, RDW ve BUN arasında pozitif yönde korelasyon tespit edilirken lenfosit ve hematokrit değerleri arasında negatif yönde bir korelasyon ilişkisine rastlandı.Sonuç: Sonuç olarak, dünya literatür verilerine uyumlu olarak en sık üst gastrointestinal kanama nedeni peptik ülser olup alt tip olarak en sık Forrest 3 grubu ülserler gözlendi. BUN değerleri Forrest skorları şiddet skalası ile doğru orantılıdır. Analiz sonuçlarımızda ülser olmayan kanamalar ülser kaynaklı kanamalara göre daha ileri yaşlarda tespit edilmiş olup bu olgularda RDW değerleri daha yüksek bulundu.

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Section: Yöntemunclassified

Üst Gastrointestinal Sistem Kanamalarında Endoskopik Tanılara ve Forrest Ülser Gruplarına Göre Kan Üre Nitrojen ve Hematolojik Parametrelerin Önemi

İrak¹

2022

iksstd

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“…Timepoint to set up our system (hours after t0) 4.5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) Timepoint of blood clearance in the stomach estimated by using our system (hours after t0) 1 10. Timepoint of the disappearance of melena or bloody stool (hours after t0) 97.9 The time lag between these two methods (hours) 87.3 UGI, upper gastrointestinal.…”

Section: E1814mentioning

confidence: 99%

“…Current ways of detecting rebleeding mainly depend on monitoring hemodynamic instabilities and the occurrence of hematemesis, hematochezia, or persistent melena [5,6]. However, at least a 15 % to 30 % loss of blood volume is required to signicantly influence blood pressure and heart rate [6,7].…”

Section: Introductionmentioning

confidence: 99%

Novel upper gastrointestinal monitoring system to track upper gastrointestinal bleeding: A pilot study

Chuang

Chen

et al. 2020

Endosc Int Open

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Background and study aims Early detection of upper gastrointestinal (UGI) rebleeding is not easy by observing clinical symptoms. We developed a novel UGI monitoring system and aimed to test its feasibility of continuous tracking of UGI bleeding. Patients and methods A prospective study was conducted on patients with moderate to high risk of rebleeding. The UGI monitoring system was installed to monitor their gastric contents. It would alarm if rebleeding was suspected and the physician could review the images to make a further decision. The patient’s comfort level was also evaluated. Results Sixteen patients were enrolled. Rebleeding occurred in one patient and was detected by this system more than 5 hours earlier than with clinical symptoms. The interobserver reliability for reviewing the images to define the blood clearance in the stomach was excellent (intraclass correlation coefficient 0.79–0.96). The comfort level assessed by patients was 1.90 ± 1.39 (on the scale of 0–5). Conclusions This pilot study demonstrated the potential of this UGI monitoring system for early detection of rebleeding.

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“…1,[3][4][5] Some risk factors for recurrent bleeding include large ulcer size, nonsteroidal anti-inflammatory drug (NSAID) use, hemodynamic instability, comorbidities, active bleeding at initial endoscopy, and certain ulcer locations such as the posterior duodenal bulb and the lesser curve of the stomach. [4][5][6][7] Recurrent bleeding is associated with a substantial increased risk of mortality. 2 In a randomized controlled trial (RCT) in 40 patients with peptic ulcer bleeding, Saeed et al found that planned second-look endoscopy was associated with a decreased risk of recurrent bleeding.…”

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confidence: 99%

Role of routine second-look endoscopy in patients with acute peptic ulcer bleeding: meta-analysis of randomized controlled trials

Kamal

Khan

Lee‐Smith

et al. 2021

Gastrointestinal Endoscopy

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Background and Aims: Studies evaluating the role of routine second-look endoscopy in patients with acute upper GI bleed because of peptic ulcer disease (PUD) have reported conflicting results. This meta-analysis evaluates the usefulness of routine second-look endoscopy in these patients.Methods: We reviewed several databases from inception to September 15, 2020 to identify randomized controlled trials (RCTs) that compared routine second-look endoscopy with no planned second-look endoscopy in patients with acute upper GI bleed because of PUD. Our outcomes of interest were recurrent bleeding, mortality, need for surgery, and mean number of units of blood transfused. For categorical variables, we calculated pooled risk ratios (RRs) with 95% confidence intervals (CIs); for continuous variables, we calculated standardized mean difference with 95% CIs. Data were analyzed using a random effects model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to ascertain the quality of evidence.Results: We included 9 RTCs comprising 1452 patients; 726 patients underwent planned/routine second-look endoscopy and 726 did not. We found no significant difference in recurrent bleeding (RR, .79; 95% CI, .51-1.23), need for surgery (RR, .58; 95% CI, .29-1.15), mortality (RR, .69; 95% CI, .33-1.45), or mean number of units of blood transfused (standardized mean difference, -.06; 95% CI, -.19 to .07). Quality of evidence ranged from low to moderate based on the GRADE framework.Conclusions: Single endoscopy with complete endoscopic hemostasis is not inferior to routine second-look endoscopy in reducing the risk of recurrent bleeding, mortality, or need for surgery in patients with acute upper GI bleed because of PUD.

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Risk factors of the rebleeding according to the patterns of nonvariceal upper gastrointestinal bleeding

Cited by 9 publications

References 24 publications

Üst Gastrointestinal Sistem Kanamalarında Endoskopik Tanılara ve Forrest Ülser Gruplarına Göre Kan Üre Nitrojen ve Hematolojik Parametrelerin Önemi

Üst Gastrointestinal Sistem Kanamalarında Endoskopik Tanılara ve Forrest Ülser Gruplarına Göre Kan Üre Nitrojen ve Hematolojik Parametrelerin Önemi

Novel upper gastrointestinal monitoring system to track upper gastrointestinal bleeding: A pilot study

Role of routine second-look endoscopy in patients with acute peptic ulcer bleeding: meta-analysis of randomized controlled trials

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