BACKGROUND Serum gastrin-17(G-17),pepsinogen I(PGI),and pepsinogen II(PGII)concentrations regulate gastric acid secretion,and hypersecretion of gastric acid increases the risks of peptic ulcer and upper gastrointestin...BACKGROUND Serum gastrin-17(G-17),pepsinogen I(PGI),and pepsinogen II(PGII)concentrations regulate gastric acid secretion,and hypersecretion of gastric acid increases the risks of peptic ulcer and upper gastrointestinal bleeding.These associations suggest that serum G-17,PGI,and(or)PGII may predict gastrointestinal bleeding risk among peptic ulcer patients.AIM To evaluate the efficacies of serum G-17,PGI,PGII,and PGI/PGII ratio(PGR)for predicting upper gastrointestinal bleeding among peptic ulcer patients.METHODS A total of 199 patients diagnosed with peptic ulcer confirmed by gastroscopy and positivity for Helicobacter pylori by the 14C-urea breath test were recruited,including 107 patients with simple peptic ulcer and 92 cases complicated by upper gastrointestinal bleeding.Serum PGI,PGII,G-17,and PGR were measured by immune methods and compared between bleeding and non-bleeding groups by univariate analysis.The specificity and sensitivity of PGs and G-17 for evaluating upper gastrointestinal bleeding risk were then assessed by constructing receiver operating characteristic(ROC)curves.RESULTS Serum G-17 was significantly higher among peptic ulcer patients with upper gastrointestinal bleeding compared to simple peptic ulcer patients(25.34±14.29 vs 8.84±8.03 pmol/L,t=9.822,P<0.01),whereas serum PGI,PGII,and PGR did not differ significantly between bleeding and non-bleeding groups(all P>0.05).The risk of bleeding was significantly higher among peptic ulcer patients with elevated serum G-17(>15 pmol/L)compared to patients with normal or low serum G-17(73.2%vs 27.4%,χ2=40.72,P<0.01).The area under the ROC curve for serum G-17 was 0.866±0.024,and a cut-off of 9.86 pmol/L yielded 90.2%sensitivity and 68.2%specificity for distinguishing peptic ulcer with and without upper gastrointestinal bleeding.CONCLUSION Serum G-17 is significantly upregulated in peptic ulcer patients and higher levels are predictive of upper gastrointestinal bleeding.Conversely,serum PGI,PGII,and PGR have no predictive value.Further prospective studies are warranted to examine if high G-17 can be used to assess risk of bleeding prior to onset.展开更多
Acute upper gastrointestinal bleeding(UGIB) is a gastroenterological emergency with a mortality of 6%-13%.The vast majority of these bleeds are due to peptic ulcers.Nonsteroidal anti-inflammatory drugs and Helicobacte...Acute upper gastrointestinal bleeding(UGIB) is a gastroenterological emergency with a mortality of 6%-13%.The vast majority of these bleeds are due to peptic ulcers.Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease.Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB,and is recommended within 24 h of presentation.Proton pump inhibitor(PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy,but has no effect on rebleeding,mortality and need for surgery.Endoscopic therapy should be undertaken for ulcers with high-risk stigmata,to reduce the risk of rebleeding.This can be done with a variety of modalities.High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality,particularly in patients with high-risk stigmata.展开更多
AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;fema...AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.展开更多
AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospecti...AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospective studyfor endoscopic hemoclip treatment.We used anewly developed rotatable clip-device for theapplication of hemoclip(MD850)to stopbleeding.Endoscopy was repeated if there wasany sign or suspicion of rebleeding,and re-clipping was performed if necessary andfeasible.RESULTS Initial hemostatic rate by clippingwas 95%,and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%,96%,and93% in the Fla and Flb subgroups,and totalcases,respectively.In patients with shock onadmission,hemoclipping achieved ultimatehemostasis of 71% and 83% in F1a and F1bsubgroups,respectively.Hemostasis reached100% in patients without shock regardless ofhemorrhagic activity being F1a or F1b.Theaverage number of clips used per case was 3.0(range 2-5).Spurting bleeders required moreclips on average than did oozing bleeders(3.4versus 2.8).We observed no obviouscomplications,no tissue injury,or impairmentof ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placementis an effective and safe method.With theimprovement of the clip and application device,the procedure has become easier and much moreefficient.Endoscopic hemoclipping deservesfurther study in the treatment of bleeding pepticulcers.展开更多
AIM To compare the Glasgow-Blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. METHODS Between Ja...AIM To compare the Glasgow-Blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. METHODS Between January 2008 and December 2013, 1012consecutive patients admitted with peptic ulcer bleeding(PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores(RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics(AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were evaluated.RESULTS PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome(AUROC 0.82 vs 0.67 vs0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality(AUROC0.84 vs 0.57 vs 0.64), rebleeding(AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion(AUROC 0.83 vs0.63 vs 0.58) and surgical intervention(0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome(AUROC 0.82 vs 0.69, respectively).CONCLUSION The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one 'perfect score' and we suggest that these two tests be used concomitantly.展开更多
AIM: To investigate in a prospective study whether a simplifi ed clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHOD...AIM: To investigate in a prospective study whether a simplifi ed clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were strati- fied according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis. RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. Overall, stigmata of recent haem-orrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in T1 patients than in T2/T3 cases (85% vs 3.2%; χ2 = 304.5309, P < 0.001). Older age (t=3.311; P < 0.01) and presence of comor-bidities (χ2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients. CONCLUSION: Our simplifi ed clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further,randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.展开更多
AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.METHODS:Between January 2005 and December 2009,150 patients with ...AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.METHODS:Between January 2005 and December 2009,150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed(Forrest Ⅱa) were included in the study.Patients were randomized to receive a small-volume epinephrine group(15 to 25 mL injection group;Group 1,n = 50),a large-volume epinephrine group(30 to 40 mL injection group;Group 2,n = 50) and a hemoclip group(Group 3,n = 50).The rate of recurrent bleeding,as the primary outcome,was compared between the groups of patients included in the study.Secondary outcomes compared between the groups were primary hemostasis rate,permanent hemostasis,need for emergency surgery,30 d mortality,bleeding-related deaths,length of hospital stay and transfusion requirements.RESULTS:Initial hemostasis was obtained in all patients.The rate of early recurrent bleeding was 30%(15/50) in the small-volume epinephrine group(Group 1) and 16%(8/50) in the large-volume epinephrine group(Group 2)(P = 0.09).The rate of recurrent bleeding was 4%(2/50) in the hemoclip group(Group 3);the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution(P = 0.0005 and P = 0.045,respectively).Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups.CONCLUSION:Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.展开更多
AIM:To investigate the preventive effects of low-dose proton-pump inhibitors(PPIs) for upper gastrointestinal bleeding(UGIB) in end-stage renal disease.METHODS:This was a retrospective cohort study that reviewed 544 p...AIM:To investigate the preventive effects of low-dose proton-pump inhibitors(PPIs) for upper gastrointestinal bleeding(UGIB) in end-stage renal disease.METHODS:This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013.We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs(control group).RESULTS:During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years.The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo.Bleeding occurred in only two patients in the PPI group(2.5/1000 person-years) and in 39 patients in the control group(19.2/1000 person-years).Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group(log-rank test, P < 0.001).Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB.After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group(HR = 13.7, 95%CI:1.8-101.6; P = 0.011).CONCLUSION:The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.展开更多
<strong>Objective:</strong> To assess and compare the clinical application value of nursing risk management in the diagnosis and treatment of severe peptic ulcer bleeding. <strong>Methods:</strong...<strong>Objective:</strong> To assess and compare the clinical application value of nursing risk management in the diagnosis and treatment of severe peptic ulcer bleeding. <strong>Methods:</strong> A total of 70 patients with severe peptic ulcer bleeding were selected as the research objects, randomly divided into observation group and control group, 35 cases for each. The nursing risk management and conventional nursing management were implemented for the two groups, respectively. The success rate of hemostasis, average length of stay, cure rate, complication rate, dyspnea rate, nursing dispute rate, SAS score, and SDS score were compared between the two groups. Patients’ satisfaction with nursing quality was also compared. <strong>Results:</strong> After the implementation of two different nursing management methods, all the above-mentioned metrics were better in the observation group than in the control group, and the differences were statistically significant (P < 0.01 or P < 0.05). <strong>Conclusion:</strong> The application of nursing risk management in the nursing intervention process of patients with severe peptic ulcer bleeding can effectively reduce the probability of nursing risk events, increase the cure rate, shorten the patient’s hospital stay, but also improve the patients’ psychological state and increase the patient’s satisfaction with nursing quality, which is worth clinical promotion.展开更多
BACKGROUND In monotherapy studies for bleeding peptic ulcers,large volumes of epinephrine were associated with a reduction in rebleeding.However,the impact of epinephrine volume in patients treated with combination en...BACKGROUND In monotherapy studies for bleeding peptic ulcers,large volumes of epinephrine were associated with a reduction in rebleeding.However,the impact of epinephrine volume in patients treated with combination endoscopic therapy remains unclear.AIM To assess whether epinephrine volume was associated with bleeding outcomes in individuals who also received endoscopic thermal therapy and/or clipping.METHODS Data from 132 patients with Forrest class Ia,Ib,and IIa peptic ulcers were reviewed.The primary outcome was further bleeding at 7 d;secondary outcomes included further bleeding at 30 d,need for additional therapeutic interventions,post-endoscopy blood transfusions,and 30-day mortality.Logistic and linear regression and Cox proportional hazards analyses were performed.RESULTS There was no association between epinephrine volume and all primary and secondary outcomes in multivariable analyses.Increased odds for further bleeding at 7 d occurred in patients with elevated creatinine values(aOR 1.96,95%CI 1.30-3.20;P<0.01)or hypotension requiring vasopressors(aOR 6.34,95%CI 1.87-25.52;P<0.01).Both factors were also associated with all secondary outcomes.CONCLUSION Epinephrine maintains an important role in the management of bleeding ulcers,but large volumes up to a range of 10-20 mL are not associated with improved bleeding outcomes among individuals receiving combination endoscopic therapy.Further bleeding is primarily associated with patient factors that likely cannot be overcome by increased volumes of epinephrine.However,in carefully-selected cases where ulcer location or size pose therapeutic challenges or when additional modalities are unavailable,it is conceivable that increased volumes of epinephrine may still be beneficial.展开更多
基金the Second People's Hospital of Anhui Province,Institutional Review Board(Approval No.2015-036).
文摘BACKGROUND Serum gastrin-17(G-17),pepsinogen I(PGI),and pepsinogen II(PGII)concentrations regulate gastric acid secretion,and hypersecretion of gastric acid increases the risks of peptic ulcer and upper gastrointestinal bleeding.These associations suggest that serum G-17,PGI,and(or)PGII may predict gastrointestinal bleeding risk among peptic ulcer patients.AIM To evaluate the efficacies of serum G-17,PGI,PGII,and PGI/PGII ratio(PGR)for predicting upper gastrointestinal bleeding among peptic ulcer patients.METHODS A total of 199 patients diagnosed with peptic ulcer confirmed by gastroscopy and positivity for Helicobacter pylori by the 14C-urea breath test were recruited,including 107 patients with simple peptic ulcer and 92 cases complicated by upper gastrointestinal bleeding.Serum PGI,PGII,G-17,and PGR were measured by immune methods and compared between bleeding and non-bleeding groups by univariate analysis.The specificity and sensitivity of PGs and G-17 for evaluating upper gastrointestinal bleeding risk were then assessed by constructing receiver operating characteristic(ROC)curves.RESULTS Serum G-17 was significantly higher among peptic ulcer patients with upper gastrointestinal bleeding compared to simple peptic ulcer patients(25.34±14.29 vs 8.84±8.03 pmol/L,t=9.822,P<0.01),whereas serum PGI,PGII,and PGR did not differ significantly between bleeding and non-bleeding groups(all P>0.05).The risk of bleeding was significantly higher among peptic ulcer patients with elevated serum G-17(>15 pmol/L)compared to patients with normal or low serum G-17(73.2%vs 27.4%,χ2=40.72,P<0.01).The area under the ROC curve for serum G-17 was 0.866±0.024,and a cut-off of 9.86 pmol/L yielded 90.2%sensitivity and 68.2%specificity for distinguishing peptic ulcer with and without upper gastrointestinal bleeding.CONCLUSION Serum G-17 is significantly upregulated in peptic ulcer patients and higher levels are predictive of upper gastrointestinal bleeding.Conversely,serum PGI,PGII,and PGR have no predictive value.Further prospective studies are warranted to examine if high G-17 can be used to assess risk of bleeding prior to onset.
文摘Acute upper gastrointestinal bleeding(UGIB) is a gastroenterological emergency with a mortality of 6%-13%.The vast majority of these bleeds are due to peptic ulcers.Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease.Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB,and is recommended within 24 h of presentation.Proton pump inhibitor(PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy,but has no effect on rebleeding,mortality and need for surgery.Endoscopic therapy should be undertaken for ulcers with high-risk stigmata,to reduce the risk of rebleeding.This can be done with a variety of modalities.High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality,particularly in patients with high-risk stigmata.
基金Supported by The Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,Science and Technology(NRF-2010-0021482)to Suk KT
文摘AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.
文摘AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
文摘AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospective studyfor endoscopic hemoclip treatment.We used anewly developed rotatable clip-device for theapplication of hemoclip(MD850)to stopbleeding.Endoscopy was repeated if there wasany sign or suspicion of rebleeding,and re-clipping was performed if necessary andfeasible.RESULTS Initial hemostatic rate by clippingwas 95%,and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%,96%,and93% in the Fla and Flb subgroups,and totalcases,respectively.In patients with shock onadmission,hemoclipping achieved ultimatehemostasis of 71% and 83% in F1a and F1bsubgroups,respectively.Hemostasis reached100% in patients without shock regardless ofhemorrhagic activity being F1a or F1b.Theaverage number of clips used per case was 3.0(range 2-5).Spurting bleeders required moreclips on average than did oozing bleeders(3.4versus 2.8).We observed no obviouscomplications,no tissue injury,or impairmentof ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placementis an effective and safe method.With theimprovement of the clip and application device,the procedure has become easier and much moreefficient.Endoscopic hemoclipping deservesfurther study in the treatment of bleeding pepticulcers.
文摘AIM To compare the Glasgow-Blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. METHODS Between January 2008 and December 2013, 1012consecutive patients admitted with peptic ulcer bleeding(PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores(RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics(AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were evaluated.RESULTS PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome(AUROC 0.82 vs 0.67 vs0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality(AUROC0.84 vs 0.57 vs 0.64), rebleeding(AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion(AUROC 0.83 vs0.63 vs 0.58) and surgical intervention(0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome(AUROC 0.82 vs 0.69, respectively).CONCLUSION The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one 'perfect score' and we suggest that these two tests be used concomitantly.
文摘AIM: To investigate in a prospective study whether a simplifi ed clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were strati- fied according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis. RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. Overall, stigmata of recent haem-orrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in T1 patients than in T2/T3 cases (85% vs 3.2%; χ2 = 304.5309, P < 0.001). Older age (t=3.311; P < 0.01) and presence of comor-bidities (χ2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients. CONCLUSION: Our simplifi ed clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further,randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.
文摘AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.METHODS:Between January 2005 and December 2009,150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed(Forrest Ⅱa) were included in the study.Patients were randomized to receive a small-volume epinephrine group(15 to 25 mL injection group;Group 1,n = 50),a large-volume epinephrine group(30 to 40 mL injection group;Group 2,n = 50) and a hemoclip group(Group 3,n = 50).The rate of recurrent bleeding,as the primary outcome,was compared between the groups of patients included in the study.Secondary outcomes compared between the groups were primary hemostasis rate,permanent hemostasis,need for emergency surgery,30 d mortality,bleeding-related deaths,length of hospital stay and transfusion requirements.RESULTS:Initial hemostasis was obtained in all patients.The rate of early recurrent bleeding was 30%(15/50) in the small-volume epinephrine group(Group 1) and 16%(8/50) in the large-volume epinephrine group(Group 2)(P = 0.09).The rate of recurrent bleeding was 4%(2/50) in the hemoclip group(Group 3);the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution(P = 0.0005 and P = 0.045,respectively).Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups.CONCLUSION:Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.
基金Supported by Grant from Hallym University Medical Center Research Fund
文摘AIM:To investigate the preventive effects of low-dose proton-pump inhibitors(PPIs) for upper gastrointestinal bleeding(UGIB) in end-stage renal disease.METHODS:This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013.We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs(control group).RESULTS:During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years.The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo.Bleeding occurred in only two patients in the PPI group(2.5/1000 person-years) and in 39 patients in the control group(19.2/1000 person-years).Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group(log-rank test, P < 0.001).Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB.After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group(HR = 13.7, 95%CI:1.8-101.6; P = 0.011).CONCLUSION:The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.
文摘<strong>Objective:</strong> To assess and compare the clinical application value of nursing risk management in the diagnosis and treatment of severe peptic ulcer bleeding. <strong>Methods:</strong> A total of 70 patients with severe peptic ulcer bleeding were selected as the research objects, randomly divided into observation group and control group, 35 cases for each. The nursing risk management and conventional nursing management were implemented for the two groups, respectively. The success rate of hemostasis, average length of stay, cure rate, complication rate, dyspnea rate, nursing dispute rate, SAS score, and SDS score were compared between the two groups. Patients’ satisfaction with nursing quality was also compared. <strong>Results:</strong> After the implementation of two different nursing management methods, all the above-mentioned metrics were better in the observation group than in the control group, and the differences were statistically significant (P < 0.01 or P < 0.05). <strong>Conclusion:</strong> The application of nursing risk management in the nursing intervention process of patients with severe peptic ulcer bleeding can effectively reduce the probability of nursing risk events, increase the cure rate, shorten the patient’s hospital stay, but also improve the patients’ psychological state and increase the patient’s satisfaction with nursing quality, which is worth clinical promotion.
基金Supported by the National Institutes of Health,No. T32 2T32DK007356-42
文摘BACKGROUND In monotherapy studies for bleeding peptic ulcers,large volumes of epinephrine were associated with a reduction in rebleeding.However,the impact of epinephrine volume in patients treated with combination endoscopic therapy remains unclear.AIM To assess whether epinephrine volume was associated with bleeding outcomes in individuals who also received endoscopic thermal therapy and/or clipping.METHODS Data from 132 patients with Forrest class Ia,Ib,and IIa peptic ulcers were reviewed.The primary outcome was further bleeding at 7 d;secondary outcomes included further bleeding at 30 d,need for additional therapeutic interventions,post-endoscopy blood transfusions,and 30-day mortality.Logistic and linear regression and Cox proportional hazards analyses were performed.RESULTS There was no association between epinephrine volume and all primary and secondary outcomes in multivariable analyses.Increased odds for further bleeding at 7 d occurred in patients with elevated creatinine values(aOR 1.96,95%CI 1.30-3.20;P<0.01)or hypotension requiring vasopressors(aOR 6.34,95%CI 1.87-25.52;P<0.01).Both factors were also associated with all secondary outcomes.CONCLUSION Epinephrine maintains an important role in the management of bleeding ulcers,but large volumes up to a range of 10-20 mL are not associated with improved bleeding outcomes among individuals receiving combination endoscopic therapy.Further bleeding is primarily associated with patient factors that likely cannot be overcome by increased volumes of epinephrine.However,in carefully-selected cases where ulcer location or size pose therapeutic challenges or when additional modalities are unavailable,it is conceivable that increased volumes of epinephrine may still be beneficial.