Importance of risk assessment,endoscopic hemostasis,and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding

Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)is a common medical emergency in clinical practice.While the incidence has significantly reduced,the mortality rates have not undergone a similar reduction in the last few decades,thus presenting a significant challenge.This editorial outlines the key causes and risk factors of ANVUGIB and explores the current standards and recent updates in risk assessment scoring systems for predicting mortality and endoscopic treatments for achieving hemostasis.Since ANUVGIB predominantly affects the elderly population,the impact of comorbidities may be responsible for the poor outcomes.A thorough drug history is important due to the increasing use of antiplatelet agents and anticoagulants in the elderly.Early risk stratification plays a crucial role in deciding the line of management and predicting mortality.Emerging scoring systems such as the ABC(age,blood tests,co-morbidities)score show promise in predicting mortality and guiding clinical decisions.While conventional endoscopic therapies remain cornerstone approaches,novel techniques like hemostatic powders and over-the-scope clips offer promising alternatives,particularly in cases refractory to traditional modalities.By integrating validated scoring systems and leveraging novel therapeutic modalities,clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with ANVUGIB.

Rare causes of acute non-variceal upper gastrointestinal bleeding: A comprehensive review

Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Gastroenterologists and other involved clinicians are generally assisted by international guidelines in its management.However,NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines,with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and treatment.Conversely,the management of rare and extraordinary rare causes of NVUGIB is not covered by current guidelines.Given they are frequently lifethreatening conditions,all the involved clinicians,that is emergency physicians,diagnostic and interventional radiologists,surgeons,in addition obviously to gastroenterologists,should be aware of and familiar with their management.Indeed,they typically require a prompt diagnosis and treatment,engaging a dedicated,patient-tailored,multidisciplinary team approach.The aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.

Relationships of hospitalization outcomes and timing to endoscopy in non-variceal upper gastrointestinal bleeding:A nationwide analysis

BACKGROUND The optimal timing of esophagogastroduodenoscopy(EGD)and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding(NVUGIB)remains an area of active research.AIM To identify independent predictors of outcomes in patients with NVUGIB,with a particular focus on EGD timing,anticoagulation(AC)status,and demographic features.METHODS A retrospective analysis of adult patients with NVUGIB from 2009 to 2014 was performed using validated ICD-9 codes from the National Inpatient Sample database.Patients were stratified by EGD timing relative to hospital admission(≤24 h,24-48 h,48-72 h,and>72 h)and then by AC status(yes/no).The primary outcome was all-cause inpatient mortality.Secondary outcomes included healthcare usage.RESULTS Of the 1082516 patients admitted for NVUGIB,553186(51.1%)underwent EGD.The mean time to EGD was 52.8 h.Early(<24 h from admission)EGD was associated with significantly decreased mortality,less frequent intensive care unit admission,shorter length of hospital stays,lower hospital costs,and an increased likelihood of discharge to home(all with P<0.001).AC status was not associated with mortality among patients who underwent early EGD(aOR 0.88,P=0.193).Male sex(OR 1.30)and Hispanic(OR 1.10)or Asian(aOR 1.38)race were also independent predictors of adverse hospitalization outcomes in NVUGIB.CONCLUSION Based on this large,nationwide study,early EGD in NVUGIB is associated with lower mortality and decreased healthcare usage,irrespective of AC status.These findings may help guide clinical management and would benefit from prospective validation.

Role of endoscopic ultrasound in non-variceal upper gastrointestinal bleeding management

Non-variceal upper gastrointestinal bleeding(NVUGIB)is one of the challenging situations in clinical practice.Despite that gastric ulcer and duodenal ulcer are still the main causes of acute NVUGIB,there are other causes of bleeding which might not always be detected through the standard endoscopic evaluation.Standard endoscopic management of UGIB consists of injection,thermal coagulation,hemoclips,and combination therapy.However,these methods are not always successful for rebleeding prevention.Endoscopic ultrasound(EUS)has been used recently for portal hypertension management,especially in managing acute variceal bleeding.EUS has been considered a better tool to visualize the bleeding vessel in gastroesophageal variceal bleeding.There have been studies looking at the role of EUS for managing NVUGIB;however,most of them are case reports.Therefore,it is important to review back to see the evolution and innovation of endoscopic treatment for NVUGIB and the role of EUS for possibility to replace the standard endoscopic haemostasis management in daily practice.

Influence of non-alcoholic fatty liver disease on non-variceal upper gastrointestinal bleeding:A nationwide analysis

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of liver disease globally with an estimated prevalence of 25%,with the clinical and economic burden expected to continue to increase.In the United States,non-variceal upper gastrointestinal bleeding(NVUGIB)has an estimated incidence of 61-78 cases per 100000 people with a mortality rate of 2%-15%based on co-morbidity burden.AIM To identify the outcomes of NVUGIB in NAFLD hospitalizations in the United States.METHODS We utilized the National Inpatient Sample from 2016-2019 to identify all NVUGIB hospitalizations in the United States.This population was divided based on the presence and absence of NAFLD.Hospitalization characteristics,outcomes and complications were compared.RESULTS The total number of hospitalizations for NVUGIB was 799785,of which 6%were found to have NAFLD.NAFLD and GIB was,on average,more common in younger patients,females,and Hispanics than GIB without NAFLD.Interestingly,GIB was less common amongst blacks with NAFLD.Multivariate logistic regression analysis was conducted,controlling for the multiple covariates.The primary outcome of interest,mortality,was found to be significantly higher in patients with NAFLD and GIB[adjusted odds ratio(aOR)=1.018(1.013-1.022)].Secondary outcomes of interest,shock[aOR=1.015(1.008-1.022)],acute respiratory failure[aOR=1.01(1.005-1.015)]and acute liver failure[aOR=1.016(1.013-1.019)]were all more likely to occur in this cohort.Patients with NAFLD were also more likely to incur higher total hospital charges(THC)[$2148($1677-$2618)];however,were less likely to have a longer length of stay[0.27 d(0.17-0.38)].Interestingly,in our study,the patients with NAFLD were less likely to suffer from acute myocardial infarction[aOR=0.992(0.989-0.995)].Patients with NAFLD were not more likely to suffer acute kidney injury,sepsis,blood transfusion,intubation,or dialysis.CONCLUSION NVUGIB in NAFLD hospitalizations had higher inpatient mortality,THC,and complications such as shock,acute respiratory failure,and acute liver failure compared to those without NAFLD.

Endoscopic advances in the management of non-variceal upper gastrointestinal bleeding:A review

Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and nonvariceal gastrointestinal bleeding.Non-variceal upper gastrointestinal bleeding remains a common clinical problem globally.It is associated with high mortality,morbidity,and cost of the health care system.Despite the continuous improvement of therapeutic endoscopy,the 30-d readmission rate secondary to rebleeding and associated mortality is an ongoing issue.Available Food and Drug Administration approved traditional or conventional therapeutic endoscopic modalities includes epinephrine injection,argon plasma coagulation,heater probe,and placement of through the scope clip,which can be used alone or in combination to decrease the risk of rebleeding.Recently,more attention has been paid to the novel advanced endoscopic devices for primary treatment of the bleeding lesion and as a secondary measure when conventional therapies fail to achieve hemostasis.This review highlights emerging endoscopic modalities used in the management of non-variceal upper gastrointestinal related bleeding such as over-the-scope clip,Coagrasper,hemostatic sprays,radiofrequency ablation,cryotherapy,endoscopic suturing devices,and endoscopic ultrasound-guided angiotherapy.In this review article,we will also discuss the technical aspects of the common procedures,outcomes in terms of safety and efficacy,and their advantages and limitations in the setting of non-variceal upper gastrointestinal bleeding.

Prophylactic transcatheter arterial embolization reduces rebleeding in non-variceal upper gastrointestinal bleeding: A meta-analysis

BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial embolization(PTAE)added to successful hemostatic treatment among NVUGIB patients.METHODS We searched three databases from inception through October 19th,2020.Randomized controlled trials(RCTs)and observational cohort studies were eligible.Studies compared patients with NVUGIB receiving PTAE to those who did not get PTAE.Investigated outcomes were rebleeding,mortality,reintervention,need for surgery and transfusion,length of hospital(LOH),and intensive care unit(ICU)stay.In the quantitative synthesis,odds ratios(ORs)and weighted mean differences(WMDs)were calculated with the random-effects model and interpreted with 95%confidence intervals(CIs).RESULTS We included a total of 3 RCTs and 9 observational studies with a total of 1329 patients,with 486 in the intervention group.PTAE was associated with lower odds of rebleeding(OR=0.48,95%CI:0.29–0.78).There was no difference in the 30-d mortality rates(OR=0.82,95%CI:0.39–1.72)between the PTAE and control groups.Patients who underwent PTAE treatment had a lower chance for reintervention(OR=0.48,95%CI:0.31–0.76)or rescue surgery(OR=0.35,95%CI:0.14–0.92).The LOH and ICU stay was shorter in the PTAE group,but the difference was non-significant[WMD=-3.77,95%CI:(-8.00)–0.45;WMD=-1.33,95%CI:(-2.84)–0.18,respectively].CONCLUSION PTAE is associated with lower odds of rebleeding and any reintervention in NVUGIB.However,further RCTs are needed to have a higher level of evidence.

Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%.

Aspirin use for primary prophylaxis: Adverse outcomes in non-variceal upper gastrointestinal bleeding

AIM: To compare outcomes of patients with nonvariceal upper gastrointestinal bleeding(NVUGIB) taking aspirin for primary prophylaxis to those not taking it.METHODS: Patients not known to have any vascular disease(coronary artery or cerebrovascular disease) who were admitted to the American University of Beirut Medical Center between 1993 and 2010 with NVUGIB were included. The frequencies of in-hospital mortality, re-bleeding, severe bleeding, need for surgery or embolization, and of a composite outcome defined as the occurrence of any of the 4 bleeding related adverse outcomes were compared between patients receiving aspirin and those on no antithrombotics. We also compared frequency of in hospital complications and length of hospital stay between the two groups.RESULTS: Of 357 eligible patients, 94 were on aspirin and 263 patients were on no antithrombotics(controlgroup). Patients in the aspirin group were older, the mean age was 58 years in controls and 67 years in the aspirin group(P < 0.001). Patients in the aspirin group had significantly more co-morbidities, including diabetes mellitus and hypertension [25(27%) vs 31(112%) and44(47%) vs 74(28%) respectively,(P = 0.001)], as well as dyslipidemia [21(22%) vs 16(6%), P < 0.0001).Smoking was more frequent in the aspirin group [34(41%) vs 60(27%), P = 0.02)]. The frequencies of endoscopic therapy and surgery were similar in both groups. Patients who were on aspirin had lower inhospital mortality rates(2.1% vs 13.7%, P = 0.002),shorter hospital stay(4.9 d vs 7 d, P = 0.01), and fewer composite outcomes(10.6% vs 24%, P = 0.01). The frequencies of in-hospital complications and re-bleeding were similar in the two groups.CONCLUSION: Patients who present with NVUGIB while receiving aspirin for primary prophylaxis had fewer adverse outcomes. Thus aspirin may have a protective effect beyond its cardiovascular benefits.

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

AIM:To identify clinical parameters,and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score.METHODS:Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defi ned from the receiver operating curve and prospectively validated in another set of patients with UGIB.RESULTS:Among 261 patients with UGIB,47 (18%) had variceal and 214 (82%) had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4,95% CI 8.3-60.4,P < 0.001),red vomitus (OR 4.6,95% CI 1.8-11.9,P = 0.02),and red nasogastric (NG) aspirate (OR 3.3,95% CI 1.3-8.3,P = 0.011). The UGIB Etiology Score was calculated from (3.1 × previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vomitus) + (1.2 × red NG aspirate),when 1 and 0 are used for the presence and absence of each factor,respectively. Using a cutoff≥ 3.1,the sensitivity,specificity,accuracy,positive predictive value (PPV),and negative predictive value (NPV) in predicting variceal bleeding were 85%,81%,82%,50%,and 96%,respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%,respectively.CONCLUSION:The UGIB Etiology Score,composed of 3 parameters,using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting

AIM: To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death. METHODS: We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals. Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used χ2 goodness-of-fit tests to assess the degree of calibration, and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system. RESULTS: For rebleeding, the χ2 goodness-of-fit test indicated an acceptable fit for the model [χ2 (8) = 12.83, P = 0.12]. For surgical procedures [χ2 (8) = 5.3, P = 0.73] and death [χ2 (8) = 3.78, P = 0.88], the tests showed solid correspondence between observed proportions and predicted probabilities. The AUC was 0.59 (95% CI: 0.55-0.62) for the outcome of rebleeding and 0.60 (95% CI: 0.54-0.67) for surgical procedures, representing apoor discriminative ability of the scoring system. For the outcome of death, the AUC was 0.73 (95% CI: 0.69-0.78), indicating an acceptable discriminative ability. CONCLUSION: The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures.

Advancements in hemostatic strategies for managing upper gastrointestinal bleeding: A comprehensive review

Upper gastrointestinal(GI)hemorrhage presents a substantial clinical challenge.Initial management typically involves resuscitation and endoscopy within 24 h,although the benefit of very early endoscopy(<12 h)for high-risk patients is debated.Treatment goals include stopping acute bleeding,preventing rebleeding,and using a multimodal approach encompassing endoscopic,pharmacological,angiographic,and surgical methods.Pharmacological agents such as vasopressin,prostaglandins,and proton pump inhibitors are effective,but the increase in antithrombotic use has increased GI bleeding morbidity.Endoscopic hemostasis,particularly for nonvariceal bleeding,employs techniques such as electrocoagu-lation and heater probes,with concerns over tissue injury from monopolar electrocoagulation.Novel methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have limitations.Currently,the first-line therapy includes thermal probes and hemoclips,with over-the-scope clips emerging for larger ulcer bleeding.The gold probe,combining bipolar electrocoagulation and injection,offers targeted coagulation but has faced device-related issues.Future advancements involve combining techniques and improving endoscopic imaging,with studies exploring combined approaches showing promise.Ongoing research is crucial for developing standardized and effective hemorrhage management strategies.

Efficacy and safety of over-the-scope-clips in the therapy of acute nonvariceal upper gastrointestinal bleeding:Meta-analysis

BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(ANVUGIB)is a frequent lifethreatening acute condition in gastroenterology associated with high morbidity and mortality.Over-the-scope-clip(OTSC)is a new endoscopic hemostasis technique,which is being used in ANVUGIB and is more effective.AIM To summarize and analyze the effects of the OTSC in prevention of recurrent bleeding,clinical success rate,procedure time,hospital stay,and adverse events in the treatment of ANVUGIB,to evaluate whether OTSC can replace standard endoscopic therapy as a new generation of treatment for ANVUGIB.METHODS The literature related to OTSC and standard therapy for ANVUGIB published before January 2023 was searched in PubMed,Web of Science,EMBASE,Cochrane,Google,and CNKI databases.Changes in recurrent bleeding(7 or 30 days),clinical results(clinical success rate,conversion rate to surgery,mortality),therapy time(procedure time,hospital stay),and adverse events in the OTSC intervention group were summarized and analyzed,and the MD or OR of 95%CI is calculated by Review Manager 5.3.RESULTS This meta-analysis involved 11 studies with 1266 patients.Total risk of bias was moderate-to-high.For patients in the OTSC group,7-and 30-days recurrent bleeding rates,as well as procedure time,hospital stay,and intensive care unit stay,were greatly inhibited.OTSC could significantly improve the clinical success rate of ANVUGIB.OTSC therapy did not cause serious adverse and was effective in reducing patient mortality.CONCLUSION OTSC may provide more rapid and sustained hemostasis,and thus,promote recovery and reduce mortality in patients with ANVUGIB.In addition,the safety of OTSC is assured.

Comparative Analysis of Continuous versus Intermittent Proton Pump Inhibitor Therapy in Patients with Upper Gastrointestinal Bleeding Due to Ulcers

Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bleeding ulcers recommend a continuous infusion of proton pump inhibitors (PPI). However, studies comparing intermittent dosing of PPI therapy show that this regimen achieves similar clinical benefits. If the clinical efficacy remains equivalent, intermittent dosing will be more cost-effective for patients and the health care system. Our research study aims to analyze the comparative effectiveness of intermittent versus continuous PPI therapy after endoscopic treatment in patients with UGIB, focusing on such endpoints as rebleeding risk at 3-and 7-day mortality rates. Methods: Resources searched included MEDLINE, EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials databases from January 2010 through December 2023 with the inclusion of meta-analysis, systematic review, review, or ACG guideline recommendations. Results of the analysis show how recommendations regarding high vs. low PPI regimen changed over time: from no difference in regimen in 2010 to recommending continuous regimen in 2012 to declaring insufficient evidence between choosing one regimen over another in 2013 to determine that both regimens were comparable to each other in 2014-2018 and finally to recommending both regimens in 2021. To conclude, our review shows that in patients with bleeding ulcers and high-risk endoscopic findings, intermittent PPI therapy is non-inferior to continuous PPI infusion for three days, seven days bleeding risk or mortality rates;however, it remains challenging to determine the most optimal intermittent regimen due to heterogeneity of RCTs included in meta-analyses, and further trials will need to be performed.

MH-STRALP:A scoring system for prognostication in patients with upper gastrointestinal bleeding

BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS In this retrospective study,692 patients with UGIB were enrolled from two cen-ters and divided into a training(n=591)and a validation cohort(n=101).The clinical data were collected to develop new prognostic prediction models.The en-dpoint was compound outcome defined as(1)demand for emergency surgery or vascular intervention,(2)being transferred to the intensive care unit,or(3)death during hos-pitalization.The models’predictive ability was compared with previously esta-blished scores by receiver operating characteristic(ROC)curves.RESULTS Totally 22.2%(131/591)patients in the training cohort and 22.8%(23/101)in the validation cohort presented poor outcomes.Based on the stepwise-forward Lo-gistic regression analysis,eight predictors were integrated to determine a new post-endoscopic prognostic scoring system(MH-STRALP);a nomogram was de-termined to present the model.Compared with the previous scores(GBS,Rock-all,ABC,AIMS65,and PNED score),MH-STRALP showed the best prognostic prediction ability with area under the ROC curves(AUROCs)of 0.899 and 0.826 in the training and validation cohorts,respectively.According to the calibration cur-ve,decision curve analysis,and internal cross-validation,the nomogram showed good calibration ability and net clinical benefit in both cohorts.After removing the endoscopic indicators,the pre-endoscopic model(pre-MH-STRALP score)was conducted.Similarly,the pre-MHSTRALP score showed better predictive value(AUROCs of 0.868 and 0.767 in the training and validation cohorts,respectively)than the other pre-endoscopic scores.CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple,convenient,and accurate tools for prognosis prediction of UGIB,and may be applied for early decision on its management strategies.

Upper gastrointestinal bleeding in Bangladeshi children:Analysis of 100 cases

BACKGROUND Upper gastrointestinal bleeding(UGIB)is defined as bleeding that occurs proximal to the ligament of Treitz and can sometimes lead to potentially serious and life-threatening clinical situations in children.Globally,the cause of UGIB differs significantly depending on the geographic location,patient population and presence of comorbid conditions.AIM To observe endoscopic findings of UGIB in children at a tertiary care center of Bangladesh.METHODS This retrospective study was carried out in the department of Pediatric Gastroenterology and Nutrition of Bangabandhu Shiekh Mujib Medical University,a tertiary care hospital of Bangladesh,between January 2017 and January 2019.Data collected from hospital records of 100 children who were 16 years of age or younger,came with hematemesis,melena or both hematemesis and melena.All patients underwent upper gastrointestinal endoscopy(Olympus CV 1000 upper gastrointestinal video endoscope)after initial stabilization.Necessary investigations to diagnose portal hypertension and chronic liver disease with underlying causes for management purposes were also done.RESULTS A total of 100 patients were studied.UGIB was common in the age group 5-10 years(42%),followed by above 10 years(37%).Hematemesis was the most common presenting symptom(75%)followed by both hematemesis and melena(25%).UGIB from ruptured esophageal varices was the most common cause(65%)on UGI endoscopy followed by gastric erosion(5%)and prolapsed gastropathy(2%).We observed that 23%of children were normal after endoscopic examination.CONCLUSION Ruptured esophageal varices were the most common cause of UGIB in children in Bangladesh.Other causes included gastric erosions and prolapsed gastropathy syndrome.

Application Effect of Staged Health Education in the Nursing Care of Patients with Upper Gastrointestinal Bleeding

Objective:To investigate the application effect of staged health education in the care of patients with upper gastrointestinal bleeding.Methods:This study takes health education in the care of patients with upper gastrointestinal bleeding as the main direction.160 patients with upper gastrointestinal bleeding who received treatment in our hospital were selected as samples,and the grouping software was used to divide them into the reference group and the study group,with 80 patients each.The reference group and the study group used routine health education and staged health education respectively.Relevant research data were recorded during the nursing process,analyzed,and used as research indicators.Results:The compliance behavior of the study group was higher than that of the reference group after the staged nursing care,and at the same time,the nursing care satisfaction of the study group was higher than that of the reference group(P<0.05).Conclusion:The use of staged health education for the care of patients with upper gastrointestinal bleeding not only enhances the degree of patient awareness and compliance but also improves nursing satisfaction,which is worthy of promotion and application.

Upper non-variceal gastrointestinal bleeding-review the effectiveness of endoscopic hemostasis methods

Upper non-variceal gastrointestinal bleeding is a conditionthat requires immediate medical intervention and has a high associated mortality rate(exceeding 10%). The vast majority of upper gastrointestinal bleeding cases are due to peptic ulcers. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and aspirin are the main risk factors for peptic ulcer disease. Endoscopic therapy has generally been recommended as the firstline treatment for upper gastrointestinal bleeding as it has been shown to reduce recurrent bleeding, the need for surgery and mortality. Early endoscopy(within 24 h of hospital admission) has a greater impact than delayed endoscopy on the length of hospital stay and requirement for blood transfusion. This paper aims to review and compare the efficacy of the types of endoscopic hemostasis most commonly used to control non-variceal gastrointestinal bleeding by pooling data from the literature.

Age-specific causes of upper gastrointestinal bleeding in children

The etiology of upper gastrointestinal bleeding(UGIB)varies by age,from newborns to adolescents,with some of the causes overlapping between age groups.While particular causes such as vitamin K deficiency and cow’s milk protein allergy are limited to specific age groups,occurring only in neonates and infants,others such as erosive esophagitis and gastritis may be identified at all ages.Furthermore,the incidence of UGIB is variable throughout the world and in different hospital settings.In North America and Europe,most UGIBs are nonvariceal,associated with erosive esophagitis,gastritis,and gastric and duodenal ulcers.In recent years,the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries.However,variceal bleeding still predominates in certain parts of the world,especially in South Asia.The most severe hemorrhage arises from variceal bleeding,peptic ulceration,and disseminated intravascular coagulation.Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients.Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings,the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIBincludes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability,followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis inthe pediatric population because some of them are unique to children. Endoscopic techniques are of significantdiagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally,surgical treatment is reserved for the most severe bleeding.

A Nomogram Model for Prediction of Mortality Risk of Patients with Dangerous Upper Gastrointestinal Bleeding:A Two-center Retrospective Study

Objective:This study aimed to establish a nomogram model to predict the mortality risk of patients with dangerous upper gastrointestinal bleeding(DUGIB),and identify high-risk patients who require emergent therapy.Methods:From January 2020 to April 2022,the clinical data of 256 DUGIB patients who received treatments in the intensive care unit(ICU)were retrospectively collected from Renmin Hospital of Wuhan University(n=179)and the Eastern Campus of Renmin Hospital of Wuhan University(n=77).The 179 patients were treated as the training cohort,and 77 patients as the validation cohort.Logistic regression analysis was used to calculate the independent risk factors,and R packages were used to construct the nomogram model.The prediction accuracy and identification ability were evaluated by the receiver operating characteristic(ROC)curve,C index and calibration curve.The nomogram model was also simultaneously externally validated.Decision curve analysis(DCA)was then used to demonstrate the clinical value of the model.Results:Logistic regression analysis showed that hematemesis,urea nitrogen level,emergency endoscopy,AIMS65,Glasgow Blatchford score and Rockall score were all independent risk factors for DUGIB.The ROC curve analysis indicated the area under curve(AUC)of the training cohort was 0.980(95%CI:0.962-0.997),while the AUC of the validation cohort was 0.790(95%CI:0.685-0.895).The calibration curves were tested for Hosmer-Lemeshow goodness of fit for both training and validation cohorts(P=0.778,P=0.516).Conclusion:The developed nomogram is an effective tool for risk stratification,early identification and intervention for DUGIB patients.