Visibility of the bleeding point in acute rectal hemorrhagic ulcer using red dichromatic imaging:A case report

BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.

Usefulness of anti-ulcer drugs for the prevention and treatment of peptic ulcers induced by low doses of aspirin

AIM： To investigate the usefulness of anti-ulcer drugs for the prevention and treatment of low-dose aspirin-induced peptic ulcer.METHODS： Upper gastrointestinal endoscopy was performed in 68 patients receiving daily low-dose aspirin （81 or 100 rag/day）. The endoscopic findings were classified according to the Lanza score, and the scores were compared between groups categorized according to the concomitant use of anti-ulcer drugs and the types of drugs used. In another study, 31 hemorrhagic peptic ulcer patients who had been receiving low-dose aspirin were enrolled. The patients were randomly classified into the proton pump inhibitor （PPI）-treated group and the H2 receptor antagonist （H2RA）-treated group. The administration of low-dose aspirin was continued concomitantly, and endoscopic examinations were performed 8 wk later.RESULTS： The Lanza scores （mean ± SD） of the gastro-mucosal lesions were 1.0 ± 1.9 and 1.9 ± 2.3 in 8 and 16 patients receiving prevention therapy with a PPI and an H2RA, respectively. Both scores were significantly smaller than the scores in 34 patients who were not receiving prevention therapy （4.7 ± 1.0） and in 10 patients receiving cytoprotective anti-ulcer drugs （4.3± 1.6）. In the prospective study, 18 and 13 patients received a PPI and an H2RA, respectively. Endoscopic examinations revealed that the tissue in the region of the gastro-mucosal lesions had reverted to normal in all patients in the PPI-treated group and in 12 patients （92%） in the H2RA-treated group; no significant differences were observed between the groups.CONCLUSION： H2RA therapy was effective for both the prevention and treatment of low-dose aspirin-induced peptic ulcer, similar to the effects of PPIs, while cytoprotective anti-ulcer drugs were ineffective in preventing ulceration.

Upper-gastrointestinal bleeding secondary to peptic ulcer disease:Incidence and outcomes

AIM: To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD).

Helicobacter pylori infection in bleeding peptic ulcer patients after non-steroidal antiinflammatory drug consumption

AIM： TO establish the prevalence of He/icobacterpy/on （H. pylori） infection in patients with a bleeding peptic ulcer after consumption of non-steroidal antiinflammatory drugs （NSAIDs）.METHODS： A very early upper endoscopy was performed to find the source of upper gastrointestinal bleeding and to take biopsy specimens for analysis of H. pylori infection by the rapid urease （CLO） test, his- tological examination, and bacterial culture. TgG anti- CagA were also sought. The gold standard for identifying H. pylori infection was positive culture of biopsy specimens or contemporary positivity of the CLO test and the presence of H. pylori on tissue sections.RESULTS： Eighty patients, 61 males （76.3%）, mean age 61.2 ~ 15.9 years, were consecutively enrolled. Forty-seven （58.8%） patients occasionally consumed NSAIDs, while 33 （41.3%） were on chronic treatment with low-dose aspirin （LD ASA）. Forty-four （55.0%） patients were considered infected by H. pylori. The infection rate was not different between patients who occasionally or chronically consumed NSAIDs. The culture of biopsy specimens had a sensitivity of 86.4% and a specificity of 100%; corresponding figures for histological analysis were 65.9% and 77.8%, for the CLO test were 68.2% and 75%, for the combined use of histology and the CLO test were 56.8% and 100%, and for IgG anti-CagA were 90% and 98%. The high- est accuracy （92.5%） was obtained with the culture of biopsy specimens.CONCLUSION： Patients with a bleeding peptic ulcer after NSAID/LD ASA consumption frequently have H. pylori infection. Biopsy specimen culture after an early upper gastrointestinal tract endoscopy seems the most efficient test to detect this infection.

Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding

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.

The therapeutic effect of high-dose esomeprazole on stress ulcer bleeding in trauma patients

Purpose： To compare the therapeutic effects of different doses of intravenous esomeprazole on treating trauma patients with stress ulcer bleeding. Methods： A total of 102 trauma patients with stress ulcer bleeding were randomly divided into 2 groups： 52 patients were assigned to the high-dose group who received 80 mg intravenous esomeprazole, and then 8 mg/h continuous infusion for 3 days; 50 patients were assigned to the conventional dose group who received 40 mg intravenous esomeprazole sodium once every 12 h for 72 h. Results： Compared with the conventional dose group, the total efficiency of the high-dose group and conventional dose group was 98.08% and 86.00%, respectively （p 〈 0.05）, the hemostatic time was 22.10 h ± 5.18 h and 28.27 h ± 5.96 h, respectively （p 〈 0.05）. Conclusion： Both doses of intravenous esomeprazole have good hemostatic effects on stress ulcer bleeding in trauma patients. The high-dose esomeprazole is better for hemostasis.

因既往未知的原发性甲状旁腺功能亢进引起的危及生命的十二指肠溃疡出血

Peptic ulcer bleeding due to primary hyperparathyroidism is extremely rare.We report a case of a 42-year-old male with life-threatening acute upper gastrointestinal bleeding secondary to a duodenal ulcer and a history of kidney stones.Gastroscopic therapy,Billroth II gastrointestinal anastomosis and angiographic embolization were sequentially conducted to arrest the hemorrhage.A complete investigative work-up revealed that the duodenal ulcer bleeding was due to primary hyperparathyroidismcoexisting with a parathyroid adenoma.Following this event,the patient developed a severe abdominal cavity infection and sepsis.An elective parathyroidectomy was performed,and the histology was confirmed to be a typical parathyroid adenoma.Postoperatively,the patient’s calcium and parathyroid levels were normalized.Attention should be paid to patients with an upper gastrointestinal ulcer,especially when it is accompanied by kidney stones.