Role of second look endoscopy in endoscopic submucosal dissection and peptic ulcer bleeding:Meta-analysis of randomized controlled trials

BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for Endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE.For mortality between SLE and non-SLE groups in PUD,the OR was 0.88,95%CI:0.45 to 1.72;P=0.70.CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding.SLE also does not provide any significant improvement in mortality,need for interventions,or blood transfusions in PUD patients.SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.

Serum gastrin-17 concentration for prediction of upper gastrointestinal tract bleeding risk among peptic ulcer patients

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.

Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy

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.

Clinical characteristics of Helicobacter pylori-negative drugnegative peptic ulcer bleeding

AIM:To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori(H.pylori)-negative and drug-negative]peptic ulcer bleeding(PUB).METHODS:A consecutive series of patients who experienced PUB between 2006 and 2012 was retrospectively analyzed.A total of 232 patients were enrolled in this study.The patients were divided into four groups according to the etiologies of PUB:idiopathic,H.pylori-associated,drug-induced and combined(H.pylori-associated and drug-induced)types.We compared the clinical characteristics and outcomes between the groups.When the silver stain or rapid urease tests were H.pylori-negative,we obtained an additional biopsy specimen by endoscopic re-examination and performed an H.pylori antibody test 6-8 wk after the initial endoscopic examination.For a diagnosis of idiopathic PUB,a negative result of an H.pylori antibody test was confirmed.In all cases,re-bleeding was confirmed by endoscopic examination.For the risk assessment,the Blatchford and the Rockall scores were calculated for all patients.RESULTS:For PUB,the frequency of H.pylori infection was 59.5%(138/232),whereas the frequency of idiopathic cases was 8.6%(20/232).When idiopathic PUB was compared to H.pylori-associated PUB,the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis during the hospital stay(30%vs 7.4%,P = 0.02).When idiopathic PUB was compared to drug-induced PUB,the patients in the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis upon admission(30%vs 2.7%,P < 0.01).When drug-induced PUB was compared to H.pylori-associated PUB,the patients in the drug-induced PUB were older(68.49 ± 14.76 years vs 47.83 ± 15.15 years,P< 0.01) and showed a higher proportion of gastric ulcer(77%vs 49%,P < 0.01).However,the Blatchford and the Rockall scores were not significantly different between the two groups.Among the patients who experienced drug-induced PUB,no significant differences were found with respect to clinical characteristics,irrespective of H.pylori infection.CONCLUSION:Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission.Therefore,these patients need to undergo close surveillance upon admission.

Management of acute nonvariceal upper gastrointestinal bleeding:Current policies and future perspectives

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.

Scoring systems for peptic ulcer bleeding: which one to use?

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.

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.

Application of Nursing Risk Management in Nursing of Severe Peptic Ulcer Bleeding

Objective: To assess and compare the clinical application value of nursing risk management in the diagnosis and treatment of severe peptic ulcer bleeding. Methods: 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. Results: 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). Conclusion: 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.

Gastric ulcer treated using an elastic traction ring combined with clip: A case report

BACKGROUND There is a high annual incidence of acute,nonvariceal upper gastrointestinal bleeding in Chinese adults.Early endoscopic intervention can reduce rates of rebleeding,surgery,and mortality.The metal clip is the most common method for establishing homeostasis;however,it possesses several limitations.In patients with bleeding secondary to large gastric ulcers,the clip will often fail to stop the bleeding.This article highlights the use of an elastic traction ring as a novel hemostatic method for patients with upper gastrointestinal bleeding.CASE SUMMARY An elderly male presented to the emergency room with complaints of hematemesis and melena.Endoscopic examination revealed an ulcer(Forrest IIa)in the lesser curvature of the gastric antrum.Six tissue clips and one elastic traction ring were inserted into the stomach cavity to suture the ulcer.The patient recovered quickly without postoperative gastrointestinal bleeding.Two months later,the patient's ulcer was significantly healed.CONCLUSION To our best knowledge,this is the first report to demonstrate the safety and efficacy of elastic traction rings for upper gastrointestinal bleeding.Elastic traction rings should be considered a routine therapeutic modality for patients with upper gastrointestinal bleeds.

Impact of epinephrine volume on further bleeding due to high-risk peptic ulcer disease in the combination therapy era

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.

Epinephrine injection therapy versus a combination of epinepnrine injection and endoscopic hemoclip in the treatment of bleeding ulcers

AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection alone.METHODS: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures studied.RESULTS: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly different.CONCLUSION: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.

Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding

AIM:To compare the effectiveness of argon plasma coagulation (APC) and heater probe coagulation (HPC) in non-variceal upper gastrointestinal bleeding.METHODS:Eighty-five (18 female,67 male) patients admitted for acute gastrointestinal bleeding due to gastric or duodenal ulcer were included in the study.Upper endoscopy was performed and HPC or APC were chosen randomly to stop the bleeding.Initial hemostasis and rebleeding rates were primary and secondary end-points of the study.RESULTS:Initial hemostasis was achieved in 97.7% (42/43) and 81% (36/42) of the APC and HPC groups,respectively (P < 0.05).Rebleeding rates were 2.4% (1/42) and 8.3% (3/36) in the APC and HPC groups,respectively,at 4 wk (P > 0.05).CONCLUSION:APC is an effective hemostatic method in bleeding peptic ulcers.Larger multicenter trials are necessary to confirm these results.

Trends on gastrointestinal bleeding and mortality:Where are we standing?

Bleeding from the gastrointestinal tract and its management are associated with significant morbidity and mortality.The predisposing factors that led to the occurrence of these hemorrhagic instances are largely linked to the life style of the affected persons.Designing a new strategy aimed at educating the publics and improving their awareness of the problem could effectively help in eradicating this problem with no associated risks and in bringing the mortality rates down to almost zero.

Etiology of Upper GI Bleeding on Endoscopy

Background: Several circumstances and conditions lead to UGIB. The commonest among them peptic ulcer to an approximation of 50% in cases. The second major cause may be esoghageal varices and third is mallory-weis tears. There are also other causes, which may include erosins, tumors and other malformations like arteriovenous. Methods: This was an observational retrospective study of all patients referred to endoscopy. The study exclusion criteria include all patients who had repeat endoscopies within one month of the previous endoscopy whereas all the patients with UGIB were included in this study. Results: We retrieved data of total 150 patients who had experienced upper gastrointestinal endoscopy during the selected time period covered in the study, March 2015 to February 2016. The mean age of the patients was 43.3 ± 13.80. 80 (53.3%) of the patients were male and 70 (46.7%) were females. Exploring more into UGIB causes the majority of patients were with esophageal varices 68 (45.3%) with male to female share was 2:1. The second most cause was esophagitis (n = 22, (14.67%)), the distribution of the cause was similar in male to female. Conclusion: We may conclude from our findings that the most common cause of UGIB is esophageal varices in our population.

Z-per-oral endoscopic myotomy as definitive prevention of a bleeding ulcer in Zenker’s diverticulum:A case report

BACKGROUND Bleeding from Zenker’s diverticulum is extremely rare.At present,there are no guidelines for the management of bleeding Zenker’s diverticulum because of its rarity.Per-oral endoscopic myotomy(Z-POEM)is a precision myotomy technique and minimally invasive procedure for the treatment of Zenker’s diverticulum.We present a systematic review and a rare case of bleeding Zenker’s diverticulum that was effectively treated using Z-POEM.CASE SUMMARY A 72-year-old presented after 3 d of hematemesis.He had a 2-year history of progressive dysphagia and reported no antiplatelet,anticoagulant,or nonsteroidal anti-inflammatory drug use.His vital signs were stable,and the hematocrit was 36%.Previous gastroscopy and barium swallow had revealed Zenker’s diverticulum before the bleeding occurred.We performed gastroscopy and found a 5-mm ulcer with a minimal blood clot and spontaneously resolved bleeding.Z-POEM for definitive treatment was performed to reduce accumulation of food and promote ulcer healing.He had no complications and no bleeding;at the follow-up 6 mo later,the ulcer was healed.CONCLUSION Z-POEM can be definitive prevention for bleeding ulcer in Zenker’s diverticulum that promotes ulcer healing,reducing the risk of recurrent bleeding.Z-POEM is also a definitive endoscopic surgery for treatment of Zenker’s diverticulum.

基于信息-动机-行为技巧模型的知信行健康宣教及护理在消化性溃疡合并上消化道出血患者中的应用效果

目的研究基于信息-动机-行为技巧模型(IMB)的知信行健康宣教及护理在消化性溃疡合并上消化道出血患者中的应用效果。方法选择2021年3月至2022年10月安徽省安庆市立医院接受治疗的患者82例,根据随机数字表法将其分为对照组与观察组,各41例。对照组采用常规知信行宣教及护理进行干预,观察组在对照组的基础上给予基于IMB模型的知信行宣教及护理。比较两组干预前与出院1个月后药物依从性、疾病不确定感、自我效能。结果出院后1个月,两组依从性得分均高于干预前,且研究组高于对照组,差异有统计学意义(P<0.05)。出院后1个月,两组疾病不确定感各项得分均低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。出院后1个月,两组自我效能得分均高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论基于IMB模型的知信行健康宣教及护理,能够有效提高消化性溃疡合并上消化道出血患者的治疗效果,值得推广运用。

奥曲肽联合胃镜治疗消化性溃疡伴出血患者的临床效果

目的:分析奥曲肽联合胃镜治疗消化性溃疡伴出血患者的临床效果。方法:选择2021年1月—2023年1月曲靖市第一人民医院收治的200例消化性溃疡伴出血患者作为研究对象,根据治疗方法的不同分为对照组和观察组,各100例。对照组采用胃镜治疗,观察组在对照组的基础上加用奥曲肽治疗。比较两组的症状缓解时间、住院时间、疼痛程度、炎症因子指标、生活质量。结果:治疗后,观察组腹痛缓解时间、呕血停止时间、住院时间均短于对照组,差异有统计学意义(P<0.05);治疗后24 h、48 h,观察组视觉模拟评分法(VAS)评分均低于对照组,差异有统计学意义(P<0.05);治疗后,观察组白细胞介素-2(IL-2)高于对照组,白细胞介素-6(IL-6)低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组健康调查简表(SF-36)各维度评分均高于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:奥曲肽联合胃镜治疗消化性溃疡伴出血患者可较快缓解患者的呕血和疼痛症状,调节炎症因子指标,提升患者生活质量,促进患者早日康复出院。

奥曲肽与泮托拉唑治疗消化性溃疡并发上消化道出血的疗效

目的探讨奥曲肽与泮托拉唑联合治疗消化性溃疡并发上消化道出血的效果。方法选取2018年5月—2020年12月在宁德师范学院附属宁德市医院接受治疗的70例消化性溃疡并发上消化道出血患者,基于随机数字表法分为对照组(n=35,给予“泮托拉唑”治疗)与观察组(n=35,给予“奥曲肽+泮托拉唑”治疗)。比较2组患者治疗效果及相关炎症因子水平情况。结果观察组与对照组治疗有效率[97.14%vs.82.85%]比较,差异有统计学意义(P<0.05)。观察组患者的黑便次数(0.60±0.19)次、止血时间(0.43±0.13)d、腹痛缓解时间(0.45±0.15)d,均明显低于对照组的(1.34±0.53)次、(1.06±0.42)d和(1.15±0.54)d(P<0.05)。观察组患者治疗后的血常规指标均明显优于对照组(P<0.05)。在炎症水平方面,观察组患者治疗后的炎症因子水平明显低于对照组,差异有统计学意义(P<0.05)。2组患者均未出现相关不良反应。结论对于消化并发上消化道出血,给予单一用药(泮托拉唑)的疗效不甚理想,但基于联合用药(“奥曲肽”与“泮托拉唑”)的综合效果更理想,可以有效控制出血、改善相关症状,并且血常规、炎症因子水平等改善效果更显著,用药安全。

艾司奥美拉唑镁肠溶片四联方案治疗老年消化性溃疡出血患者疗效及对Hp清除率、胃肠激素和不良反应的影响

目的分析老年消化性溃疡出血(peptic ulcer bleeding,PUB)患者接受艾司奥美拉唑镁肠溶片四联方案治疗的效果。方法对2019年1月-2023年8月青岛市胶州中心医院收治的180例老年PUB患者的资料进行回顾性分析,根据治疗方法不同分为观察组(n=92)及对照组(n=88)。对照组予以雷尼替丁四联方案,观察组予以艾司奥美拉唑镁肠溶片四联方案,疗程均为2周。观察并比较2组疗效、Hp清除率、症状改善情况、胃肠激素、炎症因子、不良反应、药物经济学。结果治疗2周后,观察组总有效率及Hp清除率均高于对照组(P<0.05);观察组黑便及呕血频率及GAS、TNF-α、IL-17、IL-6水平均低于对照组(P<0.05),SS水平高于对照组(P<0.05);2组不良反应发生率差异无统计学意义(P>0.05);观察组治疗有效率的成本-效果(C/E值)低于对照组(P<0.05)。结论艾司奥美拉唑镁肠溶片四联方案治疗老年PUB患者,效果确切,可促进Hp清除,改善患者症状及胃肠激素水平,缓解炎症反应,药物经济学价值较高,具有一定的临床应用价值。

系统化护理在胃溃疡合并上消化道出血患者中的应用效果

目的:探讨系统化护理在胃溃疡合并上消化道出血患者中的应用效果。方法:选取2020年1月—2022年9月遵义市播州区人民医院收治的胃溃疡合并上消化道出血患者100例作为研究对象,采用随机数字表法分为两组,各50例。对照组行常规护理,观察组行系统化护理。比较两组自我管理能力、依从性及症状改善时间。结果:护理后,两组健康知识掌握度评分高于护理前,且观察组高于对照组,差异有统计学意义(P<0.001)。观察组治疗总依从率高于对照组,差异有统计学意义(P=0.010)。护理后,两组日常生活、健康行为、用药评分高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组黑便消失时间、咯血消失时间、腹痛消失时间、粪便性状恢复正常时间、排便次数恢复正常时间均短于对照组,差异有统计学意义(P<0.001)。结论:系统化护理在胃溃疡合并上消化道出血患者中的应用效果显著,能够提高患者健康知识掌握度、治疗依从性及自我管理能力,促进患者症状改善。