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Abstract Mucor is a rare cause of gastrointestinal ulcers. This case describes a case of mucormycosis that occurred in a patient with liver cirrhosis who was hospitalized to accept a splenectomy for traumatic splenic rupture. During the perioperative period, the patient developed upper gastrointestinal bleeding(UGIB), which was diagnosed as mucormycosis-related gastric ulcer according to gastroscopy. Patients with liver cirrhosis often get UGIB for Portal hypertension, but they also can develop UGIB for multiple other reasons, including infectious ulcers for immunosuppression. The case emphasizes the importance of excluding fungal-induced ulcer haemorrhage before diagnosing Portal hypertensive-induced variceal haemorrhage in patients with liver cirrhosis.

Novel direct oral anticoagulants (DOACs) are prescribed worldwide in the treatment of non-valvular atrial fibrillation. Adverse reactions have been reported following the use of DOACs. One notable trend in the literature is the growing number of reported cases of esophagitis dissecans superficialis (EDS) generated by DOAC use. We hereby report the case of a 73-year-old woman who presented to the hospital with asthenia, dysphagia, and melena two days prior to admission. The patient had taken apixaban due to non-valvular paroxysmal atrial fibrillation for a few weeks. The biological panel showed moderate anemia with a hemoglobin level of 7.7 g/dL Apixaban-induced EDS was diagnosed by the characteristic endoscopic findings. The patient received treatment with a proton pump inhibitor (pantoprazole) in a double dose. Also, an iron treatment was recommended for a period of six months. The follow-up endoscopy at one month confirmed the healing of the esophageal lesions. The case was discussed with the cardiologist. The first anticoagulant treatment proposed after discharge was a vitamin K antagonist (acenocumarol) but the patient refused this medication and thus it was decided to initiate rivaroxaban. Although DOACs have demonstrated their efficacy in the prevention and treatment of stroke and thromboembolism among the aging demographic, cases of DOAC-induced EDS will continue to pose numerous challenges for physicians worldwide.

Background: Prophylactic antibacterial drugs are used for patients with liver cirrhosis and upper gastrointestinal bleeding, and independent studies have concluded that they can decrease the rate of infection, mortality, and rebleeding in these diseases. However, no comprehensive assessment of this effect has been reported in recent years and available data pertaining to the prognostic implications of diverse categories of antibiotic prophylaxis in individuals afflicted with cirrhosis are notably limited. The objective of this article is to assess the clinical effectiveness of prophylactic antibacterial drugs for patients with liver cirrhosis and upper gastrointestinal bleeding. Methods: Relevant randomized controlled studies and cohort studies which examined the value of prophylactic antibacterial drugs for patients with liver cirrhosis and upper gastrointestinal bleeding were retrieved via Cochrane Library, EMBASE, MedLine, and Web of Science. The search period was from database inception until 30 April 2023. Summing up the relevant data, the dichotomous variable was statistically analysed using the relative risk (RR) value and its 95% confidence interval (CI) and the continuous variable using the mean difference (MD) value and its 95% CI. All analyses were performed using Revman 5.4 software. The study has been registered on the PROSPERO website under registration number CRD42022343352. Results: Twenty-six studies (18 RCTs and 8 cohort studies, including 13,670 participants) were included to evaluate the effect of antibacterial prophylaxis versus no antibacterial prophylaxis or placebo. Prophylactic antibiotics reduced mortality rates (RR 0.66, 95% CI 0.51-0.83), infection rates (RR 0.41, 95% CI 0.35-0.49), rebleeding rates (RR 0.42, 95% CI 0.31-0.56), and length of hospital stay (MD -5.29, 95% CI -7.53, -3.04). Subgroup analysis revealed that the prophylactic administration of quinolone antimicrobials demonstrated the most favorable efficacy, followed by cephalosporins. Both interventions were effective in averting infections frequently observed in patients with liver cirrhosis and upper gastrointestinal bleeding. Conclusion: Based on our investigation, the prophylactic antibacterial drugs confers noteworthy advantages in patients afflicted by liver cirrhosis with upper gastrointestinal bleeding. It has been associated with reductions in mortality, infection incidence, rebleeding occurrences, and the duration of hospitalization. Among prophylactic antibacterial options, quinolones emerged as the foremost choice, with cephalosporins ranking closely thereafter. [ABSTRACT FROM AUTHOR]

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a surgical emergency, usually managed via endoscopy. Approximately 2% of patients will have another significant bleed after therapeutic endoscopy and may require either transarterial embolization (TAE) or surgery. In 2011, the National Institute for Health and Care Excellence guidelines recommended that TAE should be the preferred option offered in this setting. This study aimed to conduct an appraisal of guidelines on NVUGIB using the Appraisal of Guidelines for Research and Evaluation II tool. A specific review of their recommendations on the management of adult patients with failed endoscopic hemostasis that required TAE or surgery was conducted. The quality of the guidelines was moderate; most could be recommended with changes. However, their recommendations regarding TAE vs surgery were widely heterogeneous. A closer review of the underpinning evidence showed that most studies were retrospective, with a small sample size and missing data. Because of the heterogeneity in evidence, the decision regarding TAE vs surgery requires further research. Deciding between these modalities is primarily based on TAE availability and patient comorbidities. However, surgery should not be dismissed as a key option after failed endoscopic hemostasis. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding can manifest as hematemesis (bright red vomiting or coffee ground emesis). Upper gastrointestinal bleeding (UGIB) is defined as blood loss from a gastrointestinal source above the ligament of Treitz. Cases of gastrointestinal bleeding account for 150 inpatients per 100,000 population each year, with upper gastrointestinal bleeding 1.5-2 times more common than lower gastrointestinal bleeding. The incidence is higher in elderly patients and patients whom taking multiple medications or multi-pharmacy. If not treated properly, gastrointestinal bleeding can cause death. Idiopathic thrombocytopenic Purpura (ITP) is an autoimmune disease characterized by low platelet counts, purpura, and hemorrhagic episodes caused by antiplatelet autoantibodies. ITP cases most often occur in children with 85% not requiring treatment and young adults aged 20-50 years who are healthy within a few weeks of being infected with the virus. The problem is described using a descriptive case study method starting from history taking, physical examination, evaluation, diagnosis to the intervention management given to patients qualitatively. We reported a-70-year-old patient with Hematemesis and Melena accompanied by Idiopathic Thrombocytopenia Purpura. Then the patient was given treatment SF 2x1 tablet, Mersibion 2x1 tablet, Metformin 1x 500mg tablet. Parenteral treatment with Vit K 3x10, Omeprazole 1x40 mg injection, Ondansetron 2x8mg injection, Transamin 3x500 injectionz, NS 0.9% 500cc 6 hours/kolf. [ABSTRACT FROM AUTHOR]

A considerable number of patients with nonvariceal upper gastrointestinal bleeding (UGIB) need endoscopic intervention. The aim of this study was to determine factors that predict the need for endoscopic intervention at the time of admission to the emergency department. Consecutive patients with International Classification of Diseases, Tenth Revision diagnosis code K92.2 (gastrointestinal hemorrhage) who underwent upper endoscopy between February 2019 and February 2022, including patients diagnosed with nonvariceal UGIB in the emergency department in the study were reviewed retrospectively. The patients were divided into two groups: those treated endoscopically and those not treated endoscopically. These two groups were compared according to clinical and laboratory findings at admission and independent predictors for endoscopic intervention were determined using multivariate regression analysis. Although 123 patients (30.3%) were treated endoscopically, endoscopic treatment was not required in 283 (69.7%) patients. Syncope, mean arterial pressure (MAP), and blood urea nitrogen (BUN) at admission were independent predictors for endoscopic intervention in the multivariate analysis, after adjusting for endoscopy time. The area under the curve of the syncope+MAP+BUN combination for endoscopic intervention was 0.648 (95% CI 0.588–0.708). Although the syncope+MAP+BUN combination predicted the need for intervention significantly better than pre-endoscopy Rockall and AIMS65 scores (p = 0.010 and p < 0.001, respectively), there was no significant difference in its comparison with the Glasgow-Blatchford score (p = 0.103). Syncope, MAP, and BUN at admission were independent predictors for endoscopic therapy in patients with nonvariceal UGIB. Rather than using complicated scores, it would be more practical and easier to predict the need for endoscopic intervention with these three simple parameters, which are included in the Glasgow-Blatchford score. [ABSTRACT FROM AUTHOR]

Background: Selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of upper gastrointestinal bleeding (UGIB) in older patients but little is known about the risk associated with individual SSRI drugs and doses. Aims: To quantify the risk of UGIB in relation to individual SSRI use in older adults. Methods: We conducted a nested case–control study within a cohort of 9565 patients aged ⩾65 years prescribed SSRIs from 2000 to 2013 using claims data of universal health insurance in Taiwan. Incident cases of UGIB during the follow-up period were identified and matched with three control subjects. Conditional logistic regression was used to estimate the odds ratio (OR) of UGIB associated with individual SSRI use and cumulative dose. Results: UGIB risk increased with the increasing cumulative doses of SSRIs (adjusted OR: 1.28, 95% confidence interval (CI): 1.02–1.62 for the highest vs. the lowest tertile). Compared with users of other SSRIs, fluoxetine users were at an increased risk of UGIB (adjusted OR: 1.25, 95% CI: 1.03–1.50) with a dose–response manner, whereas paroxetine users had 29% decreased odds (95% CI: 0.56–0.91). The increased risk was only observed among current fluoxetine users. Conclusions: Fluoxetine therapy was associated with an increased risk of UGIB in a dose–response manner among older adults. [ABSTRACT FROM AUTHOR]

Background: In patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB), early (≤ 24 h) endoscopy is recommended following hemodynamic resuscitation. Nevertheless, scarce data exist on the optimal timing of endoscopy in patients with NVUGIB receiving anticoagulants. Objective: To analyze how the timing of endoscopy may influence outcomes in anticoagulants users admitted with NVUGIB. Methods: Retrospective cohort study which consecutively included all adult patients using anticoagulants presenting with NVUGIB between January 2011 and June 2020. Time from presentation to endoscopy was assessed and defined as early (≤ 24 h) and delayed (> 24 h). The outcomes considered were endoscopic or surgical treatment, length of hospital stay, intermediate/intensive care unit admission, recurrent bleeding, and 30-day mortality. Results: From 636 patients presenting with NVUGIB, 138 (21.7%) were taking anticoagulants. Vitamin K antagonists were the most frequent anticoagulants used (63.8%, n = 88). After adjusting for confounders, patients who underwent early endoscopy (59.4%, n = 82) received endoscopic therapy more frequently (OR 2.4; 95% CI 1.1–5.4; P = 0.034), had shorter length of hospital stay [7 (IQR 6) vs 9 (IQR 7) days, P = 0.042] and higher rate of intermediate/intensive care unit admission (OR 2.7; 95% CI 1.3 – 5.9; P = 0.010) than patients having delayed endoscopy. Surgical treatment, recurrent bleeding, and 30-day mortality did not differ significantly between groups. Conclusion: Early endoscopy (≤ 24 h) in anticoagulant users admitted with acute nonvariceal upper gastrointestinal bleeding is associated with higher rate of endoscopic treatment, shorter hospital stay, and higher intermediate/intensive care unit admission. The timing of endoscopy did not influence the need for surgical intervention, recurrent bleeding, and 30-day mortality. [ABSTRACT FROM AUTHOR]

Background: Acute esophageal variceal bleeding accounts for up to 70% of upper-gastrointestinal bleeding in cirrhotic patients. About 10–20% of patients with acute variceal bleeding have refractory bleeding that is not controlled by medical or endoscopic therapy, and this condition can be life-threatening. Balloon tamponade is a long-standing therapy which is only effective temporarily and has several complications, while transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation may not be readily available at some centers. The use of self-expandable metal stents (SEMSs) in refractory esophageal variceal bleeding has been studied for effectiveness and adverse events and has been recommended for use as a bridge to a more definitive treatment. Aim: To investigate the effectiveness and safety of SEMSs in managing refractory variceal bleeding. Methods: A systematic search of the MEDLINE, EMBASE, and Cochrane library databases was performed from inception to October 2022 using the following terms: "esophageal stent", "self-expandable metal stents", "endoscopic hemostasis", "refractory esophageal varices", and "esophageal variceal bleeding". Studies were included in the meta-analysis if they met the following criteria: (1) patients' age older than 18 and (2) a study (or case series) that has at least 10 patients in the study. Exclusion criteria included (1) non-English publications, (2) in case of overlapping cohorts, data from the most recent and/or most appropriate comprehensive report were collected. DerSimonian–Laird random-effects meta-analysis was performed using the meta package in R statistical software(version 4.2.2). Results: Twelve studies involving 225 patients with 228 stents were included in the analyses. The mean age and/or median age ranged from 49.4 to 69 years, with a male-to-female ratio of 4.4 to 1. The median follow-up period was 42 days. The mean SEMS dwell time was 9.4 days. The most common cause of acute refractory variceal bleeding in chronic liver disease patients included alcohol use followed by viral hepatitis. The pooled rate of immediate bleeding control was 91% (95% CI 82–95%, I2 = 0). The pooled rate of rebleeding was 17% (95% CI 8–32%, I2 = 69). The pooled rate of stent ulceration was 7% (95% CI 3–13%, I2 = 0), and the pooled rate of stent migration was 18% (95% CI 9–32%, I2 = 38). The pooled rate of all-cause mortality was 38% (95% CI 30–47%, I2 = 34). Conclusions: SEMSs should be primarily considered as salvage therapy when endoscopic band ligation and sclerotherapy fail and can be used as a bridge to emergent TIPS or definitive therapy, such as liver transplantation. [ABSTRACT FROM AUTHOR]

In this study, our research team analyzed the improvement of the gastrointestinal nutritional status of elderly patients with upper gastrointestinal bleeding by predictive nursing before and after intravenous infusion. To this end, 126 older adults with upper gastrointestinal bleeding admitted between January 2023 and June 2023 at the Yuyao People’s Hospital of Zhejiang Province, Yuyao, China, were recruited. The patients were randomized into two groups: conventional nursing (control group) and predictive nursing (experimental group). The inter-group comparison revealed markedly reduced bleeding frequency, bleeding volume, shorter length of hospital stays, and fewer complications in the experimental group compared with the control group (P < 0.05). The nutritional status and patient comfort in the experimental group were better overall than in the control group (P < 0.05). These results suggest that predictive nursing is conducive to accelerating the rehabilitation of elderly upper gastrointestinal bleeding patients, ensuring the safety of intravenous infusions, and enhancing their nutritional status. [ABSTRACT FROM AUTHOR]

Objective Bleeding originating from proximal to the ligament of Treitz is referred to as upper gastrointestinal tract (GI) bleeding. Upper GI bleeding is an important cause of morbidity and mortality and should be excluded in patients presenting with blood in the mouth, black stools or blood in the stool. Diagnosis of upper GI bleeding, prediction of prognosis and mortality, and early intervention are crucial in emergency departments. In this study, we aimed to determine the prognostic value of hemogram parameters, vital values and risk scores in patients hospitalized with upper GI bleeding from emergency department. Material and Method In this study, 259 patients aged 18 years and older who were admitted to Süleyman Demirel University Faculty of Medicine Emergency Department between January 2015 and January 2020 for upper GI bleeding were retrospectively evaluated. Vital signs, hemogram parameters such as hemoglobin, hematocrit, red cell distribution width (RDW), white blood cell (WBC), platelet, vital values and risk scores (Glasgow-Blacthford and AIMS65) at admission were recorded from hospital records. Then survival status was also investigated. Patients who were pregnant, had malignancy, hematologic disease, history of esophageal varices, patients who were discharged directly from the emergency department, patients who were referred, patients who left the emergency department by signing a refusal of treatment or without permission, and patients whose file data could not be accessed were not included in the study. Results A total of 259 patients (157 females, 102 males, mean age: 72.7±17 years) with non-variceal upper GI bleeding were included in the study. Patients who died had significantly higher age, shock index, pulse rate, neutrophil/lymphocyte ratio, RDW, GlasgowBlatchford and AIMS65 scores (p:0.009; p<0.001; p:0.004; p:0.013; p:0.001; p<0.001; p<0.001; respectively) and lower mean arterial pressure (p:0.006). As a result of the ROC analysis, it was observed that AIMS65 score above the threshold of 2 had the highest sensitivity (82.5%) and RDW above the threshold of 16.5 had the highest specificity (62.6%) in predicting mortality in patients with upper GI bleeding. Conclusion Evaluation of vital values, shock index, neutrophil/ lymphocyte ratio, RDW, AIMS65 and GlasgowBlatchford score in patients with upper GI bleeding admitted to the emergency department contributes to the emergency physician to predict prognosis, need for early treatment and mortality. WBC and platelet indices are thought to have no effect in predicting prognosis and mortality. [ABSTRACT FROM AUTHOR]

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a medical emergency that has significant morbidity and mortality. The available data about the impact of COVID-19 infection on mortality in patients with NVUGIB is limited. We identified all hospitalizations with a principal diagnosis of NVUGIB in 2020. The baseline characteristics and clinical outcomes of patients with COVID-19 infection were compared to those without COVID-19 infection. NVUGIB patients with COVID-19 infection had higher mortality (5% vs 2%, P < 0.0001), a longer mean length of stay (6.85 vs 4.48 days, P < 0.0001), and a lower rate of esophagogastroduodenoscopy utilization (40% vs 51%, P < 0.0001) than those without COVID-19 infection. Multivariate logistic regression analysis showed that COVID-19 infection was associated with a higher mortality rate (odds ratio 2.2, 95% confidence interval, 1.4–3.4). COVID-19 infection is an independent predictor of mortality in adults hospitalized with NVUGIB. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding (UGIB) in COVID‐19 presents challenges in patient management. Existing studies lack comprehensive review due to varied designs, samples, and demographics. A meta‐analysis can provide valuable insights into the incidence, features, and outcomes of UGIB in COVID‐19. A comprehensive literature search was carried out using several databases. We considered all appropriate observational studies from all over the world. Mantel‐Haenszel odds ratios and associated 95% confidence intervals (CIs) were produced to report the overall effect size using random effect models. Besides, Random effects models were used to calculate the overall pooled prevalence. Funnel plots, Egger regression tests, and Begg‐Mazumdar's rank correlation test were used to appraise publication bias. Data from 21 articles consisting of 26,933 COVID‐19 patients were considered. The pooled estimate of UGIB prevalence in patients admitted with COVID‐19 across studies was 2.10% (95% CI, 1.23–3.13). Similarly, the overall pooled estimate for severity, mortality, and rebleeding in COVID‐19 patients with UGIB was 55% (95% CI, 37.01–72.68), 29% (95% CI, 19.26–40.20) and 12.7% (95% CI, 7.88–18.42) respectively. Further, UGIB in COVID‐19 patients was associated with increased odds of severity (OR = 3.52, 95% CI 1.80–6.88, P = 0.001) and mortality (OR = 2.16, 95% CI 1.33–3.51, P = 0.002) compared with patients without UGIB. No significant publication bias was evident in the meta‐analysis. The results of our study indicate that UGIB in individuals with COVID‐19 is linked to negative outcomes such as severe illness, higher mortality rates, and an increased risk of re‐bleeding. These findings highlight the significance of identifying UGIB as a significant complication in COVID‐19 cases and emphasise the importance of timely clinical assessment and proper treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives: Variceal bleeding (VB) is the most concerning condition that is difficult to treat after atezolizumab/bevacizumab in patients with advanced hepatocellular carcinoma (HCC). Materials and Methods: We would like to introduce the cases of two patients who underwent bevacizumab reduction or discontinuation when VB occurred after atezolizumab/bevacizumab. Results: VB occurred in two patients who showed good tumor response after atezolizumab/bevacizumab treatment, and all VBs were successfully treated with endoscopic variceal ligations. In the first patient, VB did not occur as the tumor response decreased after a 50% reduction in bevacizumab. In the second patient, VB occurred again after a 50% bevacizumab reduction, so bevacizumab was discontinued and treatment with atezolizumab alone has been successfully maintained. Conclusions: Accordingly, we would like to suggest that considering bevacizumab dose reduction instead of changing to tyrosine kinase inhibitor may be a good clinical choice in atezolizumab/bevacizumab patients who develop VB. [ABSTRACT FROM AUTHOR]

Abstract We report a case of ruptured cystic artery pseudoaneurysm after self‐expandable metal stent placement for malignant biliary obstruction. A 78‐year‐old woman on palliative care after chemotherapy for unresectable pancreatic head cancer presented with obstructive jaundice. Imaging revealed a dilated common bile duct and an enlarged gallbladder with cystic wall thickening. Endoscopic retrograde cholangiopancreatography was performed and a fully‐covered self‐expandable metal stent was placed in the bile duct, leading to resolution of jaundice. She presented with hematochezia 7 days later. Contrast‐enhanced computed tomography revealed a cystic artery pseudoaneurysm with extravasation of contrast into a blood‐filled gallbladder. Hemostasis was achieved after emergent transcatheter arterial embolization. Rupture of cystic artery pseudoaneurysm should be raised as a differential diagnosis for hemobilia after self‐expandable metal stent placement, particularly in cases accompanied by inflamed gallbladders.

Introduction: ABO blood group (BG) antigens found in many cells and tissues, especially in erythrocytes, have been associated with many diseases including cardiovascular diseases, infections, and malignancies. The association of ABO BG with duodenal and gastric ulcers and upper gastrointestinal bleeding (UGB) has been investigated in few studies and the information on this subject is limited. The primary objective of our study is to examine whether there is an association between ABO BG and UGB, and the secondary objective is to examine whether there is an association between ABO BG and UGB in patients who received blood transfusions after bleeding.Methods: The prevalence values of A, B, AB, 0 BG and Rh antigens, endoscopic procedure, and blood transfusion information of patients who were diagnosed with UGB by endoscopic examination and hospitalized were recorded. Healthy individuals without UGB in the same period were included as the control group (CG). Those who had UGB by endoscopic examination constituted the study group (SG) while those who received at least 2 units of blood transfusion formed the transfusion group (TG).Results: SG consisted of 423 patients, TG included 383 patients, and CG had 1650 individuals. While the risk of bleeding was higher in SG patients with BG 0 (OR 1.33 1.07-1.66 P=0.009), the bleeding risk was lower in SG patients with BG B (OR 0.77 0.63-0.95 P=0.014). In addition, while the risk of bleeding was higher in TG patients with BG 0 (OR 1.35 1.08-1.70 P=0.009), the bleeding risk was lower in TG patients with BG B (OR 0.55 0.38-0.79 P=0.001). There was no statistically significant difference in SG, and TG in other BG A and AB and no significant difference in Rh.Conclusion: While UGB is more common in individuals with BG 0, it is less common in individuals with BG B. The risk of need for blood transfusion during the follow-up period of these patients in the ward is higher in patients with BG 0 but lower in patients with BG B.Keywords: Blood group, bleeding, transfusion

Background: Endoscopic screening for esophageal varices (EV) is suggested for all cirrhotic patients. Patients with steady liver function should have a screening endoscopy every 2 years if no varices are found. In addition, a liver function test should be performed yearly for those with worsening liver function. Aims and Objectives: The study aimed to investigate non-invasive parameters’ predictive efficacy, such as Platelet count/splenic diameter ratio (PC/SD ratio), by diagnosing EV in cirrhotic patients. Materials and Methods: A Prospective, analytical, single-center study was conducted on 50 patients admitted to Government Rajaji Hospital, Madurai, with cirrhosis between March 2021 and August 2021. Patients with cirrhosis histories and clinical characteristics were admitted to the medical ward of Government Rajaji Hospital. The ultrasonogram (for splenic diameter) and a platelet count were performed on all 50 patients. Results: Thirty-three of the 50 patients had EV during upper gastrointestinal endoscopy. A platelet count/splenic diameter ratio of 900. Therefore, the study’s total of 33 patients had a ratio of

Aortoesophageal fistula (AEF) is rarely seen in gastroenterology practice. It is a very fatal condition. Common causes of AEF are aortic aneurysms and dissections, foreign body ingestion, traumatic aortic injuries, ruptured penetrating aortic ulcers, esophageal or bronchogenic malignancies, and thoracic surgery such as thoracic endovascular aortic repair (TEVAR). Post-TEVAR AEF is a very rare cause of massive upper gastrointestinal bleeding (UGIB). Management of AEF is difficult and causes serious outcomes. Here we report a case presented with UGIB related to post-TEVAR AEF. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding (UGIB) is a significant concern in children, contributing to 6–20% of cases in pediatric intensive care units. This study evaluates the roles of Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drug (NSAID) usage in the etiology of UGIB in children, with a particular focus on trends observed during the COVID-19 pandemic. We conducted a retrospective analysis of 103 pediatric patients who underwent esophagogastroduodenoscopy (EGD) for UGIB between January 2015 and December 2023. Of these, 88 patients were included in the final analysis, where the source of bleeding was successfully identified. Hematemesis was the most common presentation, and the source of bleeding was identified in 85.43% of cases. The prevalence of H. pylori infection remained stable across the pre-pandemic (39.7%) and post-pandemic (36.7%) periods. However, NSAID usage increased nearly threefold during the pandemic, with 36.7% of post-pandemic UGIB cases associated with NSAID use, compared to 12.1% pre-pandemic. These findings underscore the significant roles of H. pylori and NSAID use in pediatric UGIB, with a notable increase in NSAID-related cases during the pandemic.

The current standard of treatment for nonvariceal upper gastrointestinal bleeding (NVUGIB) includes endoscopic hemostasis with either through-the-scope clips or thermal therapy. However, they may be associated with rebleeding, especially in high-risk ulcers. Over-the-scope clips (OTSC) have been demonstrated in multiple recent studies to be an effective measure for NVUGIB. We aimed to analyze the current literature on standard therapy with OTSC to manage NVUGIB. A meta-analysis was performed by pooling the data from randomized studies obtained from a comprehensive search of Medline, Embase, and Scopus from inception to February 2023. The outcomes analyzed included rates of persistent bleeding, rebleeding, mortality, and duration of hospitalization. A total of five studies were included in the final analysis. There was no significant difference in the risk of persistent bleeding between the groups, with a risk ratio (RR) of 0.29 (95% confidence interval [CI]: 0.07–1.27). The use of OTSC was associated with a significantly lower risk of 7-day and 30-day rebleeding compared with standard therapy with RR of 0.30 (95% CI: 0.16–0.59) and 0.42 (95% CI: 0.24–0.72), respectively. There was no difference in the risk of 30-day mortality or the duration of hospitalization. There was no change in the effect on subgroup analysis of studies using OTSC as first-line therapy. The use of OTSC can reduce the rebleeding rates after endoscopic hemostasis. However, they may not reduce the risk of persistent bleeding or mortality. Future studies are required on the cost-efficacy of this modality.

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a life-threatening presentation to the emergency department (ED). In a busy emergency department, emergency department, proper risk stratification is critical to better patients management for patients with variceal or nonvariceal bleeding. This study study was designed to the scoring systems (Modified Early Warning Score (MEW), Pre-endoscopic Rockall (PER), and Glasgow Blatchford Score (GBS) in predicting 15-day mortality, requirement of blood transfusion, probability of rebleeding, and patient outcome within 15-day period in ED. MATERIAL AND METHODS: This study was carried out in with 51 acute UGIB at the emergency department, Department (ED) and department of Medical gastroenterology (MGE) of Narayana Medical College and Hospital, Nellore, India, from February 2020 to June 2022. Clinical The clinical history, presenting signs and symptoms, comorbidities, vitals, laboratory variables, endoscopic diagnosis and treatment history of all patients were recorded and they were followed for 15 days to evaluate rebleeding and its outcome. The chi-square test was applied to qualitative variables. RESULTS: The study enroled 51 patients, of which 82.4% were male, with the majority between 51 and 60 years of age. The majority of cases were presented to the emergency department with haematemesis (60.8%). Non-vasriceal bleeding observed in 94.1% cases. In the 15-day follow- up, 7 patients (7.84%) died and 7 patients (13.7%) rebleed. Totally 26 (50.9%) had a MEWS score of 1, 13 (25.4%) had a score of 2, 9 (17.64%) had a score of >3, and 3 (5.88%) had a score of 0. A PER score of 1 was found in 17 (33.3%), 2 in 4 (7.84%), 3 in 3 (5.88%), 4 in 6 (11.76), 5 in 10 (19.6%) and 6 in 5 (9.80%) patients. 9 (17.6%) cases had a low-risk GBS score of 0-5. Compared to MEWS and GBS, the ROC curve for mortality calculated at 15 days for PERS was 0.96; 95% CI of 0.9 - 1.0, indicating good accuracy. The AUCROC curve for predicting rebleed by PERS score showed area under curve - 0.79, which is also better than the other 2 scoring systems. CONCLUSIONS: PER had a higher negative predictive value (90%) than GBS (80.7%) and MEWS (88.1%) for rebleed measurement. GBS had a higher negative predictive value (96.15%) than PER (52.5%) and MEWS (42.8%) to predict admission of a patient with UGIB. The GBS score >8.5, MEWS score >1.5, and the PER score 4.5 predicted rebleeding. The GBS predicted the need for packed red blood cell transfusions better than the MEWS score and the pre-endoscopic Rockall score. The MEWS score is better at predicting admission and type of bleeding.

Objective:We had validation of H3B2 scoring on Turkish patients in this study. In addition, it was compared with Glasgow-Blatchford and AIMS65 scoring.Method:This study was conducted retrospectively and single centered. It was continued by scanning of tertial education hospital datum in 07-2021 to 07-2022. Patients were the adults who was made endoscopic intervention during initial 24 hours. Glasgow-Blatchford, AIMS65 and H3B2 scoring were calculated according to initial parameters.Results:The study included 116 patients. Median age was 60 (45,53) years. H3B2, AIMS65 and Glasgow-Blatchford scoring were significantly higher in non-survivor group than survivor group (p=0.005,

Dieulafoy’s lesion is a life-threatening and rare vascular malformation of the submucosal vessel that protrudes to the mucosa of the gastrointestinal tract. The vessel is abnormally dilated, and if it ruptures, it can cause severe acute gastrointestinal bleeding. We report an upper GI bleeding case due to Dieulafoy’s lesion in the gastric fundus of the stomach in a 76-year-old female. The patient presented with hematemesis and melena associated with anemia. An esophagogastroduodenoscopy (OGD) was performed which showed profuse pulsatile bleeding at the gastric fundus. Following that, gastrotomy confirmed the diagnosis of Dieulafoy’s lesion. Endoscopy is the main diagnostic and therapeutic tool for Dieulafoy’s lesion. Endoscopic treatment includes injective, ablative and mechanical therapies. The majority of cases are treated endoscopically, while in some cases, surgical intervention is deemed to be necessary as it is currently the only definitive treatment of Dieulafoy’s lesion.

Simple Summary: Pancreatic cancer can be categorized into pancreatic head, body, and tail cancer, all of which carry a grim prognosis. Pancreatic tail cancer frequently invades the splenic hilum and splenic vein. It is currently unclear whether splenic hilar involvement is associated with a poor prognosis. Splenic vein occlusion can also lead to sinistral portal hypertension, which can in turn give rise to gastric varices. The clinical impact of sinistral portal hypertension and hemorrhagic events has yet to be elucidated. In this study, we explore the effect of splenic hilar involvement and sinistral portal hypertension on outcomes in patients with pancreatic tail cancer. The results of this study may contribute to better prediction of outcomes and assist physicians in the education and care of their patients. Background: Pancreatic tail cancer (PTC) frequently displays splenic hilar involvement (SHI), but its impact on clinical outcomes remains unclear. We investigated the clinical impact of SHI in patients with unresectable PTC. Methods: We retrospectively reviewed all patients with unresectable PTC who received first-line therapy at our institution from 2016 to 2020. Results: Of the 111 included patients, 48 had SHI at diagnosis. SHI was significantly associated with younger age, liver metastasis, peritoneal dissemination, larger tumor size, modified Glasgow prognostic score of 1 or more, splenic artery involvement, gastric varices, and splenomegaly. Shorter median overall survival (OS; 9.3 vs. 11.6 months, p = 0.003) and progression-free survival (PFS; 4.3 vs. 6.3 months, p = 0.013) were observed in SHI patients. Poor performance status of 1 or 2, tumor size > 50 mm, hepatic metastasis, mGPS of 1 or 2, and SHI (hazard ratio: 1.65, 95% confidence interval: 1.08–2.52, p = 0.020) were independent predictors of shorter OS. Splenic artery pseudoaneurysm rupture and variceal rupture were rare and only observed in cases with SHI. Conclusions: Splenic hilar involvement is associated with worse outcomes in pancreatic tail cancer. [ABSTRACT FROM AUTHOR]

Introduction: Calcium is an essential co-factor in the coagulation cascade, and hypocalcemia is associated with adverse outcomes in bleeding patients, including trauma patients, women with postpartum hemorrhage, and patients with intracranial hemorrhage. In this retrospective, single-center, cohort study, we aimed to determine whether admission-ionized calcium (Ca++) is associated with higher rates of therapeutic interventions among patients presenting with acute nonvariceal upper gastrointestinal bleeding (NV-UGIB). Methods: Adult patients admitted due to NV-UGIB between January 2009 and April 2020 were identified. The primary outcome was defined as a need for clinical intervention (two or more packed cell transfusions, need for endoscopic, surgical, or angiographic intervention). Univariate and multivariable logistic regression analyses were performed to determine whether Ca++ was an independent predictor of the need for therapeutic interventions. Propensity score matching was performed to adjust the imbalances of covariates between the groups. Results: A total of 434 patients were included, of whom 148 (34.1%) had hypocalcemia (Ca++ <1.15 mmol/L). Patients with hypocalcemia were more likely to require therapeutic interventions than those without hypocalcemia (48.0% vs. 18.5%, p < 0.001). Specifically, patients with hypocalcemia were more likely to require endoscopic intervention for control of bleeding (25.0% vs. 15.7%, p = 0.03) and multiple packed cell transfusions (6.8% vs. 0.3%, p < 0.001). Additionally, they had significantly longer hospital stay (5.0 days [IQR 3.0–8.0] vs. 4.0 days [IQR 3.0–6.0], p = 0.01). After adjusting for multiple covariates, Ca++ was an independent predictor of the need for therapeutic intervention (aOR 1.62, 95% confidence interval [CI] 1.22–2.14, p < 0.001). The addition of Ca++ to the Modified Glasgow Blatchford score improved its accuracy in the prediction of therapeutic intervention from AUC of 0.68 (95% CI 0.63–0.72) to 0.72 (95% CI 0.67–0.76), p = 0.02. After incorporation of the propensity score, the results did not change significantly. Conclusion: These findings suggest that hypocalcemia is common and is associated with an adverse clinical course in patients with NV-UGIB. Measurement of Ca++ on admission may facilitate risk stratification in these patients. Trials are needed to assess whether the correction of hypocalcemia will lead to improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Upper gastrointestinal bleeding (UGIB) is a life-threatening emergency that causes considerable mortality and morbidity. The current study goal was to look at the endoscopic profile and clinical outcomes of patients with UGIB in Alexandria emergency department. Patients and methods: 120 patients who had been admitted with acute UGIB were included in this study. All patients underwent upper gastrointestinal endoscopy. Outcomes that were determined included complications like re-bleeding, need for surgical intervention, mortality, hospital stay length, admission to intensive care units (ICUs), transfusion requirement, and readmission. Results: The majority of patients were males (69.2%) with a mean age of (45.47 ± 10.46). The most prevalent lesions causing UGIB were esophageal varices (65.8%) and (45.0%) presented with hematemesis. 51.7% were treated by band ligation. Death was reported in 5.00% and all patients who died had comorbidities, 6.7% re-bled and 50.0% of patients who re-bled were = 60 years. 36.6% of patients had Rockall score (RS) =3. There was statistically significant relation between high RS and re-bleeding and mortality (p < 0.001). Conclusion: We encountered that the timing of endoscopy was a good determinant of adverse outcomes in UGIB. [ABSTRACT FROM AUTHOR]

We present a case of life-threatening gastrointestinal bleeding caused by a penetrating atherosclerotic ulcer (PAU) that ruptured into the esophagus. A 65-year-old man presented with pyrexia and nausea. Contrast-enhanced computed tomography (CT) performed on admission revealed a hematoma between the lower esophagus and descending aorta due to a contained rupture of a PAU, which was undiagnosed at that time. Esophagogastroduodenoscopy (EGD) performed on the fifth day of admission revealed a subepithelial lesion in the lower esophagus, further complicated by ulcer formation. Biopsy did not reveal any malignant findings. On the eighth day of admission, the patient experienced substantial hematemesis with vital signs indicative of shock. Emergency EGD was performed, which revealed life-threatening bleeding in the lower esophagus. Contrast-enhanced CT revealed an aortoesophageal fistula with massive hematemesis, after which the patient died. An autopsy revealed perforation of the PAU into the esophagus without aortic dissection or a true aneurysm. Patients with atherosclerosis who develop recent-onset gastrointestinal symptoms, progressive anemia, and/or periaortic lesions should be carefully evaluated using contrast-enhanced CT, and PAU should be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Acute upper gastrointestinal bleeding refers to bleeding caused by lesions in the digestive tract above flexor ligament, including the esophagus. stomach.duodenum, or pancreaticobiliary tract, and it is a common critical illness. Its clinical manifestations include nausea, dizziness, fatigue, vomiting of coffee like gastric contents, black stools, and in severe cases, accompanied by hematemesis, bloody stools, and even symptoms of acute peripheral circulatory failure and hemorrhagic shock. Predictive nursing is based on the concept of risk warning, taking targeted nursing measures in advance to address potential adverse reactions of patients. It is beneficial for mobilizing the work enthusiasm of nursing staff, shortening the recovery time of patients. and reducing medical costs. The article reviews the application of predictive nursing in patients with acute upper gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Background: Endoscopic screening for esophageal varices (EV) is suggested for all cirrhotic patients. Patients with steady liver function should have a screening endoscopy every 2 years if no varices are found. In addition, a liver function test should be performed yearly for those with worsening liver function. Aims and Objectives: The study aimed to investigate non-invasive parameters' predictive efficacy, such as Platelet count/splenic diameter ratio (PC/SD ratio), by diagnosing EV in cirrhotic patients. Materials and Methods: A Prospective, analytical, singlecenter study was conducted on 50 patients admitted to Government Rajaji Hospital, Madurai, with cirrhosis between March 2021 and August 2021. Patients with cirrhosis histories and clinical characteristics were admitted to the medical ward of Government Rajaji Hospital. The ultrasonogram (for splenic diameter) and a platelet count were performed on all 50 patients. Results: Thirty-three of the 50 patients had EV during upper gastrointestinal endoscopy. A platelet count/splenic diameter ratio of <900 was found in 33 patients. The two remaining patients have seen a ratio of >900. Therefore, the study's total of 33 patients had a ratio of <900. Varices were absent in 2 of them. The mean platelet count/spleen diameter ratio of patients without varices was 948.98, and with varices it was 826.9. Hence, using a ratio of 870 as a cutoff, 96% of patients with varices were detected (sensitivity: 94.12% and specificity: 93.94%). Conclusion: This study suggests that a lower Platelet count/splenic diameter ratio (PC/SD ratio) identifies patients needing endoscopy for esophagal varices preventative therapy. Platelet count, spleen bipolar diameter, and PSR are non-invasive, cost-friendly diagnostics. [ABSTRACT FROM AUTHOR]

Gastric high-grade B-cell lymphoma (HGBL) with adrenal gland invasion is a rare clinical entity with few cases reported in the literature. Patients usually present with nonspecific symptoms that lead to delays in the diagnosis, initiation of treatment, and prognosis. In this report, we present a case of a middle-aged woman in her 60s who presented with shortness of breath, dysphagia, early satiety, and melena. Further investigations confirmed the presence of an ulcerated gastric mass with invasion to the left adrenal gland, and histopathological and molecular studies of the gastric mass confirmed the diagnosis of B-Cell Lymphoma with MYC and BCL-6 rearrangements, a rare aggressive lymphoma subtype known as HGBL. Consequently, she was started on R-CHOP-21 chemotherapy protocol with good outcomes and resolution of the mass on repeat imaging; the current report aimed to emphasize the importance of recognizing unusual presentations of HGBL, especially gastric HGBL, which will help in early recognition, treatment, and prognosis. [ABSTRACT FROM AUTHOR]

Background and aim An endoscope is a visual instrument used to inspect the internal cavities of the human body. Upper endoscopy has effective diagnostic and therapeutic functions; it can be used in patients with signs or symptoms suggestive of upper gastrointestinal (GI) disease, surveillance for upper gastrointestinal tract (GIT) malignancy in high-risk population, and also stoppage of upper GIT bleeding. The work is aimed to document the demographic characteristics, indications, endoscopic findings, and interventions done among patients referred to Al-Azhar Assiut University Hospital in the last 2 years (2019–2020). Patients and methods The study was conducted at the endoscopy unit in from January 2019 to December 2020. Results Our study showed that the most prevalent age group was aged between 20 and 50 years (65.4%). There is a slight predominance of female patients (51%) versus 49% who were males and the most common indications, while peptic ulcer disease was the most common endoscopic finding. Conclusion The most common indications were epigastric pain and upper GIT bleeding, while the most common GI finding was peptic ulcer disease. Also, esophageal varices were common esophageal findings for which band ligation and injection sclerotherapy were done.

A 73‐year‐old female with metastatic renal cell carcinoma (RCC) presented with melena and lethargy. She was found to be iron deficient with a hemoglobin of 101 g/L. Her gastroscopy found six irregular pedunculated non‐bleeding polyps, 10–20 mm in diameter. Histopathology of the resected polyp returned as metastatic clear cell renal cell carcinoma. Gastric metastases from any primary malignancy are rare and metastatic RCC accounts for only 7% of these tumors. Furthermore, while RCC commonly metastasises to the lung, bone and lymph nodes, metastasis to the gastrointestinal tract is extremely rare, occurring in <1% of patients. Presentation of RCC as a gastric polyp is usually a late event, and on average occurs 6.7 years after initial diagnosis of RCC. Therefore, this case highlights a rare but important late complication of RCC, presenting as gastrointestinal bleeding secondary to gastric metastases. [ABSTRACT FROM AUTHOR]

Dieulafoy lesions (DL) are an uncommon cause of gastrointestinal bleeding which is often difficult to diagnose due to the rarity of the condition and varying clinical presentations. This case describes an unusual presentation of upper gastrointestinal bleeding in an 85-year-old female with findings on two separate gastroscopies of both a gastric ulcer and duodenal DL. The pathophysiology of DL remains poorly understood and despite shared risk factors, these two pathologies are rarely reported concurrently. The presence of a concomitant gastric ulcer further complicated the diagnosis and treatment of the duodenal DL in this case. This highlights the importance of clinician awareness of this pathology and its presentation and the need for early repeat endoscopy. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We estimate the economic impact of applying risk assessment tools to identify very low-risk patients with upper gastrointestinal bleeding who can be safely discharged from the emergency department using a cost minimization analysis. METHODS: We compare triage strategies (Glasgow-Blatchford score = 0/0-1 or validated machine learning model) with usual care using a Markov chain model from a US health care payer perspective. RESULTS: Over 5 years, the Glasgow-Blatchford score triage strategy produced national cumulative savings over usual care of more than $2.7 billion and the machine learning strategy of more than $3.4 billion. DISCUSSION: Implementing risk assessment models for upper gastrointestinal bleeding reduces costs, thereby increasing value. [ABSTRACT FROM AUTHOR]

Black esophagus or acute esophageal necrosis is characterized by circumferential black discoloration of the distal esophageal mucosa. It is a rare condition with a multifactorial pathogenesis, and its most common clinical presentation is acute upper gastrointestinal bleeding. It usually affects elderly patients with multiple comorbidities and is associated with a high mortality rate. This is a case report of a 90-year-old man with multiple comorbidities, including diabetes mellitus, atrial fibrillation with complete atrioventricular block, and a history of ischemic stroke, who presented to the emergency department for a syncopal episode followed by coffee ground emesis. Thoraco-abdominal computer tomography showed thickening of the distal esophagus and ruled out major complications such as perforation. The following esophagogastroduodenoscopy showed black circumferential necrosis of the mid and distal esophagus. Multiple irregular ulcers with black necrotic areas were also present in the bulb and second duodenal portion. During the hospitalization, the patient was treated with PPI, NPO nutrition, and broad-spectrum antibiotics with benefits. Two months later, the patient returned to the emergency department due to a new episode of hematemesis with endoscopic evidence of esophageal stricture without necrosis and recurrence of duodenal ulcers. After a few days, the patient died due to worsening of the underlying comorbidities. A black esophagus is associated with duodenal ulcers, which may recur and are possibly due to a common ischemic origin. In this case report, we explore the potential link between black esophagus and duodenal ulcers, discussing the underlying mechanisms and relevant literature supporting this association. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding (UGIB) from malignancies is associated with a poor outcome. Only a small number of studies on gastrointestinal tumor bleeding have been published so far, focusing mainly on bleeding from gastric cancer. Since the information on patients with UGIB from esophageal cancer appears insufficient, this study aimed to present clinical and endoscopic findings, treatment options as well as clinical outcomes such as rebleeding and survival of those patients. This retrospective analysis included all patients admitted with UGIB from esophageal cancer at our university hospital during a 10-year period. 45 patients were analyzed of whom 26 (57.8%) already had cancer stage IV at index bleeding. 22 (48.9%) patients presented with hemodynamic instability and 30 (66.7%) patients received blood transfusions. Active bleeding was present in 24 (53.3%) patients, of whom 20 (83.3%) received endoscopic therapy. Successful hemostasis was achieved in 18 (90%) of 20 patients with Argon plasma coagulation used most frequently (52.4%). Early and delayed rebleeding occurred in 5 (12.5%) and 11 (27.5%) of all inoperable patients, respectively. Intake of anticoagulation or anti-platelet drugs were risk factors for delayed rebleeding and the median overall survival after index bleeding was 1.2 months. UGIB from esophageal cancer occurred most frequently in advanced tumor stages and was associated with significant blood loss. Even though initial endoscopic therapy was effective, rebleeding occurred in a significant number of patients. Those taking anticoagulants or anti-platelet drugs should be closely monitored for rebleeding. The overall survival after index bleeding was poor. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is controversial whether prophylactic endotracheal intubation (PEI) protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding (UGIB). The study aimed to explore the predictive value of PEI for cardiopulmonary outcomes and identify high-risk patients with UGIB undergoing endoscopy. METHODS: Patients undergoing endoscopy for UGIB were retrospectively enrolled in the eICU Collaborative Research Database (eICU-CRD). The composite cardiopulmonary outcomes included aspiration, pneumonia, pulmonary edema, shock or hypotension, cardiac arrest, myocardial infarction, and arrhythmia. The incidence of cardiopulmonary outcomes within 48 h after endoscopy was compared between the PEI and non-PEI groups. Logistic regression analyses and propensity score matching analyses were performed to estimate effects of PEI on cardiopulmonary outcomes. Moreover, restricted cubic spline plots were used to assess for any threshold effects in the association between baseline variables and risk of cardiopulmonary outcomes (yes/no) in the PEI group. RESULTS: A total of 946 patients were divided into the PEI group (108/946, 11.4%) and the non-PEI group (838/946, 88.6%). After propensity score matching, the PEI group (n=50) had a higher incidence of cardiopulmonary outcomes (58.0% vs. 30.3%, P=0.001). PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders (odds ratio [OR] 3.176, 95% confidence interval [95% CI] 1.567-6.438, P=0.001). The subgroup analysis indicated the similar results. A shock index >0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI (P=0.015). The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index (OR 1.465, 95% CI 1.079-1.989, P=0.014) and shock index >0.77 (compared with shock index =0.77 [OR 2.981, 95% CI 1.186-7.492, P=0.020, AUC=0.764]). CONCLUSION: PEI may be associated with cardiopulmonary outcomes in elderly and critically ill patients with UGIB undergoing endoscopy. Furthermore, a shock index greater than 0.77 could be used as a predictor of a worse prognosis in patients undergoing PEI. [ABSTRACT FROM AUTHOR]

The current standard of treatment for nonvariceal upper gastrointestinal bleeding (NVUGIB) includes endoscopic hemostasis with either through-the-scope clips or thermal therapy. However, they may be associated with rebleeding, especially in high-risk ulcers. Over-the-scope clips (OTSC) have been demonstrated in multiple recent studies to be an effective measure for NVUGIB. We aimed to analyze the current literature on standard therapy with OTSC to manage NVUGIB. A meta-analysis was performed by pooling the data from randomized studies obtained from a comprehensive search of Medline, Embase, and Scopus from inception to February 2023. The outcomes analyzed included rates of persistent bleeding, rebleeding, mortality, and duration of hospitalization. A total of five studies were included in the final analysis. There was no significant difference in the risk of persistent bleeding between the groups, with a risk ratio (RR) of 0.29 (95% confidence interval [CI]: 0.07–1.27). The use of OTSC was associated with a significantly lower risk of 7-day and 30-day rebleeding compared with standard therapy with RR of 0.30 (95% CI: 0.16–0.59) and 0.42 (95% CI: 0.24–0.72), respectively. There was no difference in the risk of 30-day mortality or the duration of hospitalization. There was no change in the effect on subgroup analysis of studies using OTSC as first-line therapy. The use of OTSC can reduce the rebleeding rates after endoscopic hemostasis. However, they may not reduce the risk of persistent bleeding or mortality. Future studies are required on the cost-efficacy of this modality. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a life-threatening presentation to the emergency department (ED). In a busy emergency department, emergency department, proper risk stratification is critical to better patients management for patients with variceal or nonvariceal bleeding. This study study was designed to the scoring systems (Modified Early Warning Score (MEW), Pre-endoscopic Rockall (PER), and Glasgow Blatchford Score (GBS) in predicting 15-day mortality, requirement of blood transfusion, probability of rebleeding, and patient outcome within 15-day period in ED. MATERIAL AND METHODS: This study was carried out in with 51 acute UGIB at the emergency department, Department (ED) and department of Medical gastroenterology (MGE) of Narayana Medical College and Hospital, Nellore, India, from February 2020 to June 2022. Clinical The clinical history, presenting signs and symptoms, comorbidities, vitals, laboratory variables, endoscopic diagnosis and treatment history of all patients were recorded and they were followed for 15 days to evaluate rebleeding and its outcome. The chi-square test was applied to qualitative variables. RESULTS: The study enroled 51 patients, of which 82.4% were male, with the majority between 51 and 60 years of age. The majority of cases were presented to the emergency department with haematemesis (60.8%). Non-vasriceal bleeding observed in 94.1% cases. In the 15-day follow-up, 7 patients (7.84%) died and 7 patients (13.7%) rebleed. Totally 26 (50.9%) had a MEWS score of 1, 13 (25.4%) had a score of 2, 9 (17.64%) had a score of >3, and 3 (5.88%) had a score of 0. A PER score of 1 was found in 17 (33.3%), 2 in 4 (7.84%), 3 in 3 (5.88%), 4 in 6 (11.76), 5 in 10 (19.6%) and 6 in 5 (9.80%) patients. 9 (17.6%) cases had a low-risk GBS score of 0-5. Compared to MEWS and GBS, the ROC curve for mortality calculated at 15 days for PERS was 0.96; 95% CI of 0.9 - 1.0, indicating good accuracy. The AUCROC curve for predicting rebleed by PERS score showed area under curve - 0.79, which is also better than the other 2 scoring systems. CONCLUSIONS: PER had a higher negative predictive value (90%) than GBS (80.7%) and MEWS (88.1%) for rebleed measurement. GBS had a higher negative predictive value (96.15%) than PER (52.5%) and MEWS (42.8%) to predict admission of a patient with UGIB. The GBS score >8.5, MEWS score >1.5, and the PER score 4.5 predicted rebleeding. The GBS predicted the need for packed red blood cell transfusions better than the MEWS score and the pre-endoscopic Rockall score. The MEWS score is better at predicting admission and type of bleeding. [ABSTRACT FROM AUTHOR]

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Background: Several risk scores have attempted to risk stratify patients with acute upper gastrointestinal bleeding (UGIB) who are at a lower risk of requiring hospital-based interventions or negative outcomes including death. This systematic review and meta-analysis aimed to compare predictive abilities of pre-endoscopic scores in prognosticating the absence of adverse events in patients with UGIB. Methods: We searched MEDLINE, EMBASE, Central, and ISI Web of knowledge from inception to February 2023. All fully published studies assessing a pre-endoscopic score in patients with UGIB were included. The primary outcome was a composite score for the need of a hospital-based intervention (endoscopic therapy, surgery, angiography, or blood transfusion). Secondary outcomes included: mortality, rebleeding, or the individual endpoints of the composite outcome. Both proportional and comparative analyses were performed. Results: Thirty-eight studies were included from 2153 citations, (n = 36,215 patients). Few patients with a low Glasgow-Blatchford score (GBS) cutoff (0, ≤1 and ≤2) required hospital-based interventions (0.02 (0.01, 0.05), 0.04 (0.02, 0.09) and 0.03 (0.02, 0.07), respectively). The proportions of patients with clinical Rockall (CRS = 0) and ABC (≤3) scores requiring hospital-based intervention were 0.19 (0.15, 0.24) and 0.69 (0.62, 0.75), respectively. GBS (cutoffs 0, ≤1 and ≤2), CRS (cutoffs 0, ≤1 and ≤2), AIMS65 (cutoffs 0 and ≤1) and ABC (cutoffs ≤1 and ≤3) scores all were associated with few patients (0.01–0.04) dying. The proportion of patients suffering other secondary outcomes varied between scoring systems but, in general, was lowest for the GBS. GBS (using cutoffs 0, ≤1 and ≤2) showed excellent discriminative ability in predicting the need for hospital-based interventions (OR 0.02, (0.00, 0.16), 0.00 (0.00, 0.02) and 0.01 (0.00, 0.01), respectively). A CRS cutoff of 0 was less discriminative. For the other secondary outcomes, discriminative abilities varied between scores but, in general, the GBS (using cutoffs up to 2) was clinically useful for most outcomes. Conclusions: A GBS cut-off of one or less prognosticated low-risk patients the best. Expanding the GBS cut-off to 2 maintains prognostic accuracy while allowing more patients to be managed safely as outpatients. The evidence is limited by the number, homogeneity, quality, and generalizability of available data and subjectivity of deciding on clinical impact. Additional, comparative and, ideally, interventional studies are needed. [ABSTRACT FROM AUTHOR]

Background: Upper Gastrointestinal Bleeding (UGIB) occurs in the lumen from the proximal of the Treitz ligament. It is divided into variceal and non-variceal bleeding. The risk factors include age, smoking, alcohol, portal hypertension, hepatitis, and medications. UGIB manifests as hematemesis and melena. This study aims to determine characteristics, and relationship of risk factors with UGIB in patients undergoing endoscopy in Dr. Doris Sylvanus General Regional Hospital Palangka Raya in 2019-2020. Method: An analytical observational study with a cross-sectional design using the patient's medical record data who had undergone endoscopy at Dr. Doris Sylvanus Hospital Palangka Raya with total sampling. Subjects were divided into the group with variceal and non-variceal bleeding then analyzed the relationship of risk factors using the contingency coefficient test. Results: The results showed that there were 72 patients with UGIB, including 44 males (61.1%), age group was < 60 years old in 47 patients (65.28%). Peptic ulcer was the most common etiology, occurring in 43 patients (59.72%). The highest clinical manifestations were melena in 47 patients (65.28%) and smoking in 32 patients (44.4%). The results of the bivariate analysis showed a significant relationship between upper GI bleeding and risk factors for certain drugs, portal hypertension, and hepatitis with a p-value of 0.013, 0.000, and 0.002. Conclusion: In this study, was the most common is a non-variceal bleeding, in men, age group <60 years, with melena and there was a significant relationship between UGIB with certain drugs, portal hypertension, and hepatitis. [ABSTRACT FROM AUTHOR]

Guidelines for the management of upper gastrointestinal bleeding (UGIB) are regularly published, yet little is known concerning adherence to recommendations in practice. We aimed to assess adherence to European Society of Gastrointestinal Endoscopy (ESGE) recommendations in patients with non-variceal UGIB. All hospitalized patients with an esophagogastroduodenoscopy (EGD) performed due to suspected non-variceal UGIB at our department were included in a prospective registry. Data between 2018–2020 from this registry were retrospectively analyzed. Adherence to the 2015 ESGE bleeding and propofol sedation guidelines was assessed. Adherence to recommendations concerning preendoscopic (risk) evaluation, preendoscopic PPI, transfusion management, and endoscopic management of peptic ulcers was analyzed. Among 1005 patients (mean age 70.4 years, 42.1% women) the most common bleeding etiologies were gastric or duodenal ulcers (16.8%), esophagitis/GERD (11.1%), and angiodysplasia (9.9%); mortality was 7.6%. Adherence to preendosopic risk evaluation was low, in 0% a Mallampati classification and in 37.5% an ASA scoring was documented. Preendoscopic PPI was started at 58.6%, and adherence to recommended transfusion management was >98%. Peptic ulcers were Forrest-graded in 72.8%. High-risk ulcers were treated appropriately in 77.9% and low-risk ulcers were not treated in 73.6%. Especially Forrest Ib ulcers were undertreated, with an adherence of 59.6%. Only 22/179 (12.3%) patients with peptic ulcers and early endoscopy were consistently managed according to ESGE recommendations. Adherence to ESGE guidelines in patients with non-variceal UGIB is moderate to low, even at a tertiary university hospital. Strategies must be devised for guidelines to reach patients in everyday practice. [ABSTRACT FROM AUTHOR]