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Background: To evaluate the optimal endoscopy time in elderly patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) based on clinical outcomes. Methods: Patients over 65 years of age presenting with NVUGIB are three patient groups based on endoscopy timing: very early endoscopy (< 12 h), early endoscopy (12–24 h) and late endoscopy (> 24 h). Endoscopic intervention was undertaken during the first 12 h for patients who had unstable hemodynamic settings, ongoing bleeding, or a low hematocrit despite transfusion. The clinical outcomes investigated were: The primary endpoint was 30-day mortality, with the need for endoscopic intervention, rebleeding, and length of hospital stay considered as secondary endpoints. Results: The study population was 468, 260 of whom were ≥ 65 years. Based on the timing of endoscopy, very early endoscopy (within 12 h) was performed in 180 (69.2%) patients aged > 65 years and 150 (72.1%) younger patients (p > 0.05). Early endoscopy (12–24 h) was performed in patients aged > 65 years and younger patients 53 (20.4%) vs. 41 (19.7%), respectively, while late endoscopy (24–48 h) was performed in 27 (10.4%) vs. 17 (8.2%) patients, respectively (p > 0.05, for all parameters). The clinical results of subgroups based on endoscopy time in the ≥ 65 population and comparisons between groups. When groups were compared, it was found that the very early endoscopy group had a considerably lower likelihood of need for surgical/radiological intervention than the late endoscopy group [3 (1,7) vs. (3,7), p = 0.016], and 30-day mortality rates by the endoscopy timing were statistically significantly different in the very early group (15.6%), early endoscopy group (7.5%), and late endoscopy group (29.6%) (p < 0.05, for all groups). Endoscopy time within 24–48 h (late) (OR: 3.133, 95%Cl: 1.127–8.713, p: 0.029) was an independent predictor of rebleeding during the hospital stay. Conclusions: Early endoscopy may benefit the management of acute UGIB, especially in the elderly population with high comorbidities and the severity of bleeding. Highlights: UGIB is a significant clinical concern in older persons, who have higher rates of hospitalized adverse events and death than young patients. Because mortality tends to be higher in older patients with UGIB, determining the best endoscopic time becomes even more difficult. Close monitoring, risk stratification, and good endoscopic and medical treatment are important approaches for decreasing poor clinical outcomes in the elderly with UGIB. Very early endoscopy group over the age of 65 is associated with less surgical/radiological intervention and lower 30-day mortality. The establishment of a health assessment strategy for older patients presenting with acute UGIB should be advantageous, considering the rise in comorbidities associated with aging concomitant medications, and various chronic diseases that have contributed to morbidity and death. Early endoscopy may be beneficial in the therapy of acute UGIB, particularly in the elderly with significant comorbidities and severe bleeding. [ABSTRACT FROM AUTHOR]

Background: Upper gastrointestinal bleeding (UGIB) is a critical emergency with substantial morbidity and mortality. Outcomes depend on bleeding severity, patient risk factors, and comorbidities. This study evaluated clinical patterns and factors influencing disease severity and hospital stay among patients present with UGIB symptoms at two major Ethiopian hospitals. Methods: A retrospective, cross-sectional review was conducted on 199 UGIB patients admitted to Yekatit 12 Hospital Medical College (Y12HMC) and Tikur Anbesa Specialized Hospital (TASH) from September 2022 to September 2023. Data on demographics, clinical presentations, endoscopic findings, and outcomes were analyzed using SPSS version 26. Binary logistic regression assessed associations, with statistical significance set at P < 0.05. Results: Of 199 patients, 70.9% were male, predominantly aged 18–40. Hematemesis (63.8%) and hematemesis with melena (27.6%) were common presentations. Endoscopy was not performed on more than half of the participants, with 116 patients (58.3%) not undergoing this procedure. Among the 83 cases who did have endoscopy, esophageal varices emerged as the most common condition, observed in 43.3% (36 cases. Smoking (AOR = 1.77), alcohol intake (AOR = 1.89), and drug use (AOR = 1.34) were linked to higher severity scores. Alcohol use, comorbidities, liver disease, and previous drug use correlated with prolonged hospital stays. Conclusion: UGIB predominantly affects younger males, with hematemesis as the primary presentation. Key factors like smoking, alcohol intake, and drug use were associated with greater disease severity and longer hospital stays. These findings suggest the importance of lifestyle interventions, particularly in resource-limited settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Studies have reported the benefits of tranexamic acid (TXA) in controlling bleeding across various conditions. However, the effect of TXA in upper gastrointestinal bleeding (UGIB) remains controversial, and its therapeutic impact when combined with acid suppression, particularly proton pump inhibitors (PPIs), which are considered first‐line therapy for bleeding peptic ulcers, has not been reported.We systematically searched PubMed, Embase, and Google Scholar from January 1987 to June 2024 using predefined keywords to identify RCTs meeting our inclusion criteria, including details of TXA dosage, route of administration, and choice of acid suppressants. Data from selected trials were extracted, and a meta‐analysis was performed using random‐effects modeling.Six trials with 709 participants were included. Baseline patient characteristics in the selected trials were balanced. The rebleeding rate, mortality, need for blood transfusion, units of blood transfused, and need for salvage therapy were compared. The TXA with acid suppression group significantly reduced the risk of rebleeding (RR: 0.63, 95% CI: 0.41–0.96), units of blood transfused (mean difference: −1.08, 95% CI: −1.44 to −0.71), and the need for salvage therapy (RR: 0.28, 95% CI: 0.12–0.64). No significant difference was observed in mortality rate (RR: 0.74) and need for blood transfusion (RR: 1.01) between the two groups, but outcomes favored the TXA and acid suppression group.We suggest combining TXA with acid suppression as a first‐line therapy for UGIB patients. Further trials should be conducted to determine the optimal dose and route of TXA administration for better care. [ABSTRACT FROM AUTHOR]

Background: TC-325 powder has been successfully used in the management of malignancy-related upper gastrointestinal bleeding (UGIB) with favorable results. We conducted a meta-analysis of randomized controlled trials (RCTs) comparing TC-325 hemostatic powder with standard endoscopic treatments in the management of malignancy-related UGIB. Methods: Several databases were reviewed from inception to May 02, 2024 to identify RCTs comparing TC-325 and standard endoscopic treatments for the management of malignancy-related UGIB. Our outcomes of interest were immediate hemostasis, 30-day rebleeding, length of hospital stay, need for surgery, need for angiographic embolization, and all-cause mortality. We calculated pooled risk ratio (RR) with 95% confidence intervals (CI) for categorical variables and mean difference (MD) with 95% CI for continuous variables. We used a random effect model to analyze the data and heterogeneity was assessed by I2 statistic. Results: Four RCTs with 227 patients were included. We found that, the rate of immediate hemostasis was significantly higher in the TC-325 group compared to the standard therapy group, RR (95% CI): 1.48 (1.26, 1.74). There was no significant difference in 30-day rebleeding between the groups RR (95% CI): 0.52 (0.15, 1.76). We found no significant difference in other outcomes between groups such as the need for angiographic embolization, all-cause mortality, length of hospital stay, and need for surgery. Conclusions: We found that, TC-325 hemostatic powder was superior to standard endoscopic treatments in achieving immediate hemostasis in patients with malignancy-related UGIB. [ABSTRACT FROM AUTHOR]

Tumor imaging represents an ideal environment for collecting novel biomarkers from different technologies, as patients with tumors often undergo multiple imaging studies.With the aging of the Chinese population, the number of elderly patients with gastric cancer is also increasing. In the past, patients with gastric cancer in the elderly have been conservative in whether surgical treatment can be performed, and advanced age is regarded as a relative contraindication to the effect of surgical treatment on gastric cancer patients. To investigate the clinical characteristics of patients with upper gastrointestinal hemorrhage complicated by deep vein thrombosis in elderly patients with gastric cancer. One patient with upper gastrointestinal hemorrhage complicated by deep venous thrombosis, and elderly gastric cancer patients admitted to our hospital on 11 October 2020, were selected. After anti-shock symptomatic support, filter placement, prevention and treatment of thrombosis, gastric cancer eradication, anticoagulation, immune regulation, etc. Treatment and long-term follow-up observation. Long-term follow-up showed that the patient's condition was stable, there was no sign of metastasis or recurrence after radical gastrectomy for gastric cancer, and there were no serious pre- and post-operative complications such as upper gastrointestinal bleeding and deep vein thrombosis, and the prognosis was satisfactory. How to choose the appropriate operation timing and method for elderly gastric cancer patients with upper gastrointestinal bleeding and deep vein thrombosis at the same time to maximize benefits, clinical experience in this area is particularly valuable. [ABSTRACT FROM AUTHOR]

The relationship between exposure to ambient air pollutants and emergency attendance for upper gastrointestinal bleeding (UGIB) remains inconclusive. This study examines the association between short‐term exposure to various ambient pollutants and the risk of UGIB emergency attendance. Data on daily UGIB emergency attendance, ambient pollutants, and meteorological conditions in Hong Kong were collected from 2017 to 2022. A time‐series study using a distributed lag non‐linear model to analyze the data, considering lag days. Stratified analysis was performed based on sex, seasons, and the COVID‐19 pandemic period. The burden was quantified using attributable fraction (AF) and number (AN). The study included 31,577 UGIB emergency records. Exposure to high levels of PM2.5 significantly increased the risk of UGIB emergency attendance from lag day 3 (RR: 1.012) to day 6 (RR: 1.008). High NO2 exposure also posed a significant risk from lag day 0 (RR: 1.026) to day 2 (RR: 1.014), and from lag day 5 (RR: 1.013) to day 7 (RR: 1.024). However, there was no association between UGIB and high O3 levels. The attributable burden of high‐concentration NO2 exposure was higher compared to those of PM2.5. Males and elderly individuals (≥65 years) faced a higher risk of UGIB emergencies, particularly during cold seasons. Our study suggests that both PM2.5 and NO2 exposure are associated with an increased risk of emergency attendance for UGIB. Ambient pollutant exposure has a stronger effect on UGIB in males and the elderly, particularly during cold seasons. Plain Language Summary: Our research in Hong Kong from 2017 to 2022 investigated the impact of brief exposure to air pollution on emergency visits for upper gastrointestinal bleeding (UGIB). We examined various types of air pollutants, including fine particulate matter (PM) and ozone, with a specific focus on identifying the most harmful pollutants and their temporal patterns. Our findings demonstrate that even a slight increase in levels of fine PM and nitrogen dioxide can significantly contribute to an upsurge in emergency cases of UGIB. Notably, these effects are more pronounced during colder months and in the elderly. The burden was more severe before the COVID‐19 pandemic. This study underscores the direct influence of air pollution on public health and emphasizes the imperative need to enhance air quality, particularly in densely populated urban areas. Our finding could help to inform public health policies and to promote measures aiming at reducing individuals' exposure to pollutants. Key Points: Short‐term exposure to high concentration of PM2.5 and NO2 significantly raise upper gastrointestinal bleeding (UGIB) emergency visitsThe impact of air pollution on the occurrence of UGIB emergencies is exacerbated by cold weather and among the elderly populationThe results of our study underscore the necessity for policy interventions aimed at enhancing air quality and promoting health safety [ABSTRACT FROM AUTHOR]

Key Clinical Message: The occurrence of terlipressin‐induced skin necrosis in cirrhotic patients is a rare but serious adverse event that warrants further investigation. Clinicians should be aware of this potential complication in cirrhotic patients receiving terlipressin therapy and closely monitor for any signs of skin necrosis. Early recognition and prompt intervention are crucial in preventing further complications and improving patient outcomes. Further research is needed to better understand the risk factors associated with terlipressin‐induced skin necrosis and to develop effective preventive strategies. Overall, healthcare providers should exercise caution when prescribing terlipressin to cirrhotic patients, weighing the potential benefits against the risks of this rare but significant adverse event. Terlipressin is commonly used to manage conditions related to portal hypertension, such as hepatorenal syndrome and esophageal variceal bleeding. Despite its therapeutic benefits, terlipressin can rarely lead to severe ischemic complications involving the skin vasculature, known as terlipressin‐induced skin necrosis. We present a 50‐year‐old male with cirrhosis and acute variceal bleeding who developed skin necrosis following terlipressin administration. We performed a comprehensive review of the literature by analyzing 18 case reports/case series comprising 22 cirrhotic patients with terlipressin‐induced skin necrosis. Among these individuals, we found a mean age of 51 years with a male predominance (78%). Further analysis showed that the onset of skin necrosis ranged from 2 to 5 days post‐terlipressin initiation, with bolus administration being predominant (85.7%). The underlying pathophysiological mechanisms of terlipressin‐induced skin ischemia are still elusive but primarily attributed to the vasoconstrictive and thrombogenic effects. Management involves terlipressin discontinuation and supportive care. Physicians should be aware of this potential complication in patients receiving terlipressin and closely observe for any signs of skin rash. [ABSTRACT FROM AUTHOR]

Peptic ulcer disease is an important cause of upper gastrointestinal bleeding. Current guidelines recommend endoscopic treatment for ulcers with active bleeding or non‐bleeding visible vessels, but the optimal management of ulcers with adherent clots is unclear. We performed a systematic review of the efficacy of endoscopic versus medical management of peptic ulcers with adherent clots. A systematic literature search was performed through September 2022 (MEDLINE, Embase, and CENTRAL). Randomized controlled trials (RCTs) comparing the effect of endoscopic versus medical management alone for peptic ulcers with adherent clots on the outcome of recurrent bleeding were incuded. A random‐effects meta‐analysis was performed to estimate the overall treatment effect. We included seven RCTs reporting on the endoscopic versus medical management of peptic ulcers with adherent clots. The pooled cohort comprised 268 patients with a mean age of 62.8 years and a mean follow up of 20 days. There was a significant reduction in the risk of recurrent bleeding with endoscopic hemostatic treatment for peptic ulcers with adherent clots, compared with medical management alone (risk ratio [RR] = 0.40, 95% confidence interval [CI] 0.16–0.95, 268 participants). However, there was no difference in mortality (RR = 0.90, 95% CI 0.23–3.59, 52 participants) or need for ulcer surgery (RR = 0.48, 95% CI 0.10–2.28, 52 participants) between endoscopic and medical management groups. In summary, there was evidence for a reduction in recurrent bleeding from peptic ulcers with adherent clots treated with endoscopic hemostatic techniques compared with medical management alone but no difference in rates of mortality or need for surgery. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Background Upper gastrointestinal bleeding (UGIB) is a critical emergency with substantial morbidity and mortality. Outcomes depend on bleeding severity, patient risk factors, and comorbidities. This study evaluated clinical patterns and factors influencing disease severity and hospital stay among patients present with UGIB symptoms at two major Ethiopian hospitals. Methods A retrospective, cross-sectional review was conducted on 199 UGIB patients admitted to Yekatit 12 Hospital Medical College (Y12HMC) and Tikur Anbesa Specialized Hospital (TASH) from September 2022 to September 2023. Data on demographics, clinical presentations, endoscopic findings, and outcomes were analyzed using SPSS version 26. Binary logistic regression assessed associations, with statistical significance set at P

Abstract Background To evaluate the optimal endoscopy time in elderly patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) based on clinical outcomes. Methods Patients over 65 years of age presenting with NVUGIB are three patient groups based on endoscopy timing: very early endoscopy ( 24 h). Endoscopic intervention was undertaken during the first 12 h for patients who had unstable hemodynamic settings, ongoing bleeding, or a low hematocrit despite transfusion. The clinical outcomes investigated were: The primary endpoint was 30-day mortality, with the need for endoscopic intervention, rebleeding, and length of hospital stay considered as secondary endpoints. Results The study population was 468, 260 of whom were ≥ 65 years. Based on the timing of endoscopy, very early endoscopy (within 12 h) was performed in 180 (69.2%) patients aged > 65 years and 150 (72.1%) younger patients (p > 0.05). Early endoscopy (12–24 h) was performed in patients aged > 65 years and younger patients 53 (20.4%) vs. 41 (19.7%), respectively, while late endoscopy (24–48 h) was performed in 27 (10.4%) vs. 17 (8.2%) patients, respectively (p > 0.05, for all parameters). The clinical results of subgroups based on endoscopy time in the ≥ 65 population and comparisons between groups. When groups were compared, it was found that the very early endoscopy group had a considerably lower likelihood of need for surgical/radiological intervention than the late endoscopy group [3 (1,7) vs. (3,7), p = 0.016], and 30-day mortality rates by the endoscopy timing were statistically significantly different in the very early group (15.6%), early endoscopy group (7.5%), and late endoscopy group (29.6%) (p

Abstract Background Glomus tumors (GTs) are mesenchymal neoplasms that are typically benign. Gastric GTs are uncommon and occur mainly in the upper gastrointestinal tract. Malignant gastric GTs are extremely rare, constituting less than 1% of gastric tumors. Because their features are similar to those of other tumors found in the same gastrointestinal region, such as stromal tumors, leiomyomas, lymphomas, and lipomas, the diagnosis is challenging. Case Presentation A 52-year-old male patient presented with fatigue and melena. The initial endoscopic examination did not locate any source of bleeding. Six months later, pan-gastroscopy, performed due to progressive microcytic anemia, revealed a 40 × 30 mm polypoid lesion with deep ulcerations; histopathological analysis confirmed that it was a gastric GT with expression of alpha-actin and cadherin 17 and a Ki-67 index of 20%. The patient delayed surgical therapy until his symptoms worsened. Laparoscopic sleeve resection revealed a 65 × 45 × 25 mm tumor, and secondary immunohistochemical analysis revealed extensive spread into the mucosa and subserosa. Focally, the tumor bulged into some large veins. Genetic examination with RNA isolation further supported the histopathological diagnosis of gastric GT with uncertain malignant potential. Conclusions This case underscores the diagnostic challenges posed by gastric GTs because they are rare and their clinical features are similar to those of other gastric tumors. Thorough histopathological and molecular analysis is essential for an accurate diagnosis. Surgical intervention remains the primary therapeutic approach. This case also emphasizes the need for long-term follow-up due to the potential for recurrence and malignancy.

Upper gastrointestinal (GI) bleeding in older children is generally caused by conditions like esophagitis, esophageal variceal rupture, and peptic ulcer disease. However, it is rare for bleeding to result from a ruptured vascular aneurysm of the gastroduodenal artery, particularly when associated with peptic ulcer disease. This report describes a case involving a 13-year-old male who presented with severe upper GI bleeding and hemodynamic instability, requiring blood transfusion. During an emergency upper GI endoscopy, a bleeding gastric ulcer classified as Forrest IIB was identified. The bleeding was managed initially with endoscopic hemostasis and surgical suturing. Despite these interventions, the patient experienced recurrent bleeding. Further investigation with contrast-enhanced computed tomography (CT) imaging revealed a vascular aneurysm in the gastroduodenal artery. The patient subsequently underwent successful endovascular embolization, as confirmed by digital subtraction angiography (DSA). Following this procedure, there were no further episodes of GI bleeding. This case highlights the critical need for thorough diagnostic evaluation using contrast-enhanced CT and endoscopy in managing complex GI bleeding cases. Early detection and appropriate intervention are essential, especially in pediatric patients where the cause of bleeding may be rare and severe.

Background : : Hepatic encephalopathy (HE) is an adverse prognostic indicator of liver cirrhosis, often triggered by various precipitating factors, with gastrointestinal bleeding being the most common. Comparing the Child–Pugh and Model for End-Stage Liver Disease (MELD) scores to predict the severity and outcome of complications in patients with cirrhosis could help establish an accurate prognosis.Methods : : We retrospectively reviewed the records of patients with cirrhosis aged 18 and older who were referred to the Gastroenterology Department at Imam Khomeini Hospital in Ahvaz from April to September 2023. A statistical analysis was conducted to compare MELD and Child-Pugh score (CPS) in 95 patients with cirrhosis.Results : : The in-hospital mortality rate was strongly correlated with certain complications of cirrhosis. Gastrointestinal bleeding and HE showed statistical significance (P < 0.05). Additionally, the co-occurrence of cirrhosis complications, particularly HE in conjunction with others, was associated with increased mortality rates. Abnormal levels of the international normalized ratio, prothrombin time, partial thromboplastin time, bilirubin, and liver enzymes (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase) were also associated with mortality (P < 0.05). Specific laboratory factors in ascites fluid, namely total cell count and red blood count, were linked to the 6-month survival rate (P < 0.05). Furthermore, CPS was identified as a more specific and sensitive independent predictor of 6-month in-hospital survival than the MELD score (logistic regression: odds ratio, 2.3; standard error, 0.0189; P < 0.05).Conclusion : : We recommend continuing to use the CPS for predicting in-hospital mortality in patients with cirrhosis and for the individual evaluation of liver disease in daily clinical practice.

Abstract Background Ulcer erosion into the cystic artery is a rare cause of bleeding in duodenal ulcers, with only a limited number of cases described in the literature. Historically, treatment has predominantly involved surgical intervention. We present three cases of duodenal ulcer bleeding due to cystic artery erosion, which were successfully managed with cystic artery embolization. Case presentation This case series includes three male patients with duodenal ulcer bleeding, aged 90, 81, and 82 years, respectively, and no prior history of biliary system disorders. The ulcer locations were identified as two in the post-bulbar region and one in the anterior bulb. After the failure of medical and endoscopic treatment, transcatheter arterial embolization was adopted. Initial angiography did not reveal any contrast medium extravasation. Empirical embolization of the gastroduodenal artery using gelatin sponge particles and coils failed to achieve hemostasis. Super-selective cystic artery angiography confirmed the source of bleeding as the cystic artery. One patient was embolized with gelatin sponge particles and coils, while the other two patients were embolized with N-butyl-cyanoacrylate. All patients achieved successful hemostasis without gallbladder infraction. Conclusions Cystic artery embolization proved to be a minimally invasive technique for achieving hemostasis in these cases, indicating that it may be a safe and effective alternative to surgery for this uncommon cause of upper gastrointestinal bleeding. Validation through further studies is warranted.

Abstract Background and aims This study aimed to determine the performance of AIMS65, Rockall score, and Glasgow-Blatchford score (GBS) in patients presenting with upper gastrointestinal bleeding (UGIB) and to compare results between patients with nonvariceal UGIB (NVUGIB) and variceal UGIB (VUGIB). Methods We conducted a single-center prospective cohort study between December 2021 and December 2022. A total of 400 patients who met the inclusion criteria were included in the study, out of which 232 patients (58%) had NVUGIB and 168 patients (42%) had VUGIB. Receiver operating characteristic curve analysis was performed for all outcomes for comparison. Results Of the total of 400 patients with UGIB, 232 patients (58%) had NVUGIB, and 168 patients (42%) had VUGIB. The present study showed that GBS (AUROC 0.729, 95% CI: 0.598–0.859, p = 0.001) and RS (AUROC 0.693, 95% CI: 0.579–0.807, p = 0.005) but not AIMS65 (AUROC, 0.545, 95% CI: 0.412–0.679, p = 0.500) predicted in-hospital and overall 6-week mortality in patients with UGIB. All the three scores predicted need for blood transfusion and poor composite outcomes (p 0.05). Conclusions GBS and RS were superior to AIMS65 in predicted in-hospital and overall 6-week mortality in all the three categories: OUGIB, NVUGIB, and VUGIB patients.

Introduction :HemosuccusPancreaticus is an extremely rare cause of Upper GI bleeding and is described as a haemorrhage from the ampulla of Vater passing through the main pancreatic duct toward the second portion of the duodenum. Discussion :Hemosuccuspancreaticus is a rare and potentially life-threatening obscure cause of upper gastrointestinal bleeding. It is described as bleeding from the ampulla of Vater via the pancreatic duct. It is one of least frequent cause of upper gastrointestinal bleeding and is most often caused by chronic pancreatitis, pancreatic tumours and sometimes pancreatic pseudocysts [ABSTRACT FROM AUTHOR]

Key Clinical Message: Upper gastrointestinal bleeding due to primary aortoesophageal fistula is a rare clinical condition burdened with high mortality rate. However, the outcomes are closely related to the level of clinical awareness, the complementary and multidisciplinary approach during the diagnostic workup, and the selected treatment option. We present an atypical case of an aneurysm of the thoracoabdominal aorta complicated with primary aortoesophageal fistula (AEF). A 55‐year‐old male with no previous diseases, presented with prolonged and intense back pain and upper gastrointestinal bleeding. The gastroscopy detected an unusual culprit lesion in the distal esophagus resembling an esophageal wall defect, and the computed tomography revealed an aneurysm of the thoracoabdominal aorta, remarkable surrounding hematoma, and active contrast extravasation. Despite the urgent surgical repair, a lethal outcome occurred. AEF patients require high clinical awareness and complementary multidisciplinary approach in order to provide a rapid diagnosis and optimal treatment. [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. [ABSTRACT FROM AUTHOR]

Background: Ulcer erosion into the cystic artery is a rare cause of bleeding in duodenal ulcers, with only a limited number of cases described in the literature. Historically, treatment has predominantly involved surgical intervention. We present three cases of duodenal ulcer bleeding due to cystic artery erosion, which were successfully managed with cystic artery embolization. Case presentation: This case series includes three male patients with duodenal ulcer bleeding, aged 90, 81, and 82 years, respectively, and no prior history of biliary system disorders. The ulcer locations were identified as two in the post-bulbar region and one in the anterior bulb. After the failure of medical and endoscopic treatment, transcatheter arterial embolization was adopted. Initial angiography did not reveal any contrast medium extravasation. Empirical embolization of the gastroduodenal artery using gelatin sponge particles and coils failed to achieve hemostasis. Super-selective cystic artery angiography confirmed the source of bleeding as the cystic artery. One patient was embolized with gelatin sponge particles and coils, while the other two patients were embolized with N-butyl-cyanoacrylate. All patients achieved successful hemostasis without gallbladder infraction. Conclusions: Cystic artery embolization proved to be a minimally invasive technique for achieving hemostasis in these cases, indicating that it may be a safe and effective alternative to surgery for this uncommon cause of upper gastrointestinal bleeding. Validation through further studies is warranted. [ABSTRACT FROM AUTHOR]

Background and aims: This study aimed to determine the performance of AIMS65, Rockall score, and Glasgow-Blatchford score (GBS) in patients presenting with upper gastrointestinal bleeding (UGIB) and to compare results between patients with nonvariceal UGIB (NVUGIB) and variceal UGIB (VUGIB). Methods: We conducted a single-center prospective cohort study between December 2021 and December 2022. A total of 400 patients who met the inclusion criteria were included in the study, out of which 232 patients (58%) had NVUGIB and 168 patients (42%) had VUGIB. Receiver operating characteristic curve analysis was performed for all outcomes for comparison. Results: Of the total of 400 patients with UGIB, 232 patients (58%) had NVUGIB, and 168 patients (42%) had VUGIB. The present study showed that GBS (AUROC 0.729, 95% CI: 0.598–0.859, p = 0.001) and RS (AUROC 0.693, 95% CI: 0.579–0.807, p = 0.005) but not AIMS65 (AUROC, 0.545, 95% CI: 0.412–0.679, p = 0.500) predicted in-hospital and overall 6-week mortality in patients with UGIB. All the three scores predicted need for blood transfusion and poor composite outcomes (p < 0.05). The need for endoscopic intervention was predicted by all the three scores in overall UGIB (OUGIB) patients (p < 0.05), only GBS and RS in NVUGIB patients (p < 0.05). Rebleeding was best predicated by RS in both OUGIB and NVUGIB patients (p < 0.05). None of the scores predicted the need for endoscopic intervention, rebleeding, need for surgical and radiological intervention, and composite outcomes in VUGIB patients (p > 0.05). Conclusions: GBS and RS were superior to AIMS65 in predicted in-hospital and overall 6-week mortality in all the three categories: OUGIB, NVUGIB, and VUGIB patients. [ABSTRACT FROM AUTHOR]

Background Hemostatic powders are used as second-line treatment in acute gastrointestinal (GI) bleeding (AGIB). Increasing evidence supports the use of TC-325 as monotherapy in specific scenarios. This prospective, multicenter study evaluated the performance of TC-325 as monotherapy for AGIB. Methods Eighteen centers across Europe and USA contributed to a registry between 2016 and 2022. Adults with AGIB were eligible, unless TC-325 was part of combined hemostasis. The primary endpoint was immediate hemostasis. Secondary outcomes were rebleeding and mortality. Associations with risk factors were investigated (statistical significance at P=0.05). Results One hundred ninety patients were included (age 51-81 years, male: female 2:1), with peptic ulcer (n=48), upper GI malignancy (n=79), post-endoscopic treatment hemorrhage (n=37), and lower GI lesions (n=26). The primary outcome was recorded in 96.3% (95% confidence interval [CI]: 92.6-98.5) with rebleeding in 17.4% (95%CI 11.9-24.1); 9.9% (95%CI 5.8-15.6) died within 7 days, and 21.7% (95%CI 15.6-28.9) within 30 days. Regarding peptic ulcer, immediate hemostasis was achieved in 88% (95%CI 75-95), while 26% (95%CI 13-43) rebled. Higher ASA score was associated with mortality (OR 23.5, 95%CI 1.60-345; P=0.02). Immediate hemostasis was achieved in 100% of cases with malignancy and post-intervention bleeding, with rebleeding in 17% and 3.1%, respectively. Twenty-six patients received TC-325 for lower GI bleeding, and in all but one the primary outcome was achieved. Conclusions TC-325 monotherapy is safe and effective, especially in malignancy or postendoscopic intervention bleeding. In patients with peptic ulcer, it could be helpful when the primary treatment is unfeasible, as bridge to definite therapy. [ABSTRACT FROM AUTHOR]

Background: Acute cerebral infarction (ACI) is a complication of upper gastrointestinal bleeding (UGIB), but the risk factors for ACI in UGIB patients have not been fully explored. The purpose of the current study was to investigate the risk factors for ACI in UGIB patients. Methods: Upper gastrointestinal bleeding patients admitted to Nanchang University Affiliated Ganzhou Hospital from January 2019 to December 2021 were included. Patients were divided into an ACI group and a non-ACI group according to whether they had a complication of ACI. Propensity score matching was used to match the data between the two groups. The risk factors for ACI in UGIB patients were analyzed by conditional multivariate logistic regression analysis, and receiver operator characteristic (ROC) curves were used to test the performance of risk factors. Results: There were 1379 UGIB patients included in this study: 50 patients in the ACI group and 1329 patients in the non-ACI group. Forty-eight pairs werematched after propensity scorematching according to sex, age, smoking, drinking, hypertension, coronary heart disease (CHD), diabetes, previous history of cerebral infarction, gout, peptic ulcer, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and hepatic cirrhosis. Univariate analysis showed that RBC transfusion was a risk factor for ACI. Compared with middle rate pressure product (RPP) at admission, low RPP and high RPP were risk factors for ACI in UGIB patients. Hemoglobin, mean platelet volume (MPV) and albumin were protective factors for ACI. Conditional multivariate logistic regression showed that red blood cell (RBC) transfusion (OR 3.136, 95% CI 1.711-5.750, p < 0.001)was an independent risk factor for ACI. Compared with middle RPP at admission, low RPP and high RPP were independent risk factors for ACI in UGIB patients. The ROC curve analysis showed that the areas under the curve (AUCs) of the RPP at admission and after RBC transfusion were 0.625 (0.513-0.737, p < 0.05) and 0.688 (0.580-0.795, p < 0.01), respectively. Conclusions: Compared with middle RPP at admission, low RPP and high RPP were independent risk factors for ACI in UGIB patients, and RBC transfusion was also an independent risk factor for ACI in UGIB patients. [ABSTRACT FROM AUTHOR]

Variceal and nonvariceal upper gastrointestinal bleeding (VUGIB and NVUGIB, respectively) require prompt intervention. Existing studies offer limited insight into the impact of interhospital transfers on patients with VUGIB and NVUGIB. We conducted a retrospective study using the US National Inpatient Sample database from 2017 to 2020. The outcomes included in-hospital mortality, incidence of complications, procedural performance, and resource utilization. A total of 28,275 VUGIB and 781,370 NVUGIB adult patients were included. Transferred VUGIB and NVUGIB patients, when compared to nontransferred ones, demonstrated higher inpatient mortality (adjusted odds ratio [AOR] 1.49 and 1.86, P < 0.05). Patients with VUGIB and NVUGIB had a higher likelihood of acute kidney injury requiring dialysis (AOR 3.79 and 1.76, respectively, P = 0.01), vasopressor requirement (AOR 2.13 and 2.37, respectively, P < 0.01), need for mechanical ventilation (AOR 1.73 and 2.02, respectively, P < 0.01), and intensive care unit admission (AOR 1.76 and 2.01, respectively, P < 0.01). Compared to their nontransferred counterparts, transferred VUGIB patients had a higher rate of undergoing transjugular intrahepatic portosystemic shunt (AOR 3.26, 95% CI 1.92–5.54, P < 0.01), while transferred NVUGIB patients had a higher rate of interventional radiology-guided embolization (AOR 2.01, 95% CI 1.73–2.34, P < 0.01) and endoscopic hemostasis (AOR 1.10, 95% CI 1.05–1.15, P < 0.01). Interhospital transfer is associated with worse clinical outcomes and higher resource utilization for VUGIB and NVUGIB patients. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding (UGIB) is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency clinicians to be aware of the current evidence regarding the diagnosis and management of this disease. This paper evaluates key evidence-based updates concerning UGIB for the emergency clinician. UGIB most frequently presents with hematemesis. There are numerous causes, with the most common peptic ulcer disease, though variceal bleeding in particular can be severe. Nasogastric tube lavage for diagnosis is not recommended based on the current evidence. A hemoglobin transfusion threshold of 7 g/dL is recommended (8 g/dL in those with myocardial ischemia), but patients with severe bleeding and hemodynamic instability require emergent transfusion regardless of their level. Medications that may be used in UGIB include proton pump inhibitors, prokinetic agents, and vasoactive medications. Antibiotics are recommended for those with cirrhosis and suspected variceal bleeding. Endoscopy is the diagnostic and therapeutic modality of choice and should be performed within 24 h of presentation in non-variceal bleeding after resuscitation, though patients with variceal bleeding may require endoscopy within 12 h. Transcatheter arterial embolization or surgical intervention may be necessary. Intubation should be avoided if possible. If intubation is necessary, several considerations are required, including resuscitation prior to induction, utilizing preoxygenation and appropriate suction, and administering a prokinetic agent. There are a variety of tools available for risk stratification, including the Glasgow Blatchford Score. An understanding of literature updates can improve the ED care of patients with UGIB. [ABSTRACT FROM AUTHOR]

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Objective: Numerous scoring systems have been developed to assess the risk associated with upper gastrointestinal bleeding (UGIB), and several studies have investigated their comparative accuracy in predicting patient outcomes. This study was undertaken to compare four well-known scoring systems, namely the pre-endoscopy Rockall score, full Rockall score, Glasgow-Blatchford Bleeding score (GBS), and AIMS65, with the aimof predicting five distinct outcomes in cases of non-variceal UGIB. Methods: This prospective observational study was conducted focusing on adult patients with UGIB presenting to the emergency department (ED). The primary endpoints of this study included in-hospital mortality, the need for re-endoscopy, the requirements for packed red blood cell (PRBC) transfusion, massive transfusion, and one-month rebleeding. Results: A total number of 320 patients were enrolled, with 44 (13.75%) in-hospital deaths. Based on the area under the curves (AUC), while certain scores outperformed others in specific outcome prediction, the AIMS65 scoring system demonstrated superior predictive capability for both in-hospital mortality (0.91) and massive transfusion (0.71). Regarding PRBC transfusion requirements, both AIMS65 and GBS exhibited similar predictive capacities (AUC=0.67 and 0.68, respectively). In terms of re-endoscopy and one-month rebleeding, the GBS scoring system displayed slightly better performance compared to the other systems (AUC=0.61 and 0.63, respectively). In the composite outcome, all scores had significant associations, and among them, the AIMS-65 score had the highest AUC (0.76). Conclusion: The AIMS65 scoring system was the most reliable tool for predicting in-hospital mortality and, to a lesser extent, massive transfusion requirements, while GBS and AIMS65 could be moderately and cautiously relied on for preparations regarding the need for PRBC transfusion. [ABSTRACT FROM AUTHOR]

Ethylicin is a pesticide with excellent bactericidal ability. The incidence of poisoning has increased in recent years with the widespread use of ethylicin in green agriculture, but reports are lacking. In this study, we described three cases of oral ethylicin poisoning. Patients developed severe upper gastrointestinal bleeding after oral administration of ethylicin. Gastroscopy showed extensive mucosal erosions and ulcerations in the esophagus, stomach, and duodenum. Impaired consciousness, multiorgan injury, irreversible shock, and cardiac arrest were observed in cases where larger doses of ethylicin were ingested. Patients were treated with comprehensive therapeutic measures, including total gastrointestinal decontamination, medications such as proton pump inhibitors and somatostatin to reduce gastric bleeding. Endoscopic hemostasis was performed when pharmacologic hemostasis was not effective. Parenteral nutritional support and organ function support were given. In patients’ follow up, esophageal stenosis and dysphagia during feeding was noted, which severely affected the quality of life. Ethylicin poisoning has been a public health problem and the awareness should be raised.

Abstract 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

Abstract The relationship between exposure to ambient air pollutants and emergency attendance for upper gastrointestinal bleeding (UGIB) remains inconclusive. This study examines the association between short‐term exposure to various ambient pollutants and the risk of UGIB emergency attendance. Data on daily UGIB emergency attendance, ambient pollutants, and meteorological conditions in Hong Kong were collected from 2017 to 2022. A time‐series study using a distributed lag non‐linear model to analyze the data, considering lag days. Stratified analysis was performed based on sex, seasons, and the COVID‐19 pandemic period. The burden was quantified using attributable fraction (AF) and number (AN). The study included 31,577 UGIB emergency records. Exposure to high levels of PM2.5 significantly increased the risk of UGIB emergency attendance from lag day 3 (RR: 1.012) to day 6 (RR: 1.008). High NO2 exposure also posed a significant risk from lag day 0 (RR: 1.026) to day 2 (RR: 1.014), and from lag day 5 (RR: 1.013) to day 7 (RR: 1.024). However, there was no association between UGIB and high O3 levels. The attributable burden of high‐concentration NO2 exposure was higher compared to those of PM2.5. Males and elderly individuals (≥65 years) faced a higher risk of UGIB emergencies, particularly during cold seasons. Our study suggests that both PM2.5 and NO2 exposure are associated with an increased risk of emergency attendance for UGIB. Ambient pollutant exposure has a stronger effect on UGIB in males and the elderly, particularly during cold seasons.

Key Clinical Message The occurrence of terlipressin‐induced skin necrosis in cirrhotic patients is a rare but serious adverse event that warrants further investigation. Clinicians should be aware of this potential complication in cirrhotic patients receiving terlipressin therapy and closely monitor for any signs of skin necrosis. Early recognition and prompt intervention are crucial in preventing further complications and improving patient outcomes. Further research is needed to better understand the risk factors associated with terlipressin‐induced skin necrosis and to develop effective preventive strategies. Overall, healthcare providers should exercise caution when prescribing terlipressin to cirrhotic patients, weighing the potential benefits against the risks of this rare but significant adverse event. Abstract Terlipressin is commonly used to manage conditions related to portal hypertension, such as hepatorenal syndrome and esophageal variceal bleeding. Despite its therapeutic benefits, terlipressin can rarely lead to severe ischemic complications involving the skin vasculature, known as terlipressin‐induced skin necrosis. We present a 50‐year‐old male with cirrhosis and acute variceal bleeding who developed skin necrosis following terlipressin administration. We performed a comprehensive review of the literature by analyzing 18 case reports/case series comprising 22 cirrhotic patients with terlipressin‐induced skin necrosis. Among these individuals, we found a mean age of 51 years with a male predominance (78%). Further analysis showed that the onset of skin necrosis ranged from 2 to 5 days post‐terlipressin initiation, with bolus administration being predominant (85.7%). The underlying pathophysiological mechanisms of terlipressin‐induced skin ischemia are still elusive but primarily attributed to the vasoconstrictive and thrombogenic effects. Management involves terlipressin discontinuation and supportive care. Physicians should be aware of this potential complication in patients receiving terlipressin and closely observe for any signs of skin rash.

BackgroundAcute kidney injury (AKI) is a common and serious complication in patients with acute non-variceal upper gastrointestinal bleeding (NVUGIB). Early prediction and intervention are crucial for improving patient outcomes.MethodsData for patients presenting with acute NVUGIB in this retrospective study were sourced from the MIMC-IV database. Patients were randomly allocated into training and validation cohorts for further analysis. Independent predictors for AKI were identified using least absolute shrinkage and selection operator regression and multivariable logistic regression analyses in the training cohort. Based on the logistic regression results, a nomogram was developed to predict early AKI onset in acute NVUGIB patients, and implemented as a web-based calculator for clinical application. The nomogram’s performance was evaluated through discrimination, using the C-index, calibration curves, and decision curve analysis (DCA) to assess its clinical value.ResultsThe study involved 1082 acute NVUGIB patients, with 406 developing AKI. A multivariable logistic regression identified five key AKI predictors: CKD, use of human albumin, chronic liver disease, glucose, and blood urea nitrogen. The nomogram was constructed based on independent predictors. The nomogram exhibited robust accuracy, evidenced by a C-index of 0.73 in the training cohort and 0.72 in the validation cohort. Calibration curves demonstrated satisfactory concordance between predicted and observed AKI occurrences. DCA revealed that the nomogram offered considerable clinical benefit within a threshold probability range of 7% to 54%.ConclusionOur nomogram is a valuable tool for predicting AKI risk in patients with acute NVUGIB, offering potential for early intervention and improved clinical outcomes.

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

Objective To establish a model that can predict the occurrence of acute kidney injury (AKI) in elderly patients with HBV-related acute-on-chronic liver failure (HBV-ACLF), and to conduct a preliminary evaluation of the performance of the model. Methods A total of 276 patients with HBV-ACLF hospitalised in The First Affiliated Hospital of Harbin Medical University from January 2020 to January 2023 were retrospectively included and divided into 72 (26.09%) in the AKI group and 204 (73.91%) in the non AKI group, according to whether AKI occurred during hospitalisation. The clinical data of all patients were extracted and screened for independent risk factors for AKI during hospitalisation using multivariate logistic regression. A prediction model was constructed accordingly, and then the efficacy of the prediction model was evaluated using ROC curves. Results Multivariate logistic regression analysis showed that age ＞70 years (OR=1.404, 95%CI: 1.134～1.737), procalcitonin＞1 ng/L (OR=1.473, 95%CI: 1.074～2.019), model for end stage liver disease (MELD) score ＞34 (OR=1.702, 95%CI: 1.254～2.311), and combined upper gastrointestinal bleeding (OR=1.516, 95%CI: 1.123～2.047) were independent risk factors for the occurrence of AKI in HBV-ACLF patients during hospitalisation (P＜0.05). A prediction model for the occurrence of AKI in HBV-ACLF patients during hospitalisation was established based on the above four parameters, and the ROC curve showed that the AUC predicted by the model was 0.882 (95%CI: 0.838～0.917), with a sensitivity of 66.67%, a specificity of 93.14% and an accuracy of 86.23%. Conclusion Elderly, high MELD score and procalcitonin level, and concomitant upper gastrointestinal bleeding are independent risk factors for AKI in patients with HBV-ACLF during hospitalisation, and the model constructed accordingly can predict the risk of AKI, thus assisting clinical disease management.

Renal cell carcinoma (RCC) is a common malignant kidney tumor; however, gastric metastasis is rare. We report the case of an 82-year-old male patient who developed gastric metastasis 12 years after an initial diagnosis of RCC. The patient underwent endoscopic full-thickness resection (EFTR), and the gastric metastatic focus was successfully removed. Postoperative pathology and immunohistochemistry showed that the gastric metastasis originated from RCC. Although gastric metastasis of RCC is rare, it should be suspected in patients with a history of RCC or gastrointestinal symptoms. EFTR is associated with reduced trauma and greater retention of gastric tissue and function. It is a more appropriate choice than surgical resection; however, it requires more endoscopists. [ABSTRACT FROM AUTHOR]

The incidence of chronic liver disease is on the rise. One of the primary causes of hospital admissions for patients with cirrhosis is hepatic encephalopathy (HE), a debilitating neurological complication. HE is defined as a reversible syndrome, yet there is growing evidence stating that, under certain conditions, HE is associated with permanent neuronal injury and irreversibility. The pathophysiology of HE primarily implicates a strong role for hyperammonemia, but it is believed other pathogenic factors are involved. The fibrotic scarring of the liver during the progression of chronic liver disease (cirrhosis) consequently leads to increased hepatic resistance and circulatory anomalies characterized by portal hypertension, hyperdynamic circulatory state and systemic hypotension. The possible repercussions of these circulatory anomalies on brain perfusion, including impaired cerebral blood flow (CBF) autoregulation, could be implicated in the development of HE and/or permanent brain injury. Furthermore, hypotensive insults incurring during gastrointestinal bleed, infection, or liver transplantation may also trigger or exacerbate brain dysfunction and cell damage. This review will focus on the role of hypotension in the onset of HE as well as in the occurrence of neuronal cell loss in cirrhosis. [ABSTRACT FROM AUTHOR]

Background and Aim: This study investigates the effectiveness of bedside ultrasonography in predicting blood transfusion requirements in patients with upper gastrointestinal bleeding (UGIB). It focuses on evaluating the inferior vena cava (IVC) diameter, IVC collapsibility index (CI), and stroke volume (SV) as ultrasonographic measures. Methods: A hundred adult patients enrolled in this prospective clinical study. The patients were divided into two groups (group 1: only saline administered group, group 2: saline and blood administered group). IVC diameter, IVC CI, and SV were measured at the time of admission and after treatment. Results: At the initial admission, group 1 exhibited an IVC CI of 20.4% and an SV of 65.0 mL, whereas group 2 displayed an IVC CI of 26.6% and an SV of 58.0 mL. Upon analyzing the relationship between the Glasgow–Blatchford score (GBS) and SV, we identified a significant negative correlation (r = −0.7350; P < 0.001). Similarly, a weak negative correlation was observed between the Rockall score (RS) and SV (r = −0.4718; P < 0.001). It is worth noting that patients with UGIB require blood transfusion if their SV falls below 62.5 mL, with an area under the curve (AUC) of 89.1% and a 95% confidence interval (CI) ranging from 82.8% to 95.4%. Conclusion: IVC CI and SV can be used as parameters to predict the need for blood transfusion in the ED in patients with UGIB. [ABSTRACT FROM AUTHOR]

Background: This work evaluated the effects of proton pump inhibitors (PPIs) on cardiovascular events (CVEs) and inflammatory factors in patients with upper gastrointestinal bleeding (UGIB) undergoing dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. Clinical data from these patients were analysis, intending to provide relevant theoretical evidence for clinical practice. Materials and methods: Data of 166 patients who underwent percutaneous coronary intervention and developed UGIB while on DAPT at The First People' Hospital of Linping District from April 2021 to April 2023 were retrospectively analyzed. The patients were rolled into two groups: those who received PPI treatment and those who did not, namely, PPI and non-PPI group, respectively. Furthermore, occurrence of CVEs and the levels of inflammatory factors of patients in all groups were statistically analyzed. Results: In patients with UGIB, melena is a common presentation. The incidence of CVE in the PPI group showed no statistically significant difference compared to the control group, and there was no significant variance observed in the distribution of CVE incidence among different PPIs. However, levels of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) were significantly lower in the PPI group compared to the non-PPI group (P < 0.05). Conclusion: Melena was the most frequent clinical manifestation in UGIB patients. The use of PPIs did not increase the risk of CVEs, and different PPI drugs did not affect the occurrence of CVEs. Furthermore, PPIs lowered CRP and TNF-α levels in serum of these patients. [ABSTRACT FROM AUTHOR]

Objective To analyze the value of the modified early warning scoring system (MEWS) combined with body temperature adjusted shock index (ASI) in the pre-hospital emergency condition assessment in patients with upper gastrointestinal bleeding. Methods A total of 92 patients with upper gastrointestinal bleeding in prehospital emergency care in this hospital from January 2021 to January 2023 were selected, and the patients were classified into a moderately severe group (blood loss≥500 mL, 61 cases）, and a mild group (blood loss ＜ 500 mL, 31 cases) according to their different blood loss. The MEWS and ASI scores of patients in the 2 groups were compared to analyze the value of MEWS combined with ASI for pre-hospital emergency medical assessment of patients with upper gastrointestinal bleeding. Results The MEWS and ASI scores of patients in the moderately severe group were significantly higher than those of the mild group, and the differences were statistically significant (P＜0. 05）;the MEWS and ASI scores were related to the patient′s condition, and the differences were statistically significant (OR=2. 470, 2. 605, P＜0. 05）. The MEWS, ASI, and the combination of subjects used for the assessment of the condition of pre-hospital emergency care for patients with upper gastrointestinal bleeding The area under the working curve was 0. 847, 0. 714, and 0. 870, respectively, all of which had some assessment value, and the combined assessment of the patient′s condition was more valuable. Conclusion Both MEWS and ASI have certain value in prehospital emergency condition assessment of patients with upper gastrointestinal bleeding, and the value of joint assessment of patients′ condition is higher. [ABSTRACT FROM AUTHOR]

Background & Objective: Although higher age was previously associated with upper gastrointestinal bleeding (UGIB), rebleeding due to low PH has been recently considered as a crucial prognosis factor. In this regard, pantoprazole, a Proton pump inhibitor (PPIs), along with endoscopy was applied in high-risk patients. As it is an undeniably momentous approach to discover the best PPIs injection method, the advantages and disadvantages of continuous and intermittent PPIs’ infusion were compared in high-risk UGIBs patients. Materials & Methods: Eighty selected patients were randomly divided into two equal groups. In the continuous infusion, there were 6 and 34 patients with adherent clot ulcers and visible vessel ulcers without bleeding; however, 2 and 38 patients with these ulcers were present in the intermittent infusion group in turn. After three days, ulcers, packed cells, and surgery needs were evaluated between the two groups. Results: After 72 hours of treatment, 29, 3 and 8 patients in the continuous group showed clean base, flat pigmented spot, and visible vessel ulcer with bleeding, respectively. Whereas in the intermittent group, these records were 35, 5 and 0, respectively (p≤0.028). The number of patients in the continuous infusion group with a visible vessel ulcer was significantly higher (p>0.028). A significant difference was also observed between the groups in terms of length of hospitalizations (p≤0.001) with no mortality. Conclusion: Based on the findings, the intermittent infusion of PPIs is obviously superior over continuous mode. However, further studies with a larger population are recommended to discover the merits and drawbacks of this method in high-risk UGIBs. [ABSTRACT FROM AUTHOR]

Gastritis cystica profunda (GCP) is a rare lesion of the stomach. It is characterised by hyperplasia and cystic dilation of the gastric gland in the submucosal layer. It is usually believed to occur at the site of previous gastric surgeries, as the anastomotic remnants act as a foundation for the development of the lesion. We present a case of a 39-year-old female, previously healthy with no history of gastric surgeries, who sought medical care for melena and lethargy of one month’s duration. Her complete blood count showed a significant drop in haemoglobin (from 13 to 9 g/dl). Upper endoscopy revealed a submucosal lesion in the pre-pyloric region; biopsies showed the characteristic findings of GCP. The latter is a rare cause of upper gastrointestinal (GI) bleeding and its diagnosis and treatment remain challenging. Medical literature has not unveiled its association with chronic inflammation and Helicobacter pylori infection as many cases are being found in previously unoperated individuals. Even though GCP remains a rare entity, it should be incorporated in the differential diagnoses of upper GI bleeding and further prospective studies should highlight other contributing factors.

Key Clinical Message Upper gastrointestinal bleeding due to primary aortoesophageal fistula is a rare clinical condition burdened with high mortality rate. However, the outcomes are closely related to the level of clinical awareness, the complementary and multidisciplinary approach during the diagnostic workup, and the selected treatment option. Abstract We present an atypical case of an aneurysm of the thoracoabdominal aorta complicated with primary aortoesophageal fistula (AEF). A 55‐year‐old male with no previous diseases, presented with prolonged and intense back pain and upper gastrointestinal bleeding. The gastroscopy detected an unusual culprit lesion in the distal esophagus resembling an esophageal wall defect, and the computed tomography revealed an aneurysm of the thoracoabdominal aorta, remarkable surrounding hematoma, and active contrast extravasation. Despite the urgent surgical repair, a lethal outcome occurred. AEF patients require high clinical awareness and complementary multidisciplinary approach in order to provide a rapid diagnosis and optimal treatment.

BackgroundThe neutrophil-lymphocyte ratio (NLR) is a simple marker of systemic inflammatory responses. The present study aims to evaluate the prognostic significance of the NLR on admission day in predicting outcomes for patients with upper gastrointestinal bleeding (UGIB), which is a prevalent medical emergency.Methods726 patients who were admitted to our clinic between January 2019 and December 2022 diagnosed with UGIB, and who underwent necessary examinations, were included in the study. The patients’ Glasgow-Blatchford Score (GBS), Full Rockall Score (FRS), and NLR levels were calculated at the first admission. Outcomes were defined as in-hospital mortality, need for blood transfusion, surgical treatment and endoscopic therapy. Patients were categorized into four groups using NLR quartile levels to compare their clinical characteristics, Glasgow Blatchford Score, Full Rockall Score levels, and prognosis. Secondary, we modified FRS and GBS by adding NLR, respectively. We used area under the receiver operating characteristic curve (AUROC) to assess the accuracy of risk prediction for NLR, NLR-GBS, and NLR-FRS improved models.ResultsOf 726 patients, 6% died in hospital, 23.9% received endoscopic interventon, 4.8% received surgical treatment, and 46.4% received transfusion therapy. Multifactorial logistic regression showed that a high level of NLR was a risk factor for death in patients with UGIB (p = 0.028). NLR, GBS, FRS, NLR-GBS, and NLR-FRS have sufficient accuracy in predicting inpatient mortality, endoscopic treatment, and transfusion treatment, and the differences are statistically significant (p

Background: Upper gastrointestinal bleeding (UGIB) is a prevalent etiology for hospital admissions on a global scale. However, the significance of UGIB as a warning sign of gastrointestinal (GI) cancer is frequently disregarded due to its uncommon and atypical symptoms. Methods: In the Kailuan study, participants diagnosed with UGIB were assigned as the case group and were randomly matched in a 1:4 ratio with a control group of comparable age and sex from 2006 to 2018 in Tangshan. The statistical analysis included a total of 1250 UGIB patients and 5000 individuals without UGIB. The impact of UGIB on cancer incidence was evaluated using a Cox proportional hazards model, enabling the investigation of both site-specific and time-dependent effects of UGIB on cancer incidence. Results: The mean age of the patients was 60.91 ± 13.08 years. Over an average follow-up period of 8.92 years, there were 102 cases of cancer in the UGIB group and 210 cases in the non-UGIB group. The results of the Cox model analysis indicated that the strength of association between UGIB and cancer depends on specific cancer site. Excluding patients with follow-up periods of less than 1, 3, and 5 years weakened the associations between UGIB and GI cancer in sensitivity analysis. Conclusion: UGIB may serve as a sign of occult cancer, necessitating thorough evaluation of middle-aged and elderly patients presenting with this warning symptom to detect the possibility of missing a cancer diagnosis.

ObjectiveTo develop a model that integrates radiomics features and clinical factors to predict upper gastrointestinal bleeding (UGIB) in patients with decompensated cirrhosis.Methods104 decompensated cirrhosis patients with UGIB and 104 decompensated cirrhosis patients without UGIB were randomized according to a 7:3 ratio into a training cohort (n = 145) and a validation cohort (n = 63). Radiomics features of the abdominal skeletal muscle area (SMA) were extracted from the cross-sectional image at the largest level of the third lumbar vertebrae (L3) on the abdominal unenhanced multi-detector computer tomography (MDCT) images. Clinical-radiomics nomogram were constructed by combining a radiomics signature (Rad score) with clinical independent risk factors associated with UGIB. Nomogram performance was evaluated in calibration, discrimination, and clinical utility.ResultsThe radiomics signature was built using 11 features. Plasma prothrombin time (PT), sarcopenia, and Rad score were independent predictors of the risk of UGIB in patients with decompensated cirrhosis. The clinical-radiomics nomogram performed well in both the training cohort (AUC, 0.902; 95% CI, 0.850–0.954) and the validation cohort (AUC, 0.858; 95% CI, 0.762–0.953) compared with the clinical factor model and the radiomics model and displayed excellent calibration in the training cohort. Decision curve analysis (DCA) demonstrated that the predictive efficacy of the clinical-radiomics nomogram model was superior to that of the clinical and radiomics model.ConclusionClinical-radiomics nomogram that combines clinical factors and radiomics features has demonstrated favorable predictive effects in predicting the occurrence of UGIB in patients with decompensated cirrhosis. This helps in early diagnosis and treatment of the disease, warranting further exploration and research.

Introduction: Gastric cancer is the fourth most common cause of cancer death, with more than 90% of the cases being adenocarcinomas. Among the diverse subtypes, mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) is one of the rarest types. Gastric cancer can manifest with significant bleeding in up to 5% of patients. Case Presentation: The authors present a case of a healthy 26-year-old male who experienced two episodes of major upper gastrointestinal bleeding that were resolved with endoscopic treatment. During the second endoscopy, a 15-mm nodular subepithelial lesion was identified at the gastroesophageal junction. Endoscopic ultrasound revealed a homogeneous and hypoechoic lesion with well-defined limits in the deep mucosa. Histological examination of the biopsies showed an adenocarcinoma. The patient later underwent a distal esophagectomy and a total gastrectomy, followed by chemotherapy. Histological examination of the surgical specimen showed a mixed adenoneuroendocrine carcinoma composed of an adenocarcinoma with tubular/glandular pattern and signet ring cells and a large cell-type neuroendocrine carcinoma. The neoplasia had infiltrated the outer muscular layers of the stomach and had disseminated to 3 regional lymph nodes, leading to its classification as stage IIb. Two years following the treatment, there is no evidence of recurrence. All genetic tests applied were negative. Discussion: A MiNEN occurs when both neuroendocrine and non-neuroendocrine components represent at least 30% of the lesion. Due to its rarity, epidemiology and standard treatment are not well established because most data published are from case reports. In this context, we present a compelling case study, highlighting the patient’s young age, the rarity of this specific cancer, and its uncommon presentation.

Background: Extrahepatic portal vein thrombosis (EHPVT) is a cause of portal hypertension in children. It is complicated by upper gastrointestinal variceal bleeding. Aim of the work: to study shear wave elastography (SWE) assessed liver and spleen stiffness among children with EHPVT as a predictor of esophageal varices, its grade and/or upper gastrointestinal (GIT) bleeding. Methods: This case-control study included 18 children with EHPVT who were not secondary to liver disease and 18 healthy children as a control group who underwent ultrasonography and SWE of the liver and spleen. The patient group underwent upper GIT endoscopy as well. Results: The mean ± SD age of the children with EPVT was 9.11 ± 5.26 years, and 5 (27.7%) were females. Three (16.7%) had thrombophilia, 11 (61.1%) had undergone neonatal placement of umbilical catheter, both neonatal intensive care unit admission and thrombophilia in 2 (11.1%) and omphalitis in one (5.5%). All had clinically evident splenomegaly and sonographic evidence of portal vein cavernoma, 2 had recanalized portal vein. SWE stiffness of the right lobe was 7.39 ± 0.86 kPa, the left lobe was 7.64± 0.99 kPa and splenic stiffness was (mean± SD was 68.1 ± 22.8 kPa and range 28-121 kPa) among those with EHPVT, compared to the control group which was 6.83 ± 0.37 kPa, 7.39 ± 0.85 kPa, and (mean± SD was 19.61 ± 2.7 kPa and range 17.2-24.2 kPa), (p = 0.018), (p=0.036) and (p=0.00001) respectively. Esophageal varices bleeding and grade did not correlate with the modified caudate to right lobe diameter ratio (p=0.621), and (p= 0.53), stiffness of the right lobe (p=0.64) and (p= 0.684), left lobe (p=0.297) and (p= 0.223), or spleen stiffness (p=0.499) and (p= 0.196) respectively. Eleven (61.1%) had patent lienorenal collaterals, they were older (mean age 10± 5.3years) compared to those who did not develop (6.7 ± 3.6 years) lienorenal collaterals (p=0.06). The development of spontaneous lienorenal shunts was associated with a decreased risk of variceal bleeding (p= 0.013). Conclusion: EHPVT in children was associated with hepatic and splenic stiffness compared to the control group. The stiffness did not correlate with the upper GIT variceal grade or bleeding. The development of spontaneous lienorenal shunts seems to deflate portosystemic shunt pressure and reduce the risk of variceal bleeding.

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.