ORIGINAL INVESTIGATION
|
|
- Amber Lambert
- 6 years ago
- Views:
Transcription
1 ORIGINAL INVESTIGATION A Prospective Randomized Comparative Trial Showing That Prevents Rebleeding in Patients With Bleeding Peptic Ulcer After Successful Endoscopic Therapy Hwai-Jeng Lin, MD, FACG; Wen-Ching Lo, MD; Fa-Yauh Lee, MD; Chin-Lin Perng, MD; Guan-Ying Tseng, MD Background: A blood clot in a peptic ulcer is unstable in a low ph environment. The use of omeprazole may prevent rebleeding by elevating intragastric ph in patients with bleeding peptic ulcer after hemostasis has been achieved. Objectives: To assess the influence of using omeprazole and cimetidine on 24-hour intragastric ph and to determine their ability to prevent rebleeding after having achieved initial hemostasis in patients with active bleeding or nonbleeding visible vessels. Methods: One hundred patients with bleeding peptic ulcers who had obtained initial hemostasis were enrolled in this randomized comparative trial. In the cimetidine group, a 300-mg intravenous bolus of cimetidine was given, followed by a 1200-mg continuous infusion daily for 3 days. Thereafter, 400 mg of cimetidine was given orally twice daily for 2 months. In the omeprazole group, a 40-mg intravenous bolus of omeprazole was given, followed by 160 mg of continuous infusion daily for 3 days. Thereafter, 20 mg of omeprazole was given orally once daily for 2 months. A ph meter was inserted in each patient s fundus under fluoroscopic guidance after the intravenous bolus of cimetidine or omeprazole had been administered. Results: The stigmata of recent hemorrhage before endoscopic therapy in the omeprazole and cimetidine groups were, respectively, spurting (9 vs 12), oozing (4 vs 9), and nonbleeding visible vessel (37 vs 29) (P.05). The duration of intragastric ph higher than 6.0 was longer in the omeprazole group (mean[±sd], 84.4%±22.9%) than that of the cimetidine group (mean[±sd], 53.5%±32.3%) (P.001). Rebleeding occurred in 2 patients (4%) in the omeprazole group and in 12 patients (24%) in the cimetidine group by day 14 after enrollment (P=.004). There was a tendency for patients in the omeprazole group to require less blood transfusion (median, 0 ml; range, ml) than those in the cimetidine group (median, 0 ml; range, ml) (P=.08). The hospital stay and number of operations and mortality rate were similar between both groups. Conclusions: The use of omeprazole is more effective than cimetidine in increasing intragastric ph and reducing rebleeding episodes in patients with bleeding peptic ulcers after successful endoscopic therapy. This suggests that omeprazole should be used routinely after successful endoscopic therapy. Arch Intern Med. 1998;158:54-58 From the Division of Gastroenterology, Department of Medicine, Veterans General Hospital, and National Yang-Ming University, School of Medicine, Taipei, Taiwan. PATIENTS WITH major bleeding and endoscopic evidence of an ulcer with active bleeding or a nonbleeding visible vessel (NBVV) are at high risk for persistent or recurrent bleeding and should receive endoscopic therapy. 1 In the various endoscopic treatments for peptic ulcer hemorrhage, heater probe thermocoagulation (HPT) and multipolar electrocoagulation (MPEC) are the 2 most promising techniques. 1 Although a high initial hemostatic rate can be obtained with endoscopic therapy, rebleeding occurs in 10% to 30% of these patients. 2-5 Rebleeding has been consistently described as the most important prognostic factor. 6,7 If it can be prevented, the mortality rate is reduced accordingly. A stable blood clot in a peptic ulcer is crucial to hemostasis. However, in a low ph environment, platelet dysfunction has been observed. 8,9 In addition, pepsin can lyse the blood clots that plug vessels in the ulcer base and induce rebleeding thereafter Thus, the hypothesis that by suppressing the intragastric acid, use of omeprazole might benefit patients at risk for further hemorrhage was proposed. inhibits H + -K + adenosine triphosphatase, dose-dependently suppressing basal and stimulated gastric acid secretion. 12 administered intravenously appears effective in maintaining an intragastric ph higher than 4 for a 54
2 PATIENTS, MATERIALS, AND METHODS CRITERIA FOR INCLUSION AND EXCLUSION Patients were accepted for endoscopic therapy if a peptic ulcer with active bleeding or an NBVV was observed within 12 hours of hospital admission. The possibility of endoscopic therapy was discussed with patients and/or their relatives and a written informed consent was obtained before the trial. After initial hemostasis was achieved with either HPT or MPEC, the patients were enrolled in this study. The study was approved by the Clinical Research Committee of the Veterans General Hospital, Taipei, Taiwan. Patients were excluded from the study if they were pregnant, did not give written informed consent, had bleeding tendency (platelet count /L, serum prothrombin 30% of normal, or were taking anticoagulants), uremia, or bleeding gastric cancer. ENDOSCOPIC THERAPY Endoscopic hemostasis was performed by one of us (H.-J. L.) who had experience with at least 1000 patients in endoscopic hemostatic therapy. Two therapeutic modalities (HPT or MPEC) were used according to the availability of the hemostatic machine (we used HPT in the emergency department, and MPEC after admission). The methods of performing HPT or MPEC are described in our previous study. 4 RANDOMIZATION AND MEDICINE Patients enrolled in the study were randomly allocated into 2 groups using sealed envelopes containing a therapeutic option (cimetidine or omeprazole) derived from a randomized table. In the cimetidine group, a 300-mg intravenous bolus of cimetidine was given followed by a 1200-mg continuous infusion daily for 3 days. Thereafter, 400 mg of cimetidine was given orally twice daily for 2 months. In the omeprazole group, a 40-mg intravenous bolus of omeprazole was given followed by a 160-mg continuous infusion daily for 3 days. Thereafter, 20 mg of omeprazole was given orally once daily for 2 months. A nasogastric tube and a ph meter (Gastrograph Mark III, Medical Instruments Corporation, Solothurn, Switzerland) were inserted in each patient s fundus under fluoroscopic guidance after the intravenous bolus of cimetidine or omeprazole had been administered. The intragastric ph was recorded and stored at 6-second intervals for 24 hours. MONITORING Patients vital signs were checked every hour for the first 12 hours, every 2 hours for the second 12 hours, and every 4 hours for the following 24 hours until they became stable, then 4 times daily. The hemoglobin level and hematocrit were checked at least once daily, and a blood transfusion was given if the hemoglobin level decreased to lower than 90 g/l or if the patient s vital signs deteriorated. The attending physicians or surgeons were made aware of the exact endoscopic findings and treatment given in each case. Endoscopy was undertaken 72 hours later. If no blood clot or hemorrhage was observed at the ulcer base, the patient was discharged and followed up in the outpatient department. Active bleeding was defined as a continuous blood flow spurting or oozing from the ulcer base. An NBVV at endoscopy was defined as a discrete protuberance at the ulcer base that was resistant to washing and was often associated with the freshest clot in the ulcer base. Shock was defined as systolic blood pressure lower than 100 mm Hg and a pulse rate of more than 100/min accompanied by cold sweats, pallor, and oliguria. Initial hemostasis was defined as no visible hemorrhage lasting for 5 minutes after endoscopic therapy. Ultimate hemostasis was defined as no rebleeding during the 14 days after endoscopic therapy. Rebleeding was suspected if unstable vital signs, continued tarry, bloody stools, or a drop in the hemoglobin level of more than 20 g/l within 24 hours was observed during hospitalization. For these patients, an emergency endoscopy was performed immediately. Rebleeding was concluded if either blood in the stomach 24 hours after therapy or a fresh blood clot or bleeding in the ulcer base was found. All patients with rebleeding were treated a second time by endoscopic hemostasis unless they refused. An emergency operation was performed if bleeding could not be controlled with HPT or MPEC or if rebleeding occurred after 2 attempts with HPT or MPEC therapy. At entry to the study, the following data were recorded: age, sex, signs of bleeding (hematemesis or melena), the location of the ulcer (esophagus, stomach, duodenum, or stoma), ulcer size, presence of overlying clot, the appearance of gastric contents (clear, coffee grounds, and blood), stigmata of bleeding (spurting, oozing, and NBVV), volume of blood transfusion at entry, presence of shock, hemoglobin level, nonsteroidal anti-inflammatory drug ingestion, cigarette smoking, alcohol drinking, and comorbid illness. END POINTS The outcome of measure was the rebleeding rate at day 3 and day 14 after entry to the study. At day 14, volume of blood transfused, number of procedures performed, and the mortality rates of the 2 groups were compared as well. STATISTICS The sample size estimation was based on an expected rebleeding rate of 30% in the cimetidine group. The trial was designed to detect a 25% difference in favor of the omeprazole group with a type I error of 0.05 and type II error of 0.2. At least 43 patients were essential for each group. We used the Student t test (paired, 2-tailed) to compare the basic data of age, ulcer size, volume of blood transfused after entry, initial hemoglobin level, intragastric ph, and hospital stay between both groups. The 2 test, with or without Yates correction, and Fisher exact test were used when appropriate to compare sex, number of rebleeding episodes, emergency operations, mortality rate, the location of the bleeding, presence of overlying clot, gastric contents, stigmata of bleeding, presence of shock, nonsteroidal anti-inflammatory drug ingestion, cigarette smoking, alcohol drinking, comorbid illness, and the hemostatic effect between the 2 groups. A probability value of less than.05 was considered significant. 55
3 Table 1. Clinical Parameters of the and the Groups Parameters Median age, y (range) 65 (17-84) 66.5 (33-86)* Sex, M/F 46/4 43/7 Sign of bleeding Hematemesis Melena Location of bleeding Esophagus 0 1 Stomach Duodenum Stoma 1 3 Median ulcer size, cm (range) 0.6 ( ) 0.9 ( ) No. with overlying clot Gastric content Clear Coffee grounds Blood Stigmata of bleeding Spurting 9 12 Oozing 4 9 Nonbleeding visible vessel Median volume of blood transfusion at entry, ml (range) 500 (0-2500) 0 (0-5000) No. with shock 14 9 Median hemoglobin, g/l (range) 99 (58-150) 105 (37-152) Median serum urea nitrogen, mmol/l [mg/dl] (range) 10.1 [28.5] ( [5-216]) 12.1 [34] ( [6-73]) Nonsteroidal anti-inflammatory drug ingestion Cigarette smoking Alcohol drinking 6 6 Comorbid illness *No statistical significance of clinical parameters between the 2 groups. 24-hour period The role of omeprazole in preventing rebleeding in patients with peptic ulcer bleeding has been controversial The aims of this study were to assess the influence of omeprazole and cimetidine on 24- hour intragastric ph and to determine their ability to prevent rebleeding after having achieved initial hemostasis in patients with active bleeding or NBVV. RESULTS Between November 1995 and June 1996, 617 patients received emergency endoscopy in our hospital because of hematemesis and/or tarry stool. We found obscure bleeding in 15 patients, a clear ulcer in 184 patients, pigmented spots in 127 patients, adherent blood clots in 96 patients, an NBVV in 61 patients, active bleeding in 47 patients, and esophageal or fundic varices in 87 patients. Of the patients with active bleeding or an NBVV (n=108), we obtained initial hemostasis in 107 patients. Seven patients were excluded from the study because of inability to give informed consent (n=4), bleeding tendency (n=1), and the presence of a bleeding gastric malignant neoplasm (n=2). Hence, a total of 100 patients were enrolled in the trial. Fifty patients received omeprazole and the same number received cimetidine intravenously. There was no statistical difference in the clinical parameters of the 2 groups (Table 1). We performed HPT for 30 and 39 patients and MPEC for 20 and 11 patients Intragastric ph Bolus Time, h Mean intragastric ph profile in the omeprazole group and the cimetidine group during the 24 hours following initial bolus injection and sustained infusion. in the omeprazole and cimetidine groups, respectively (P.05). Eleven patients rebled after receiving HPT and 3 patients rebled after receiving MPEC (P.10). The mean intragastric ph rose to 6.0 one hour after the initial bolus of omeprazole in the omeprazole group; it persisted around this value for the rest of the 24 hours (Figure). In the cimetidine group, the mean intragastric ph rose to 4.0 one hour after the initial bolus of cimetidine and persisted around 4.5 to 5.5 for the rest of the 24 hours. The duration in time of the raised intra- 56
4 Table 2. Major Clinical Outcomes of Both Groups Clinical Outcomes gastric ph ( 6.0) was 84.4%±22.9% (mean±sd) in the omeprazole group, compared with 53.5%±32.3% in the cimetidine group (P.001). By day 3 after entry, no patient rebled in the omeprazole group, whereas 8 patients rebled in the cimetidine group (P=.003). By 2 weeks after entry, 2 patients rebled in the omeprazole group and 12 patients rebled in the cimetidine group (P=.004) (Table 2). Rebleeding episodes occurred in 2 patients in the omeprazole group 8 days after endoscopic therapy. One had uneventful recovery after conservative treatment, while another received HPT twice plus omeprazole and recovered smoothly. In the rebleeding patients in the cimetidine group, rebleeding occurred at 1 day (3 patients), 2 days (2 patients), 3 days (2 patients), 5 days (1 patient), 6 days (2 patients), 8 days (1 patient), and 10 days (1 patient) after endoscopic therapy. Six received MPEC plus omeprazole therapy, 2 received MPEC plus cimetidine therapy, 1 received HPT plus omeprazole therapy, and 1 received HPT plus cimetidine therapy. These 10 patients recovered uneventfully. The remaining 2 patients died despite further endoscopic therapy (one had cholangiocarcinoma with metastasis and died of bleeding after a second administration with MPEC plus omeprazole, while the other had renal cell carcinoma with metastasis and died of sepsis after endoscopic therapy was provided 3 times). Patients with ulcers located at the lesser curvature of the gastric high body (n=2, cimetidine group) and posterior wall of the duodenal bulb (n=5, 4 in the omeprazole group and 1 in the cimetidine group) did not have a higher rebleeding rate than patients with ulcers in other locations (2/7 vs 12/93, respectively; P=.25). There was a tendency for the patients in omeprazole group to have a lower volume of blood transfused (median, 0 ml; range, ml) compared with those in the cimetidine group (median, 0 ml; range, ml). The length of hospital stay, number of procedures performed, and mortality rates of the 2 groups were not statistically different. COMMENT Rebleeding Day Day Median volume of blood transfused 0 (0-2500) 0 (0-5000).05 after entry, ml (range) No. of operations Mortality Days in hospital 7 (3-27) 6 (3-31).05 A bleeding peptic ulcer remains a serious medical problem with significant morbidity and mortality. Endoscopic therapy significantly reduces further bleeding, surgery, and mortality in patients with bleeding peptic ulcers 24 P and is now recommended as the first hemostatic modality for these patients. 1,24 After obtaining initial hemostasis, rebleeding is another important impact to the prognosis. An ideal therapy includes a successful endoscopic therapy plus a low rebleeding rate. Rebleeding episodes occur within 3 days in most instances In addition, an intragastric ph higher than 6.0 is a prerequisite for preventing rebleeding in patients with bleeding peptic ulcers. 8 Therefore, a drug that rapidly increases intragastric ph and lasts for 3 to 4 days is necessary to prevent rebleeding. With conventional recommended doses of histamine 2 blockers, intragastric ph cannot be maintained higher than 4.0 for a long period in patients with a bleeding peptic ulcer. 15,28-30 Continuous intravenous histamine 2 - blocker infusion does not influence the natural history of bleeding peptic ulcers. 16 In this study, we achieved a similar intragastric recording and rebleeding rate. Pharmacologically, omeprazole can quickly achieve an optimal intragastric ph condition for support of the physiological cascade of hemostasis. 14 The optimal dose was found to be continuous infusion of 8 mg/h or 160 mg/24 h of omeprazole. 14,19,31 In this study, we used a similar dose of omeprazole and obtained intragastric ph of 6.0 or more in 84.4%±22.9% (mean±sd) time period in the omeprazole group. The use of omeprazole is reported to be ineffective in patients with peptic ulcer bleeding either with 17 or without endoscopic therapy. 16 In these 2 studies, the authors used an 80-mg intravenous bolus of omeprazole followed by 40 mg every 8 hours. There are at least 3 pitfalls in their studies. First, the dose of omeprazole was suboptimal. Second, the interval of omeprazole injection administered intravenously (8 hours) was too long. Because proton pumps are continuously being generated, 32 and the half-life of omeprazole in the circulation is short (50 minutes), it needs to be given more frequently (eg, every 3 hours) or continuously. 14 According to the published data, it will fail to raise intragastric ph higher than 4.0 continuously in the studied period with the above-mentioned methods ,33 Third, Daneshmend et al 16 did not restrict their patients to those from high-risk groups. Hence, a type II error may occur under these conditions. In this study, we obtained remarkable acid suppression in the omeprazole group; no rebleeding episodes occurred during continuous infusion of omeprazole. The 2 rebleeding episodes occurred after patients received 20 mg of omeprazole once daily (8 days after enrollment). One had minor rebleeding, which subsided spontaneously, while the other had an uneventful recovery after HPT was given a third time as well as 20 mg of omeprazole twice daily. Whether an increased dosage of omeprazole (eg, 20 mg twice daily) after continuous infusion can prevent rebleeding awaits further study. Hospital stay, number of procedures, and mortality rate of the 2 groups were similar. This may be due to the early detection of rebleeding episodes and the aggressive endoscopic therapy given, thus minimizing the difference between the 2 groups. administered intravenously as a 40-mg bolus followed by a 160-mg continuous infu- 57
5 sion daily can elevate intragastric ph remarkably and prevent rebleeding in patients with peptic ulcer bleeding after initial hemostasis has been achieved. It should be used routinely in these patients after successful endoscopic therapy. Accepted for publication April 23, Reprints: Hwai-Jeng Lin, MD, FACG, Division of Gastroenterology, Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China. REFERENCES 1. Consensus Development Panel. Consensus statement on therapeutic endoscopy and bleeding ulcers. Gastrointest Endosc. 1990;36:S62-S Lin HJ, Lee FY, Kang WM, Tsai YT, Lee SD, Lee CH. Heat probe thermocoagulation and pure alcohol injection in massive peptic ulcer haemorrhage: a prospective, randomized controlled trial. Gut. 1990;31: Llach J, Bordas JM, Salmerón JM, et al. A prospective randomized trial of heater probe thermocoagulation versus injection therapy in peptic ulcer hemorrhage. Gastrointest Endosc. 1996;43: Lin HJ, Wang K, Perng CL, Lee CH, Lee SD. Heat probe thermocoagulation and multipolar electrocoagulation for arrest of peptic ulcer bleeding: a prospective, randomized comparative trial. J Clin Gastroenterol. 1995;21: Laine L. Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers: a prospective, randomized trial. Gastroenterology. 1990; 99: Allan R, Dykes P. A study of the factors influencing mortality rates from gastrointestinal haemorrhage. QJM. 1976;45: Turner IB, Jones M, Piper DW. Factors influencing mortality from bleeding peptic ulcers. Scand J Gastroenterol. 1991;26: Green FW, Kaplan MM, Curtis LE, Levine PH. Effect of acid and pepsin on blood coagulation and platelet aggregation. Gastroenterology. 1978;74: Low J, Dodds AJ, Biggs JC. Fibrinolytic activity of gastroduodenal secretions: a possible role in upper gastrointestinal haemorrhage. Thromb Res. 1980;17: Patchett SE, Enright H, Afdhal N, O Connell W, O Donoghue DP. Clot lysis by gastric juice: an in vitro study. Gut. 1989;30: Barkham P, Tocantins TM. Action of human gastric juice on human blood clots. J Appl Physiol. 1953;6: Wilde MI, McTavish D. : an update of its pharmacology and therapeutic use in acid-related disorders. Drugs. 1994;48: Andersen J, Ström M, NÆsdal J, Leire K, Walan A. Intravenous omeprazole: effect of a loading dose on 24-h intragastric ph. Aliment Pharmacol Ther. 1990; 4: Brunner G, Luna P, Thiesemann C. Drugs for ph control in upper gastrointestinal bleeding. Aliment Pharmacol Ther. 1995;9(suppl 1): Cederberg C, Thompson ABR, Kirdeikis P, Kristersson C. Effect of continuous intravenous infusion of omeprazole on 24-hour intragastric ph in fasting DU patients: comparison to repeated bolus doses of omeprazole or ranitidine. Gastroenterology. 1992;102(suppl):A Daneshmend TK, Hawkey CJ, Langman MJS, Logan RFA, Long RG, Walt RP. versus placebo for acute upper gastrointestinal bleeding: randomised double blind controlled trial. Gut. 1992;304: Villanueva C, Balanzó J, Torras X, et al. versus ranitidine as adjunct therapy to endoscopic injection in actively bleeding ulcers: a prospective and randomized study. Endoscopy. 1995;27: Brunner G, Chang J. Intravenous therapy with high doses of ranitidine and omeprazole in critically ill patients with bleeding peptic ulcerations of the upper intestinal tract: an open randomized controlled trial. Digestion. 1990;45: Brunner GHG, Thiesemann C. The potential clinical role of intravenous omeprazole. Digestion. 1992;51(suppl 1): Muckadell OBS, Havelund T, Harling H, et al. improved outcome in peptic ulcer bleeding. Gastroenterology. 1995;108:A212. Abstract. 21. Lind T, Aadland E, Eriksson S, Fernström P, Hasselgren G, Lundell L. Beneficial effects of I.V. omeprazole (OME) in patients with peptic ulcer bleeding (PUB). Gastroenterology. 1995;108:A150. Abstract. 22. Lanas A, Artal A, Blás JM, Arroyo MT, Lopez-Zaborras J, Sáinz R. Effect of parenteral omeprazole and ranitidine on gastric ph and the outcome of bleeding peptic ulcer. J Clin Gastroenterol. 1995;21: Grosso C, Rossi A, Gambitta P, et al. Non-bleeding visible vessel treatment: perendoscopic injection therapy versus omeprazole infusion. Scand J Gastroenterol. 1995;30: Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology. 1992;102: Lin HJ, Perng CL, Lee FY, Lee CH, Lee SD. Clinical courses and predictors for rebleeding in patients with peptic ulcers and non-bleeding visible vessels: a prospective study. Gut. 1994;35: Lin HJ, Perng CL, Wang K, Lee SD, Lee CH. Long-term results of heater probe thermocoagulation for patients with massive peptic ulcer bleeding: a prospective observation. Am J Gastroenterol. 1995;90: Lin HJ, Wang K, Perng CL, Lee FY, Lee CH, Lee SD. Natural history of bleeding peptic ulcers with a tightly adherent blood clot: a prospective observation. Gastrointest Endosc. 1996;43: Reynolds JR, Walt RP, Clark AG, Hardcastle JD, Langman MJS. Intragastric ph monitoring in acute upper gastrointestinal bleeding and the effect of intravenous cimetidine and ranitidine. Aliment Pharmacol Ther. 1987;1: Peterson WL, Barnett C, Feldman M, Richardson CT. Reduction of twenty-fourhour gastric acidity with combination drugs therapy in patients with duodenal ulcer. Gastroenterology. 1979;77: Merki HS, Witzel L, Kaufman D, et al. Continuous intravenous infusions of famotidine maintain high intragastric ph in duodenal ulcer. Gut. 1988;29: Walt RP, Reynolds JR, Langman MJS, et al. Intravenous omeprazole rapidly raises intragastric ph. Gut. 1985;26: Sachs G. Therapeutic control of acid secretion: pharmacology of the parietal cell. Curr Opin Gastroenterol. 1990;6: Baak LC, Biemond I, Jansen JBMJ, Lamers CBHW. Repeated intravenous bolus injections of omeprazole: effects on 24-hour intragastric ph, serum gastrin, and serum pepsinogen A and C. Scand J Gastroenterol. 1991;26:
A bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk?
Focus on CME at the University of British Columbia A bleeding ulcer: What can the GP do? By Robert Enns, MD, FRCP Gastrointestinal bleeding is a relatively common disorder affecting thousands of Canadians
More informationComparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding
Gut 1999;44:715 719 715 Division of Gastroenterology, Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China H-J Lin G-Y Tseng C-L Perng F-Y Lee F-Y Chang S-D Lee Correspondence
More informationACG Clinical Guideline: Management of Patients with Ulcer Bleeding
ACG Clinical Guideline: Management of Patients with Ulcer Bleeding Loren Laine, MD 1,2 and Dennis M. Jensen, MD 3 5 1 Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut,
More informationOral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful endoscopic therapy
Yen et al. BMC Gastroenterology 2012, 12:66 RESEARCH ARTICLE Open Access Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful
More informationPantoprazole infusion as adjuvant therapy to endoscopic treatment in patients with peptic ulcer bleeding: Prospective randomized controlled trial
Blackwell Publishing AsiaMelbourne, AustraliaJGHJournal of Gastroenterology and Hepatology0815 93192006 Blackwell Publishing Asia Pty Ltd200621716721Original Article Pantoprazole in bleeding peptic ulcerssa
More informationOn-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding
On-Call Upper GI Bleeding John R Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Upper Gastrointestinal Bleeding 300,000000 hospitalizations/year
More informationT he aim of a scheduled second endoscopy is to detect and
1403 STOMACH Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial P W Y Chiu, C Y W Lam, S W Lee, K H Kwong, S H Lam, D T Y Lee, S P Y Kwok... See
More informationScottish Medicines Consortium
Scottish Medicines Consortium esomeprazole, 40mg vial of powder for solution for intravenous injection or infusion (Nexium I.V. ) No. (578/09) AstraZeneca 09 October 2009 The Scottish Medicines Consortium
More informationImproved risk assessment in upper GI bleeding
EDITORIAL Improved risk assessment in upper GI bleeding Acute upper GI bleeding is the most common GI emergency, with a reported incidence in various epidemiological studies ranging from 50 to over 100
More informationIntragastric ph With Oral vs Intravenous Bolus Plus Infusion Proton- Pump Inhibitor Therapy in Patients With Bleeding Ulcers
Intragastric ph With Oral vs Intravenous Bolus Plus Infusion Proton- Pump Inhibitor Therapy in Patients With Bleeding Ulcers LOREN LAINE, ABBID SHAH, and SHAHROOZ BEMANIAN Division of Gastrointestinal
More informationReview article: management of peptic ulcer bleeding the roles of proton pump inhibitors and Helicobacter pylori eradication
Aliment Pharmacol Ther 2004; 19 (Suppl. 1): 66 70. Review article: management of peptic ulcer bleeding the roles of proton pump inhibitors and Helicobacter pylori eradication G. HOLTMANN* & C. W. HOWDEN
More informationThe New England Journal of Medicine
The New England Journal of Medicine Copyright, 2000, by the Massachusetts Medical Society VOLUME 343 A UGUST 3, 2000 NUMBER EFFECT OF INTRAVENOUS OMEPRAZOLE ON RECURRENT BLEEDING AFTER ENDOSCOPIC TREATMENT
More informationEffect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical trial
Aliment Pharmacol Ther 2003; 17: 211 216. doi: 10.1046/j.0269-2813.2003.01416.x Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical
More informationAcute Upper Gastrointestinal Hemorrhage Surgical Perspective. Dr.J.H.Barnard Dept. of Surgery PAH
Acute Upper Gastrointestinal Hemorrhage Surgical Perspective Dr.J.H.Barnard Dept. of Surgery PAH Introduction: AGH is a leading cause of admissions into ICU. Overall mortality 5-12%, but increases to 40%
More informationHelicobacter pylori. Objectives. Upper Gastrointestinal Bleeding Peptic Ulcer Disease
Upper Gastrointestinal Bleeding Peptic Ulcer Disease Pharmacotherapy Issues in Acute Management and Secondary Prevention Peter J. Zed, B.Sc., B.Sc.(Pharm), Pharm.D. Pharmacotherapeutic Specialist - Emergency
More informationSystematic Review of the Predictors of Recurrent Hemorrhage After Endoscopic Hemostatic Therapy for Bleeding Peptic Ulcers
American Journal of Gastroenterology ISSN 0002-9270 C 2008 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2008.02070.x Published by Blackwell Publishing CLINICAL REVIEWS Systematic Review of
More informationSangrado Gastrointestinal Alto Upper GI Bleeding
Sangrado Gastrointestinal Alto Upper GI Bleeding Curso Internacional Retos Clinicos en la Gastroenterologia de Urgencias Asociacion Colombiana de Gastroenterologia 31 de Agosto, 2012 Pereira, Risaralda
More informationPeptic ulcers remain the most common cause of upper
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:33 47 STATE OF THE ART Endoscopic Therapy for Bleeding Ulcers: An Evidence-Based Approach Based on Meta-Analyses of Randomized Controlled Trials LOREN LAINE*
More informationClinical Study Effect of High-Dose Oral Rabeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcers
Gastroenterology Research and Practice Volume 2012, Article ID 317125, 8 pages doi:10.1155/2012/317125 Clinical Study Effect of High-Dose Oral Rabeprazole on Recurrent Bleeding after Endoscopic Treatment
More informationUpper gastrointestinal bleeding in children. Nguyễn Diệu Vinh, MD Department of Gastroenterology
Upper gastrointestinal bleeding in children Nguyễn Diệu Vinh, MD Department of Gastroenterology INTRODUCTION Upper gastrointestinal (UGI) bleeding : arising proximal to the ligament of Treitz in the distal
More informationSimon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor
Simon Everett Consultant Gastroenterologist, SJUH, Leeds if this is what greets you in the morning, you probably need to go see a doctor Presentation Audit data and mortality NICE guidance Risk assessment
More informationvolume endoscopic injection of epinephrine for peptic ulcer bleeding
A prospective, randomized trial of large- versus small-, volume endoscopic injection of epinephrine for peptic ulcer bleeding Hwaideng Lin, MD, FACG,Yu-Hsi Hsieh, MD, Guan-Ying Tseng, MD, Chin-Lin Perng,
More informationJames Irwin Gastroenterology Department Palmerston North Hospital. Acute Medicine Meeting Hutt Hospital. June 21, 2015
The Management of Acute Upper Gastrointestinal Bleeding James Irwin Gastroenterology Department Palmerston North Hospital Acute Medicine Meeting Hutt Hospital June 21, 2015 Outline Common Definitions and
More informationIntermittent vs Continuous Proton Pump Inhibitor Therapy for High-Risk Bleeding Ulcers A Systematic Review and Meta-analysis
Research Original Investigation Intermittent vs Continuous Proton Pump Inhibitor Therapy for High-Risk Bleeding Ulcers A Systematic Review and Meta-analysis Hamita Sachar, MD; Keta Vaidya, MD; Loren Laine,
More informationprospective, randomised controlled trial
Gut, 1990,31,753-757 Division of Gastroenterology, Departments of Medicine and Emergency, Veterans General Hospital, Taipei, Taiwan, Republic of China H J Lin F Y Lee W M Kang Y T Tsai S D Lee C H Lee
More informationSUMMARY INTRODUCTION. Accepted for publication 11 May 2005
Aliment Pharmacol Ther 2005; 22: 169 174. doi: 10.1111/j.1365-2036.2005.02546.x Systematic review and meta-analysis: proton-pump inhibitor treatment for ulcer bleeding reduces transfusion requirements
More informationACUTE UPPER GASTROINTESTINAL HEMORRHAGE: PHARMACOLOGIC MANAGEMENT
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationUGI Bleeding: Impact and Outcome of Early Endoscopy at the Referral Community Hospital ABSTRACT
Original Article Jewsuebpong T THAI J GASTROENTEROL 2008 Vol. 9 No. 2 May - Aug. 2008 67 UGI Bleeding: Impact and Outcome of Early Endoscopy at the Referral Community Hospital Jewsuebpong T ABSTRACT Background:
More informationGASTROINESTINAL BLEEDING. Dr.Ammar I. Abdul-Latif
GASTROINESTINAL BLEEDING Dr.Ammar I. Abdul-Latif CLASSIFICATION OF G.I.BLEEDING GIB Appearance Acuity Site Apparent Acute Upper Obscure Chronic Lower UPPER&LOWER G.I.BLEEDING CAUSES OF UPPER G.I. BLEEDING
More informationUpper Gastrointestinal Bleeding Score for Differentiating Variceal and Nonvariceal Upper Gastrointestinal Bleeding ABSTRACT
44 Original Article Upper Gastrointestinal Bleeding Score for Differentiating Variceal and Jaroon Chasawat Varayu Prachayakul Supot Pongprasobchai ABSTRACT Background: Upper gastrointestinal bleeding (UGIB)
More informationComparison of the Effectiveness of Interventional Endoscopy in Bleeding Peptic Ulcer Disease according to the Timing of Endoscopy
Gut and Liver, Vol. 3, No. 4, December 2009, pp. 266-270 original article Comparison of the Effectiveness of Interventional Endoscopy in Bleeding Peptic Ulcer Disease according to the Timing of Endoscopy
More informationUpper GI Bleeding. HH Tsai MD FRCP FECG Consultant Gastroenterologist
Upper GI Bleeding HH Tsai MD FRCP FECG Consultant Gastroenterologist Financial Disclosures I have no financial relationship with any manufacturer or supplier of any product mentioned in this talk. GI Audits:
More informationPeptic ulcer bleeding remains the most common cause of hospitalization
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:311 316 Predicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy PHILIP W. Y. CHIU,* ENDERS K. W. NG,* FRANCES K. Y. CHEUNG,*
More informationEugenia Lauret, Jesús Herrero, Lorena Blanco, Olegario Castaño, Maria Rodriguez, Isabel Pérez, Verónica Alvarez, Adolfo Suárez, and Luis Rodrigo
Gastroenterology Research and ractice Volume 2013, Article ID 584540, 5 pages http://dx.doi.org/10.1155/2013/584540 Clinical Study Epidemiological Clinical Features and Evolution of Gastroduodenal Ulcer
More informationAnticoagulants are a contributing factor. Other causes are Mallory-Weiss tears, AV malformations, and malignancy and aorto-enteric fistula.
Upper GI Bleeding EMU2018 Dr. Walter Himmel MD Incidence: In non-cirrhotics, the commonest causes are peptic ulcer disease (50%) followed by erosive gastritis. In cirrhotic patients, variceal bleeding
More informationOptimizing the Intragastric ph as a Supportive Therapy in Upper GI Bleeding
YALE JOURNAL OF BIOLOGY AND MEDICINE 69 (1996), pp. 225-23 1. Copyright C 1997. All rights reserved. Optimizing the Intragastric ph as a Supportive Therapy in Upper GI Bleeding Gorig Brunnera, Pablo Luna,
More informationREVIEW ARTICLE. High-Dose vs Non High-Dose Proton Pump Inhibitors After Endoscopic Treatment in Patients With Bleeding Peptic Ulcer
REVIEW ARTICLE LESS IS MORE High-Dose vs Non High-Dose Proton Pump Inhibitors After Endoscopic Treatment in Patients With Bleeding Peptic Ulcer A Systematic Review and Meta-analysis of Randomized Controlled
More informationReview article: pharmacology of esomeprazole and comparisons with omeprazole
Aliment Pharmacol Ther 2003; 17 (Suppl. 1): 5 9. Review article: pharmacology of esomeprazole and comparisons with omeprazole J. DENT Department of Gastroenterology, Hepatology and General Medicine, Royal
More informationOmeprazole before Endoscopy in Patients with Gastrointestinal Bleeding
T h e n e w e ng l a nd j o u r na l o f m e dic i n e original article before Endoscopy in Patients with Gastrointestinal Bleeding James Y. Lau, M.D., Wai K. Leung, M.D., Justin C.Y. Wu, M.D., Francis
More informationBritish Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion
British Society of Gastroenterology UK Com parat ive Audit of Upper Gast roint est inal Bleeding and t he Use of Blood Transfusion Extract December 2007 St. Elsewhere's Hospital National Comparative Audit
More informationUpper gastrointestinal (GI) bleeding represents a substantial
Clinical Guidelines Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Alan Barkun, MD, MSc; Marc Bardou, MD, PhD; and John K. Marshall, MD, MSc, for the Nonvariceal
More informationManagement of acute upper gastrointestinal bleeding
1 Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 OSF, UK 2 Section of Digestive Diseases, Yale School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Connecticut,
More informationContinuation of Low-Dose Aspirin Therapy with Either PR or PO Administration in Patients with Peptic Ulcer Bleeding
Continuation of Low-Dose Aspirin Therapy with Either PR or PO Administration in Patients with Peptic Ulcer Bleeding IRB Protocol Lucian Iancovici February 4, 2010 A. Study Design and Purpose Aspirin has
More informationOriginal Article INTRODUCTION
Original Article Endoscopic treatment for high risk bleeding peptic ulcers: A randomized, controlled trial of epinephrine alone with epinephrine plus fresh Mahsa Khodadoostan, Mohammad Karami Horestani,
More informationTurning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient
Turning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient John Greenaway 1 Turning off the tap: Endoscopy Answer the questions Benefits and risks of endoscopy Urgency
More informationValidation of the Rockall risk scoring system in upper gastrointestinal bleeding
Gut 1999;44:331 335 331 Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands E M Vreeburg E A J Rauws JFWMBartelsman GNJTytgat Department of Gastroenterology,
More informationOutcome of Upper Gastrointestinal Hemorrhage According to the BLEED Risk Classification: a Two-year Prospective Survey
Bahrain Medical Bulletin, Vol. 29, No. 1, March 2007 Outcome of Upper Gastrointestinal Hemorrhage According to the BLEED Risk Classification: a Two-year Prospective Survey Javad Salimi, MD* Ahmad Salimzadeh,
More informationEndoClot PHS A medical application on 74 patients march 2013
EndoClot PHS A medical application on 74 patients march 2013 EndoClot PHS as a new method to achieve hemostasis of gastrointestinal bleeding Evaluation of a medical application involving 74 patients. Introduction
More informationEmergency Surgery Board Department of General Surgery Rambam Health Care Campus
Emergency Surgery Board Department of General Surgery Rambam Health Care Campus Surgical Complications of Peptic Ulcer Disease Bleeding Case Presentation and Review of the Literature Case Presentation
More informationContinuous Intravenous Infusion of Omeprazole in Elderly Patients with Peptic Ulcer Bleeding
Continuous Intravenous Infusion of Omeprazole in Elderly Patients with Peptic Ulcer Bleeding Results of a Placebo-Controlled Multicenter Study G. HASSELGREN, T. LIND, L. LUNDELL, E. AADLAND, P. EFSKIND,
More informationDo Continuous Infusions of Omeprazole and Ranitidine Retain Their Effect With Prolonged Dosing?
GASROENEROLOGY 1994;106:60-64 Do Continuous Infusions of Omeprazole and Ranitidine Retain heir Effect With Prolonged Dosing? HANS S. MERKI and CLIVE H. WILDER-SMIH Gastrointestinal Unit, Department of
More informationProton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding (Review)
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding (Review) Sreedharan A, Martin J, Leontiadis GI, Dorward S, Howden CW, Forman D, Moayyedi P This
More informationClinical guideline Published: 13 June 2012 nice.org.uk/guidance/cg141
Acute upper gastrointestinal bleeding in over 16s: management Clinical guideline Published: June 2012 nice.org.uk/guidance/cg141 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationGuidelines for the Management of Upper gastrointestinal bleeding
Guidelines for the Management of Upper gastrointestinal bleeding By Dr. Sinan Butrus F.I.C.M.S Clinical Standards & Guidelines Kurdistan Board For Medical Specialties Upper gastrointestinal bleeding is
More informationAcute Upper Gastro Intestinal (UGI) Bleeding
T Acute Upper Gastro Intestinal (UGI) Bleeding University Hospitals of Leicester NHS Trust Guidelines for Management of Acute Medical Emergencies 1. Has there been a GI bleed? There are also UHL trust
More informationCOPYRIGHTED MATERIAL. 1 Approach to the patient with gross gastrointestinal bleeding. Grace H. Elta, Mimi Takami
1 Approach to the patient with gross gastrointestinal bleeding Grace H. Elta, Mimi Takami Gastrointestinal (GI) bleeding is a common clinical problem that requires more than 300 000 hospitalizations annually
More informationEndoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding
Online Submissions: http://www.wjgnet.com/1007-9327office wjg@wjgnet.com doi:10.3748/wjg.v18.i18.2219 World J Gastroenterol 2012 May 14; 18(18): 2219-2224 ISSN 1007-9327 (print) ISSN 2219-2840 (online)
More informationProton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding (Review)
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding (Review) Sreedharan A, Martin J, Leontiadis GI, Dorward S, Howden CW, Forman D, Moayyedi P This
More informationUpper Gastrointestinal Bleeding Among Saudis: Etiology And Prevalence The Riyadh Central Hospital Experience
Upper Gastrointestinal Bleeding Among Saudis: Etiology And Prevalence The Riyadh Central Hospital Experience Mohammed Al-Mofarreh, Facharzt; Yisa M. Fakunle, MD, FRCP (London); Mohammed Al-Moagel, Facharzt
More informationUGI BLEED. Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore
UGI BLEED Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore Outline UGI bleed: etiology and presentation Management: Non variceal / variceal bleed
More informationstatin depresses pancreatic endocrine'6 and small scale trials where somatostatin has been used in the treatment of upper gastrointestinal bleedings
Gut, 1985, 26, 221-226 Alimentary tract and pancreas Randomised double blind trial of somatostatin in the treatment of massive upper gastrointestinal haemorrhage I MAGNUSSON, T IHRE, C JOHANSSON, U SELIGSON,
More informationAetiology Of Upper Gastrointestinal Bleeding In North- Eastern Nigeria: A Retrospective Endoscopic Study
ISPUB.COM The Internet Journal of Third World Medicine Volume 8 Number 2 Aetiology Of Upper Gastrointestinal Bleeding In North- Eastern Nigeria: A Retrospective Endoscopic S Mustapha, N Ajayi, A Shehu
More informationClinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy
ORIGINAL ARTICLE Korean J Intern Med 2016;31:470-478 Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy Dong-Won Ahn 1,2,*, Young Soo Park 1,3,*,
More informationWhich peptic ulcer patients bleed?
Gut, 1988, 29, 70-74 Which peptic ulcer patients bleed? K MATTHEWSON, S PUGH, AND T C NORTHFIELD From the Gastroenterology Units, St James Hospital, Balham and University College Hospital, London SUMMARY
More informationEfficacy of dual therapy (APC & Adrenaline) in high risk peptic ulcer bleeding
ISSN: 2347-3215 Volume 2 Number 7 (July-2014) pp. 203-208 www.ijcrar.com Efficacy of dual therapy (APC & Adrenaline) in high risk peptic ulcer bleeding Saleh Azad Bakht*, Manouchehr Khoshbaten, Kamal Bostani,
More informationComplicated issues in GI bleeding for internists? Nonthalee Pausawasdi, M.D. Faculty of Medicine Siriraj Hospital
Complicated issues in GI bleeding for internists? Nonthalee Pausawasdi, M.D. Faculty of Medicine Siriraj Hospital Complicated issues in GI bleeding; Survey results from internists Optimal resuscitation
More informationCite this article as: BMJ, doi: /bmj f (published 31 January 2005)
Cite this article as: BMJ, doi:10.1136/bmj.38356.641134.8f (published 31 January 2005) Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding Grigoris I Leontiadis,
More informationSurgery for Complications of Peptic Ulcer Disease (Definitive Treatment)
Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Amid Keshavarzi, MD UCHSC Grand Round 3/20/2006 Department of Surgery Introduction Epidemiology Pathophysiology Clinical manifestation
More informationHemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy
Original article Hemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy Authors Yeong Jin Kim, Jun Chul Park, Eun Hye Kim, Sung Kwan Shin,
More informationSELECTED ABSTRACTS. Figure. Risk Stratification Matrix A CLINICIAN S GUIDE TO THE SELECTION OF NSAID THERAPY
SELECTED ABSTRACTS A CLINICIAN S GUIDE TO THE SELECTION OF NSAID THERAPY The authors of this article present a 4-quadrant matrix based on 2 key clinical parameters: risk for adverse gastrointestinal (GI)
More informationA cute upper gastrointestinal haemorrhage is
399 BEST PRACTICE Management of haematemesis and melaena K Palmer... Acute upper gastrointestinal bleeding is a common medical emergency which carries hospital mortality in excess of 10%. The most important
More informationPREVENTING ASPIRIN-RELATED ULCER COMPLICATIONS
PREVENTING ASPIRIN-RELATED ULCER COMPLICATIONS LANSOPRAZOLE FOR THE PREVENTION OF RECURRENCES OF ULCER COMPLICATIONS FROM LONG-TERM LOW-DOSE ASPIRIN USE KAM CHUEN LAI, M.R.C.P., SHIU KUM LAM, M.D., KENT
More informationInternational Journal of Research in Pharmacology and Pharmacotherapeutics
44 Available Online at: Print ISSN : 2278-2648 Online ISSN: 2278-2656 (Research article) Find out the prevalance of various non-variceal diseases producing upper GI bleeding * 1 N.Junior Sundresh, 2 S.Narendran,
More informationNew Techniques. Incidence of Peptic Ulcer. Changing. Contents - with an emphasis on peptic ulcer bleeding. Cause of death in peptic ulcer bleeding
Contents - with an emphasis on peptic ulcer bleeding New Techniques in Treating GI Bleeding Incidence and cause of death Acid suppression Endoscopic hemostasis Prediction of rebleeding and death Second
More informationMcHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2018 #10 Acute GI Bleeds
McHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2018 #10 Acute GI Bleeds Gastrointestinal bleeding is a very common problem in emergency medicine. Between
More informationClinical Endoscopic Parameters of Upper Gastrointestinal Bleeding Hemal Shah, 1 T. P. Manohar 2
Original Article Clinical Endoscopic Parameters of Upper Gastrointestinal Bleeding Hemal Shah, 1 T. P. Manohar 2 1 Junior Resident 2 Associate Professor,Department of Medicine, N.K.P. Salve Institute Of
More informationWhen to Scope in Lower GI Bleeding: It Must Be Done Now. Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA
When to Scope in Lower GI Bleeding: It Must Be Done Now Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA Outline Epidemiology Overview of available tests Urgent
More informationAN ANNOTATED ALGORITHMIC APPROACH TO UPPER GASTROINTESTINAL BLEEDING
American Society For Gastrointestinal Endoscopy AN ANNOTATED ALGORITHMIC APPROACH TO UPPER GASTROINTESTINAL BLEEDING Algorithms for appropriate utilization of endoscopy are based on a critical review of
More informationACG Clinical Guideline: Management of Patients with Acute Lower Gastrointestinal Bleeding
ACG Clinical Guideline: Management of Patients with Acute Lower Gastrointestinal Bleeding Lisa L. Strate, MD, MPH, FACG 1 and Ian M. Gralnek, MD, MSHS 2 1 Division of Gastroenterology, University of Washington
More informationControlled Trial of Y AG Laser Treatment of Upper Digestive Hemorrhage
GASTROENTEROLOGY 1982;83:410-6 Controlled Trial of Y AG Laser Treatment of Upper Digestive Hemorrhage P. RUTGEERTS, G. VANTRAPPEN, L. BROECKAERT, J. JANSSENS, G. COREMANS, K. GEBOES, and P. SCHURMANS Departments
More informationEGD Data Collection Form
Sociodemographic Information Type Zip Code Gender Height (in inches) Race Ethnicity Inpatient Outpatient Male Female Birth Date Weight (in pounds) American Indian (Native American) or Alaska Native Asian
More informationAddition of a Second Endoscopic Treatment Following Epinephrine Injection Improves Outcome in High-Risk Bleeding Ulcers
GASTROENTEROLOGY 2004;126:441 450 Addition of a Second Endoscopic Treatment Following Epinephrine Injection Improves Outcome in High-Risk Bleeding Ulcers XAVIER CALVET,* MERCEDES VERGARA,* ENRIC BRULLET,*
More informationThe long-term management of patients with bleeding duodenal ulcers
Aliment Pharmacol Ther (1997); 11: 505±510. The long-term management of patients with bleeding duodenal ulcers M. E. MCALINDON, J. S. W. TAYLOR & S. D. RYDER Department of Medicine, University Hospital,
More informationORIGINAL INVESTIGATION. Maintenance Treatment Is Not Necessary After Helicobacter pylori Eradication and Healing of Bleeding Peptic Ulcer
ORIGINAL INVESTIGATION Maintenance Treatment Is Not Necessary After Helicobacter pylori Eradication and Healing of Bleeding Peptic Ulcer A 5-Year Prospective, Randomized, Controlled Study Chen-Chiung Liu,
More informationTreatment of Helicobacter pylori in Patients With Duodenal Ulcer Hemorrhage A Long-Term Randomized, Controlled Study
THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 95, No. 9, 2000 2000 by Am. Coll. of Gastroenterology ISSN 0002-9270/00/$20.00 Published by Elsevier Science Inc. PII S0002-9270(00)01041-8 Treatment of Helicobacter
More informationEvidence-based medicine: data mining and pharmacoepidemiology research
Data Mining VII: Data, Text and Web Mining and their Business Applications 307 Evidence-based medicine: data mining and pharmacoepidemiology research B. B. Little 1,2,3, R. A. Weideman 3, K. C. Kelly 3
More informationClinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage
ORIGINAL ARTICLE Clin Endosc 2015;48:380-384 http://dx.doi.org/10.5946/ce.2015.48.5.380 Print ISSN 2234-2400 On-line ISSN 2234-2443 Open Access Clinical Application of AIMS65 Scores to Predict Outcomes
More informationDischarge hemoglobin and outcome in patients with acute nonvariceal upper gastrointestinal bleeding
E865 Discharge hemoglobin and outcome in patients with acute nonvariceal upper gastrointestinal bleeding Authors Jae Min Lee 1, *, Eun Sun Kim 1, *, Hoon Jai Chun 1, Young-Jae Hwang 2, Jae Hyung Lee 1,
More informationClinical and Endoscopic Features of Peptic Ulcer Bleeding in Malaysia
Clinical and Endoscopic Features of Peptic Ulcer Bleeding in Malaysia * P Kandasami, FRCS, ** K Harjit, FRCS, *** H Hanafiah, FRCS * Department of Surgery, International Medical University, ** Department
More informationResearch Article Outcome of Holiday and Nonholiday Admission Patients with Acute Peptic Ulcer Bleeding: A Real-World Report from Southern Taiwan
BioMed Research International, Article ID 906531, 6 pages http://dx.doi.org/10.1155/2014/906531 Research Article Outcome of Holiday and Nonholiday Admission Patients with Acute Peptic Ulcer Bleeding: A
More informationManagement of Bleeding Gastroduodenal Ulcers
Complications in Oesophageal and Gastric Surgery Dig Surg 2002;19:99 104 Management of Bleeding Gastroduodenal Ulcers J.J.B. van Lanschot a M. van Leerdam b O.M. van Delden c P. Fockens b Departments of
More informationNon-variceal upper gastrointestinal haemorrhage: guidelines
iv1 GUIDELINES Non-variceal upper gastrointestinal haemorrhage: guidelines British Society of Gastroenterology Endoscopy Committee... 1.0 INTRODUCTION Acute upper gastrointestinal bleeding is the commonest
More informationLower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY
Lower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY 15 FEB 2018 Sources Sources Sources Initial evaluation History Physical examination Laboratory evaluation Obtained at
More informationShort-Term Healing Process of Artificial Ulcers after Gastric Endoscopic Submucosal Dissection
Gut and Liver, Vol. 5, No. 3, September 2011, pp. 293-297 ORiginal Article Short-Term Healing Process of Artificial Ulcers after Gastric Endoscopic Submucosal Dissection Osamu Goto*, Mitsuhiro Fujishiro,
More informationBleeding in the Digestive Tract
Bleeding in the Digestive Tract National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH U.S. Department of Health
More informationSupplementary Online Content
Supplementary Online Content Sachar H, Vaidya K, Laine L. Intermittent vs continuous proton pump inhibitor therapy for highrisk bleeding ulcers: systematic review and meta-analysis. JAMA Intern Med. Published
More informationPerforated peptic ulcer
Perforated peptic ulcer - Despite the widespread use of gastric anti-secretory agents and eradication therapy, the incidence of perforated peptic ulcer has changed little, age limits increase NSAIDs elderly
More informationPeptic ulcer bleeding patients with Rockall scores 6 are at risk of long-term ulcer rebleeding: A 3.5-year prospective longitudinal study
bs_bs_banner doi:10.1111/jgh.13822 GASTROENTEROLOGY Peptic ulcer bleeding patients with Rockall scores 6 are at risk of long-term ulcer rebleeding: A 3.5-year prospective longitudinal study Er-Hsiang Yang,*,,1
More informationComparison of Endoscopic Injection Sclerotherapeutic Agents in Nonvariceal Upper GI Bleeding: A Retrospective Study
Article ID: WMC002108 2046-1690 Comparison of Endoscopic Injection Sclerotherapeutic Agents in Nonvariceal Upper GI Bleeding: A Retrospective Study Corresponding Author: Dr. Ibrahim Masoodi, Gastroenterologist,
More information