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2019 | 13 | 2 |

Tytuł artykułu

Is upper gastrointestinal bleeding still a life-threatening condition?

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Warianty tytułu

Języki publikacji

EN

Abstrakty

EN
Background: Upper gastrointestinal bleeding is a common clinical problem and one of the main reasons for emergency hospitalization. It is associated with an overall mortality rate of 2% to 13%, despite advances in medical therapy. First-choice management is conservative treatment with endoscopic hemostasis. Aim of the study: The aim of the study was to examine the epidemiological and clinical characteristics of patients with upper gastrointestinal bleeding with a focus on the course of hospitalization based on the etiology Material and methods: A retrospective study was conducted in the Department of Surgery at the 4th Military Teaching Hospital in the years 2011–2016, comprising a total of 200 hospitalizations. 150 (75%) of the study group were men, and the mean age was 63.6±15.8 years. Results: Patients most frequently presented with melena (n=105; 53.1%) and hematemesis (n=79; 40%) or coffee ground vomiting (n=57; 28.7%). . 138 (69%) of hemorrhages were managed with endoscopic hemostasis, and in 43 (21.5%) of cases conservative treatment was adequate. In 12 (6%) of cases, laparotomy was the first-choice therapy and in 7 (3.5%) cases, surgery was performed after an attempt at endoscopic treatment had failed. The sources of bleeding were: gastric ulcer – 58 (29%), duodenal ulcer – 48 (24%), esophageal varices – 31 (15.5%), gastric tumor – 15 (7.5%), Mallory-Weiss syndrome – 10 (5%), and Dieulafoy’s lesion – 3 (1.5%). 16 (8%) of the hospitalizations were fatal. Conclusions: Upper gastrointestinal bleeding still has a high mortality rate (8%). It more frequently affects men and the elderly. Gastric and duodenal ulcers are the most common etiologies of bleeding. Esophageal varices and neoplasms are also a significant source of bleeding. Despite the progress in the pharmacological treatment of peptic ulcers, the complications resulting from gastrointestinal bleeding continue to be a serious clinical problem.

Słowa kluczowe

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-

Rocznik

Tom

13

Numer

2

Opis fizyczny

p.18-23,fig.,ref.

Twórcy

autor
  • Department of Vascular, General and Transplantation Surgery, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland
  • Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
  • Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
autor
  • Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
autor
  • Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
autor
  • Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
autor
  • Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
  • Department of Surgery, 4th Military Teaching Hospital, Rudolfa Weigla 5, 50-981 Wroclaw, Poland

Bibliografia

  • 1. Lanas A, García-Rodríguez L, Polo-Tomás M, Ponce M, Alonso-Abreu I, Perez-Aisa M, et al. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol 2009; 104(7): 1633–1641.
  • 2. Barkun A, Sabbah S, Enns R, Armstrong D, Gregor J, Fedorak R, et al. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE ): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol 2004; 99(7): 1238–1246.
  • 3. Button L, Roberts S, Evans P, Goldacre M, Akbari A, Dsilva R, et al. Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study. Aliment Pharmacol Ther 2010; 33(1): 64–76.
  • 4. Cavallaro L, Monica F, Germanà B, Marin R, Sturniolo G, Saia M. Time trends and outcome of gastrointestinal bleeding in the Veneto Region: a retrospective population based study from 2001 to 2010. Dig Liver Dis 2014; 46(4): 313–317.
  • 5. Kim J, Sheibani S, Park S, Buxbaum J, Laine L. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol 2014; 48(2): 113–118.
  • 6. Lee Y, Min B, Kim E, Park K, Cho K, Jang B, et al. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding. Korean J Intern Med 2015; 31(1): 54–64.
  • 7. Laine L, Yang H, Chang S, Datto C. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol 2012; 107(8): 1190–1195.
  • 8. Leerdam M, Vreeburg E, Rauws E, Geraedts A, Tijssen J, Reitsma J, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003; 98(7): 1494–1499.
  • 9. Loperfido S, Baldo V, Piovesana E, Bellina L, Rossi K, Groppo M, et al. Changing trends in acute upper-GI bleeding: a populationbased study. Gastrointest Endosc 2009; 70(2): 212–224.
  • 10. Paspatis G, Konstantinidis K, Chalkiadakis I, Tribonias G, Chlouverakis G, Roussomoustakaki M. Changing trends in acute upper gastrointestinal bleeding in Crete, Greece. Eur J Gastroenterol Hepatol 2012; 24(1): 102–103.
  • 11. Theocharis G, Thomopoulos K, Sakellaropoulos G, Katsakoulis E, Nikolopoulou V. Changing trends in the epidemiology and clinical outcome of acute upper gastrointestinal bleeding in a defined geographical area in Greece. J Clin Gastroenterol 2008; 42(2): 128–133.
  • 12. Acosta R, Wong R. Differential diagnosis of upper gastrointestinal bleeding proximal to the ligament of Trietz. Gastrointest Endosc Clin N Am 2011; 21(4): 555–566.
  • 13. Rotondano G. Epidemiology and diagnosis of acute nonvariceal upper gastrointestinal bleeding. Gastroenterol Clin North Am 2014; 43(4): 643–663.
  • 14. Hreinsson J, Kalaitzakis E, Gudmundsson S, Björnsson E. Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting. Scand J Gastroenterol 2013; 48(4): 439–447.
  • 15. Boonpongmanee S, Fleischer D, Pezzullo J, Collier K, Mayoral W, Al-Kawas F, et al. The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc 2004; 59(7): 788–794.
  • 16. Hearnshaw S, Logan R, Lowe D, Travis S, Murphy M, Palmer K. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60(10): 1327–1335.
  • 17. Hallas J, Lauritsen J, Villadsen H, Gram L. Nonsteroidal antiinflammatory drugs and upper gastrointestinal bleeding, identifying high-risk groups by excess risk estimates. Scand J Gastroenterol 1995; 30(5): 438–444.
  • 18. Gralnek I, Dumonceau J, Kuipers E, Lanas A, Sanders D, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47(10): a1–a46.
  • 19. Garcia-Tsao G, Sanyal A, Grace N, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46(3): 922–938.
  • 20. Enestvedt B, Gralnek I, Mattek N, Lieberman D, Eisen G. An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium. Gastrointest Endosc 2008; 67(3): 422–429.
  • 21. Polakowska M, Piotrowski W, Tykarski A, Drygas W, Wyrzykowski B, Pajak A, et al. Nałóg palenia tytoniu w populacji polskiej. Wyniki programu WOBASZ. Kardiol Pol 2005; 63(6 Suppl 4): 626–631. (In Polish).
  • 22. Jamal A, King BA , Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults – United States, 2005–2015. MMWR Morb Mortal Wkly Rep 2016; 65(44): 1205–1211.
  • 23. Schabowski J. Peptic ulcer among Polish rural population and the nicotinic index. Ann Agric Environ Med 2000; 7(2): 119–123.
  • 24. Alharbi A, Almadi M, Barkun A, Martel M, REA SON Investigators. Predictors of a variceal source among patients presenting with upper gastrointestinal bleeding. Can J Gastroenterol 2012; 26(4): 187–192.
  • 25. Matei D, Groza I, Furnea B, Puie L, Levi C, Chiru A, et al. Predictors of variceal or nonvariceal source of upper gastrointestinal bleeding. An etiology predictive score established and validated in a tertiary referral center. J Gastrointestin Liver Dis 2013; 22: 379–384.

Typ dokumentu

Bibliografia

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