WorldWideScience

Sample records for active gastrointestinal bleeding

  1. [Gastrointestinal bleeding].

    Science.gov (United States)

    Lanas, Ángel

    2015-09-01

    In the Digestive Disease Week in 2015 there have been some new contributions in the field of gastrointestinal bleeding that deserve to be highlighted. Treatment of celecoxib with a proton pump inhibitor is safer than treatment with nonselective NSAID and a proton pump inhibitor in high risk gastrointestinal and cardiovascular patients who mostly also take acetylsalicylic acid. Several studies confirm the need to restart the antiplatelet or anticoagulant therapy at an early stage after a gastrointestinal hemorrhage. The need for urgent endoscopy before 6-12 h after the onset of upper gastrointestinal bleeding episode may be beneficial in patients with hemodynamic instability and high risk for comorbidity. It is confirmed that in Western but not in Japanese populations, gastrointestinal bleeding episodes admitted to hospital during weekend days are associated with a worse prognosis associated with delays in the clinical management of the events. The strategy of a restrictive policy on blood transfusions during an upper GI bleeding event has been challenged. Several studies have shown the benefit of identifying the bleeding vessel in non varicose underlying gastric lesions by Doppler ultrasound which allows direct endoscopic therapy in the patient with upper GI bleeding. Finally, it has been reported that lower gastrointestinal bleeding diverticula band ligation or hemoclipping are both safe and have the same long-term outcomes. PMID:26520197

  2. Computed tomography angiography in patients with active gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Reis, Fatima Regina Silva; D' Ippolito, Giuseppe, E-mail: fatima.rsreis@gmail.com [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Cardia, P.P. [Hospital Vera Cruz, Campinas, SP (Brazil)

    2015-11-15

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. (author)

  3. Computed tomography angiography in patients with active gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Fatima Regina Silva Reis

    2015-12-01

    Full Text Available Abstract Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding.

  4. Electrodermal screening of biologically active points for upper gastrointestinal bleeding.

    Science.gov (United States)

    Tseng, Ying-Jung; Hu, Wen-Long; Hung, I-Ling; Hsieh, Chia-Jung; Hung, Yu-Chiang

    2014-01-01

    The purpose of this case-control study was to investigate the relationship between the electrical resistance of the skin at biologically active points (BAPs) on the main meridians and upper gastrointestinal bleeding (UGIB). Electrical resistance to direct current at 20 BAPs on the fingers and toes of 100 patients with (38 men, 12 women; mean age [range], 58.20 ± 19.62 [18-83] years) and without (27 men, 23 women; 49.54 ± 12.12 [22-74] years) UGIB was measured through electrodermal screening (EDS), based on the theory of electroacupuncture according to Voll (EAV). Data were compared through analysis of variance (ANOVA), receiver operating characteristic (ROC) curve analysis, and logistic regression. The initial readings were lower in the UGIB group, indicating blood and energy deficiency due to UGIB. Significant differences in indicator drop values were observed at nine BAPs (p < 0.05) on the bilateral small intestine, bilateral stomach, bilateral circulation, bilateral fibroid degeneration, and right lymph meridians. The area under the ROC curve values of the BAPs on the bilateral small intestine and stomach meridians were larger than 0.5, suggesting the diagnostic accuracy of EDS for UGIB on the basis of the indicator drop of these BAPs. Logistic regression revealed that when the indicator drop of the BAP on the left stomach meridian increased by one score, the risk of UGIB increased by about 1.545-3.523 times. In conclusion, the change in the electrical resistance of the skin measured by EDS at the BAPs on the bilateral small intestine and stomach meridians provides specific information on UGIB.

  5. [Acute gastrointestinal bleeding].

    Science.gov (United States)

    Baumbach, Robert; Faiss, Siegbert; Cordruwisch, Wolfgang; Schrader, Carsten

    2016-04-01

    Acute gastrointestinal bleeding is a common major emergency (Internal medical or gastroenterological or medical), approximately 85 % of which occur in the upper GI tract. It is estimated that about a half of upper GI bleeds are caused by peptic ulcers. Upper GI bleeds are associated with more severe bleeding and poorer outcomes when compared to middle or lower GI bleeds. Prognostic determinants include bleeding intensity, patient age, comorbid conditions and the concomitant use of anticoagulants. A focused medical history can offer insight into the bleeding intensity, location and potential cause (along with early risk stratification). Initial measures should focus on rapid assessment and resuscitation of unstable patients. The oesophagogastroduodenoscopy (OGD) is the gold standard method for localizing the source of bleeding and for interventional therapy. Bleeding as a result of peptic ulcers is treated endoscopically with mechanical and / or thermal techniques in combination with proton pump inhibitor (PPI) therapy. When variceal bleeding is suspected, pre-interventional use of vasopressin analogues and antibiotic therapies are recommended. Endoscopically, the first line treatment of esophageal varices is endoscopic ligature therapy, whereas that for gastric varices is the use of Histoacryl injection sclerotherapy. When persistent and continued massive hemorrhage occurs in a patient with known or suspected aortic disease the possibility of an aorto-enteric fistula must be considered. PMID:27078246

  6. Gastrointestinal bleeding under dabigatran

    Directory of Open Access Journals (Sweden)

    C Stöllberger

    2014-01-01

    Full Text Available Dabigatran-absorption is dependent on the intestinal P-glycoprotein (P-gp-system, and P-gp activity is modulated by several drugs. We report an 83-old female with atrial fibrillation who developed gastrointestinal bleeding. She was under a therapy with non-steroidal anti-inflammatory drugs (NSAID and P-gp-modulating drugs and renal function was impaired. We conclude that NSAID and P-gp-modulating drugs should be avoided in dabigatran-treated patients. If renal function deteriorates the dabigatran-dosage should be reduced or the therapy should be stopped. There is an urgent need to increase knowledge about drug interactions with dabigatran.

  7. Active gastrointestinal bleeding:Use of hemostatic forceps beyond endoscopic submucosal dissection

    Institute of Scientific and Technical Information of China (English)

    Dimitri; Coumaros; Niki; Tsesmeli

    2010-01-01

    To the best of our knowledge,this is the f irst report of the application of hemostatic forceps in active gastrointestinal(GI) bleeding that is not related to endoscopic submucosal dissection.An 86-year-old woman with chronic intake of low-dose aspirin had a Dieulafoy's lesion of the third duodenal portion.Bleeding control with epinephrine injection was unsuccessful.A 60-year-old man presented with a bleeding ulcer in the duodenal bulb.Ten days after combined endotherapy,he had recurrent bleeding from two m...

  8. Treatment of massive gastrointestinal bleeding occurred during autologous stem cell transplantation with recombinant activated factor VII and octreotide

    Directory of Open Access Journals (Sweden)

    Erman Atas

    2015-01-01

    Full Text Available After hematopoietic stem cell transplantation (HSCT, patients may suffer from bleeding. One of the bleeding type is gastrointestinal (GI which has serious morbidity and mortality in children with limited treatment options. Herein, we presented a child with upper GI bleeding post autologous HSCT controlled successfully by using recombinant activated factor VII (rFVIIa and octreotide infusion.

  9. The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Hyo Sung; Han, Young Min; Lee, Soo Teik [Chonbuk National University, Jeonju (Korea, Republic of)

    2009-08-15

    To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography. We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates. Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure. The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.

  10. Radionuclide detection of lower gastrointestinal bleeding sites

    International Nuclear Information System (INIS)

    A retrospective review of two years' experience with radionuclide screening to detect lower gastrointestinal bleeding sites was conducted at New York's Montefiore Medical Center. Of 82 studies performed in 63 patients, 13 identified active bleeding sites. Only three of eight angiograms obtained in these 13 patients were positive. Thirteen contrast angiograms were performed in the group of 50 patients with negative radionuclide studies of which ten were negative and one was equivocal. The results of this study suggest that the Tc-99m sulfur colloid study for active lower gastrointestinal (GI) bleeding is an effective screening procedure. Positive studies help determine which vessel to catheterize selectively if an angiogram is to be performed. If vascular ectasis is still suspected following a negative radionuclide study, contrast angiography can be more efficaciously performed on a nonemergent basis

  11. An unusual cause of gastrointestinal bleed

    Directory of Open Access Journals (Sweden)

    C K Adarsh

    2014-01-01

    Full Text Available Gastrointestinal (GI bleed often brings the patient to the emergency medical service with great anxiety. Known common causes of GI bleed include ulcers, varices, Mallory-Weiss among others. All causes of GI bleed should be considered however unusual during the evaluation. Aortoenteric fistula (AEF is one of the unusual causes of GI bleed, which has to be considered especially in patients with a history of abdominal surgery in general and aortic surgery in particular.

  12. Role of videocapsule endoscopy for gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Cristina Carretero; Ignacio Fernandez-Urien; Maite Betes; Miguel Mu(n)oz-Navas

    2008-01-01

    Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of an unknown origin that persists or recurs after negative initial upper and lower endoscopies.Several techniques,such as endoscopy,arteriography,scintigraphy and barium radiology are helpful for recognizing the bleeding source;nevertheless,in about 5%-10% of cases the bleeding lesion cannot be determined.The development of videocapsule endoscopy (VCE) has permitted a direct visualization of the small intestine mucosa.We will analyze those techniques in more detail.The diagnostic yield of CE for OGIB varies from 38% to 93%,being in the higher range in those cases with obscure-overt bleeding.

  13. Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Fahad Saeed

    2011-01-01

    Full Text Available Gastrointestinal (GI bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI in chronic kidney disease (CKD and end-stage renal disease (ESRD patients. We suggest an approach to diagnosis and management of this problem.

  14. Scintigraphic detection of gastrointestinal bleeding: a review of current methods

    International Nuclear Information System (INIS)

    Recent experience with radionuclide imaging has provided the clinician with several techniques to noninvasively detect and locate sources of gastrointestinal hemorrhage. These tests can be rapidly performed and often in an ICU setting. One method used Tc-99m sulfur colloid which, in an animal model, has been shown to detect acute bleeding at rates as low as 0.1 ml/min. However, because the tracer remains in the blood for a short period of time, it may be suboptimal for identifying patients with intermittent bleeding. Tc-99m red cells is a tracer that remains within the blood and permits detection of both acute and intermittent bleeding. With tagged red cells, sites of bleeding from both the upper and lower gastrointestinal tract can be found. Both of these techniques can provide important information in the patient with suspected active gastrointestinal bleeding and aid the clinician in more effective management including the use of invasive diagnostic and therapeutic techniques

  15. Gastrointestinal bleeding 30 years after a complicated cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Thorsten; Brechmann; Wolff; Schmiegel; Volkmar; Nicolas; Markus; Reiser

    2010-01-01

    Gastrointestinal bleeding from small-bowel varices is a rare and difficult to treat complication of portal hypertension. We describe the case of a 79-year-old female patient with recurrent severe hemorrhage from smallbowel varices 30 years after a complicated cholecystectomy. When double balloon enteroscopy was unsuccessful to reach the site of bleeding, a rendezvous approach was favored with intraoperative endoscopy. Active bleeding from varices within a biliodigestive anastomosis was found and controlled ...

  16. Scintigraphic detection and localization of gastrointestinal bleeding sites

    International Nuclear Information System (INIS)

    Successful management of acute gastrointestinal (GI) bleeding usually depends on accurate localization of the bleeding site. History and clinical findings are often misleading in determination of the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provide accurate diagnoses for the majority of patients bleeding from the upper GI tract, but lower GI bleeding still poses a serious diagnostic challenge. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases (3-5), has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding at a rate greater than 0.5 ml/min, and since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. The diagnosis of lower GI bleeding is usually easy to make. In contrast, localizing the site of bleeding may be extremely difficult. Using the techniques described the nuclear physician may be able to detect the bleeding site precisely. However, if the cautions detailed are not observed, the tracer studies will show GI bleeding, but not at the true bleeding site. This must be carefully understood and avoided. Done correctly, these tests can have a major impact on patient care

  17. Devil's claw root: ulcers and gastrointestinal bleeding?

    Science.gov (United States)

    2013-12-01

    Harpagophytum procumbens, or devil's claw, is an African plant whose root is used to relieve minor joint symptoms. Several cases of gastrointestinal bleeding associated with the use of devil's claw root have been reported. A systematic review of the adverse effects of devil's claw root in about 20 randomised, double-blind, placebo-controlled clinical trials showed mainly gastrointestinal effects: gastralgia and dyspepsia. In practice, devil's claw root exposes patients to the risk of sometimes serious upper gastrointestinal disorders, yet has no established efficacy beyond a placebo effect. It is best avoided. PMID:24600731

  18. Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

    Institute of Scientific and Technical Information of China (English)

    Bong; Sik; Matthew; Kim; Bob; T; Li; Alexander; Engel; Jaswinder; S; Samra; Stephen; Clarke; Ian; D; Norton; Angela; E; Li

    2014-01-01

    Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is notapparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Obscure gastrointestinal bleeding is recurrent bleeding when the source remains unidentified after upper endoscopy and colonoscopic evaluation and is usually from the small intestine. Accurate clinical diagnosis is crucial and guides definitive investigations and interventions. This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians.

  19. The Approach to Occult Gastrointestinal Bleed.

    Science.gov (United States)

    Naut, Edgar R

    2016-09-01

    Occult gastrointestinal bleeding is not visible and may present with a positive fecal occult blood test or iron deficiency anemia. Obscure bleeding can be overt or occult, with no source identified despite an appropriate diagnostic workup. A stepwise approach to this evaluation after negative upper and lower endoscopy has been shown to be cost effective. This includes repeat endoscopies if warranted, followed by video capsule endoscopy (VCE) if no obstruction is present. If the VCE is positive then specific endoscopic intervention may be possible. If negative, patients may undergo either repeat testing or watchful waiting with iron supplements.

  20. [Epidemiology of upper gastrointestinal bleeding in Gabon].

    Science.gov (United States)

    Gaudong Mbethe, G L; Mounguengui, D; Ondounda, M; Magne, C; Bignoumbra, R; Ntsoumou, S; Moussavou Kombila, J-B; Nzenze, J R

    2014-01-01

    The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

  1. The role of endoscopy in pediatric gastrointestinal bleeding

    Science.gov (United States)

    Franke, Markus; Geiß, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-Jürgen; Bausch, Dirk; Fischer, Andreas

    2016-01-01

    Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no

  2. The role of nuclear medicine in acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, P. (Saint James' s Hospital, Leeds (United Kingdom). Dept. of Radiology)

    1993-10-01

    In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. [sup 99]Tc[sup m]-sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. [sup 99]Tc[sup m]-labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author).

  3. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)

  4. An Unusual Case of Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Kristin N. Fiorino

    2011-01-01

    Full Text Available A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA, which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment.

  5. Capsule endoscopy: Current status in obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    R Gupta; Nageshwar Duvvuru Reddy

    2007-01-01

    Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy.Capsule endoscopy has a very high diagnostic yield especially if the bleeding is ongoing. This technique appears to be superior to other techniques for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal (GI)bleed.

  6. A STUDY ON ENDOSCOPIC EVALUATION OF UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Pranaya Kumar

    2016-03-01

    Full Text Available CONTEXT Upper gastrointestinal bleeding (UGIB is one of the commonest gastrointestinal emergencies encountered by clinicians. Peptic ulcers are the most common cause of UGIB. Endoscopy has become the preferred method for diagnosis in patients with acute UGIB. This study is done in a diagnostic upper gastrointestinal endoscopy (UGIE setup of a tertiary care hospital to ascertain the causes of UGIB prevalent in this part of our country which might differ from other studies. AIM To ascertain prevalent causes of UGIB in patients of this part of India admitted to a Govt. Tertiary Hospital with a provisional diagnosis of UGIB. METHOD One hundred consecutive patients with UGIB were subjected to UGIE to find out the aetiology. The clinical profile and endoscopic findings were analysed and compared with the data on UGIB from other studies. RESULTS The mean age of patients was 47.03 years with male: female ratio of 2.33:1. 58% of patients were first time bleeders. Majority of patients presented with melaena. Visualisation of active bleeding achieved to 85.7% when endoscopy was done within first 24 hrs. The commonest cause of UGIB was duodenal ulcer (DU which accounted for 41% cases. Gastric ulcer was responsible in 13% of cases. Portal hypertension was responsible for bleed in only 13%. Neoplasms accounted for 25% of cases. Other less common causes were erosive gastritis (3%, gastric polyp (3%, Mallory-Weiss tear (1%, and Dieulafoy’s lesion (1%. Among bleeding peptic ulcers, 27.8% of cases were classified as Forrest IIa and 20.4% in Forrest IIb & IIc each. Acid peptic disease was past history elicited in majority (33% followed by NSAID (26% and alcohol (26%. CONCLUSION The present study has diagnosed various causes of upper gastrointestinal bleeding in this part of country. The incidence of gastric carcinoma as a cause of upper gastrointestinal bleeding is significantly high compared to those in other studies. UGI endoscopy should be done in every case

  7. A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

    Directory of Open Access Journals (Sweden)

    Zeytunlu Murat

    2009-01-01

    Full Text Available Abstract Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding.

  8. Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

    DEFF Research Database (Denmark)

    Kjeldsen, A D; Kjeldsen, J

    2000-01-01

    Gastrointestinal bleeding occurs in a number of patients with hereditary hemorrhagic telangiectasia (HHT) and may lead to a high transfusion need. The aim of this study was to estimate the occurrence and severity of gastrointestinal bleeding in a geographically well defined HHT population....

  9. Tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Bennett, Cathy; Klingenberg, Sarah Louise; Langholz, Ebbe;

    2014-01-01

    Background Tranexamic acid reduces haemorrhage through its antifibrinolytic effects. In a previous version of the present review, we found that tranexamic acid may reduce mortality. This review includes updated searches and new trials.Objectives To assess the effects of tranexamic acid versus......-effect and random-effects model meta-analyses and presented results as risk ratios (RRs) with 95% confidence intervals (CIs) and used I² as a measure of between-trial heterogeneity. We analysed tranexamic acid versus placebo or no intervention and tranexamic acid versus antiulcer drugs separately. To analyse...... sources of heterogeneity and robustness of the overall results, we performed subgroup, sensitivity and sequential analyses.Main results We included eight randomised controlled trials on tranexamic acid for upper gastrointestinal bleeding. Additionally, we identified one large ongoing pragmatic randomised...

  10. Methods of Nuclear Medicine in gastrointestinal bleeding detection

    International Nuclear Information System (INIS)

    Several methods used in the diagnostic of gastrointestinal bleeding are presented. Two radioisotopic methods are considered the main ones: coloidal sulphur labeled with technetium-99m, more useful for low and acute bleeding and red blood cells labeled with technetium-99m, adequate for high and intermitent bleeding. (Author)

  11. Interventional angiography in the diagnosis of acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Interventional angiography with the use of indwelling arterial catheters, anticoagulants, vasodilators and fibrinolytic agents, complements conventional angiography in the diagnosis of acute lower gastrointestinal bleeding. These interventional techniques prolong, augment or reactive bleeding and, by enabling better timing of examinations, they increase the diagnostic efficacy of angiography. In the reported series of 63 patients with acute lower gastrointestinal hemorrhage, interventions increased the diagnostic yield of angiography for demonstration of extravasation from 32% to 65% and decreased the percentage of negative angiograms from 27% to 16%. Indications, techniques and risks of interventional angiography in the diagnosis of acute lower gastrointestinal bleeding are discussed. (orig.)

  12. New insights to occult gastrointestinal bleeding: From pathophysiology to therapeutics

    Institute of Scientific and Technical Information of China (English)

    Antonio; Damián; Sánchez-Capilla; Paloma; De; La; Torre-Rubio; Eduardo; Redondo-Cerezo

    2014-01-01

    Obscure gastrointestinal bleeding is still a clinical challenge for gastroenterologists. The recent development of novel technologies for the diagnosis and treatment of different bleeding causes has allowed a better management of patients, but it also determines the need of a deeper comprehension of pathophysiology and the analysis of local expertise in order to develop a rational management algorithm. Obscure gastrointestinal bleeding can be divided in occult, when a positive occult blood fecal test is the main manifestation, and overt, when external sings of bleeding are visible. In this paper we are going to focus on overt gastrointestinal bleeding, describing the physiopathology of the most usual causes, analyzing the diagnostic procedures available, from the most classical to the novel ones, and establishing a standard algorithm which can be adapted depending on the local expertise or availability. Finally, we will review the main therapeutic options for this complex and not so uncommon clinical problem.

  13. Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia.

    Science.gov (United States)

    Lakhwani, M N; Ismail, A R; Barras, C D; Tan, W J

    2000-12-01

    Despite advancements in endoscopy and pharmacology in the treatment of peptic ulcer disease the overall mortality has remained constant at 10% for the past four decades. The aim of this study was to determine the age, gender, racial distribution, incidence and causes of endoscopically diagnosed cases of upper gastrointestinal (UGI) bleeding to summarise treatments undertaken and to report their outcome. A prospective study of UGI bleeding in 128 patients was performed in two surgical wards of Kuala Lumpur Hospital, involving both elective and emergency admissions. The study group comprised of 113 (88.2%) males and 15 (11.7%) females. The mean age was 51.9 years (range 14 to 85 years) and 37.5% (48 of 128 patients) were older than 60 years. The Indian race was over-represented in all disease categories. Smoking (50.1%), alcohol consumption (37.5%), non-steroidal anti-inflammatory drugs (NSAIDs) (17.2%), traditional remedies (5.5%), anti-coagulants (2.3%) and steroids (0.8%) were among the risk factors reported. Common presenting symptoms and signs included malaena (68.8%), haematemesis (59.4%) and fresh per rectal bleeding (33.6%). The commonest causes of UGI bleeding were duodenal ulcer (32%), gastric ulcer (29.7%), erosions (duodenal and gastric) (21.9%), oesophageal varices (10.9%) and malignancy (3.9%). UGI bleeding was treated non-surgically in 90.6% of cases. Blood transfusions were required in 62.6% (67/107) of peptic ulcer disease patients. Surgical intervention for bleeding peptic ulcer occurred in around 10% of cases and involved under-running of the bleeding vessel in most high risk duodenal and gastric ulcer patients. The overall mortality from bleeding peptic ulcer disease was 4.7%. Six patients died from torrential UGI haemorrhage soon after presentation, without the establishment of a cause. Active resuscitative protocols, early endoscopy, more aggressive interventional therapy, early surgery by more senior surgeons, increasing intensive care unit

  14. An unusual cause of upper gastrointestinal system bleeding: Duodenal varices

    OpenAIRE

    Yılmaz, Ömer; Ataseven, Hilmi

    2012-01-01

    Abstract Duodenal varices are an uncommon site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report the case of a 27- year- old man with liver cirrhosis who presented with upper gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed nodular varices in the second portion of the duodenum which were considered to be the source of bleeding. We decided to inject N-butyl-2-cyanoacrylate (Histoacryl), an adhesive agent, and...

  15. Congenital portosystemic shunts with and without gastrointestinal bleeding - case series

    Energy Technology Data Exchange (ETDEWEB)

    Gong, Ying; Chen, Jun; Chen, Qi; Ji, Min; Pa, Mier; Qiao, Zhongwei [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Zhu, Hui [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Zheng, Shan [Children' s Hospital of Fudan University, Department of Surgery, Shanghai (China)

    2015-12-15

    The clinical presentation of congenital portosystemic shunt is variable and gastrointestinal bleeding is an uncommon presentation. To describe the imaging features of congenital portosystemic shunt as it presented in 11 children with (n = 6) and without gastrointestinal bleeding (n = 5). We performed a retrospective study on a clinical and imaging dataset of 11 children diagnosed with congenital portosystemic shunt. A total of 11 children with congenital portosystemic shunt were included in this study, 7 with extrahepatic portosystemic shunts and 4 with intrahepatic portosystemic shunts. Six patients with gastrointestinal bleeding had an extrahepatic portosystemic shunt, and the imaging results showed that the shunts originated from the splenomesenteric junction (n = 5) or splenic vein (n = 1) and connected to the internal iliac vein. Among the five cases of congenital portosystemic shunt without gastrointestinal bleeding, one case was an extrahepatic portosystemic shunt and the other four were intrahepatic portosystemic shunts. Most congenital portosystemic shunt patients with gastrointestinal bleeding had a shunt that drained portal blood into the iliac vein via an inferior mesenteric vein. This type of shunt was uncommon, but the concomitant rate of gastrointestinal bleeding with this type of shunt was high. (orig.)

  16. Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Lajos Csermely; Hassan Jaafar; Jorgen Kristensen; Antonio Castella; Waldemar Gorka; Ahmed Ali Chebli; Fawaz Trab; Hussain Alizadeh; Béla Hunyady

    2006-01-01

    A 55-year old male patient was diagnosed with strongyloides hyper-infection with stool analysis and intestinal biopsy shortly after his chemotherapy for myeloma.He was commenced on albendazole anthelmintic therapy. After initiation of the treatment he suffered lifethreatening gastrointestinal (GI) bleeding. Repeated endoscopies showed diffuse multi-focal intestinal bleeding. The patient required huge amounts of red blood cells and plasma transfusions and correction of haemostasis with recombinant activated factor Ⅶ.Abdominal aorto-angiography showed numerous microinferior mesenteric arteries' territories. While the biopsy taken prior to the treatment with albendazole did not show evidence of vasculitis, the biopsy taken after initiation of therapy revealed leukoclastic aggregations around the vessels. These findings suggest that, in addition to direct destruction of the mucosa, vasculitis could be an important additive factor causing the massive GI bleeding during the anthelmintic treatment.This might result from substances released by the worms that have been killed with anthelmintic therapy.Current guidelines advise steroids to be tapered and stopped in case of systematic parasitic infections as they might reduce immunity and precipitate parasitic hyper-infection. In our opinion, steroid therapy might be of value in the management of strongyloides hyperinfection related vasculitis, in addition to the anthelmintic treatment. Indeed, steroid therapy of vasculitis with other means of supportive care resulted in cessation of the bleeding and recovery of the patient.

  17. Splenic angiosarcoma metastasis to small bowel presented with gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Jun-Te Hsu; Chin-Yew Lin; Ting-Jun Wu; Han-Ming Chen; Tsann-Long Hwang; Yi-Yin Jan

    2005-01-01

    Primary splenic angiosarcoma is a very rare,aggressive neoplasm with a high metastatic rate and dismal prognosis. This neoplasm usually presents with abdominal pain, splenomegaly, anemia, and thrombocytopenia. Splenic angiosarcoma with bleeding gastrointestinal metastases is extremely rare. The literature contains only two case reports. This study reported a 44-year-old male patient with splenic angiosarcoma with sustained repeated gastrointestinal bleeding due to small bowel metastases. Salvage surgery was performed by splenectomy and resection of the metastatic small bowel tumors. The post-operative course was uneventful; the patient survived with the disease and had no GI bleeding, 7 mo after surgery.

  18. PRE-AETHIOLOGICAL TREATMENT IN UPPER GASTRO-INTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    G. Dimofte

    2005-01-01

    Full Text Available Upper gastro-intestinal bleeding remains a cornerstone in surgical practice and unfortunately its’ management is profoundly variable according to hospital protocols and local standards of care. Medical interventions are acting at different levels of medical care and a range of specialist are involved in the process, starting from family practitioners to surgeons, as well as highly trained specialist in interventional endoscopy or radiology. This review is trying to establish the landmarks in the early assessment and care of patients with upper gastro-intestinal bleeding, irrespective of the morphological cause of the bleeding. We propose a protocol for the management both of portal and non-portal upper-gastrointestinal bleedings, prior to endoscopic diagnosis. It is fundamental to establish a standard of care which is feasible in Romania and can work both in university and district hospitals. The protocol is marking the essential gestures with their relevance for the bleeding patient but also reminds the significance of clinical evaluation and safety in transportation of the patient to the nearest emergency room. A battery of simple test should be performed in every patient and data interpreted with care, as results vary according to the level of haemodynamic compensation. Standard empiric therapy for upper gastro-intestinal bleeding is not yet been established but a couple of alternatives emerge as possible solutions. We discuss the benefits of a standard therapy based on H2 blockers, proton pump inhibitors, octreoctide and somatostatin regarding both portal and non-portal bleedings.

  19. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

  20. Multidetector computed tomography in acute lower gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    John Palma

    2010-11-01

    Full Text Available John Palma, Marius Mihaila, Frank PilleulDépartement de Radiologie Digestive et des Urgences, Hôpital Edouard Herriot, Hospices Civils de Lyon, CHU, Lyon, FranceBackground: The aim of this study is to evaluate multidetector computed tomography (MDCT in acute massive lower gastrointestinal bleeding, with endoscopy and surgery as reference examinations.Methods: A single-center retrospective study involving 34 patients with acute massive lower gastrointestinal bleeding was carried out. All patients were evaluated by MDCT scan then endoscopic or surgical examinations. Sensitivity, specificity, and positive and negative predictive values of MDCT scan were calculated using the extravasation of the contrast agent as the main criterion.Results: Extravasation of the contrast agent was found in 30 of 34 patients (88%. The bleeding site seen on CT was always the same as on endoscopic or surgical examinations (100%. Sensitivity of MDCT scan was 94%, specificity 100%, positive predictive value 100%, and negative predictive value 50% (P < 0.001. Twelve diverticulum bleedings were seen on MDCT scan compared with 13 (92% on endoscopic or surgical examinations. Angiodysplasia was overestimated by MDCT scan.Conclusion: MDCT scan appears to be an excellent tool to find and localize the bleeding site in cases of acute massive lower gastrointestinal disease.Keywords: MDCT, acute lower gastrointestinal bleeding, extravasation, contrast agent

  1. [Jejunal GIST with obscure gastrointestinal bleeding].

    Science.gov (United States)

    Nelly Manrique, María; Frisancho, Oscar; Rivas Wong, Luz; Palomino, Américo

    2011-01-01

    We report the case of a woman of 84 years with a history of cardiac arrhythmia and hemorrhoids. She had multiple hospitalizations and transfusions for symptomatic iron deficiency anemia, endoscopic studies showed only small diverticula and colon polyps. He was later hospitalized with bloody stools red wines, upper endoscopy and colonoscopy showed gastritis, small colonic ulcers, colonic polyp and multiple diverticula. Readmitted with bleeding of obscure origin, on that occasion showed gastritis, antral erosions, small ulcers, colon polyps and colon ulcers in the process of healing, capsule endoscopy showed angiodysplasia in jejunum, anterograde enteroscopy detected some erythematous lesions in proximal jejunum without evidence of bleeding. Again hospitalized for melena and abdominal. PMID:22086325

  2. Endoscopic Removal of an Unusual Foreign Body Causing Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    A. Karaman

    2010-09-01

    Full Text Available Foreign body ingestion is a condition more common in the pediatric population than in adults. In adults, although foreign body ingestion can be well tolerated, approximately 10–20% of patients require endoscopic intervention. Delayed diagnosis and unremoved foreign bodies can cause serious and fatal complications including perforation, fistula and gastrointestinal bleeding. Here we report a patient with bleeding duodenal ulcer thought to be initiated by a large foreign body.

  3. Scintigraphic demonstration of gastrointestinal bleeding due to mesenteric varices

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, M.E.; Coleman, R.E. (Duke Univ. Medical Center, Durham, NC (USA))

    1990-07-01

    Mesenteric varices can appear as massive, acute lower gastrointestinal bleeding. The small bowel or colon may be involved, varices usually developing at sites of previous surgery or inflammation in patients with portal hypertension. Two patients with alcoholic cirrhosis and protal hypertension presented with rectal bleeding. Tc-99m RBC studies demonstrated varices and extravasation into the adjacent bowel. The varices were documented by mesenteric angiography. Characteristic features of Tc-99m labeled RBC studies can identify mesenteric varices as the cause of intestinal bleeding and localize the abnormal vessels.

  4. /sup 99m/Tc-labeled RBC scan. Diagnostic method for lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    The experience with 62 /sub 99m/Tc-labeled in vivo scans performed for lower gastrointestinal bleeding is discussed. Thirty-seven scans were deemed positive. The tendency of scans to become positive correlated with observations of active bleeding. Five patients had fulminant hemorrhage, necessitating emergency operation. In this group, scanning accurately located the bleeding sources prior to intervention. Seven other patients having later operations bled less rapidly. The bleeding site was localized accurately by scanning in three of these patients. Two studies were falsely positive and two were negative, whereas angiography was positive in two patients studied. Labeled RBC scanning is a useful technique in the early evaluation of patients with lower gastrointestinal bleeding, obviating the need of arteriography in some cases

  5. Angiography and angiotherapy of gastrointestinal tract bleeding

    International Nuclear Information System (INIS)

    In selected patients with upper and lower gastrointestinal hemorrhage there is an indication for angiography. Vasoconstrictive drugs or embolization materials can be submitted through the catheter to stop the hermorrhage (angiotherapy). 81 patients were diagnosed by this method. Treatment through the angiographic catheter followed the diagnostic procedure in 41 cases. The hemorrhage was controlled in 36 patients. (orig.)

  6. Detection of gastrointestinal bleeding with /sup 99m/Tc-sulfur colloid

    International Nuclear Information System (INIS)

    We have developed a single scintigraphic technique to detect and localize the site of bleeding in the gastrointestinal tract. This examination requires only intravenous administration of /sup 99m/Tc sulfur colloid and imaging of the abdomen. Very shortly after the introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. This phenomenon is repeated each time the blood recirculates adding another, but smaller fraction to the extravasated activity at the site of hemorrhage. Because of continued clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast is eventually reached between the site of bleeding and surrounding background. Based on animal experiments bleeding rates as low as .05-0.1 cc/min can be detected with this technique. The sensitivity of the approach in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques which utilize radioactive blood pool indicators. We have mainly used this technique in the evaluation of patients with GI bleeding. In more than 25 patients with negative scintigrams for hemorrhage, arteriography showed no evidence of bleeding. In 38 patients with scintigraphic evidence of bleeding. In 38 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding in les than 50% of the cases. No false positive results have been noted in the latter group. This technique appears to offer a simple, practical and reliable approach to the evaluation of patients with gastrointestinal bleeding

  7. Efficacy of endoscopic therapy for gastrointestinal bleeding from Dieulafoy's lesion

    Institute of Scientific and Technical Information of China (English)

    Jun Cui; Liu-Ye Huang; Yun-Xiang Liu; Bo Song; Long-Zhi Yi; Ning Xu; Bo Zhang; Cheng-Rong Wu

    2011-01-01

    AIM: To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy's lesion. METHODS: One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy's lesion were treated with three endoscopic hemostasis methods: aethoxysklerol injection (46 cases), endoscopic hemoclip hemostasis (31 cases), and a combination of hemoclip hemostasis with aethoxysklerol injection (30 cases). RESULTS: The rates of successful hemostasis using the three methods were 71.7% (33/46), 77.4% (24/31) and 96.7% (29/30), respectively, with significant differences between the methods (P < 0.05). Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis, 7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aethoxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no re-bleeding was found during a 1-year follow-up. CONCLUSION: The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy's lesion.

  8. New Endoscopic Techniques for Obscure Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Henk den Ouden

    2007-01-01

    Full Text Available The case of a postmenopausal woman with a congenital aortic stenosis is presented. She presented with severe iron deficiency anemia. After negative extensive gastrointestinal analysis, she was treated with octreotide for six months. After cessation of octreotide, anemia rapidly recurred. A second capsule endoscopy and a double balloon enteroscopy were performed, and an intestinal vascular malformation was found. After surgical segment resection, the patient had stable, normal levels of hemoglobin and no complaints after 14 months of follow-up.

  9. Guideline for Capsule Endoscopy: Obscure Gastrointestinal Bleeding

    OpenAIRE

    Shim, Ki-Nam; Moon, Jeong Seop; Chang, Dong Kyung; Do, Jae Hyuk; Kim, Ji Hyun; Min, Byung Hoon; Jeon, Seong Ran; Kim, Jin-Oh; Choi, Myung-Gyu; ,

    2013-01-01

    Capsule endoscopy (CE) is considered as a noninvasive and reliable diagnostic tool of examining the entire small bowel. CE has been performed frequently at many medical centers in South Korea; however, there is no evidence-based CE guideline for adequate diagnostic approaches. To provide accurate information and suggest correct testing approaches for small bowel disease, the guideline on CE was developed by the Korean Gut Image Study Group, a part of the Korean Society of Gastrointestinal End...

  10. Evaluation and outcomes of patients with obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Cositha; Santhakumar; Ken; Liu

    2014-01-01

    Obscure gastrointestinal bleeding(OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previous techniques. Following a negative bidirectional endoscopy, capsule endoscopy and double balloon enteroscopy remain the cornerstone of investigation in OGIB given their high diagnostic yield. Longterm outcome data in patients with OGIB is limited, but is most promising for capsule endoscopy. This article reviews the current literature and provides an overview of the clinical evaluation of patients with OGIB, available diagnostic and therapeutic modalities and longterm clinical outcomes.

  11. Telemetric real-time sensor for the detection of acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Schostek, Sebastian; Zimmermann, Melanie; Keller, Jan; Fode, Mario; Melbert, Michael; Schurr, Marc O; Gottwald, Thomas; Prosst, Ruediger L

    2016-04-15

    Acute upper gastrointestinal bleedings from ulcers or esophago-gastric varices are life threatening medical conditions which require immediate endoscopic therapy. Despite successful endoscopic hemostasis, there is a significant risk of rebleeding often requiring close surveillance of these patients in the intensive care unit (ICU). Any time delay to recognize bleeding may lead to a high blood loss and increases the risk of death. A novel telemetric real-time bleeding sensor can help indicate blood in the stomach: the sensor is swallowed to detect active bleeding or is anchored endoscopically on the gastrointestinal wall close to the potential bleeding source. By telemetric communication with an extra-corporeal receiver, information about the bleeding status is displayed. In this study the novel sensor, which measures characteristic optical properties of blood, has been evaluated in an ex-vivo setting to assess its clinical applicability and usability. Human venous blood of different concentrations, various fluids, and liquid food were tested. The LED-based sensor was able to reliably distinguish between concentrated blood and other liquids, especially red-colored fluids. In addition, the spectrometric quality of the small sensor (size: 6.5mm in diameter, 25.5mm in length) was comparable to a much larger and technically more complex laboratory spectrophotometer. The experimental data confirm the capability of a miniaturized sensor to identify concentrated blood, which could help in the very near future the detection of upper gastrointestinal bleeding and to survey high-risk patients for rebleeding.

  12. Factors affecting hospital mortality in acute upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Alam Mohammed

    2000-01-01

    Full Text Available This retrospective analysis studied the records of 564 consecutive patients admitted to Gastrointestinal Bleeding Unit of Riyadh Medical Complex with acute upper gastrointestinal bleeding over a 2-year period (May 1996-April 1998. The purpose of the study was to analyze the mortality with an aim to identify the risk factors affecting mortality in these patients. Majority of patients were men (82% and Saudis (54%. Their mean age was 52.46 + 17.8 years. Esophageal varices (45% were the main causes of bleeding followed by duodenal ulcers (24%. Overall mortality in this series was 15.8% (89 patients. Comorbid diseases were responsible for death in 68 (76% patients, whereas, bleeding was considered to be directly responsible for death in 21 (24% patients. On analysis of data from this study, old age (>60 years, systolic pressure < 90 mm Hg on admission, comorbid disease, variceal bleeding and Child′s grade C in patients with chronic liver disease were associated with adverse outcome.

  13. Infliximab stopped severe gastrointestinal bleeding in Crohn's disease

    OpenAIRE

    Aniwan, Satimai; Eakpongpaisit, Surasak; Imraporn, Boonlert; Amornsawadwatana, Surachai; Rerknimitr, Rungsun

    2012-01-01

    To report the result of rapid ulcer healing by infliximab in Crohn’s patients with severe enterocolic bleeding. During 2005 and 2010, inflammatory bowel disease database of King Chulalongkorn Memorial and Samitivej hospitals were reviewed. There were seven Crohn’s disease (CD) patients (4 women and 3 men; mean age 52 ± 10.4 years; range: 11-86 years). Two of the seven patients developed severe gastrointestinal bleeding (GIB) as a flare up of CD whereas the other five patients presented with G...

  14. [Gastric lipoma as an unusual cause of upper gastrointestinal bleeding].

    Science.gov (United States)

    Vogt, W; Allemann, J; Simeon, B; Fornaro, M; Rehli, V

    1995-04-18

    This is a case report of a gastric lipoma causing a severe upper gastrointestinal bleeding. About 200 cases of this very rare benign gastric tumor have been reported so far. Symptoms are not characteristic, but may also mimic malignancy when occurring with bleeding, obstruction or weight loss. Malignant transformation is possible, but extremely rare. Because the tumor is situated under the submucosal layer in 90%, preoperative diagnosis by endoscopic biopsy is almost never possible. The tumor has to be treated by resection. A diagnosis by frozen section during the operation is recommended.

  15. Massive extra-enteric gastrointestinal bleeding: angiographic diagnosis.

    Science.gov (United States)

    Koehler, P R; Nelson, J A; Berenson, M M

    1976-04-01

    Two patients with massive gastrointestinal bleeding are reported. One bled from an aneurysm of a branch of the left hepatic artery, the blood reaching the bowel through communication with the biliary tree. The second had an aneurysm of a branch of the splenic artery which communicated with the pancreatic duct. This type of bleeding is intermittent and, consequently, actual extravasation of contrast media is not always seen. Therefore, if one sees an aneurysm of a visceral artery, even if it does not directly supply the enteric tract, one should consider the possibility that it is the origin of the hemorrhage. Pathogenesis, diagnostic modalities, and therapeutic implications are discussed. PMID:1083037

  16. Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography

    International Nuclear Information System (INIS)

    Preliminary experience with technetium-99m sulfur colloid scintigraphy in 43 patients with lower gastrointestinal bleeding is described. Within minutes of the intravenous introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. Because of rapid clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast develops between the site of bleeding and surrounding background. Based on animal experiments, bleeding rates as low as 0.05-0.1 ml/min can be detected with this technique. The sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators. In this study all patients underwent both scintigraphy and arteriography within several hours. In 20 patients with negative scintigrams, arteriography showed no evidence of bleeding. In the other 23 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding only in 10. In 19 of the 23 patients, a cause for bleeding was eventually established by other means. This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding

  17. Localization of gastrointestinal bleeding: superiority of /sup 99m/Tc sulfur colloid compared with angiography

    International Nuclear Information System (INIS)

    Preliminary experience with technetium-99m sulfur colloid scintigraphy in 43 patients with lower gastrointestinal bleeding is described. Within minutes of the intravenous introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. Because of rapid clearance of the radiopharmaceutical from the vascular pool by the rediculoendothelial system, a contrast develops between the site of bleeding and surrounding background. Based on animal experiments, bleeding rates as low as 0.05-0.1 ml/min can be detected with this technique. The sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators. In this study all patients underwent both scintigraphy and arteriography within several hours. In 20 patients with negative scintigrams, arteriography showed no evidence of bleeding. In the other 23 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding only in 10. In 19 of the 23 patients, a cause for bleeding was eventually established by other means. This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding

  18. Clinical application of Hawkeye VG SPECT/CT imaging in the bleeding position of lower gastrointestinal

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical application of Hawkeye VG SPECT/CT imaging on diagnosing and locating lower gastrointestinal bleeding using in vivo labeling 99Tcm-RBC. Methods: Fifty-six patients (42 males, 14 females, age ranging from 10 to 76 years) who had definite lower gastrointestinal bleeding were studied retrospectively. All patients had intravenous injection with 370 MBq 99Tcm-RBC and then underwent planar, SPECT, and CT imaging respectively in the abdomen before exploratory laparotomy. Images from SPECT and CT were fused thereafter to locate the active bleeder, if any. χ2 test was performed to show the differences of diagnostic sensitivity and accuracy between planar and SPECT/CT imaging. Results: In 56 patients with lower gastrointestinal bleeding, 50 patients showed abnormally concentrated radionuclide activity with planar images and 52 patients showed the similar imaging pattern with SPECT/CT. Among these patients, concordant bleeding with operation findings was found in 31 patients with planar images and 48 patients with SPECT/CT images. The sensitivity and accuracy were 89.3% (50/56) and 73.8% (31/42) in planar images, and 92.9% (52/56) and 92.3% (48/52) in SPECT/CT images (χ2=0.11, P>0.05; χ2=4.63, P<0.05). Conclusion: Hawkeye VG SPECT/CT imaging shows an effective, simple and accurate method and could be used for diagnosing and locating lower gastrointestinal bleeding. (authors)

  19. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Erwin; Biecker

    2015-01-01

    Non-variceal upper gastrointestinal bleeding(UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions,erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor(PPI) therapy. These drugs are highly effective but the best route of application(oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal antiinflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased.

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

    Institute of Scientific and Technical Information of China (English)

    Ahmed Mahmoud EI-Tawil

    2012-01-01

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

  1. An Unusual Cause of Gastrointestinal Bleeding: Duodenal Lipoma

    Directory of Open Access Journals (Sweden)

    R. Kadaba

    2011-04-01

    Full Text Available Common causes of chronic upper gastrointestinal bleeding include oesophageal varices, gastroduodenal ulcers and malignancy, and patients mostly present with iron deficiency type anaemia. We present the case of a 60-year-old lady who presented with iron deficiency anaemia and on investigation was found to have a large duodenal polyp requiring surgical excision. On histological examination, the polyp was revealed to be a lipoma. We review the recent literature and formulate a management plan for this rare entity.

  2. The efficacy of Hemospray in patients with upper gastrointestinal bleeding from tumor

    Science.gov (United States)

    Pittayanon, Rapat; Prueksapanich, Piyapan; Rerknimitr, Rungsun

    2016-01-01

    Background and study aims: Currently, conventional endoscopic treatments provide an unsatisfactory hemostatic outcome in upper gastrointestinal bleeding from tumor. Hemospray has been shown to be useful in many active gastrointestinal bleeding conditions. This study aimed to compare the efficacy of Hemospray and conventional endoscopic hemostasis. Patients and methods: Fourteen patients with active upper gastrointestinal bleeding from tumor were recruited. Hemospray was applied at the bleeding site until hemostasis was achieved. Four patients were excluded because they prematurely received definitive therapy to prevent further bleeding within 48 hours. Another 10 patients from historical control were matched based on the type of gastrointestinal tumors. The 14-day rebleeding rates, length of hospital stay (LOS) and mortality rate at 30-day follow up were assessed. Results: Baseline characteristics including age, stage of tumor, and Blatchford score did not differ between the two groups. The 14-day rebleeding rate in the Hemospray group was 3 times lower than the control group but not statistically significant (10 % vs. 30 %; P = 0.60). LOS was no different between the 2 groups (28.2 ± 21.2 vs. 23.8 ± 12.5 days; P = 0.26). The 30-day mortality rate in the Hemospray group was 3 times lower than that of in the conventional therapy group but not significant (10 % vs. 30 %, P = 0.7). Conclusions: Hemospray is a promising therapy for initial hemostasis in upper gastrointestinal bleeding from tumor because it can achieve hemostasis during the first 14 days, thus potentially allowing sufficient time before appropriate definitive intervention is considered. PMID:27652296

  3. Detection and localization of lower gastrointestinal bleeding site with scintigraphic techniques

    International Nuclear Information System (INIS)

    Successful management of acute gastrointestinal (GI) bleeding frequently depends on accurate localization of the bleeding site. History and clinical findings are often misleading in localizing the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provides accurate diagnoses for the majority of patients with upper GI tract hemorrhage, but lower GI bleeding still is a serious diagnostic problem. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases, has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding. Since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. Repeated angiography to pursue recurrent episodes of bleeding is impractical. Because of these shortcomings, in the past decade several noninvasive scintigraphic techniques have been developed to detect and localize sites of GI bleeding. In this chapter the authors discuss details related to the technetium 99m sulfur colloid (Tc-SC) and technetium 99m-labeled red blood cell (Tc-RBC) techniques

  4. Dual-source dual-energy CT angiography with virtual non-enhanced images and iodine map for active gastrointestinal bleeding: Image quality, radiation dose and diagnostic performance

    International Nuclear Information System (INIS)

    Highlights: • GIB is a common gastrointestinal emergency with a high mortality rate. • Detection and localization of GIB source are important for imaging modality. • DSDECTA using a dual-phase scan protocol is clinically feasible. • DSDECTA with VNE and iodine map images can diagnose the active GIB source accurately. • DSDECTA can reduce radiation dose compared with conventional CT examination in GIB. - Abstract: Objectives: To evaluate the clinical feasibility of dual-source dual-energy CT angiography (DSDECTA) with virtual non-enhanced images and iodine map for active gastrointestinal bleeding (GIB). Methods: From June 2010 to December 2012, 112 consecutive patients with clinical signs of active GIB underwent DSDECTA with true non-enhanced (TNE), arterial phase with single-source mode, and portal-venous phase with dual-energy mode (100 kVp/230 mAs and Sn 140 kVp/178 mAs). Virtual non-enhanced CT (VNE) image sets and iodine map were reformatted from ‘Liver VNC’ software. The mean CT number, noise, signal to noise ratio (SNR), image quality and radiation dose were compared between TNE and VNE image sets. Two radiologists, blinded to clinical data, interpreted images from DSDECTA with TNE (protocol 1), and DSDECTA with VNE and iodine map (protocol 2) respectively, with discordant interpretation resolved by consensus. The standards of reference included digital subtraction angiography, endoscopy, surgery, or final pathology reports. Receiver–operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated for CT protocols 1 and 2, respectively. Results: There was no significant difference in mean CT numbers of all organs (including liver, pancreas, spleen, kidney, abdominal aorta, and psoas muscle) (P > 0.05). Lower noise and higher SNR were found on VNE images than TNE images (P < 0.05). Image quality of VNE was lower than that of TNE without significant difference (P > 0.05). The active GIB source was identified

  5. Dual-source dual-energy CT angiography with virtual non-enhanced images and iodine map for active gastrointestinal bleeding: Image quality, radiation dose and diagnostic performance

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Hao, E-mail: sunhao_robert@126.com [Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing 100730 (China); Hou, Xin-Yi, E-mail: hxy_pumc@126.com [Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing (China); Xue, Hua-Dan, E-mail: bjdanna95@hotmail.com [Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing 100730 (China); Li, Xiao-Guang, E-mail: xglee88@126.com [Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing 100730 (China); Jin, Zheng-Yu, E-mail: zhengyu_jin@126.com [Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing 100730 (China); Qian, Jia-Ming, E-mail: qjiaming57@gmail.com [Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (China); Yu, Jian-Chun, E-mail: yu-jch@163.com [Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (China); Zhu, Hua-Dong, E-mail: huadongzhu@hotmail.com [Department of Emergency, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (China)

    2015-05-15

    Highlights: • GIB is a common gastrointestinal emergency with a high mortality rate. • Detection and localization of GIB source are important for imaging modality. • DSDECTA using a dual-phase scan protocol is clinically feasible. • DSDECTA with VNE and iodine map images can diagnose the active GIB source accurately. • DSDECTA can reduce radiation dose compared with conventional CT examination in GIB. - Abstract: Objectives: To evaluate the clinical feasibility of dual-source dual-energy CT angiography (DSDECTA) with virtual non-enhanced images and iodine map for active gastrointestinal bleeding (GIB). Methods: From June 2010 to December 2012, 112 consecutive patients with clinical signs of active GIB underwent DSDECTA with true non-enhanced (TNE), arterial phase with single-source mode, and portal-venous phase with dual-energy mode (100 kVp/230 mAs and Sn 140 kVp/178 mAs). Virtual non-enhanced CT (VNE) image sets and iodine map were reformatted from ‘Liver VNC’ software. The mean CT number, noise, signal to noise ratio (SNR), image quality and radiation dose were compared between TNE and VNE image sets. Two radiologists, blinded to clinical data, interpreted images from DSDECTA with TNE (protocol 1), and DSDECTA with VNE and iodine map (protocol 2) respectively, with discordant interpretation resolved by consensus. The standards of reference included digital subtraction angiography, endoscopy, surgery, or final pathology reports. Receiver–operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated for CT protocols 1 and 2, respectively. Results: There was no significant difference in mean CT numbers of all organs (including liver, pancreas, spleen, kidney, abdominal aorta, and psoas muscle) (P > 0.05). Lower noise and higher SNR were found on VNE images than TNE images (P < 0.05). Image quality of VNE was lower than that of TNE without significant difference (P > 0.05). The active GIB source was identified

  6. Role of hemostatic powders in the endoscopic management of gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Marco; Bustamante-Balén; Gema; Plumé

    2014-01-01

    Acute gastrointestinal bleeding(AGIB) is a prevalent condition with significant influence on healthcare costs. Endoscopy is essential for the management of AGIB with a pivotal role in diagnosis, risk stratification and management. Recently, hemostatic powders have been added to our endoscopic armamentarium to treat gastrointestinal(GI) bleeding. These substances are intended to control active bleeding by delivering a powdered product over the bleeding site that forms a solid matrix with a tamponade function. Local activation of platelet aggregation and coagulation cascade may be also boosted. There are currently three powders commercially available: hemostatic agent TC-325(Hemospray), EndoClotTM polysaccharide hemostatic system, and Ankaferd Bloodstopper. Although the available evidence is based on short series of cases and there is no randomized controlled trial yet, these powders seem to be effective in controlling GI bleeding from a variety of origins with a very favorable side effects profile. They can be used either as a primary therapy or a secondline treatment, and they seem to be especially indi-cated in cases of cancer-related bleeding and lesions with difficult access. In this review, we will comment on the mechanism of action, efficacy, safety and technical challenges of the use of powders in several clinical scenarios and we will try to define the main current indications of use and propose new lines of research in this area.

  7. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm.

    Science.gov (United States)

    Vultaggio, Fabrice; Morère, Pierre-Henri; Constantin, Christophe; Christodoulou, Michel; Roulin, Didier

    2016-06-27

    Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment. PMID:27358680

  8. Three infants with rotavirus gastroenteritis complicated by severe gastrointestinal bleeding.

    Science.gov (United States)

    Kawamura, Yoshiki; Miura, Hiroki; Mori, Yuji; Sugata, Ken; Nakajima, Yoichi; Yamamoto, Yasuto; Morooka, Masashi; Tsuge, Ikuya; Yoshikawa, Akiko; Taniguchi, Koki; Yoshikawa, Tetsushi

    2016-01-01

    Rotavirus gastroenteritis causes substantial morbidity and mortality worldwide in children. We report three infants with rotavirus gastroenteritis complicated by various severity of gastrointestinal bleeding. Two patients (cases 1 and 2) recovered completely without any specific treatments. One patient (case 3) died despite extensive treatments including a red blood cell transfusion and endoscopic hemostatic therapy. Rotavirus genotypes G1P[8] and G9P[8] were detected in cases 2 and 3, respectively. Rotavirus antigenemia levels were not high at the onset of melena, suggesting that systemic rotaviral infection does not play an important role in causing melena. PMID:26100228

  9. Inverted meckel's diverticulum as a cause of obscure lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Inverted Meckel's diverticulum is an infrequent cause of gastrointestinal blood loss, especially in adults. A high index of suspicion is needed for this rare entity when entertaining the possible differentials of gastrointestinal bleeding.(author)

  10. The role of capsule endoscopy after negative CT enterography in patients with obscure gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Hyun Mi; Park, Chan Hyuk; Lee, Jin Ha; Kim, Bo Kyung; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho; Hong, Sung Pil [Yonsei University College of Medicine, Department of Internal Medicine and Institute of Gastroenterology, Seoul (Korea, Republic of); Lim, Joon Seok [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea, Republic of)

    2012-06-15

    The aim of the present study was to evaluate the role of capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) after negative computed tomographic (CT) enterography. We retrospectively included 30 patients with OGIB who received capsule endoscopy after negative CT enterography. The median age of the patients was 60 years, and 60% of patients were male. The median follow-up duration was 8 months. Overt bleeding was 60%, and occult bleeding was 40%. Based on capsule endoscopy results, a definitive diagnosis was made for 17 patients (57%): ulcer in nine patients (30%), active bleeding with no identifiable cause in five (17%), angiodysplasia in two (7%) and Dieulafoy's lesion in one (3%). Two patients with jejunal ulcers were diagnosed with Crohn's disease. Seven patients (41%) with positive capsule endoscopy received double balloon enteroscopy and two patients (12%) received steroid treatment for Crohn's disease. Patients with overt bleeding, a previous history of bleeding, or who received large amounts of blood transfusions were more likely to show positive capsule endoscopy. Capsule endoscopy showed high diagnostic yields in patients with OGIB after negative CT enterography and may help to provide further therapeutic plans for patients with OGIB and negative CT enterography. circle CT enterography has been widely used in evaluating obscure gastrointestinal bleeding (OGIB). circle Capsule endoscopy showed high diagnostic yield for OGIB after negative CT enterography. circle Negative CT enterography does not exclude important causes of small bowel bleeding. circle Most lesions missed at CT-enterography are flat and can be detected by capsule endoscopy. (orig.)

  11. Infliximab stopped severe gastrointestinal bleeding in Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Satimai Aniwan; Surasak Eakpongpaisit; Boonlert Imraporn; Surachai Amornsawadwatana; Rungsun Rerknimitr

    2012-01-01

    To report the result of rapid ulcer healing by infliximab in Crohn's patients with severe enterocolic bleeding.During 2005 and 2010,inflammatory bowel disease database of King Chulalongkorn Memorial and Samitivej hospitals were reviewed.There were seven Crohn's disease (CD) patients (4 women and 3 men; mean age 52 ± 10.4 years; range:11-86 years).Two of the seven patients developed severe gastrointestinal bleeding (GIB) as a flare up of CD whereas the other five patients presented with GIB as their first symptom for CD.Their mean hemoglobin level dropped from 12 ± 1.3 g/dL to 8.7 ± 1.3 g/dL in a 3-d period.Median packed red blood cells units needed for resuscitation was 4 units.Because of uncontrolled bleeding,surgical resection was considered.However,due to the poor surgical candidacy of these patients (n =3) and/or possible development of short bowel syndrome (n =6),surgery was not pursued.Likewise angiographic embolization was not considered in any due to the risk of large infarction.All severe GIBs successfully stopped by one or two doses of intravenous infliximab.Our data suggests that infliximab is an alternative therapy for CD with severe GIB when surgery has limitation or patient is a high risk.

  12. Critical gastrointestinal bleed due to secondary aortoenteric fistula.

    Science.gov (United States)

    Malik, Mohammad U; Ucbilek, Enver; Sherwal, Amanpreet S

    2015-01-01

    Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF. PMID:26653698

  13. Critical gastrointestinal bleed due to secondary aortoenteric fistula

    Directory of Open Access Journals (Sweden)

    Mohammad U. Malik

    2015-12-01

    Full Text Available Secondary aortoenteric fistula (SAEF is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A. The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

  14. Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study

    OpenAIRE

    Colin John Crooks; Timothy Richard Card; Joe West

    2013-01-01

    Editors' Summary Background Acute gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of admission to hospital. Upper gastrointestinal bleeding (bleeding derived from a source above the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm) is roughly four times as common as bleeding from the lower gastrointestinal tract and is a major cause of morbidity and mortality. Upper gastrointestinal bleeding is a...

  15. Superselective transarterial embolization for the management of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of); Cho, Chol Kyoon; Kang, Heoung Keun [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2006-03-15

    We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During

  16. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    Energy Technology Data Exchange (ETDEWEB)

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M. (Kuwait Univ. (Kuwait). Dept. of Nuclear Medicine); Al-Wafai, I.; Vallgren, S. (Kuwait Univ. (Kuwait). Dept. of Surgery)

    1989-06-01

    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of {sup 99m}Tc-DTPA, {sup 99m}Tc-RBCs and {sup 99m}Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both {sup 99m}Tc-DTPA and {sup 99m}Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only {sup 99m}Tc-DTPA was successful in detecting the bleeding site. The results indicate that {sup 99m}Tc-DTPA is the most useful {sup 99m}Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.).

  17. PROPOSAL OF A CLINICAL CARE PATHWAY FOR THE MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Matheus Cavalcante FRANCO

    2015-12-01

    Full Text Available Background - Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. Objective - The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. Methods - It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. Results - The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. Conclusion - The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

  18. Spironolactone use and the risk of upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Gulmez, Sinem E; Lassen, Annmarie T; Aalykke, Claus;

    2008-01-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Recent studies have suggested an increased risk of upper gastrointestinal bleeding (UGB) in spironolactone users. * We conducted this population-based case-control study to confirm the association between spironolactone use and acute nonvaricose UGB alone...... risk factors and quantify the absolute risk. METHODS A population based case-control study was conducted in the County of Funen, Denmark. Cases (n = 3652) were all subjects with a first discharge diagnosis of serious UGB during the period 1995 to 2006. Age- and gender-matched controls (10 for each case......) (n = 36 502) were selected by risk set sampling. Data on all subjects' drug exposure and past medical history were retrieved from a prescription database and from the County's patient register. Confounders were controlled by conditional logistic regression. RESULTS The adjusted odds ratio (OR...

  19. Distribution of bleeding gastrointestinal angioectasias in a Western population

    Institute of Scientific and Technical Information of China (English)

    Elizabeth Bollinger; Daniel Raines; Patrick Saitta

    2012-01-01

    AIM:TO define which segments of the gastrointestinal tract are most likely to yield angioectasias for ablative therapy.METHODS:A retrospective chart review was performed for patients treated in the Louisiana State University Health Sciences Center Gastroenterology clinics between the dates of July 1,2007 and October 1,2010.The selection of cases for review was initiated by use of our electronic medical record to identify all patients with a diagnosis of angioectasia,angiodysplasia,or arteriovenous malformation.Of these cases,chart reviews identified patients who had a complete evaluation of their gastrointestinal tract as defined by at least one upper endoscopy,colonoscopy and small bowel capsule endoscopy within the past three years.Patients without evidence of overt gastrointestinal bleeding or iron deficiency anemia associated with intestinal angioectasias were classified as asymptomatic and excluded from this analysis.Thirty-five patients with confirmed,bleeding intestinal angioectasias who had undergone complete endoscopic evaluation of the gastrointestinal tract were included in the final analysis.RESULTS:A total of 127 cases were reviewed.Sixtysix were excluded during subsequent screening due to lack of complete small bowel evaluation and/or lack of documentation of overt bleeding or iron deficiency anemia.The 61 remaining cases were carefully examined with independent review of endoscopic images as well as complete capsule endoscopy videos.This analysis excluded 26 additional cases due to insufficient records/images for review,incomplete capsule examination,poor capsule visualization or lack of confirmation of typical angioectasias by the principal investigator on independent review.Thirty-five cases met criteria for final analysis.All study patients were age 50 years or older and 13 patients (37.1%) had chronic kidney disease stage 3 or higher.Twenty of 35 patients were taking aspirin (81 mg or 325 mg),clopidogrel,and/or warfarin,with 8/20 on combination

  20. [Mid-gastrointestinal bleeding - endoscopy sheds light in the darkness].

    Science.gov (United States)

    May, A

    2014-08-01

    Mid-gastrointestinal bleeding is defined as a bleeding of the small bowel and is the most common indication for small bowel endoscopy. Intraoperative enteroscopy has been regarded as gold standard for a long time. With the introduction of different endoscopy techniques, they play now the central role, whereas intraoperative enteroscopy has become a reserve method for selected patients. Actually, there are, beside capsule endoscopy, five non-surgical, flexible enteroscopy techniques available. In Germany and Europe balloon-assisted enteroscopy (double balloon and single balloon enteroscopy) is mainly used. Double balloon enteroscopy (DBE) is the "oldest" flexible enteroscopy technique and has become established throughout the world for diagnostic and therapeutic examinations of the small bowel. The majority of the studies have been performed with DBE and it provides the highest rate of complete enteroscopy. Nevertheless, technical improvements to make enteroscopy easier and faster are still required. In patients with chronic MGI or problematic situations capsule endoscopy is an ideal screening option. In case of acute MGI the flexible enteroscopy techniques should be preferred because of the high diagnostic yield combined with the possibility of endoscopic therapeutic interventions. In difficult cases with unsuccessful enteroscopy, CT angiography and conventional angiography with the option of embolisation had proved their value.

  1. Gastric Glomus Tumor: A Rare Cause of Upper Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Yoshinori Handa

    2015-01-01

    Full Text Available A 24-year-old woman was referred to our department because of melena. These symptoms combined with severe anemia prompted us to perform an emergency upper endoscopy, which showed bleeding from an ulcerated 30 mm submucosal tumor in the gastric antrum. A computed tomography scan revealed a homogeneously enhanced mass, and endoscopic ultrasonography identified a well-demarcated mass in the third and fourth layers of the gastric wall. Because analysis of the possible medical causes remained inconclusive and the risk of rebleeding, laparoscopy-assisted gastric wedge resection was performed after administration of 10 units of red cell concentrate. Histological and immunohistological analysis revealed the tumor to be a gastric glomus tumor. Gastric submucosal tumors remain challenging to diagnose preoperatively as they show a variety of radiologic and clinicopathologic features and are associated with the risk of bleeding upon biopsy, as is indicated in the guidelines for gastric submucosal tumors. Gastric glomus tumors characteristically present with exsanguinating gastrointestinal hemorrhaging that often requires blood transfusion. Additionally, gastric submucosal tumors typically occur in elderly patients; however, this case involved a young patient who was 24 years old. Here, we describe this case in order to identify features that may aid in early differentiation of gastric submucosal tumors.

  2. Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Dekey Y Lhewa; Lisa L Strate

    2012-01-01

    Acute lower gastrointestinal bleeding (LGIB) is a frequent gastrointestinal cause of hospitalization,particularly in the elderly,and its incidence appears to be on the rise.Endoscopic and radiographic measures are available for the evaluation and treatment of LGIB including flexible sigmoidoscopy,colonoscopy,angiography,radionuclide scintigraphy and multi-detector row computed tomography.Although no modality has emerged as the gold standard in the management of LGIB,colonoscopy is the current preferred initial test for the majority of the patients presenting with hematochezia felt to be from a colon source.Colonoscopy has the ability to diagnose all sources of bleeding from the colon and,unlike the radiologic modalities,does not require active bleeding at the time of the examination.In addition,therapeutic interventions such as cautery and endoclips can be applied to achieve hemostasis and prevent recurrent bleeding.Studies suggest that colonoscopy,particularly when performed early in the hospitalization,can decrease hospital length of stay,rebleeding and the need for surgery.However,results from available small trials are conflicting and larger,multicenter studies are needed.Compared to other management options,colonoscopy is a safe procedure with complications reported in less than 2% of patients,including those undergoing urgent examinations.The requirement of bowel preparation (typically 4 or more liters of polyethylene glycol),the logistical complexity of coordinating after-hours colonoscopy,and the low prevalence of stigmata of hemorrhage complicate the use of colonoscopy for LGIB,particularly in urgent situations.This review discusses the above advantages and disadvantages of colonoscopy in the management of acute lower gastrointestinal bleeding in further detail.

  3. Upper non-variceal gastrointestinal bleeding-review the effectiveness of endoscopic hemostasis methods

    Institute of Scientific and Technical Information of China (English)

    Miros?aw; Szura; Artur; Pasternak

    2015-01-01

    Upper non-variceal gastrointestinal bleeding is a conditionthat requires immediate medical intervention and has a high associated mortality rate(exceeding 10%). The vast majority of upper gastrointestinal bleeding cases are due to peptic ulcers. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and aspirin are the main risk factors for peptic ulcer disease. Endoscopic therapy has generally been recommended as the firstline treatment for upper gastrointestinal bleeding as it has been shown to reduce recurrent bleeding, the need for surgery and mortality. Early endoscopy(within 24 h of hospital admission) has a greater impact than delayed endoscopy on the length of hospital stay and requirement for blood transfusion. This paper aims to review and compare the efficacy of the types of endoscopic hemostasis most commonly used to control non-variceal gastrointestinal bleeding by pooling data from the literature.

  4. Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Jaeckle, T.; Stuber, G.; Hoffmann, M.H.K.; Jeltsch, M.; Schmitz, B.L.; Aschoff, A.J. [University Hospital of Ulm, Diagnostic and Interventional Radiology, Ulm (Germany)

    2008-07-15

    The purpose of this study was to evaluate the accuracy of multi-detector row helical CT (MDCT) for detection and localization of acute upper and lower gastrointestinal (GI) hemorrhage or intraperitoneal bleeding. Thirty-six consecutive patients with clinical signs of acute bleeding underwent biphasic (16- or 40-channel) MDCT. MDCT findings were correlated with endoscopy, angiography or surgery. Among the 36 patients evaluated, 26 were examined for GI bleeding and 10 for intraperitoneal hemorrhage. Confirmed sites of GI bleeding were the stomach (n = 5), duodenum (n = 5), small bowel (n = 6), large bowel (n = 8) and rectum (n = 2). The correct site of bleeding was identifiable on MDCT in 24/26 patients with GI bleeding. In 20 of these 24 patients, active CM extravasation was apparent during the exam. Among the ten patients with intraperitoneal hemorrhage, MDCT correctly identified the bleeding source in nine patients. Our findings suggest that fast and accurate localization of acute gastrointestinal and intraperitoneal bleeding is achievable on MDCT. (orig.)

  5. Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the accuracy of multi-detector row helical CT (MDCT) for detection and localization of acute upper and lower gastrointestinal (GI) hemorrhage or intraperitoneal bleeding. Thirty-six consecutive patients with clinical signs of acute bleeding underwent biphasic (16- or 40-channel) MDCT. MDCT findings were correlated with endoscopy, angiography or surgery. Among the 36 patients evaluated, 26 were examined for GI bleeding and 10 for intraperitoneal hemorrhage. Confirmed sites of GI bleeding were the stomach (n = 5), duodenum (n = 5), small bowel (n = 6), large bowel (n = 8) and rectum (n = 2). The correct site of bleeding was identifiable on MDCT in 24/26 patients with GI bleeding. In 20 of these 24 patients, active CM extravasation was apparent during the exam. Among the ten patients with intraperitoneal hemorrhage, MDCT correctly identified the bleeding source in nine patients. Our findings suggest that fast and accurate localization of acute gastrointestinal and intraperitoneal bleeding is achievable on MDCT. (orig.)

  6. Upper gastrointestinal bleeding risk scores: Who, when andwhy?

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Upper gastrointestinal bleeding (UGIB) remains a significant cause of hospital admission. In order tostratify patients according to the risk of the complications,such as rebleeding or death, and to predict theneed of clinical intervention, several risk scores havebeen proposed and their use consistently recommendedby international guidelines. The use of risk scoringsystems in early assessment of patients suffering fromUGIB may be useful to distinguish high-risks patients,who may need clinical intervention and hospitalization,from low risk patients with a lower chance of developingcomplications, in which management as outpatientscan be considered. Although several scores havebeen published and validated for predicting differentoutcomes, the most frequently cited ones are the Rockallscore and the Glasgow Blatchford score (GBS). WhileRockall score, which incorporates clinical and endoscopicvariables, has been validated to predict mortality,the GBS, which is based on clinical and laboratorialparameters, has been studied to predict the need ofclinical intervention. Despite the advantages previouslyreported, their use in clinical decisions is still limited. Thisreview describes the different risk scores used in theUGIB setting, highlights the most important research,explains why and when their use may be helpful, reflectson the problems that remain unresolved and guidesfuture research with practical impact.

  7. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review

    DEFF Research Database (Denmark)

    Chavez-Tapia, N C; Barrientos-Gutierrez, T; Tellez-Avila, F;

    2011-01-01

    Antibiotic prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention....

  8. Occult gastrointestinal bleeding due to a Dieulafoy lesion in the terminal ileum

    NARCIS (Netherlands)

    Wegdam, J.A.; Hofker, H.S.; Dijkstra, G; Stolk, M.F.; Jacobs, M.A.; Suurmeijer, A.J.H.

    2006-01-01

    A 50-year-old man awaiting liver transplantation for primary sclerosing cholangitis developed iron-deficiency anaemia. Repeated occult gastrointestinal bleeding led to an increasing need for blood transfusions. After multiple oesophagogastroduodenoscopies and colonoscopies, videocapsule endoscopy fi

  9. [Historical schedule of management of bleeding from the upper part of gastrointestinal tract].

    Science.gov (United States)

    Wójtowicz, Jacek; Wojtuń, Stanisław; Gil, Jerzy

    2009-05-01

    Treatment of bleeding from the upper part of gastrointestinal tract were changed many times. First there were waiting (Hipocrates, Sydenham, Stahl), next transfusion of the blood were initiated (Denis, Blundell, Dieffenbach, Bierkowski, Dungren, Hirszfeld). Big (Rydygier) and small (Dragstedt) operations procedures were attempted. Discovery of endoscopy of gastrointestinal tract (Mikulicz) and initiation of elastic scopes (Hirschowitz) and exploration inhibitor of histamine receptors (H2) and proton pump inhibitors with recognition of role Helicobacter pylori in bleeding were permitted elaborate actual schemas of proceedings.

  10. Endoscopic treatment of non-variceal gastrointestinal bleeding: hemoclips and other hemostatic techniques

    Institute of Scientific and Technical Information of China (English)

    Rossana M. Moura; Jamie S. Barkin

    2000-01-01

    @@ Although the number of hospitalizations for nonvariccal gastrointestinal bleeding has decreased in recent years, acute upper gastrointestinal hemorrhage continues to be a common reason for hospital admission, and peptic ulcers account for at least fifty percent of all cases. Despite the fact that bleeding from ulcers ceases spontaneously in approximately 80% of patients, it is still a diagnosis associated with substantial medical costs and significant morbidity and mortality, the latter ranging between 8 and 14%[1], especially in the elderly.

  11. Gastrointestinal bleeding and iron absorption in the experimental blind loop syndrome.

    Science.gov (United States)

    Giannella, R A; Toskes, P P

    1976-07-01

    Rats with surgically created self-filling jejunal blind loops and the blind loop syndrome manifested gastrointestinal bleeding and hyperabsorption of iron. Although the mean hematocrit and serum iron levels of rats with self-filling blind loops became overtly anemic and manifested low-serum iron levels. It is suggested that the documented gastrointestinal bleeding in these rats with the experimental blind loop syndrome is another manifestation of damage to the intestinal epithelium in conditions of small intestinal bacterial overgrowth.

  12. Diagnostic and Therapeutic Endoscopic Approaches to Upper Gastrointestinal System Bleeding in Children

    Directory of Open Access Journals (Sweden)

    Fatih Aygün

    2012-04-01

    Full Text Available In­tro­duc­ti­on: Upper gastrointestinal system bleeding in children is always very important problems requiring further investigation. The aim of the study was to investigate retrospectively the etiologies of upper gastrointestinal bleeding, the therapeutic endoscopic approach to the bleeding, and the efficacy of the endoscopy in the treatment of pediatric age group. Materials and Methods: In this study, 139 (F/M: 63/76 cases diagnosed as upper gastrointestinal bleeding and followed up by the Department of Pediatric Gastroenterology were classified into groups according to the age, etiology, the presence of varicose veins, and history of drug ingestion. In addition bleedings caused by peptic ulcer disease were classified according to Forrest classification. Values of p0.68. Discussion: Endoscopic procedure is very useful in both the determination of etiology of upper gastrointestinal bleeding and the treatment of upper gastrointestinal bleeding in childhood. (Jo­ur­nal of Cur­rent Pe­di­at­rics 2012; 10: 1-7

  13. Massive lower gastrointestinal bleeding after low anterior resection for middle rectal cancer -case report

    Institute of Scientific and Technical Information of China (English)

    Mircea Beuran; Ionut Negoi; Sorin Paun; Valentina Negoita; Bogdan Stoica; Ioan Tanase; Mihaela Vartic; Ruxandra Irina Negoi; Sorin Hostiuc

    2015-01-01

    Objective:To emphasize the value of emergency diagnostic angiography and angioembolization in massive postoperative bleeding. Methods:A case report was presented and electronic search of U.S. National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Results: A 55 year-old male patient was addmited for rectal bleeding. ECOG index=2, digital rectal examination revealed the inferior pole of a middle rectal tumor. Colonoscopy exam validated the presence of a middle rectal tumor, 8 cm from the anal verge. CT scan showed rectal wall thickening up to 3 cm, that extends 9 cm proximally, whit infiltration of the perirectal fatty tissue and multiple enlarged lymph nodes up to 12 mm in dimension. There was a laparoscopic converted to open approach, with low anterior resection of the rectum and total mesorectal excision, an end to end stapled colorectal anastomosis and protective loop ileostomy. In the 5th postoperative day a massive lower gastrointestinal bleeding occured, with hypovolemic shock and a decrease in hemoglobin. Emergency angiography was performed. This revealed active bleeding from an internal iliac branch that was successfully angioembolized. Conclusions: Angiography with angioembolization is an effective tool in emergency setting, avoiding the morbidity and associated mortality of a surgical reinervention. In early postoperative hemorrhages, only a rapid clinical recognition, a personalized diagnostic workup and an agressive intervention may offer the patient the best chances for cure.

  14. Chronic portomesenteic venous thrombosis complicated by a high flow arteriovenous malformation presenting with gastrointestinal bleeding.

    Science.gov (United States)

    Plotnik, Adam N; Hebroni, Frank; McWilliams, Justin

    2016-02-01

    Portomesenteric venous thrombosis is a rare but potentially life-threatening condition. The presenting symptoms of chronic portomesenteric venous thrombosis are often non-specific but may present with variceal bleeding. We present the first reported case of chronic portomesenteric venous thrombosis causing a high flow arteriovenous malformation that resulted in extensive gastrointestinal bleeding. PMID:25871943

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

    NARCIS (Netherlands)

    I.L. Holster (Ingrid); E.J. Kuipers (Ernst)

    2012-01-01

    textabstractAcute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endosco

  16. Prevalence and risk factors of stress-induced gastrointestinal bleeding in critically ill children

    Institute of Scientific and Technical Information of China (English)

    Chookhuan Nithiwathanapong; Sanit Reungrongrat; Nuthapong Ukarapol

    2005-01-01

    AIM: To assess the frequency and the risk factors of stress-induced gastrointestinal (GI) bleeding in children admitted to a pediatric intensive care unit (PICU).METHODS: The medical records of children aged between 1 month and 15 years admitted to the PICU between January 2002 and December 2002 were reviewed.Demographic data, indications for PICU admission, principle diagnosis, and basic laboratory investigations were recorded. Previously described factors for stress ulcer bleeding (mechanical ventilation, sepsis, acute respiratory distress syndrome, renal insufficiency, coagulopathy,thrombocytopenia, and intracranial pathology) were used as independent variables in a multivariate analysis.RESULTS: One hundred and seventy of two hundred and five medical records were eligible for review. The most common indication for PICU admission was respiratory failure (48.8%). Twenty-five children received stress ulcer bleeding prophylaxis with ranitidine. The incidence of stress ulcer bleeding was 43.5%, in which 5.3% were clinically significant bleeding. Only mechanical ventilation and thrombocytopenia were significantly associated with stress ulcer bleeding using the univariate analysis.The odds ratio and 95% confidence intervals were 5.13(1.86-14.12) and 2.26 (1.07-4.74), respectively. However, the logistic regression analysis showed that mechanicai ventilation was the only significant risk factor with the odds ratio of 14.1.CONCLUSION: The incidence of gastrointestinal bleeding was high in critically ill children. Mechanical ventilation was an important risk factor for gastrointestinal bleeding.

  17. Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hyoung; Shin, Ji Hoon; Yoon, Hyun Ki; Chae, Eun Young; Myung, Seung Jae; Ko, Gi Young; Gwon, Dong Il; Sung, Kyu Bo [Asan Medical Center, Seoul (Korea, Republic of)

    2009-08-15

    To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 {+-} 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.

  18. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

    2016-05-01

    Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. PMID:26900095

  19. Acute upper gastrointestinal bleeding in patients with AIDS: a relatively uncommon condition associated with reduced survival.

    Science.gov (United States)

    Parente, F; Cernuschi, M; Valsecchi, L; Rizzardini, G; Musicco, M; Lazzarin, A; Bianchi Porro, G

    1991-01-01

    To determine the cumulative incidence of acute upper gastrointestinal bleeding and its effect upon survival in patients with AIDS, 453 consecutive AIDS patients diagnosed in our hospital between June 1985 and March 1989 were followed for a median period of six months (maximum 42 months). The cumulative probability of acute gastrointestinal bleeding was 3% at six months and 6% at 14 months. This event was associated with significantly reduced survival. Independent risk factors for bleeding were: severe thrombocytopenia at the time of diagnosis and non-Hodgkin's lymphoma as the first clinical manifestation of AIDS. The potential causes of bleeding were investigated in all cases by emergency endoscopy or by necropsy examination in those patients whose clinical condition precluded the procedure. In nine of 15 patients, bleeding was due to lesions specifically associated with AIDS, but in the remainder the source of bleeding was not a direct consequence of HIV infection. We conclude that acute upper gastrointestinal bleeding rarely complicates the course of AIDS, but its occurrence is associated with decreased survival. As many of the causes are potentially treatable, a complete diagnostic approach is indicated in these patients, except those who are terminally ill. PMID:1916503

  20. Diffuse gastrointestinal bleeding and BK polyomavirus replication in a pediatric allogeneic haematopoietic stem cell transplant patient.

    Science.gov (United States)

    Koskenvuo, M; Lautenschlager, I; Kardas, P; Auvinen, E; Mannonen, L; Huttunen, P; Taskinen, M; Vettenranta, K; Hirsch, H H

    2015-01-01

    Patients undergoing haematopoietic stem cell transplantation (HSCT) are at high risk of severe gastrointestinal bleeding caused by infections, graft versus host disease, and disturbances in haemostasis. BK polyomavirus (BKPyV) is known to cause hemorrhagic cystitis, but there is also evidence of BKV shedding in stool and its association with gastrointestinal disease. We report putative association of BKPyV replication with high plasma viral loads in a pediatric HSCT patient developing hemorrhagic cystitis and severe gastrointestinal bleeding necessitating intensive care. The observation was based on chart review and analysis of BKPyV DNA loads in plasma and urine as well as retrospective BKPyV-specific IgM and IgG measurements in weekly samples until three months post-transplant. The gastrointestinal bleeding was observed after a >100-fold increase in the plasma BKPyV loads and the start of hemorrhagic cystitis. The BKPyV-specific antibody response indicated past infection prior to transplantation, but increasing IgG titers were seen following BKPyV replication. The gastrointestinal biopsies were taken at a late stage of the episode and were no longer informative of BK polyomavirus involvement. In conclusion, gastrointestinal complications with bleeding are a significant problem after allogeneic HSCT to which viral infections including BKPyV may contribute. PMID:25542476

  1. Capsule endoscopy and push enteroscopy in the diagnosis of obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    戈之铮; 胡运彪; 萧树东

    2004-01-01

    Background In obscure gastrointestinal (GI) bleeding, it is often difficult to detect the bleeding sites located in the small bowel with conventional radiological, scintigraphic or angiographic techniques. Push enteroscopy and capsule endoscopy are currently considered to be the most effective diagnostic procedures. The aim of this study was to compare the detection rates between capsule endoscopy and push enteroscopy. Methods From May 2002 through January 2003, we prospectively examined by capsule endoscopy 39 patients with suspected small bowel diseases, in particular GI bleeding of unknown origin in Renji Hospital. Among them, 32 complained of obscure recurrent GI bleeding. Between January 1993 and October 1996, we used push enteroscopy on 36 patients who suffered from unexplained GI bleeding. All patients had prior normal results on gastroscopy, colonoscopy, small bowel barium radiography, scintigraphy and/or angiography. Results M2A capsule endoscopy disclosed abnormal small bowel findings in 26 (82%) out of 32 patients. Twenty-one of them had significant pathological findings explaining their clinical disorders. Diagnostic yield was therefore 66% (21 of 32 patients). Definite bleeding sites diagnosed by capsule endoscopy in 21 patients included angiodysplasia (8), inflammatory small-bowel (5), small-bowel polyps (4), gastrointestinal stromal tumour (2), carcinoid tumour and lipoma (1), and hemorrhagic gastritis (1). Push enteroscopy detected the definite sources of bleeding in 9 (25%) of the 36 patients. Patients with definite bleeding sources included angiodysplasias (2), leiomyosarcoma (2), leiomyoma (1), lymphoma (1), Crohn's disease (1), small-bowel polyps (1) and adenocarcinoma of ampulla (1). Suspected bleeding sources were shown by push enteroscopy in two additional patients (6%), and in other five patients (16%) by capsule endoscopy.Conclusions The present study of patients with obscure GI bleeding showed that capsule endoscopy significantly superior

  2. Gastrointestinal bleeding from Dieulafoy's lesion: Clinicalpresentation, endoscopic findings, and endoscopic therapy

    Institute of Scientific and Technical Information of China (English)

    Borko Nojkov; Mitchell S Cappell

    2015-01-01

    Although relatively uncommon, Dieulafoy's lesion is animportant cause of acute gastrointestinal bleeding dueto the frequent difficulty in its diagnosis; its tendency tocause severe, life-threatening, recurrent gastrointestinalbleeding; and its amenability to life-saving endoscopictherapy. Unlike normal vessels of the gastrointestinaltract which become progressively smaller in caliberperipherally, Dieulafoy's lesions maintain a large caliberdespite their peripheral, submucosal, location withingastrointestinal wall. Dieulafoy's lesions typicallypresent with severe, active, gastrointestinal bleeding,without prior symptoms; often cause hemodynamicinstability and often require transfusion of multipleunits of packed erythrocytes. About 75% of lesionsare located in the stomach, with a marked proclivity oflesions within 6 cm of the gastroesophageal junctionalong the gastric lesser curve, but lesions can alsooccur in the duodenum and esophagus. Lesions inthe jejunoileum or colorectum have been increasinglyreported. Endoscopy is the first diagnostic test, but hasonly a 70% diagnostic yield because the lesions arefrequently small and inconspicuous. Lesions typicallyappear at endoscopy as pigmented protuberances fromexposed vessel stumps, with minimal surrounding erosionand no ulceration (visible vessel sans ulcer). Endoscopictherapy, including clips, sclerotherapy, argon plasmacoagulation, thermocoagulation, or electrocoagulation,is the recommended initial therapy, with primary hemostasisachieved in nearly 90% of cases. Dual endoscopictherapy of epinephrine injection followed by ablative ormechanical therapy appears to be effective. Althoughbanding is reportedly highly successful, it entails asmall risk of gastrointestinal perforation from bandingdeep mural tissue. Therapeutic alternatives after failedendoscopic therapy include repeat endoscopic therapy,angiography, or surgical wedge resection. The mortalityhas declined from about 30% during the 1970's to9

  3. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Lip, Gregory Y H; Olesen, Jonas B;

    2015-01-01

    -2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge...... gastrointestinal bleeding. 27.1% (n=924) of patients did not resume antithrombotic treatment. Compared with non-resumption of treatment, a reduced risk of all cause mortality was found in association with restart of oral anticoagulation (hazard ratio 0.39, 95% confidence interval 0.34 to 0.46), an antiplatelet...... patients who restarted an antithrombotic treatment regimen and those who did not resume treatment. WHAT THIS STUDY ADDS: Among patients with atrial fibrillation who experience gastrointestinal bleeding while receiving antithrombotic treatment; subsequent restart of oral anticoagulation alone was associated...

  4. A rare cause of anemia due to upper gastrointestinal bleeding: Cameron lesion

    Directory of Open Access Journals (Sweden)

    Ismet Özaydın

    2014-01-01

    Full Text Available Asymptomatic large hiatal hernias may lead to iron deficiency anemia due to occult and massive bleeding from linear gastric erosions or ulcers on the mucosal folds at the level of the diaphragm called the Cameron lesions. The diagnosis is usually made during upper gastrointestinal system endoscopies. Current therapy includes the medication with proton pump inhibitors in combination with oral iron supplements and in some cases surgical reconstruction of hiatal hernia with fundoplication. We present a case of a 78-year-old woman who was admitted to the outpatient clinic with the diagnosis of iron deficiency anemia without signs of acute gastrointestinal bleeding. She was treated with medication and her follow-up gastroscopy showed a total cure. She is asymptomatic for two years after treatment with proton pump inhibitors and iron supplements. Cameron lesions should be kept in mind as an unusual cause of iron deficiency anemia due to gastrointestinal bleeding

  5. Eosinophilic gastroenteritis with refractory ulcer disease and gastrointestinal bleeding as a rare manifestation of seronegative gastrointestinal food allergy.

    Science.gov (United States)

    Raithel, Martin; Hahn, Markus; Donhuijsen, Konrad; Hagel, Alexander F; Nägel, Andreas; Rieker, Ralf J; Neurath, Markus F; Reinshagen, Max

    2014-09-17

    Gastrointestinal bleeding and iron deficiency anaemia may cause severe symptoms and may require extensive diagnostics and substantial amounts of health resources.This case report focuses on the clinical presentation of a 22 year old patient with recurrent gastrointestinal bleeding from multilocular non-healing ulcers of the stomach, duodenum and jejunum over a period of four years. Extensive gastroenterological and allergological standard diagnostic procedures showed benign ulcerative lesions with tissue eosinophilia, but no conclusive diagnosis. Multiple diagnostic procedures were performed, until finally, endoscopically guided segmental gut lavage identified locally produced, intestinal IgE antibodies by fluoro-enzyme-immunoassay.IgE antibody concentrations at the intestinal level were found to be more-fold increased for total IgE and food-specific IgE against nuts, rye flour, wheat flour, pork, beef and egg yolk compared with healthy controls.Thus, a diet eliminating these allergens was introduced along with antihistamines and administration of a hypoallergenic formula, which resulted in complete healing of the multilocular ulcers with resolution of gastrointestinal bleeding. All gastrointestinal lesions disappeared and total serum IgE levels dropped to normal within 9 months. The patient has been in remission now for more than two years.Eosinophilic gastroenteritis (EG) is well known to induce refractory ulcer disease. In this case, the mechanisms for intestinal damage and gastrointestinal bleeding were identified as local gastrointestinal type I allergy. Therefore, future diagnostics in EG should also be focused on the intestinal level as identification of causative food-specific IgE antibodies proved to be effective to induce remission in this patient.

  6. Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Hoi-Poh; Tee; Arthur; J; Kaffes

    2010-01-01

    AIM:To report the incidence of non-small-bowel bleeding pathologies encountered during double-balloon enteroscopy (DBE) procedures and to analyse their significance.METHODS: A retrospective study of a prospective DBE database conducted in a tertiary-referral center was conducted. A total of 179 patients with obscure gastrointestinal bleeding (OGIB) referred for DBE from June 2004 to November 2008 were analysed looking for the incidence of non-small-bowel lesions (NSBLs; all and newly diagnosed) encountered ...

  7. Antidepressant-warfarin interaction and associated gastrointestinal bleeding risk in a case-control study.

    Directory of Open Access Journals (Sweden)

    Hedi Schelleman

    Full Text Available BACKGROUND: Bleeding is the most common and worrisome adverse effect of warfarin therapy. One of the factors that might increase bleeding risk is initiation of interacting drugs that potentiate warfarin. We sought to evaluate whether initiation of an antidepressant increases the risk of hospitalization for gastrointestinal bleeding in warfarin users. METHODOLOGY/PRINCIPAL FINDINGS: Medicaid claims data (1999-2005 were used to perform an observational case-control study nested within person-time exposed to warfarin in those ≥18 years. In total, 430,455 warfarin users contributed 407,370 person-years of warfarin use. The incidence rate of hospitalization for GI bleeding among warfarin users was 4.48 per 100 person-years (95% CI, 4.42-4.55. Each gastrointestinal bleeding cases was matched to 50 controls based on index date and state. Warfarin users had an increased odds ratio of gastrointestinal bleeding upon initiation of citalopram (OR = 1.73 [95% CI, 1.25-2.38], fluoxetine (OR = 1.63 [95% CI, 1.11-2.38], paroxetine (OR = 1.64 [95% CI, 1.27-2.12], amitriptyline (OR = 1.47 [95% CI, 1.02-2.11]. Also mirtazapine, which is not believed to interact with warfarin, increased the risk of GI bleeding (OR = 1.75 [95% CI, 1.30-2.35]. CONCLUSIONS/SIGNIFICANCE: Warfarin users who initiated citalopram, fluoxetine, paroxetine, amitriptyline, or mirtazapine had an increased risk of hospitalization for gastrointestinal bleeding. However, the elevated risk with mirtazapine suggests that a drug-drug interaction may not have been responsible for all of the observed increased risk.

  8. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding:A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM: To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. METHODS: The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springerlink and Scopus, from January 1995 to December 2009, were searched for studies evaluating the accuracy of CT angiography in diagnosing acute GI bleeding. Studies were included if the ycompared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in ...

  9. A prospective study of aspirin use and the risk of gastrointestinal bleeding in men.

    Directory of Open Access Journals (Sweden)

    Edward S Huang

    Full Text Available Data regarding the influence of dose and duration of aspirin use on risk of gastrointestinal bleeding are conflicting.We conducted a prospective cohort study of 32,989 men enrolled in the Health Professionals Follow-up Study (HPFS in 1994 who provided biennial aspirin data. We estimated relative risk of major gastrointestinal bleeding requiring hospitalization or a blood transfusion.During 14 years of follow-up, 707 men reported an episode of major gastrointestinal bleeding over 377,231 person-years. After adjusting for risk factors, regular aspirin use (≥2 times/week had a multivariate relative risk (RR of gastrointestinal bleeding of 1.32 (95% confidence interval [CI], 1.12-1.55 compared to non-regular use. The association was particularly evident for upper gastrointestinal bleeding (multivariate RR, 1.49; 95% CI, 1.16-1.92. Compared to men who denied any aspirin use, multivariate RRs of upper gastrointestinal bleeding were 1.05 (95% CI 0.71-1.52 for men who used 0.5-1.5 standard tablets/week, 1.31 (95% CI 0.88-1.95 for 2-5 aspirin/week, 1.63 (95% CI, 1.15-2.32 for 6-14 aspirin/week and 2.40 (95% CI, 1.10-5.22 for >14 aspirin/week (P(trend<0.001. The relative risk also appeared to be dose-dependent among short-term users <5 years; P(trend<.001 and long-term users (≥5 years; P(trend = 0.015. In contrast, after controlling for dose, increasing duration of use did not appear to be associated with risk (P(trend = 0.749.Regular aspirin use increases the risk of gastrointestinal bleeding, especially from the upper tract. However, risk of bleeding appears to be more strongly related to dose than to duration of use. Risk of bleeding should be minimized by using the lowest effective dose among short-term and long-term aspirin users.

  10. Arteriovenous malformation of the mandible presented as massive upper gastrointestinal bleeding: report of one case.

    Science.gov (United States)

    Su, Kuan-Wen; Peng, Yen-Shih; Wu, Yu-Nian; Tsai, Ya-Huei; Lee, Hung-Chang

    2006-01-01

    Arteriovenous malformation is an uncommon cause of upper gastrointestinal bleeding in children. It should be taken into consideration when a child has upper gastrointestinal bleeding because without proper management, it might be fatal. We report a 10-year-old boy whose initial presentation was massive hematemesis and impending shock. After angiography, arteriovenous malformation (AVM) of the mandible was found and treated with embolization. This 10-year-old boy also had chicken pox during admission. Case reports regarding AVM of dental arches in literature are reviewed and the proposed managements are summarized. Embolization combined with surgical excision might be the optimal way to manage AVM of dental arches. PMID:17180789

  11. Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy's lesion

    Institute of Scientific and Technical Information of China (English)

    Yuliana Jamanca-Poma; Antonio Velasco-Guardado; Concepción Pi(n)ero-Pérez; Renzo Calderón-Begazo; Josue Uma(n)a-Mejía; Fernando Geijo-Martínez; Antonio Rodríguez-Pérez

    2012-01-01

    AIM:To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding.METHODS:Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy's lesion (DL) from 2005 to 2011.We analyzed the demographic characteristics of the patients,risk factors for gastrointestinal bleeding,endoscopic findings,characteristics of the endoscopic treatment,and the recurrence of bleeding.We included cases in which endoscopy described a lesion compatible with Dieulafoy.We excluded patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures.RESULTS:Twenty-nine patients with DL were identified.Most of them were men with an average age of 71.5 years.Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy.The most common location for DL was the stomach (51.7%).The main type of bleeding was oozing in 65.5% of cases.In 27.6% of cases,there was arterial (spurting) bleeding,and 6.9% of the patients presented with an adherent clot.A single endoscopic treatment was applied to nine patients (31%); eight of them with adrenaline and one with argon,while 69% of the patients received combined treatment.Six patients (20.7%)presented with recurrent bleeding at a median of 4 d after endoscopy (interquartile range =97.75).Within these six patients,the new endoscopic treatment obtained a therapeutic success of 100%.The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding (50% vs 33.3% for other type of bleeding) [P =0.024,odds ratio (OR) =8.5,95% CI =1.13-63.87].The use of combined endoscopic treatment prevented the recurrence of bleeding (10% vs 44.4% of single treatment) (P =0.034,OR =0.14,95% CI =0.19-0.99).CONCLUSION:Endoscopic treatment of DL is safe and effective.Adrenaline monotherapy and arterial (spurting) bleeding are associated with a

  12. Abnormal gastrointestinal accumulation of radiotracer by gastric bleeding during {sup 99m}Tc-MDP bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Kyung A.; Lee, Sang Woo; Lee, Jae Tae; Lee, Kyu Bo [College of Medicine, Kyungpook National Univ., Taegu (Korea, Republic of)

    1998-06-01

    We present a case in which a patient with acute hemorrhagic gastritis demonstrated abnormal gastrointestinal accumulation of radiotracer during {sup 99m}Tc-methylene diphosphonate (MDP) skeletal scintigraphy. A hemorrhagic gastritis was subsequently demonstrated by endoscopy. The mechanism for the intestinal localization of {sup 99m}Tc-MDP in this patients is not clear, but we guess that the extravasated blood containing the radiopharmaceutical cannot recirculate and stays at the bleeding site, so we can see the intestinal activity.

  13. Technetium sulfur colloid scintigraphy in the detection of lower gastrointestinal tract bleeding

    International Nuclear Information System (INIS)

    /sup 99m/Tc sulfur colloid scintigraphy is a technique which can be used to localize sites of lower gastrointestinal hemorrhage. Two reports of patients illustrate its use clinically. This procedure is non-invasive, relatively inexpensive, easily performed and has a high degree of sensitivity. The technique may, in some instances, replace angiography or endoscopy as the initial procedure used to diagnose the site of lower gastrointestinal bleeding or, more likely, serve as a complementary diagnostic modality

  14. Use of the Enteroscope for Colo-Ileoscopy: Low Yield in Unexplained Lower Gastrointestinal Bleeding

    OpenAIRE

    Belaiche, Jacques; Van Kemseke, Catherine; Louis, Edouard

    1999-01-01

    BACKGROUND AND STUDY AIMS: The small intestine is a potential origin of bleeding in patients with unexplained gastrointestinal tract hemorrhage or iron-deficiency anemia. Most reports on the investigation of these patients describe the use of upper tract enteroscopy. The diagnostic yield of combined upper and lower enteroscopy has not been widely assessed and remains to be clarified. The aim of this study was to assess the benefit of lower gastrointestinal tract enteroscopy in occult digestiv...

  15. Klippel-Trenaunay syndrome with gastrointestinal bleeding,splenic hemangiomas and left inferior vena cava

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Klippel-Trenaunay syndrome is a congenital vascular anomaly characterized by a triad of varicose veins,cutaneous capillary malformation,and hypertrophy of bone and(or)soft tissue.Gastrointestinal vascular malformations in Klippel-Trenaunay syndrome may present with gastrointestinal bleeding.The majority of patients with spleenic hemangiomatosis and/or left inferior vena cava are asymptomatic.We herein report a case admitted to the gastroenterology clinic with life-threatening hematochezia and symptomatic ir...

  16. Primary evaluation of 99mTc-RBC imaging for the diagnosis of lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    99mTc-RBC gastrointestinal (GI) scintigraphy was performed in 10 patients with lower GI bleeding which was confirmed by operation later. The results suggested that 99mTc-RBC imaging was an effective method for the diagnosis of intestinal hemorrhage, especially the small intestine. However, there was some difficulty in accurately localizing the bleeding site due to the movement of the blood containing labelled RBC from original bleeding site to lower portion during intestinal peristalsis and also displacement of the moving colon. Therefore it is necessary to completely explore the intestine carefully and awareness of the possibility of biliary hemorrhage

  17. Crohn's disease and massive lower gastrointestinal bleeding: angiographic appearance and two case reports

    International Nuclear Information System (INIS)

    Massive lower gastrointestinal bleeding is described in two patients with Crohn's disease. In case 1, extravasation of contrast material from the ileal branch of the ileocolic artery was seen during selective angiography. In case 2, results of an in vitro labeled 99Tc pyrophosphate red blood cell scan localized bleeding to the ileum. In both cases, medical management was unsuccessful, and surgical resection of the affected bowel was required to stop the bleeding. Angiographic appearance of Crohn's disease is discussed, and a review of the literature of this unusual feature of Crohn's disease is presented. 16 references

  18. Recurrent Obscure Gastrointestinal Bleeding: Dilemmas and Success with Pharmacological Therapies. Case Series and Review

    Directory of Open Access Journals (Sweden)

    Majid Almadi

    2009-01-01

    Full Text Available The present article describes three difficult cases of recurrent bleeding from obscure causes, followed by a review of the pitfalls and pharmacological management of obscure gastrointestinal bleeding. All three patients underwent multiple investigations. An intervening complicating diagnosis or antiplatelet drugs may have compounded long-term bleeding in two of the cases. A bleeding angiodysplasia was confirmed in one case but was aggravated by the need for anticoagulation. After multiple transfusions and several attempts at endoscopic management in some cases, long-acting octreotide was associated with decreased transfusion requirements and increased hemoglobin levels in all three cases, although other factors may have contributed in some. In the third case, however, the addition of low-dose thalidomide stopped bleeding for a period of at least 23 months.

  19. Lower gastrointestinal bleeding secondary to a rectal leiomyoma

    Institute of Scientific and Technical Information of China (English)

    Giovanni D De Palma; Maria Rega; Stefania Masone; Saverio Siciliano; Marcello Persico; Francesca Salvatori; Francesco Maione; Dario Esposito; Antonio Bellino; Giovanni Persico

    2009-01-01

    The occurrence of leiomyoma of the rectum is uncommon. Most of these lesions are clinically silent and are found incidentally during laparotomy or endoscopic procedures for unrelated conditions. Symptomatic leiomyomas of the rectum are encountered less frequently, with only sporadic reports in the literature. We describe a case of a leiomyoma of the rectum presenting as recurrent lower gastrointestinal hemorrhage and secondary anemia.

  20. CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Jain, T.P. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Gulati, M.S. [Department of Imaging, Queen Elizabeth Hospital NHS Trust, London (United Kingdom); Makharia, G.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)]. E-mail: govindmakharia@aiims.ac.in; Bandhu, S. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Garg, P.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)

    2007-07-15

    Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding.

  1. Use of /sup 99m/Tc-DTPA for detection and localization of site of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Abdel-Dayem, H.; Owuwanne, A.; Nawaz, K.; Kouris, K.; Higazy, E.; Mahajan, K.; Ericsson, S.; Awdeh, M.

    1988-05-01

    Intravenously injected /sup 99m/Tc-DTPA was evaluated in 64 patients for its efficiency in detecting and localizing sites of acute upper and lower gastrointestinal (G.I.) bleeding. These studies were correlated with endoscopic and surgical findings. There were 34 bleeders and 30 non bleeders giving a sensitivity of 90%, specificity of 82% and accuracy of 86%. Of these, 49 were upper G.I. studies (stomach 21 and duodenum 28) and 15 were lower G.I. studies (small intestine 8, large bowel 7). Of the 49 upper G.I. studies, 27 showed active bleeding while 22 showed no bleeding at the time of the study resulting in a sensitivity of 87.5%, specificity of 76% and accuracy of 82%. Of the 15 lower G.I. studies, 7 were bleeders while 8 were non bleeders. All the lower G.I. bleeding sites were accurately localized with the /sup 99m/Tc-DTPA. An incidental finding of these studies was the localization of /sup 99m/Tc-DTPA in the site of inflammatory and malignant lesions of the G.I. tract. Of the 64 studies, 18 inflammatory and malignant lesions were detected with the IV injected /sup 99m/Tc-DTPA; 10 were bleeders while 8 were non bleeders. Image subtraction of early from delayed images was helpful to differentiate bleeding from non bleeding cases in this last group of studies.

  2. The use of 99mTc-DTPA for detection and localization of site of acute gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Intravenously injected 99mTc-DTPA was evaluated in 64 patients for its efficiency in detecting and localizing sites of acute upper and lower gastrointestinal (G.I.) bleeding. These studies were correlated with endoscopic and surgical findings. There were 34 bleeders and 30 non bleeders giving a sensitivity of 90%, specificity of 82% and accuracy of 86%. Of these, 49 were upper G.I. studies (stomach 21 and duodenum 28) and 15 were lower G.I. studies (small intestine 8, large bowel 7). Of the 49 upper G.I. studies, 27 showed active bleeding while 22 showed no bleeding at the time of the study resulting in a sensitivity of 87.5%, specificity of 76% and accuracy of 82%. Of the 15 lower G.I. studies, 7 were bleeders while 8 were non bleeders. All the lower G.I. bleeding sites were accurately localized with the 99mTc-DTPA. An incidental finding of these studies was the localization of 99mTc-DTPA in the site of inflammatory and malignant lesions of the G.I. tract. Of the 64 studies, 18 inflammatory and malignant lesions were detected with the IV injected 99mTc-DTPA; 10 were bleeders while 8 were non bleeders. Image subtraction of early from delayed images was helpful to differentiate bleeding from non bleeding cases in this last group of studies. (orig.)

  3. Heteropic gastric pancreas associated with type II esophageal atresia with acute gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    F. Destro

    2014-06-01

    Full Text Available Heterotopic pancreas is defined as pancreatic tissue found outside its normal localization without vascular or anatomic communication with the pancreatic gland. It is usually diagnosed incidentally, but it may also be responsible for acute clinical pictures. We discuss an interesting case of ectopic pancreas associated with type II esophageal atresia and presenting with gastrointestinal acute bleeding.

  4. An Association Between Selective Serotonin Reuptake Inhibitor Use and Serious Upper Gastrointestinal Bleeding

    DEFF Research Database (Denmark)

    Dall, Michael; Schaffalitzky de Muckadell, Ove B; Lassen, Annmarie Touborg;

    2009-01-01

    -based case-control study was conducted in the county of Funen, Denmark. The 3652 cases all had a first discharge diagnosis of serious upper gastrointestinal bleeding (UGB) from 1995 to 2006. All cases were manually validated. Controls (n = 36,502), matched for age and sex, were selected by risk-set sampling...

  5. Life-threatening upper gastrointestinal bleeding due to gastric Dieulafoy's lesion: Successful minimally-invasive management.

    Science.gov (United States)

    Bondade, Nikhil; Bhandari, Suryaprakash; Rao, Prashant; Shah, Rahul; Bothara, Vishal; Maydeo, Amit

    2016-01-01

    Dieulafoy's lesion (DL) is a relatively rare, but potentially life-threatening condition. It accounts for 1-2% of acute gastrointestinal bleedings. Its serious nature makes it necessary for early diagnosis and treatment. This is a case report of a patient who presented with life-threatening haematemesis due to gastric Dieulafoy's that was successfully treated laparoscopically after failed endotherapy. PMID:27251825

  6. Recurrent lower gastrointestinal bleeding from idiopathic ileocolonic varices: a case report

    Directory of Open Access Journals (Sweden)

    Krishna Ravula

    2010-08-01

    Full Text Available Abstract Introduction Varices of the colon are a rare cause of lower gastrointestinal bleeding, usually associated with portal hypertension due to liver cirrhosis or other causes of portal venous obstruction. Idiopathic colonic varices are extremely rare. Recognition of this condition is important as idiopathic colonic varices may be a cause of recurrent lower gastrointestinal bleeding. Case presentation We report the case of a 21-year-old Asian man from north India who presented with recurrent episodes of lower gastrointestinal bleeding. Colonoscopy revealed varices involving the terminal ileum and colon to the sigmoid. Thorough evaluation was undertaken to rule out any underlying portal hypertension. Our patient underwent subtotal colectomy including resection of involved terminal ileum and an ileorectal anastomosis. Conclusion Colonic varices are an uncommon cause of lower gastrointestinal bleeding. Idiopathic colonic varices are diagnosed after excluding underlying liver disease and portal hypertension. Recognition of this condition is important as prognosis is good in the absence of liver disease and is curable by resection of the involved bowel.

  7. Effect of Transfusion Strategy in Acute Non-variceal Upper Gastrointestinal Bleeding

    DEFF Research Database (Denmark)

    Fabricius, Rasmus; Svenningsen, Peter; Hillingsø, Jens;

    2016-01-01

    BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of admissions as well as aggressive transfusion of blood products. Whether the transfusion strategy in NVUGIB impacts on hemostasis is unknown and constitutes the focus of this study. METHOD: Retrospective...

  8. Gastrointestinal bleedings during therapy with new oral anticoagulants are rarely reported

    DEFF Research Database (Denmark)

    Bay-Nielsen, Morten; Kampmann, Jens Peter; Bisgaard, Thue

    2014-01-01

    , Surgical Section, Hvidovre Hospital, during a one-year-period. Patients in treatment with NOAC and admitted for gastrointestinal bleeding were identified. Relevant patients were cross-checked for a reported adverse drug event in the Danish Health and Medi-cines Authority's database on adverse medical...

  9. Helicobacter pylori and risk of upper gastrointestinal bleeding among users of selective serotonin reuptake inhibitors

    DEFF Research Database (Denmark)

    Dall, Michael; Schaffalitzky de Muckadell, Ove B; Møller Hansen, Jane;

    2011-01-01

    A number of studies have reported a possible association between use of selective serotonin reuptake inhibitors (SSRIs) and serious upper gastrointestinal bleeding (UGB). We conducted this case-control study to assess if Helicobacter pylori (H. pylori) potentiates the risk of serious UGB in SSRI...

  10. Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Supot Pongprasobchai; Sireethorn Nimitvilai; Jaroon Chasawat; Sathaporn Manatsathit

    2009-01-01

    AIM: To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score.METHODS: Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected.Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB.RESULTS: Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding.Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding;previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011).The UGIB Etiology Score was calculated from (3.1 x previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vornitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%,82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥3.1 for variceal bleeding were 79% and 97%, respectively.CONCLUSION: The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

  11. Esophageal Involvement of Pemphigus Vulgaris Associated with Upper Gastrointestinal Bleeding

    OpenAIRE

    Chang, Sooyun; Park, Soo Jung; Kim, Sun Wook; Jin, Moo-Nyun; Lee, Jung-Hee; Kim, Hyun Ju; Hong, Sung Pil; Kim, Tae Il

    2014-01-01

    Esophageal involvement of pemphigus vulgaris is rare, and when present, the most common presenting symptoms reported in the medical literature are odynophagia and dysphagia. Here, we present two cases of pemphigus vulgaris presenting with upper gastrointestinal hemorrhage because of esophageal involvement of the disease. In case 1, a 41-year-old female patient with a prior diagnosis of pemphigus vulgaris presented with hematemesis. Esophagogastroduodenoscopy showed diffuse mucosal exfoliation...

  12. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

    Directory of Open Access Journals (Sweden)

    Pedro Monsanto

    2012-04-01

    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  13. A rare cause for severe recurrent lower gastrointestinal bleeding in a 12 year old patient

    Directory of Open Access Journals (Sweden)

    D. Belsha

    2015-09-01

    Full Text Available The cause for severe, recurrent lower gastrointestinal (LGI bleeding in children can usually be diagnosed readily by means of the commonly used investigative/diagnostic techniques such as colonoscopy, laparoscopy ± laparotomy. Occasionally less commonly used investigations may be necessary to look for more elusive causes of LGI bleeding such as capsule endoscopy, angiography, technetium-99m (99m Tc-labeled red blood cell (RBC scintigraphy, cross-sectional imaging such as CT/MRI (including angiography and laparotomy combined with on-table small bowel enteroscopy. We report a case of severe, recurrent LGI bleeding that had occurred over several years, where the cause remained elusive despite numerous investigations and interventions. The etiology of this was eventually found to be a gastric duplication cyst infiltrating into adjacent transverse colon and causing bleeding from peptic ulceration in the colon. The process by which this diagnosis was made and the lessons learned are discussed.

  14. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam (Korea, Republic of)

    2015-06-15

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  15. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism.

    Science.gov (United States)

    Kiani, Mohammad Ali; Forouzan, Arash; Masoumi, Kambiz; Mazdaee, Behnaz; Bahadoram, Mohammad; Kianifar, Hamid Reza; Ravari, Hassan

    2015-01-01

    We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT) scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy.

  16. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Kiani

    2015-01-01

    Full Text Available We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy.

  17. Evaluation of /sup 99m/Tc labeled red blood cell scintigraphy for the detection and localization of gastrointestinal bleeding sites

    Energy Technology Data Exchange (ETDEWEB)

    Markisz, J.A.; Front, D.; Royal, H.D.; Sacks, B.; Parker, J.A.; Kolodny, G.M.

    1982-08-01

    /sup 99m/Tc labeled red blood cell scintigraphy was performed upon 39 patients with clinical evidence for acute lower gastrointestinal bleeding from an unknown source. Seventeen of 39 patients (44%) had a scan became positive 6 or more h after injection, consistent with intermittent bleeding, in 8 of 17 patients (47%). In the 11 patients in whom the bleeding site was definitely identified by arteriography, surgery, or colonoscopy, scintigraphy correctly localized the bleeding site in 10 of 11 patients (91%). Four of 11 patients (36%) had an active bleeding site identified by arteriography. Ten of 17 patients (58%) with a positive scan required either gelfoam embolization (4 patients) or surgery (6 patients) to control the bleeding, whereas only 1 of 22 patients (5%) required surgery when the scan was negative. Six deaths occurred in the scan-positive patients compared with no deaths in the scan-negative patients. None of the 8 patients who had arteriography and no active bleeding site by scintigraphy had arteriographically demonstrable active bleeding. Scintigraphy provides a reliable noninvasive test to screen patients in whom arteriography is being considered to localize active bleeding sites. If the arteriogram is negative, the scintigraphic findings alone may guide the surgical or arteriographic intervention. In addition, scintigraphy identifies two patient populations which have considerably different morbidity and mortality.

  18. Selective serotonin reuptake inhibitors and gastrointestinal bleeding: a case-control study.

    Directory of Open Access Journals (Sweden)

    Alfonso Carvajal

    Full Text Available BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs have been associated with upper gastrointestinal (GI bleeding. Given their worldwide use, even small risks account for a large number of cases. This study has been conducted with carefully collected information to further investigate the relationship between SSRIs and upper GI bleeding. METHODS: We conducted a case-control study in hospitals in Spain and in Italy. Cases were patients aged ≥18 years with a primary diagnosis of acute upper GI bleeding diagnosed by endoscopy; three controls were matched by sex, age, date of admission (within 3 months and hospital among patients who were admitted for elective surgery for non-painful disorders. Exposures to SSRIs, other antidepressants and other drugs were defined as any use of these drugs in the 7 days before the day on which upper gastrointestinal bleeding started (index day. RESULTS: 581 cases of upper GI bleeding and 1358 controls were considered eligible for the study; no differences in age or sex distribution were observed between cases and controls after matching. Overall, 4.0% of the cases and 3.3% of controls used an SSRI antidepressant in the week before the index day. No significant risk of upper GI bleeding was encountered for SSRI antidepressants (adjusted odds ratio, 1.06, 95% CI, 0.57-1.96 or for whichever other grouping of antidepressants. CONCLUSIONS: The results of this case-control study showed no significant increase in upper GI bleeding with SSRIs and provide good evidence that the magnitude of any increase in risk is not greater than 2.

  19. Recurrent gastrointestinal bleeding diagnosed by delayed scintigraphy with Tc-99m-labeled red blood cells.

    Science.gov (United States)

    Nwakanma, Lois; Meyerrose, Gary; Kennedy, Shalyn; Rakvit, Ariwan; Bohannon, Todd; Silva, Micheal

    2003-08-01

    A 56-year-old woman presented with bright-red blood from the rectum. Esophagogastroduodenoscopy revealed mild gastritis. Colonoscopy demonstrated diverticulosis without active bleeding, and in vitro tagged red blood cell scintigraphy was unremarkable. There was no further evidence of bleeding and the patient was discharged home. The patient returned with recurrent bright-red blood from the rectum. Although delayed scintigraphic images seldom demonstrate the site of bleeding, delayed images at 12 hours demonstrated active bleeding near the hepatic flexure in this patient. This was confirmed with selective mesenteric angiography, and was treated with coil embolization of the tertiary branches of the right middle colic artery. PMID:12897664

  20. Outcome of patients who have undergone total enteroscopy for obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Takayoshi Shishido; Shiro Oka; Shinji Tanaka; Hiroki Imagawa; Yoshito Takemura; Shigeto Yoshida; Kazuaki Chayama

    2012-01-01

    AIM:To assess the diagnostic success and outcome among patients with obscure gastrointestinal bleeding who underwent total enteroscopy with double-balloon endoscopy.METHODS:Total enteroscopy was attempted in 156 patients between August 2003 and June 2008 at Hiroshima University Hospital and achieved in 75 (48.1%).It is assessed whether sources of bleeding were identified,treatment methods,complications,and 1-year outcomes (including re-bleeding) after treatment,and we compared re-bleeding rates among patients.RESULTS:The source of small bowel bleeding was identified in 36 (48.0%) of the 75 total enteroscopy patients; the source was outside the small bowel in 11 patients (14.7%) and not identified in 28 patients (37.3%).Sixty-one of the 75 patients were followed up for more than 1 year (27.2 ± 13.3 mo).Four (6.6%)of these patients showed signs of re-bleeding during the first year,but bleeding did not recur after treatment.Although statistical significance was not reached,a marked difference was found in the re-bleeding rate between patients in whom total enteroscopy findings were positive (8.6%,3/35) and negative (3.8%,1/26)(3/35 vs 1/26,P =0.63).CONCLUSION:A good outcome can be expected for patients who undergo total enteroscopy and receive proper treatment for the source of bleeding in the small bowel.

  1. The American Society for Gastrointestinal Endoscopy (ASGE) diagnostic algorithm for obscure gastrointestinal bleeding: eight burning questions from everyday clinical practice.

    Science.gov (United States)

    Rondonotti, Emanuele; Marmo, Riccardo; Petracchini, Massimo; de Franchis, Roberto; Pennazio, Marco

    2013-03-01

    The diagnosis and management of patients with obscure gastrointestinal bleeding are often long and challenging processes. Over the last 10 years the introduction in clinical practice of new diagnostic and therapeutic procedures (i.e. Capsule Endoscopy, Computed Tomographic Enterography, Magnetic Resonance Enterography, and Device Assisted Enteroscopy) has revolutionized the diagnostic/therapeutic work-up of these patients. Based on evidence published in the last 10 years, international scientific societies have proposed new practice guidelines for the management of obscure gastrointestinal bleeding, which include these techniques. However, although these algorithms (the most recent ones are endorsed by the American Society for Gastrointestinal Endoscopy - ASGE) allow the management of the large majority of patients, some issues still remain unsolved. The present paper reports the results of the discussion, based on the literature published up to September 2011, among a panel of experts and gastroenterologists, working with Capsule Endoscopy and with Device Assisted Enteroscopy, attending the 6th annual meeting of the Italian Club for Capsule Endoscopy and Enteroscopy. Eight unresolved issues were selected: each of them is presented as a "Burning question" and the "Answer" is the strategy proposed to manage it, according to both the available evidence and the discussion among participants.

  2. Obscure Gastrointestinal Bleeding from an Ampullary Tumour in a Patient with a Remote History of Renal Cell Carcinoma: A Diagnostic Conundrum

    Directory of Open Access Journals (Sweden)

    Rhonda M Janzen

    1998-01-01

    Full Text Available Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. The outlined case, which presented as an upper gastrointestinal bleed, is only the eighth such reported case in the English-language literature. This case is the longest reported time interval between surgical nephrectomy to presentation with ampullary metastasis at 17.5 years. The ampullary source of bleeding in this case was initially obscure and missed by conventional gastroscopy. Diagnosis was made with a side-viewing endoscope, emphasizing the usefulness of this instrument in the investigation of active bleeding from a small bowel source.

  3. Change ratio of hemoglobin has predictive value for upper gastrointestinal bleeding

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2016-01-01

    The present study aimed to identify novel predictors of upper gastrointestinal (GI) bleeding by assessing change ratios of blood test variables. Records of 1,023 patients (431 men and 592 women) who underwent endoscopy between October 2014 and September 2015 at the National Hospital Organization Shimoshizu Hospital (Yotsukaido, Japan) were retrospectively analyzed. Patients whose blood test variables for the time-point of endoscopy and three months previously were available were enrolled and subsequently categorized into a group with and another one without upper GI bleeding (n=32 and 84, respectively), and the respective change ratios were calculated for each group. One-way analysis of variance revealed that in patients with upper GI bleeding, change ratios of white blood cell count and alkaline phosphatase were significantly higher than those in patients without, while change ratios of hemoglobin (Hb), total protein and albumin were significantly reduced. Logistic regression analysis demonstrated that the change ratio of Hb was significantly correlated with upper GI bleeding. Receiver-operator characteristic analysis revealed that an 18.7% reduction of Hb was the threshold value for the prediction of upper GI bleeding. In conclusion, the present study revealed that a ≥18.7% reduction in Hb over three months has predictive value for upper GI bleeding.

  4. RECOMMENDATION FOR MANAGING PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    G. Dimofte

    2006-01-01

    Full Text Available Upper gastrointestinal bleeding remains an important problem for all emergency hospitals. Any attempt to standardise the care for these patients is dependent on the expertise of the medical and surgical team but also on the availability of emergency endoscopy and the quality of endoscopic haemostatic therapy. The present paper does not intended to present a state of the art in the matter of upper gastrointestinal haemorrhage, but to offer a working protocol that can be implemented in an emergency hospital, as long as on call emergency diagnostic endoscopy is available. Decision making is based on accurate evaluation of the bleeding lesion and its risk of rebleeding. The protocol designates responsabilities for each department and establishes criteria for ICU admission and protocols for intensive monitorisation of patients on surgical wards. Far from being definitive we consider this paper a draft open for discussions and for further improvement.

  5. Gastrointestinal bleeding from vascular malformations: Is octreotide effective to rescue difficult-to-treat patients?

    Science.gov (United States)

    Iannone, Andrea; Principi, Mariabeatrice; Barone, Michele; Losurdo, Giuseppe; Ierardi, Enzo; Di Leo, Alfredo

    2016-09-01

    Gastrointestinal vascular malformations are responsible for 2-8% of all cases of bleeding and 30-40% of all obscure hemorrhages, being the most frequent cause of occult bleeding in older people. The aim of this review was to provide an up-to-date report about the use of octreotide in bleeding from both hereditary and acquired vascular malformations of the gastrointestinal tract. A systematic literature search was performed, using the keywords "gastrointestinal vascular malformation", "octreotide", "angiodysplasia", "portal hypertensive gastropathy", "gastric antral vascular ectasia", and "hereditary vascular malformations". The first line therapy of acute/chronic bleeding from digestive vascular malformations is endoscopy, followed by angiographic embolization and surgical resection when this is unsuccessful. In the setting of difficult-to-treat patients, octreotide has been proposed as an alternative therapeutic strategy. Studies reported in the literature show a high efficacy and safety of octreotide, but described only a small number of enrolled patients, heterogeneous therapeutic schedules and short-term follow-up, with the exception of acute bleeding from esophageal varices. As a consequence, the use of octreotide is not approved in this setting and it is currently still prescribed as an off-label drug. Studies in larger populations are needed to confirm the promising results observed in the small case series reports, so as to provide physicians with a treatment option for patients without available alternatives. Octreotide could also determine a strong decrease in the management costs of these clinical conditions, and especially, could dramatically reduce hospital admission costs. PMID:27595456

  6. A rare cause of anemia due to upper gastrointestinal bleeding: Cameron lesion

    OpenAIRE

    Ismet Özaydın; Sami Doğan; Arif Aslaner; Mehmet Yaşar; Metin Aydın

    2014-01-01

    Asymptomatic large hiatal hernias may lead to iron deficiency anemia due to occult and massive bleeding from linear gastric erosions or ulcers on the mucosal folds at the level of the diaphragm called the Cameron lesions. The diagnosis is usually made during upper gastrointestinal system endoscopies. Current therapy includes the medication with proton pump inhibitors in combination with oral iron supplements and in some cases surgical reconstruction of hiatal hernia with fundoplication. We pr...

  7. Continuing challenges in the diagnosis and management of obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Veronica; Baptista; Neil; Marya; Anupam; Singh; Abbas; Rupawala; Bilal; Gondal; David; Cave

    2014-01-01

    The diagnosis and management of obscure gastrointestinal bleeding(OGIB) have changed dramatically since the introduction of video capsule endoscopy(VCE) followed by deep enteroscopy and other imaging technologies in the last decade. Significant advances have been made, yet there remains room for improvement in our diagnostic yield and treatment capabilities for recurrent OGIB. In this review, we will summarize the latest technologies for the diagnosis of OGIB, limitations of VCE, technological enhancement in VCE, and different management options for OGIB.

  8. Concurrent amoebic and histoplasma colitis:A rare cause of massive lower gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Peng; Soon; Koh; April; Camilla; Roslani; Kumar; Vasudeavan; Vimal; Mohd; Shariman; Ramasamy; Umasangar; Rajkumar; Lewellyn

    2010-01-01

    Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection with both these organisms is very rare, and the in vivo consequences are not known. A 58-year-old male presented initially to the physicians with pyrexia of unknown origin and bloody diarrhea. Amoebic colitis was diagnosed based on biopsies, and he was treated with metronidazole. Five days later...

  9. A case of massive lower gastrointestinal bleeding from a rectal Dieulafoy lesion

    Directory of Open Access Journals (Sweden)

    Yuan-Kai Lee

    2015-09-01

    Full Text Available A Dieulafoy lesion is an uncommon and sometimes life-threatening cause of gastrointestinal hemorrhage. Typically, it presents as a tiny mucosal defect with an exposed protruding artery with normal surrounding mucosa. An 84-year-old woman developed sudden massive hematochezia and had an unstable hemodynamic status. The source of bleeding was found to be an exposed vessel in the rectum without surrounding ulceration. The patient was treated successfully with an epinephrine injection given endoscopically, followed by hemostatic clipping.

  10. Continuing challenges in the diagnosis and management of obscure gastrointestinal bleeding.

    Science.gov (United States)

    Baptista, Veronica; Marya, Neil; Singh, Anupam; Rupawala, Abbas; Gondal, Bilal; Cave, David

    2014-11-15

    The diagnosis and management of obscure gastrointestinal bleeding (OGIB) have changed dramatically since the introduction of video capsule endoscopy (VCE) followed by deep enteroscopy and other imaging technologies in the last decade. Significant advances have been made, yet there remains room for improvement in our diagnostic yield and treatment capabilities for recurrent OGIB. In this review, we will summarize the latest technologies for the diagnosis of OGIB, limitations of VCE, technological enhancement in VCE, and different management options for OGIB. PMID:25400996

  11. Selection of variables using 'independence Bayes' in computer-aided diagnosis of upper gastrointestinal bleeding

    OpenAIRE

    Ohmann, C; Künneke, M.; Zaczyk, R.; Thon, K.; Lorenz, Wilfried

    1986-01-01

    In this paper two problems of computer-aided diagnosis with 'independence Bayes' were investigated: selection of variables and monotonicity in performance as the number of measurements is increased. Using prospective data from patients with upper gastrointestinal bleeding, the stepwise forward selection approach maximizing the apparent diagnostic accuracy was analysed with respect to different kinds of bias in estimation of the true diagnostic accuracy and to the stability of the number and t...

  12. Obscure gastrointestinal bleeding: difficulties in comparing CT enterography and video capsule endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Soyer, Philippe [Hopital Lariboisiere-APHP 2, Department of Imaging and Nuclear Medicine, Paris (France); UMR INSERM 965-Paris 7 ' ' Angiogenese et recherche translationnelle' ' , Paris (France); Universite Diderot-Paris 7, Paris (France)

    2012-06-15

    A paper reports the results of a retrospective study that was designed to evaluate the potential role of video capsule endoscopy (VCE) in elucidating the cause of bleeding in patients with obscure gastrointestinal bleeding (OGIB) for whom CT enterography was negative. The authors highlight the limitations of dual-phase CT enterography for the detection of flat lesions of the small bowel such as ulcers, angiodysplasias or arteriovenous malformations, and confirm the superiority of VCE for the detection of this category of lesions. This commentary discusses some of the issues raised. Key Points circle Video capsule endoscopy surpasses CT enterography in detecting flat small bowel lesions. circle Retrospective VCE and CT enterography findings in obscure bleeding need further evaluation. circle A fair and unbiased comparison of the two investigations is still needed. (orig.)

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

    Institute of Scientific and Technical Information of China (English)

    Ingrid Lisanne Holster; Ernst Johan Kuipers

    2012-01-01

    Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%.The vast majority of these bleeds are due to peptic ulcers.Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease.Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB,and is recommended within 24 h of presentation.Proton pump inhibitor (PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy,but has no effect on rebleeding,mortality and need for surgery.Endoscopic therapy should be undertaken for ulcers with high-risk stigmata,to reduce the risk of rebleeding.This can be done with a variety of modalities.High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality,particularly in patients with high-risk stigmata.

  14. Gastric Metastasis of Hepatocellular Carcinoma With Gastrointestinal Bleeding After Liver Transplant: A Case Report.

    Science.gov (United States)

    Li, L; Zhang, W H; Meng, F P; Ma, X M; Shen, L J; Jin, B; Li, H W; Han, J; Zhou, G D; Liu, S H

    2015-10-01

    Gastrointestinal (GI) metastasis of hepatocellular carcinoma is very rare. This is the first report of post-transplantation gastric metastasis. A 43-year-old man with a history of hepatitis B-related hepatocellular carcinoma (HCC) in the right anterior segment of the liver received an orthotopic liver transplant. Three months after the transplantation, pulmonary metastasis was found by chest computed tomography, and he received 1 course of gamma knife treatment. He complained of melena with anemia 17 months post liver transplantation. Abdominal CT scan showed new occupying lesions in the liver and a mass in the stomach and around the spleen with embolus in the splenic vein. Endoscopy revealed a large irregular cauliflower-like mass in fundus with ulceration and bleeding on the surface. He received symptomatic treatment, but died of cancer-related bleeding 4 months later. GI bleeding may due to gastric metastasis after liver transplantation.

  15. Gastric Metastasis of Hepatocellular Carcinoma With Gastrointestinal Bleeding After Liver Transplant: A Case Report.

    Science.gov (United States)

    Li, L; Zhang, W H; Meng, F P; Ma, X M; Shen, L J; Jin, B; Li, H W; Han, J; Zhou, G D; Liu, S H

    2015-10-01

    Gastrointestinal (GI) metastasis of hepatocellular carcinoma is very rare. This is the first report of post-transplantation gastric metastasis. A 43-year-old man with a history of hepatitis B-related hepatocellular carcinoma (HCC) in the right anterior segment of the liver received an orthotopic liver transplant. Three months after the transplantation, pulmonary metastasis was found by chest computed tomography, and he received 1 course of gamma knife treatment. He complained of melena with anemia 17 months post liver transplantation. Abdominal CT scan showed new occupying lesions in the liver and a mass in the stomach and around the spleen with embolus in the splenic vein. Endoscopy revealed a large irregular cauliflower-like mass in fundus with ulceration and bleeding on the surface. He received symptomatic treatment, but died of cancer-related bleeding 4 months later. GI bleeding may due to gastric metastasis after liver transplantation. PMID:26518968

  16. Obscure gastrointestinal bleeding: preliminary comparison of 64-section CT enteroclysis with video capsule endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Khalife, Samer; Vahedi, Kouroche; Dray, Xavier; Marteau, Philippe [Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Digestive Diseases, Paris Cedex 10 (France); Soyer, Philippe; Hamzi, Lounis; Place, Vinciane; Boudiaf, Mourad [Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Abdominal Imaging, Paris Cedex 10 (France); Alatawi, Abdullah [Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Digestive Diseases, Paris Cedex 10 (France); Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Abdominal Imaging, Paris Cedex 10 (France)

    2011-01-15

    To retrospectively compare the diagnostic capabilities of 64-section CT enteroclysis with those of video capsule endoscopy (VCE) to elucidate the cause of obscure gastrointestinal bleeding. Thirty-two patients who had 64-section CT enteroclysis and VCE because of obscure gastrointestinal bleeding were included. Imaging findings were compared with those obtained at double balloon endoscopy, surgery and histopathological analysis, which were used as a standard of reference. Concordant findings were found in 22 patients (22/32; 69%), including normal findings (n = 13), tumours (n = 7), lymphangiectasia (n = 1) and inflammation (n = 1), and discrepancies in 10 patients (10/32; 31%), including ulcers (n = 3), angioectasias (n = 2), tumours (n = 2) and normal findings (n = 3). No statistical difference in the proportions of abnormal findings between 64-section CT enteroclysis (11/32; 34%) and VCE (17/32, 53%) (P = 0.207) was found. However, 64-section CT enteroclysis helped identify tumours not detected at VCE (n = 2) and definitely excluded suspected tumours (n = 3) because of bulges at VCE. Conversely, VCE showed ulcers (n = 3) and angioectasias (n = 2) which were not visible at 64-section CT enteroclysis. Our results suggest that 64-section CT enteroclysis and VCE have similar overall diagnostic yields in patients with obscure gastrointestinal bleeding. However, the two techniques are complementary in this specific population. (orig.)

  17. Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ji Soo; Kwak, Hyo Sung; Chung, Gyung Ho [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2011-08-15

    We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

  18. Incidence and Clinical Features of Peptic Ulcer Disease In Acute Upper Gastrointestinal Bleeding: -Experience of Moroccan University Hospital Unit-

    Directory of Open Access Journals (Sweden)

    Y. Cherradi

    2015-12-01

    Full Text Available Introduction: Peptic ulcer disease (PUD has been recognized as the leading cause of acute upper gastrointestinal bleeding (AUGIB. This study aims to report general features of bleeding peptic ulcers in patients who benefit of urgent endoscopy in our department after an acute upper gastrointestinal hemorrhage. Results: A total of 1809 patients were explored for acute upper gastrointestinal bleeding in our unit since 2003 to 2008. Gastroduodenal peptic ulcers were the most frequent diagnosed etiology. They present 38% of all reported causes of bleeding (n=527 (table I. 25% were located at duodenal mucosa (n= 347 and 13% were gastric ulcers (n=180. No esophageal ulcers were reported. Incidence of both duodenal and gastric ulcers decreases during the last years. Conclusion: In our department, incidence of bleeding peptic ulcer disease is decreasing but they continue to be the first cause of AUGIB.

  19. Predictors of Early Rebleeding after Endoscopic Therapy in Patients with Nonvariceal Upper Gastrointestinal Bleeding Secondary to High-Risk Lesions

    Directory of Open Access Journals (Sweden)

    Davide Maggio

    2013-01-01

    Full Text Available BACKGROUND: In an era of increasingly shortened admissions, data regarding predictors of early rebleeding among patients with nonvariceal upper gastrointestinal bleeding (NVUGIB exhibiting high-risk stigmata (HRS having undergone endoscopic hemostasis are lacking.

  20. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

  1. Iatrogenic Complications in Five Patients with Upper Gastrointestinal Bleeding due to Ambient Air: Case Series and Literature Review

    Directory of Open Access Journals (Sweden)

    Christine N. Manser

    2012-04-01

    Full Text Available Despite the increasing use of carbon dioxide for endoscopies during the last years, ambient air is still used. The amount of air depends on several factors such as examination time, presumable diameter of the endoscope channel and of course active use of air by the operator. Although endoscopic complications due to ambient air in the gastrointestinal (GI tract are a rare observation and mostly described in the colon, we report five cases in the upper GI tract due to insufflating large amounts of air through the endoscopes. All 5 patients needed an emergency upper endoscopy for acute presumed upper GI bleeding. In two cases both esophageal variceal bleeding and ulcer bleeding were detected; the fifth case presented with a bleeding due to gastric cancer. Due to insufflation of inadequate amounts of air through the endoscope channel, all patients deteriorated in circulation and ventilation. Two rumenocenteses and consecutively three laparotomies had to be performed in three patients. In the other two, gastroscopies had to be stopped for an emergency computed tomography. All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air. Therefore in emergency situations, endoscopies should be performed with either submersion, low air flow pumps or even better by the use of carbon dioxide.

  2. Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Mahesh Kumar Goenka; Shounak Majumder; Sanjeev Kumar; Pradeepta Kumar Sethy; Usha Goenka

    2011-01-01

    AIM: To identify optimum timing to maximize diagnostic yield by capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB).METHODS: We identified patients who underwent CE at our institution from August 2003 to December 2009.Patient medical records were reviewed to determine type of OGIB (occult, overt), CE results and complications,and timing of CE with respect to onset of bleeding.RESULTS: Out of 385 patients investigated for OGIB,284 (74%) had some lesion detected by CE. In 222 patients (58%), definite lesions were detected that could unequivocally explain OGIB. Small bowel ulcer/erosions secondary to Crohn's disease, tuberculosis or non-steroidal anti-inflammatory agent use were the commonest lesions detected. Patients with overt GI bleeding for <48 h before CE had the highest diagnostic yield (87%).This was significantly greater (P < 0.05) compared to that in patients with overt bleeding prior to 48 h (68%),as well as those with occult OGIB (59%).CONCLUSION: We established the importance of early CE in management of OGIB. CE within 48 h of overt bleeding has the greatest potential for lesion detection.

  3. Re-prescribing of causative drugs in persons discharged after serious drug-induced upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Dall, M; Christensen, René dePont; Schaffalitzky de Muckadell, O B;

    2012-01-01

    Several drug classes are known to be associated with serious upper gastrointestinal bleeding (UGIB), among others NSAID, low-dose acetylsalicylic acid (ASA), vitamin K antagonists (VKA), clopidogrel and selective serotonin reuptake inhibitors (SSRIs). There are few data on how and to what extent...... these drugs are reintroduced in patients who have been discharged after a bleeding episode related to any of them....

  4. Octreotide for the Management of Gastrointestinal Bleeding in a Patient with a HeartWare Left Ventricular Assist Device

    Directory of Open Access Journals (Sweden)

    Geetanjali Dang

    2014-01-01

    Full Text Available HeartWare is a third generation left ventricular assist device (LVAD, widely used for the management of advanced heart failure patients. These devices are frequently associated with a significant risk of gastrointestinal (GI bleeding. The data for the management of patients with LVAD presenting with GI bleeding is limited. We describe a 56-year-old lady, recipient of a HeartWare device, who experienced recurrent GI bleeding and was successfully managed with subcutaneous (SC formulations of octreotide.

  5. Thrombin in combination with intensive nursing in treating upper gastrointestinal bleeding in children.

    Science.gov (United States)

    Yang, F; Xiang, M L; Liu, Y M

    2016-01-01

    Pediatric upper gastrointestinal bleeding, a commonly seen pediatric emergency, needs timely symptomatic treatment to avoid a worse outcome. To discuss the clinical effect of thrombin treatment in combination with intensive nursing on pediatric upper gastrointestinal bleeding, this study analyzed 128 children who were treated in the second ward of the Children’s Internal Medical Department in the First Affiliated Hospital of Zhengzhou University between February 2012 and December 2014. The patients were divided into two groups, an experimental group and a control group. Besides thrombin, the experimental group was given intensive nursing, consisting of regular nursing and targeted nursing, while the control group was given regular nursing only. Clinical indexes of the two groups, such as effective rate, nursing satisfaction and side effect rate, were compared. Relevant clinical indexes such as duration of hospital stay, time to stopping of bleeding and Self-Rating Anxiety Scale (SAS) score, as well as overall satisfaction level of the observation group were all better than those of the control group and differences between the two groups had statistical significance (P less than 0.05). Furthermore, difference of overall effective rate between the experimental group (90.63%) and the control group (68.75%) was significant. Difference of incidence of side effects between the two groups was statistically significant. Thus thrombin treatment in combination with intensive nursing proved to have a remarkable clinical effect and high safety level in treating pediatric upper gastrointestinal bleeding and, moreover, it shortens treatment time and enhances the patients’ quality of life. PMID:27358137

  6. The vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients

    Institute of Scientific and Technical Information of China (English)

    Peter Schemmer; Frank Decker; Genevieve Dei-Anane; Volkmar Henschel; Klaus Buhl; Christian Herfarth; Stefan Riedl

    2006-01-01

    AIM: To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal (UGI)bleeding under today's therapeutic regimen.METHODS: From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital.Based on the patients' data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis:age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time (PT), gastric ulcer (small curvature), duodenal ulcer (bulbus back wall), Forrest classification, vascular stump, variceal bleeding, MalloryWeiss syndrome, RBC substitution, recurrent bleeding,conservative and surgical therapy.RESULTS: Seventy male (58%) and 51 female (42%)patients with a median age of 70 (range: 21-96) years were treated. Their in-hospital mortality was 14%. While 12% (11/91) of the patients died after conservative therapy, 20% (6/30) died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer (n = 36; 30%), gastric ulcer (n = 35; 29%), esophageal varicosis (n = 12; 10%), Mallory-Weiss syndrome (n = 8; 7%), erosive lesions of the mucosa (n = 20;17%), cancer (n = 5; 4%), coagulopathy (n = 4; 3%),lymphoma (n = 2; 2%), benign tumor (n = 2; 2%)and unknown reason (n = 1; 1%). A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer (bulbus back wall)were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis,the location of a bleeding ulcer (bulbus back wall) and patients' gender (male) were of prognostic importance for the clinical outcome (mortality) of patients with a bleeding ulcer.CONCLUSION: Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient's vital threat posed by

  7. Sarcomatoid carcinoma of the jejunum presenting as obscure gastrointestinal bleeding in a patient with a history of gliosarcoma

    Science.gov (United States)

    Alfonso Puentes, Nidia; Jimenez-Alfaro Larrazabal, Carmen; García Higuera, Maria Isabel

    2014-01-01

    Small bowel malignant tumors are rare and sarcomatoid carcinomas have rarely been reported at this site. We report a 56-year-old woman, with history of an excised gliosarcoma, who presented with recurrent obscure gastrointestinal bleeding. She underwent endoscopy and colonoscopy, which failed to identify the cause of the bleeding. The abdominal computed tomography scan located a tumor in the small bowel. Pathology revealed a jejunal sarcomatoid carcinoma. She developed tumor recurrence and multiple liver metastases shortly after surgery. Immunohistochemistry is required for accurate diagnosis. Sarcomatoid carcinoma is a rare cause of obscure gastrointestinal bleeding, which is associated with a poor prognosis. PMID:24759341

  8. Cyanoacrylate spray as treatment in difficult-to-manage gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Liz; Toapanta-Yanchapaxi; Norberto; Chavez-Tapia; Félix; Téllez-ávila

    2014-01-01

    Gastrointestinal bleeding can be a life-treating event that is managed with standard endoscopic therapy in the majority of cases. However, up to 5%-10% of patients may have persistent bleeding that does not respond to conventional measures. Several endoscopic treatment techniques have been proposed as strategies to control such cases, such as epinephrine injection, hemoclips or argon plasma coagulation, but there are certain clinical scenarios where it is difficult to achieve hemostasis even though adequate use of the available resources is made. Reasons for these failures can be associated with the lesion features, such as extent or location. The use of long-standing techniques in nontraditional scenarios, such as with cyanoacrylate for gastric varices sclerosis, has been reported with favorable results. Although new products such as TC-325 or Ankaferd Blood Stopper hemosprays may be useful, their formulations are not available worldwide. Here we present two clinical cases with very different scenarios of gastrointestinal bleeding, where the use of cyanoac-rylate in spray had favorable results in uncommon indications. Cyanoacrylate used as a spray is a technique that can be used as an alternative method in emergent settings.

  9. Gastric Ulcer - A Cause of Portal Cavernoma and Upper Gastrointestinal Bleeding: Case Report

    Directory of Open Access Journals (Sweden)

    Laurențiu V Sima

    2014-10-01

    Full Text Available Gastric ulcers, with a long duration of the disease, can lead to an inflammatory process in the upper abdomen (supramesocolic floor, with repercussions on the surrounding structures. Such ulcers can penetrate the gastric wall, toward the pancreas and hepatic hilum, the inflammatory process can lead to splenic vein trombosis and teh appearance of a portal cavernoma. A complication of the portal cavernoma and the portal hypertension is the formation of esophageal varices. This paper reports the case of a 58 years old patient with multiple episodes of upper gastrointestinal bleeding, determined by both, esophageal varices and existing gastric ulcers. This patient was initially diagnosed with portal cavernoma and the esophageal varices were considered the cause of gastrointestinal bleeding. A spleno-renal shunt was proposed, but intraoperative it was found that this was not necessary because the portal vein was thrombosed and the bleeding was probably caused by the gastric lesions. We performed a distal spleno-pancreatectomy associated with a cuneiform resection of the gastric lession, as well as the resection of the hepatic tumor. The patient had a favorable postoperative outcome.

  10. Multi-detector CT angiography for lower gastrointestinal bleeding: can it select patients for endovascular intervention?

    International Nuclear Information System (INIS)

    Full text: This is a retrospective review of the results at our institution of using multi-detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non-invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding.

  11. 消化道出血概述%Overview of Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    刘文忠

    2015-01-01

    消化道出血是急诊科和消化科常见的临床病况之一。急性大量出血可危及生命,慢性失血可产生贫血症状,部分消化道出血是一些严重疾病,包括胃肠道恶性肿瘤的临床表现。熟悉和掌握消化道出血的临床表现、分类和处理原则,将有助于提高其预防和治疗水平。%Gastrointestinal(GI)bleeding is one of the commonly seen clinical problems in departments of emergency and gastroenterology. Acute massive bleeding may be life-threatening,and chronic blood loss can present symptoms of anemia. GI bleeding is the clinical manifestation of some serious diseases,including GI malignancies. Familiar with and mastering the clinical manifestations,classification and principles of management of GI bleeding will help to improve its prevention and treatment.

  12. Gastrointestinal bleeding secondary to trimethoprim-sulfamethoxazole-induced vitamin K deficiency.

    Science.gov (United States)

    Fotouhie, Azadeh; Desai, Hem; King, Skye; Parsa, Nour Alhoda

    2016-06-06

    There is a well-known association between vitamin K deficiency and haemorrhagic events including gastrointestinal bleeding. There is also a well-known association between both poor dietary intake of vitamin K and chronic antibiotic use and the development of vitamin K deficiency. Although the medical literature notes that cephalosporin antibiotics have a propensity to cause vitamin K deficiency due to the molecular structure of the medications and their ability to suppress the synthesis of clotting factors, there are other antibiotics that have also been implicated in the development of vitamin K deficiency. There are very few reports of trimethoprim/sulfamethoxazole causing vitamin K deficiency and further leading to bleeding episodes. We present such a case and discuss the risk factors leading to such complications.

  13. Dieulafoy's lesion-like bleeding: an underrecognized cause of upper gastrointestinal hemorrhage in patients with advanced liver disease.

    Science.gov (United States)

    Akhras, Jamil; Patel, Pragnesh; Tobi, Martin

    2007-03-01

    Dieulafoy's lesion is a gastrointestinal submucosal artery that ruptures into the lumen causing massive hemorrhage. Until recently, failure to diagnose and treat patients endoscopically may have necessitated blind gastrectomy. Because arteriolar spider nevi abound in patients with liver disease and bleeding from such lesions has been described in the upper gastrointestinal tract, we reviewed our experience to determine whether a diagnosis of advanced liver disease could facilitate recognition and treatment of this type of arterial bleeding. Endoscopy records from 1991 to 1996 for all cases of upper gastrointestinal bleeding at our institution were reviewed. Dieulafoy's lesion-like bleeding was defined as arterial-type bleeding with no evidence of mucosal ulceration or erosions. Advanced liver disease was defined as signs of portal hypertension and/or cirrhosis or infiltrative liver disease. Dieulafoy's lesion-like bleeding was the cause in 6 of 4569 cases (0.13%). Five patients with Dieulafoy's lesion-like gastrointestinal hemorrhage had advanced liver disease compared with 954 of 4569 of all patients endoscoped for gastrointestinal hemorrhage for the period evaluated (OR = 19.04; 95% CI 2.1-900.8; p < 0.002 by Fisher's exact test). Dieulafoy's lesion-like bleeding was treated successfully with epinephrine injection and endoscopic cauterization in 5 of 6 patients with 1 patient requiring surgery. No other clinical associations were evident. Dieulafoy's lesion-like bleeding occurs more commonly in patients with advanced liver disease and should be included as a potential cause for bleeding in advanced liver disease and aggressively sought. PMID:17237996

  14. Georges Brohee Prize. Oestrogen-progesterone, a new therapy of bleeding gastrointestinal vascular malformations.

    Science.gov (United States)

    Van Cutsem, E

    1993-01-01

    Gastrointestinal vascular malformations can cause haemorrhage requiring multiple transfusions. Surgical or endoscopic therapy are ineffective when the vascular malformations are spread diffusely over the gastrointestinal tract, when lesions escape identification or are not accessible for treatment. Several reports suggest that oestrogen-progesterone therapy is effective in the treatment of epistaxis in hereditary haemorrhagic telangiectasia. The aim of our studies is to test the hypothesis that oestrogen-progesterone is an effective treatment for bleeding gastrointestinal vascular malformations in patients with a very high transfusion need and in whom surgical or endoscopic treatment failed or could not be performed. The mean transfusion requirement prior to entering the studies amounted to 35.4 units packed per patient. In an uncontrolled trial oestrogen-progesterone therapy diminished significantly transfusion requirements from 3.4 units packed cells per patient per month to 0.1 units packed cells (p = 0.02). Haemorrhage ceased totally in 3 of 7 patients. A double-blind randomized placebo-controlled, cross-over trial shows that therapy with 0.050 mg ethinyloestradiol and 1 mg norethisterone is very effective in reducing transfusion requirements: 2.8 versus 11.2 units packed cells over a 6 month treatment period (p = 0.002). Only 3 of 13 patients treated with ethinyloestradiol and norethisterone required transfusions for persistent bleeding, while 12 of 13 patients in the placebo group had transfusion requirements (p = 0.001). After stopping hormonal therapy, no transfusions were needed for a mean of 10 months. This indicates a long-lasting effect of ethinyloestradiol and norethisterone on bleeding and transfusion requirements.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8342398

  15. Retrograde jejunoduodenogastric intussusception due to a replacement percutaneous gastrostomy tube presenting as upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening.Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature.We describe a case of retrograde intussusception,associated with the use of a Foley catheter as a replacement gastrostomy tube, presenting with upper gastrointestinal bleeding. To our knowledge, this is the first reported case of PEG-related retrograde intussusception successfully managed in a non-surgical manner. Retrograde intussusception likely occurred due to migration of the replacement tube with resultant securing and invagination of the proximal jejunum when the gastrostomy tube was anchored to the abdominal wall.

  16. A massive bleeding from a gastrointestinal stromal tumor of a Meckel’s diverticulum

    Directory of Open Access Journals (Sweden)

    Chabowski Mariusz

    2016-01-01

    Full Text Available Introduction. Meckel’s diverticulum is the most common congenital anomaly of the gastro intestinal tract, present in about 2% of population. Case Outline. The article presents the case of a 44-year-old otherwise healthy man with anemia, who was diagnosed lower gastrointestinal bleeding. An abdominal CT scan revealed a clearly demarcated solid tumor in hypogastric region, measuring 65 Ч 45 mm. A laparotomy through lower midline incision was performed. A surgical resection of a lesion of a Meckel’s diverticulum was carried out and a final diagnosis of gastrointestinal stromal tumor was made. The patient made an uneventful recovery. Conclusion. The preoperative diagnosis of a complicated Meckel’s diverticulum may be challenging. CT is usually an adequate method to diagnose tumors arising from Meckel’s diverticulum.

  17. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  18. Pharmaco-induced vasospasm therapy for acute lower gastrointestinal bleeding: A preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Huei-Lung, E-mail: hlliang@vghks.gov.tw [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China); Chiang, Chia-Ling [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); Chen, Matt Chiung-Yu [Department of Radiology, Yuan' s General Hospital, Kaohsiung. Taiwan (China); Lin, Yih-Huie; Huang, Jer-Shyung; Pan, Huay-Ben [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China)

    2014-10-15

    Purpose: To report a novel technique and preliminary clinical outcomes in managing lower gastrointestinal bleeding (LGIB). Materials and methods: Eighteen LGIB patients (11 men and 7 women, mean age: 66.2 years) were treated with artificially induced vasospasm therapy by semi-selective catheterization technique. Epinephrine bolus injection was used to initiate the vascular spasm, and followed by a small dose vasopressin infusion (3–5 units/h) for 3 h. The technical success, clinical success, recurrent bleeding and major complications of this study were evaluated and reported. Results: Sixteen bleeders were in the superior mesenteric artery and 2 in the inferior mesenteric artery. All patients achieved successful immediate hemostasis. Early recurrent bleeding (<30 days) was found in 4 patients with local and new-foci re-bleeding in 2 (11.1%) each. Repeated vasospasm therapy was given to 3 patients, with clinical success in 2. Technical success for the 21 bleeding episodes was 100%. Lesion-based and patient-based primary and overall clinical successes were achieved in 89.4% (17/19) and 77.7% (14/18), and 94.7% (18/19) and 88.8% (16/18), respectively. None of our patients had complications of bowel ischemia or other major procedure-related complications. The one year survival of our patients was 72.2 ± 10.6%. Conclusions: Pharmaco-induced vasospasm therapy seems to be a safe and effective method to treat LGIB from our small patient-cohort study. Further evaluation with large series study is warranted. Considering the advanced age and complex medical problems of these patients, this treatment may be considered as an alternative approach for interventional radiologists in management of LGIB.

  19. The Management of Acute Upper Gastrointestinal Bleeding: A Comparison of Current Clinical Guidelines and Best Practice

    Directory of Open Access Journals (Sweden)

    Alison A. Taylor

    2014-12-01

    Full Text Available Acute upper gastrointestinal bleeding (AUGIB is the most common GI emergency, responsible for up to 70,000 hospital admissions in the UK and around 4,000 deaths. The latest UK national audit highlighted inconsistencies in both the management and service provision. Several national and international professional bodies have produced evidence-based recommendations on the management of AUGIB. We carried out a review of the guidance documentation published by four expert bodies including the National Institute of Clinical Excellence, the Scottish Intercollegiate Guidelines Network, the American College of Gastroenterology, and those published in the Annals of Internal Medicine. Consensus is still yet to be reached for initiating blood products in the emergency situation, with some evidence suggesting that liberal transfusion could exacerbate bleeding severity, although there is a lack of large randomised trials. It is widely agreed that prompt endoscopy within 24 hours improves outcomes, but evidence suggests that lowering this threshold confers no additional benefit. Use of proton pump inhibitors both pre and post-endoscopy for non-variceal bleeds is also advocated by professional bodies, with substantial evidence that it reduces the risk of re-bleeding. For patients with suspected oesophageal or gastric variceal bleeding, prophylactic antibiotics and vasopressin analogues are recommended, although guidelines vary on specific regimens. Recent UK and international guidelines provide a useful framework to guide management of patients who present to the emergency department with suspected AUGIB; however, their advice varies in some key areas due to a lack of large randomised trials as supporting evidence.

  20. 111In oxine labeled red cells for detection of simulated lower gastrointestinal bleeding in an animal model

    International Nuclear Information System (INIS)

    111In oxine in vitro labeled red cells were evaluated in rabbits for the ability to detect gastrointestinal (Gl) bleeding. A mean labeling efficiency of 81% (+- 15.5%) was achieved. Biodistribution and translocation data demonstrated 81% of the activity within the blood pool at four hours after intravenous injection, falling to 29% by 72 hours. Peak urine excretion occurred after 60 to 150 minutes. Normal Gl excretion was less than 1% over 72 hours. Simulated lower Gl bleeding was imaged at 4, 12, and 72 hours, and amounts as small as 2 ml (1% blood volume) were seen. In rabbits the total body dose of injected 111In is 0.15 mGy/MBq (0.56 rad/mCi), and the critical organ is the spleen, which received 0.49 mGy/MBq (1.82 rad/mCi). 111In oxine labeled red cells provide a sustained blood pool label wthout significant accumulation in the Gl tract, and may have a potential use in the detection of intermittent Gl bleeding in humans

  1. Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium-99m-labeled red blood cells in an experimental model

    International Nuclear Information System (INIS)

    Proponents of [/sup 99m/Tc]sulfur colloid for GI bleeding studies argue that, although labeled red blood cells are useful for intermittent bleeding, they are not capable of detecting low bleeding rates. Studies of dogs with experimental GI bleeding have indicated bleeding rates of 0.05 ml/min can be detected with [/sup 99m/Tc]sulfur colloid. Since similar data in the dog model were unavailable for /sup 99m/Tc-labeled red blood cells, we undertook this study. To simulate lower GI bleeding, catheters were inserted into the bowel lumen. Each dog's blood was labeled with /sup 99m/Tc using an in vitro technique. Venous blood was then withdrawn and re-infused into the lumen of the bowel using a Harvard pump. Fourteen dogs were studied, ten receiving a bleeding rate from 4.6-0.02 ml/min in the descending colon and four with proximal jejunal bleeds of 0.20-0.02 ml/min. Bleeding rates of 4.6-0.2 ml/min were detected within 10 min in the colon and bleeding rates as low as 0.04 ml/min were seen by 55 min. Slower bleeding rates were not detected. Similar findings were noted for proximal jejunal bleeds. Based on the time of appearance, a minimum volume of approximately 2-3 ml labeled blood was necessary to detect bleeding. We conclude that /sup 99m/Tc-labeled RBCs are sensitive for low bleeding rates in the dog model. The rates are comparable to those described for [/sup 99m/Tc]sulfur colloid in this experimental setting. The time of appearance of activity is related to the bleeding rate

  2. Upper Gastrointestinal Bleeding from Gastric Amyloidosis in a Patient with Smoldering Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Mihajlo Gjeorgjievski

    2015-01-01

    Full Text Available Amyloidosis is a common complication of patients with monoclonal gammopathy of undetermined significance (MGUS, smoldering multiple myeloma (SMM, and multiple myeloma (MM. This proteinaceous material can be deposited intercellularly in any organ system, including the gastrointestinal (GI tract. In the GI tract, amyloidosis affects the duodenum most commonly, followed by the stomach and colorectum. Gastric amyloidosis causes symptoms of nausea, vomiting, early satiety, abdominal pain, and GI bleeding. A case of upper GI bleeding from gastric amyloidosis is presented in a patient with SMM. Esophagogastroduodenoscopy (EGD revealed a gastric mass. Endoscopic biopsies revealed amyloid deposition in the lamina propria, consistent with gastric amyloidosis. Liquid chromatography tandem mass spectrometry performed on peptides extracted from Congo red-positive microdissected areas of paraffin-embedded stomach specimens revealed a peptide profile consistent with AL- (lambda- type amyloidosis. Based on this and multiple other case reports, we recommend that patients with GI bleeding and MGUS, SMM, or MM undergo EGD and pathologic examination of endoscopic biopsies of identified lesions using Congo red stains for amyloidosis for early diagnosis and treatment.

  3. Massive Upper Gastrointestinal Bleeding Secondary to Duodenal Metastasis of Transitional Cell Carcinoma of the Urinary Bladder

    Directory of Open Access Journals (Sweden)

    Carlos H.F. Chan

    2011-04-01

    Full Text Available Acute upper gastrointestinal (UGI bleeding is a common problem in our clinical practice and is often due to peptic ulcer diseases. Occasionally, malignancy may be implicated in these situations. Here we report a rare case of UGI bleeding secondary to metastatic transitional cell carcinoma (TCC of the urinary bladder. A 62-year-old man with a history of stage IIIb TCC of the urinary bladder presented with hematemesis. Endoscopy showed a large tumor in the second stage of the duodenum that occupied 40% of the duodenal circumference, over 7 cm in length. Biopsies revealed a poorly differentiated malignant neoplasm consistent with metastasis from urothelial carcinoma that was identical to the previous surgical specimen of the urinary bladder. He was treated with supportive therapy and intravenous proton pump inhibitor and was discharged home 2 weeks later. Two weeks after discharge, the patient returned to the hospital with a painful swelling of the floor of his mouth. Biopsy again showed the same cancer type. He had unremitting bleeding from his mouth requiring multiple transfusions and a course of palliative radiation therapy. He progressively deteriorated in his cardiopulmonary and neurological functions and expired with cardiopulmonary arrest one month later.

  4. Detection of acute gastrointestinal bleeding by intra-arterial scintigraphy: an experimental study and preliminary clinical experience

    International Nuclear Information System (INIS)

    The purpose of this animal and clinical study was to compare intra-arterial (IA) scintigraphy with angiography in the localization of gastrointestinal (GI) bleeding. After sedation with intramuscularly administered ketamine, lower GI bleeding was induced in ten rabbits. Using inguinal cut-down, an arterial femoral 3F catheter was placed in the proximal mesenteric artery. Following abdominal incision to expose the bowel, lower GI bleeding was caused by incising the antimesenteric border of the small bowel wall. Initial angiography was performed, and this was followede by Tc-99m pertechnetate IA scintigarphy. Tc-99m RBC IA scintigraphy involved two patients who had undergone selective mesenteric arterial catheterizaion for the evaluation of acute lower GI bleeding. Ten rabbits, bleeding at a mean rate of 0.7g/min, were studied. IA scintigraphy was superior to angiography in four cases and equal in six. The sensitivity of angiography was 40%(4/10), and IA scintigraphy 80%(8/10). In one patient, Tc-99m RBC was administered directly into the superior mesenteric artery and ulcer bleeding in the transverse colon was identified. PRior to conventional angiography, the bleeding had been occult. In a second patient, in whom angiography had revealed a hypervascular mass, selective injection of Tc-99m RBC into the superior mesenteric artery revealed tumor(leiomyoma) bleeding in the jejunum. Selective IA scintigraphy was valuable for detecting intestinal bleeding, occult during conventional studies and may be useful for detecting acute bleeding at the time of negative angiography.=20

  5. Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding: A case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Nooman Gilani; Francisco C Ramirez

    2007-01-01

    Ampullary carcinoid is a rare tumor that can present with gastrointestinal bleeding, obstructive jaundice or pancreatitis. Some of these tumors are associated with Von Recklinghausen disease. The usual surgical options are a biliary-enteric anastomosis, Whipple procedure or rarely a local resection. The mean survival dges not appear to be much different after a pancreaticoduodenectomy versus local surgical excision.We report a very rare case of a non-metastatic ampullary carcinoid causing upper gastrointestinal bleeding, which was managed by endoscopic ampullectomy.

  6. Defining upper gastrointestinal bleeding from linked primary and secondary care data and the effect on occurrence and 28 day mortality

    Directory of Open Access Journals (Sweden)

    Crooks Colin

    2012-11-01

    Full Text Available Abstract Background Primary care records from the UK have frequently been used to identify episodes of upper gastrointestinal bleeding in studies of drug toxicity because of their comprehensive population coverage and longitudinal recording of prescriptions and diagnoses. Recent linkage within England of primary and secondary care data has augmented this data but the timing and coding of concurrent events, and how the definition of events in linked data effects occurrence and 28 day mortality is not known. Methods We used the recently linked English Hospital Episodes Statistics and General Practice Research Database, 1997–2010, to define events by; a specific upper gastrointestinal bleed code in either dataset, a specific bleed code in both datasets, or a less specific but plausible code from the linked dataset. Results This approach resulted in 81% of secondary care defined bleeds having a corresponding plausible code within 2 months in primary care. However only 62% of primary care defined bleeds had a corresponding plausible HES admission within 2 months. The more restrictive and specific case definitions excluded severe events and almost halved the 28 day case fatality when compared to broader and more sensitive definitions. Conclusions Restrictive definitions of gastrointestinal bleeding in linked datasets fail to capture the full heterogeneity in coding possible following complex clinical events. Conversely too broad a definition in primary care introduces events not severe enough to warrant hospital admission. Ignoring these issues may unwittingly introduce selection bias into a study’s results.

  7. A novel approach to assess the spontaneous gastrointestinal bleeding risk of antithrombotic agents using Apc(min/+) mice.

    Science.gov (United States)

    Wei, Huijun; Shang, Jin; Keohane, CarolAnn; Wang, Min; Li, Qiu; Ni, Weihua; O'Neill, Kim; Chintala, Madhu

    2014-06-01

    Assessment of the bleeding risk of antithrombotic agents is usually performed in healthy animals with some form of vascular injury to peripheral organs to induce bleeding. However, bleeding observed in patients with currently marketed antithrombotic drugs is typically spontaneous in nature such as intracranial haemorrhage (ICH) and gastrointestinal (GI) bleeding, which happens most frequently on top of preexisting pathologies such as GI ulcerations and polyps. Apc(min/+) mice are reported to develop multiple adenomas through the entire intestinal tract and display progressive anaemia.In this study, we evaluated the potential utility of Apc(min/+) mice as a model for assessing spontaneous GI bleeding with antithrombotic agents. Apc(min/+) mice exhibited progressive blood loss starting at the age of nine weeks. Despite the increase in bleeding, Apc(min/+) mice were in a hypercoagulable state and displayed an age-dependent increase in thrombin generation and circulating fibrinogen as well as a significant decrease in clotting times. We evaluated the effect of warfarin, dabigatran etexilate, apixaban and clopidogrel in this model by administering them in diet or in the drinking water to mice for 1-4 weeks. All of these marketed drugs significantly increased GI bleeding in Apc(min/+) mice, but not in wild-type mice. Although different exposure profiles of these antithrombotic agents make it challenging to compare the bleeding risk of compounds, our results indicate that the Apc(min/+) mouse may be a sensitive preclinical model for assessing the spontaneous GI bleeding risk of novel antithrombotic agents.

  8. Is Occult Obscure Gastrointestinal Bleeding a Definite Indication for Capsule Endoscopy? A Retrospective Analysis of Diagnostic Yield in Patients with Occult versus Overt Bleeding

    OpenAIRE

    Ikue Watari; Shiro Oka; Shinji Tanaka; Makoto Nakano; Taiki Aoyama; Shigeto Yoshida; Kazuaki Chayama

    2013-01-01

    Background/Aim. Usefulness of capsule endoscopy (CE) for diagnosing small-bowel lesions in patients with obscure gastrointestinal bleeding (OGIB) has been reported. Most reports have addressed the clinical features of overt OGIB, with few addressing occult OGIB. We aimed to clarify whether occult OGIB is a definite indication for CE. Methods. We retrospectively compared the cases of 102 patients with occult OGIB and 325 patients with overt OGIB, all having undergone CE. The diagnostic yield o...

  9. [A Case of Resected Giant Gastrointestinal Stromal Tumor Associated with Intraperitoneal Bleeding Following Imatinib Administration].

    Science.gov (United States)

    Ide, Ryuta; Suzuki, Takahisa; Takakura, Yuji; Oshita, Akihiko; Ikeda, Satoshi; Matsugu, Yasuhiro; Nakahara, Hideki; Urushihara, Takashi; Itamoto, Toshiyuki; Shinozaki, Katsunori

    2016-09-01

    A 76-year-old woman with tarry stool was referred to our hospital for further examination. Contrast-enhanced computed tomography(CT)revealed a heterogeneous 15 cm tumor located in the left upper abdominal cavity. The tumor had a rich vascularity and was associated with intra-abdominal bleeding. Gastroscopy showed a large submucosal tumor in the gastric body. A biopsy was performed, and the patient was diagnosed with a c-kit-positive gastrointestinal stromal tumor(GIST)of the stomach. Imatinib mesylate(400mg/day)was administered for 6 months. Vascularity in the tumor was diminished and no new lesion had emerged, although there was no remarkable reduction in tumor size. The patient underwent partial gastrectomy and splenectomy with curative intent. She is currently alive 1 year and 4 months after surgery with no evidence of recurrence. PMID:27628557

  10. Hypovolemic shock due to severe gastrointestinal bleeding in a child taking an herbal syrup

    Directory of Open Access Journals (Sweden)

    Paola Angela Moro

    2011-01-01

    Full Text Available We report the case of a 4-years-old boy who was admitted with hypovolemic shock due to a severe gastrointestinal bleeding. The esophagogastroduodenoscopy (EGDS showed hiatus hernia, erosions and ulcerations of the lower esophagus, possibly due to a gastroesophageal reflux, and a small duodenal erosion. The child was previously healthy and he had never shown any symptoms related to this condition. The only product taken by the child in the previous days was a syrup containing several herbs, among which Filipendula ulmaria (L. Maxim. and Salix spp. (known to contain salicylates, marketed as food and prescribed by his paediatrician to treat a mild cold accompanied by fever. Quali-quantitative analysis confirmed the presence of salicylates in the syrup. Naranjo algorithm showed a probable correlation between the onset of symptoms and the consumption of the herbal remedy. The child recovered after receiving intensive care. The product was withdrawn from Italian market.

  11. Cameron ulcers: An atypical source for a massive upper gastrointestinal bleed

    Institute of Scientific and Technical Information of China (English)

    Samir Kapadia; Sophia Jagroop; Atul Kumar

    2012-01-01

    Cameron lesions represent linear gastric erosions and ulcers on the crests of mucosal folds in the distal neck of a hiatal hernia (HH).Such lesions may be found in upto 50% of endoscopies performed for another indication.Though typically asymptomatic,these may rarely present as acute,severe upper gastrointestinal bleed (GIB).The aim is to report a case of a non-anemic 87-year-old female with history of HH and atrial fibrillation who presented with hematemesis and melena resulting in hypovolemic shock.Repeat esophagogastroduodenoscopy was required to identify multiple Cameron ulcers as the source.Endoscopy in a patient with HH should involve meticulous visualization of hernia neck and surrounding mucosa.Cameron ulcers should be considered in all patients with severe,acute GIB and especially in those with known HH with or without chronic anemia.

  12. Latent vitellointestinal duct sinus presenting with massive lower gastrointestinal bleeding in an adolescent.

    Science.gov (United States)

    Patel, Ramnik V; Evans, Kathryn; Sau, Indranil; Huddart, Simon

    2014-09-16

    A 12-year-old boy with a history, at birth, of a weeping pink fleshy lesion after his umbilical cord detached, requiring repeated chemical cauterisation, presented with massive lower gastrointestinal bleeding and required resuscitation and blood transfusion. Augmented Tc99m nuclear medicine scan confirmed ectopic gastric mucosa. The lateral view suggested its attachment behind the umbilicus. At exploration, a latent vitellointestinal duct sinus with ectopic gastric mucosal mass was found. Segmental resection of the sinus and mass excision with primary anastomosis and incidental appendicectomy was curative. Pink fleshy mass discharging coloured fluid at the umbilicus following detachment of umbilical cord should be considered a remnant of vitellointestinal duct unless proved otherwise. A pink lesion with yellowish discharge resistant to chemical cauterisation should raise the suspicion of embryonic structures. Latent vitellointestinal sinus is a new lesion in the spectrum of umbilical anomalies. Lateral view of the nuclear medicine scan is helpful in locating the site.

  13. Transfusion treatment impact in the improvement of haematological parameters in patients with gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Iliriane Bunjaku

    2012-04-01

    Full Text Available Introduction: Transfusion treatment (TT is necessary in patients with gastrointestinal bleeding (GIB for lost blood substitution. This study was aimed at assessing the changes in haematological parameters  (hemoglobin, hematocrit, red blood cell count, white cell count, platelet count and prothrombin time before and after TT in anaemic patients with GIB in order to analyse the effect of this treatment.Methods: There have been included 293 patients with GIB (the average age was 57.3, ranged from 18-89 years who were treated with TT at the Internal Clinic at the University Clinical Center Prishtina during oneyear period. Data for applied blood product and results of the coagulation screen (PT were collected from the Kosovo’s Blood Transfusion Center (KBTC.Results: TT has been carried out in 404 episodes, with 714 units of concentrated red blood cells (78.6%, 189 units of fresh frozen plasma (20.8% and concentrated platelets (0.6%, with an average dose 3.1 fortransfunded patients. Average values of Hb before and after TT were 71.8 g/L and 81.4 g/L, respectively; while the average values of hematocrite before and after TT were 22.9% and 25.6%, respectively. The averageerythrocytes count before TT was 2.6 respectively after treatment 2.8(pConclusions: Having in mind difficult clinical and unsustainable situation in patients with gastrointestinal bleeding, the Transfusion Treatment resulted in the considerable improvement of the specific blood indicators.

  14. Transfusion treatment impact in the improvement of haematological parameters in patients with gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Iliriane Bunjaku

    2012-04-01

    Full Text Available Introduction: Transfusion treatment (TT is necessary in patients with gastrointestinal bleeding (GIB for lost blood substitution. This study was aimed at assessing the changes in haematological parameters  (hemoglobin, hematocrit, red blood cell count, white cell count, platelet count and prothrombin time before and after TT in anaemic patients with GIB in order to analyse the effect of this treatment.Methods: There have been included 293 patients with GIB (the average age was 57.3, ranged from 18-89 years who were treated with TT at the Internal Clinic at the University Clinical Center Prishtina during oneyear period. Data for applied blood product and results of the coagulation screen (PT were collected from the Kosovo’s Blood Transfusion Center (KBTC.Results: TT has been carried out in 404 episodes, with 714 units of concentrated red blood cells (78.6%, 189 units of fresh frozen plasma (20.8% and concentrated platelets (0.6%, with an average dose 3.1 fortransfunded patients. Average values of Hb before and after TT were 71.8 g/L and 81.4 g/L, respectively; while the average values of hematocrite before and after TT were 22.9% and 25.6%, respectively. The averageerythrocytes count before TT was 2.6 respectively after treatment 2.8(p<0.0001. The PT was carried out in the 43% of patients with GIB before treatment with FFP, but after that only in 2% of cases.Conclusions: Having in mind difficult clinical and unsustainable situation in patients with gastrointestinal bleeding, the Transfusion Treatment resulted in the considerable improvement of the specific blood indicators.

  15. Whole blood viscosity issues VI: Association with blood salicylate level and gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Ezekiel Uba Nwose

    2010-01-01

    Full Text Available Background : This series on whole blood viscosity issues has been trying to elucidate the sensitivity, specificity and usefulness of the laboratory parameter in clinical practice. The postulation has been that since antiplatelet is used in the management of stasis, of which blood viscosity is an index, the latter would be useful laboratory indication and/or contraindication. Aim : The aim of this study was to observe whether blood level of acetylsalicylic acid differs with the level of whole blood viscosity. Patients and Methods : Out of the ten years database, 538 cases that were concomitantly tested for haematocrit, total proteins and blood level of salicylate were selected for this study. A separate nine cases of positive faecal occult blood tests were audited for blood viscosity and reviewed. Results : A statistically significant difference is observed with lower blood viscosity being associated with higher salicylate level in comparison of the former between the highest vs. lowest quartiles (p < 0.002. This observation demonstrates the effect of aspirin in lowering blood stasis. Reviewing the positive faecal occult blood cases indicate that gastrointestinal bleeding is characterized by relative hypoviscosity and that hyperviscosity is not present during bleeding complications. Conclusion : The findings affirm that whole blood viscosity is a valid clinical laboratory parameter for evidence-based contraindication, indication and monitoring of antiplatelet medication. It calls for better appreciation and clinical utility of whole blood viscosity, which (in the absence of viscometer can now be extrapolated from haematocrit and total proteins.

  16. Simple risk factors to predict urgent endoscopy in nonvariceal upper gastrointestinal bleeding pre-endoscopically.

    Science.gov (United States)

    Wang, Jianzong; Hu, Duanming; Tang, Wen; Hu, Chuanyin; Lu, Qin; Li, Juan; Zhu, Jianhong; Xu, Liming; Sui, Zhenyu; Qian, Mingjie; Wang, Shaofeng; Yin, Guojian

    2016-06-01

    The goal of this study is to evaluate how to predict high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) pre-endoscopically. A total of 569 NVUGIB patients between Match 2011 and January 2015 were retrospectively studied. The clinical characteristics and laboratory data were statistically analyzed. The severity of NVUGIB was based on high-risk NVUGIB (Forrest I-IIb), and low-risk NVUGIB (Forrest IIc and III). By logistic regression and receiver-operating characteristic curve, simple risk score systems were derived which predicted patients' risks of potentially needing endoscopic intervention to control bleeding. Risk score systems combined of patients' serum hemoglobin (Hb) ≤75 g/L, red hematemesis, red stool, shock, and blood urine nitrogen ≥8.5 mmol/L within 24 hours after admission were derived. As for each one of these clinical signs, the relatively high specificity was 97.9% for shock, 96.4% for red stool, 85.5% for red hematemesis, 76.7% for Hb ≤75 g/L, and the sensitivity was 50.8% for red hematemesis, 47.5% for Hb ≤75 g/L, 14.2% for red stool, and 10.9% for shock. When these 5 clinical signs were presented as a risk score system, the highest area of receiver-operating characteristic curve was 0.746, with sensitivity 0.675 and specificity 0.733, which discriminated well with high-risk NVUGIB. These simple risk factors identified patients with high-risk NVUGIB of needing treatment to manage their bleeding pre-endoscopically. Further validation in the clinic was required. PMID:27367977

  17. Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Jestin N. Carlson

    2015-12-01

    Full Text Available Introduction: Video laryngoscopy (VL has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII. Methods: We performed a retrospective analysis of a prospectively collected national database (NEARIII of intubations performed in United States emergency departments (EDs from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate. Results: We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other and level of operator training (post-graduate year 1, 2, etc. Proportion of successful first attempts (DL 261/295 (88.5% vs. VL 28/30 (93.3% p=0.58 and Cormack-Lehane grade views (p=0.89 were similar between devices. The need for device change was similar between DL [2/295 (0.7% and VL 1/30 (3.3%; p=0.15]. Conclusion: In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices.

  18. Upper gastrointestinal bleeding treatment by methods of interventional radiology; Leczenie krwotokow z gornego odcinka przewodu pokarmowego metodami radiologii zabiegowej

    Energy Technology Data Exchange (ETDEWEB)

    Jargiello, T.; Szajner, M.; Janczarek, M.; Szczerbo-Trojanowska, M. [Akademia Medyczna, Lublin (Poland)

    1994-12-31

    The results of arterial vasopressin infusion and transcatheter embolization in 26 patients with upper gastrointestinal bleeding were presented and evaluated. In all 26 patients vasopressin infusion was performed. The procedure was successful in 21 patients. In 5 who did not respond to the therapy hemorrhage was successfully controlled by transcatheter embolization. No complications were observed. (author). 14 refs, 2 figs.

  19. Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    The aim of this study was to assess the accuracy of technetium 99m-labeled red cell scintigraphy in localizing the site of lower gastrointestinal bleeding. The outcome of 203 patients undergoing technetium 99m-labeled red cell scintigraphy was reviewed, and the scan result was compared with the true site of bleeding. The true site of bleeding was determined by other methods including angiography and surgical pathology. Fifty-two scans (26%) were positive and indicated a specific site of bleeding. A definitive bleeding site was identified in 22 patients by other means and correlated with the technetium scan in only 9 cases. The nuclear scan was incorrect in the remaining 13 cases, implying a localization error of 25% (13 of 52). A subgroup of 19 patients with a positive scan underwent a surgical procedure directed by the nuclear scan. Eight of these 12 patients had incorrect surgical procedures based upon findings of more definitive tests, indicating a surgical error of 42% (8 of 19). We conclude that the technetium 99m-labeled red cell scan's ability to accurately localize the site of lower gastrointestinal bleeding is limited. Furthermore, performing a surgical procedure that relies exclusively on localization by red cell scintigraphy will produce an undesirable result in at least 42% of patients

  20. Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Hunter, J.M.; Pezim, M.E. (Univ. of British Columbia, Vancouver (Canada))

    1990-05-01

    The aim of this study was to assess the accuracy of technetium 99m-labeled red cell scintigraphy in localizing the site of lower gastrointestinal bleeding. The outcome of 203 patients undergoing technetium 99m-labeled red cell scintigraphy was reviewed, and the scan result was compared with the true site of bleeding. The true site of bleeding was determined by other methods including angiography and surgical pathology. Fifty-two scans (26%) were positive and indicated a specific site of bleeding. A definitive bleeding site was identified in 22 patients by other means and correlated with the technetium scan in only 9 cases. The nuclear scan was incorrect in the remaining 13 cases, implying a localization error of 25% (13 of 52). A subgroup of 19 patients with a positive scan underwent a surgical procedure directed by the nuclear scan. Eight of these 12 patients had incorrect surgical procedures based upon findings of more definitive tests, indicating a surgical error of 42% (8 of 19). We conclude that the technetium 99m-labeled red cell scan's ability to accurately localize the site of lower gastrointestinal bleeding is limited. Furthermore, performing a surgical procedure that relies exclusively on localization by red cell scintigraphy will produce an undesirable result in at least 42% of patients.

  1. Is Occult Obscure Gastrointestinal Bleeding a Definite Indication for Capsule Endoscopy? A Retrospective Analysis of Diagnostic Yield in Patients with Occult versus Overt Bleeding

    Directory of Open Access Journals (Sweden)

    Ikue Watari

    2013-01-01

    Full Text Available Background/Aim. Usefulness of capsule endoscopy (CE for diagnosing small-bowel lesions in patients with obscure gastrointestinal bleeding (OGIB has been reported. Most reports have addressed the clinical features of overt OGIB, with few addressing occult OGIB. We aimed to clarify whether occult OGIB is a definite indication for CE. Methods. We retrospectively compared the cases of 102 patients with occult OGIB and 325 patients with overt OGIB, all having undergone CE. The diagnostic yield of CE and identification of various lesion types were determined in cases of occult OGIB versus overt OGIB. Results. There was no significant difference in diagnostic yield between occult and overt OGIB. The small-bowel lesions in cases of occult OGIB were diagnosed as ulcer/erosive lesions (n=18, 18%, vascular lesions (n=11, 11%, and tumors (n=4, 3%, and those in cases of overt OGIB were diagnosed as ulcer/erosive lesions (n=51, 16%, vascular lesions (n=31, 10%, and tumors (n=20, 6%. Conclusion. CE detection rates and CE identification of various small-bowel diseases do not differ between patients with occult versus overt OGIB. CE should be actively performed for patients with either occult or overt OGIB.

  2. Evaluation of nasogastric tubes to enable differentiation between upper and lower gastrointestinal bleeding in unselected patients with melena.

    Science.gov (United States)

    Kessel, Boris; Olsha, Oded; Younis, Aurwa; Daskal, Yaakov; Granovsky, Emil; Alfici, Ricardo

    2016-02-01

    Gastrointestinal (GI) bleeding is a common surgical problem. The aim of this study was to evaluate how insertion of the nasogastric tube may enable differentiation between upper and lower GI bleeding in patients with melena. A retrospective study involving patients admitted to our surgery division with a melena was carried out between the years 2010 and 2012. A total of 386 patients were included in the study. Of these, 279 (72.2%) patients had negative nasogastric aspirate. The sensitivity of examination of nasogastric aspirate to establish the upper GI as the source of bleeding was only 28% and the negative predictive value of a negative nasogastric aspirate was less than 1%. Most patients who initially presented with melena and were found to have upper GI bleeding had a negative nasogastric aspirate. Insertion of a nasogastric tube does not affect the clinical decision to perform upper endoscopy and should not be routinely carried out.

  3. Thalidomide in refractory bleeding due to gastrointestinal angiodysplasias Talidomida en la hemorragia recidivante por angiodisplasias gastrointestinales

    Directory of Open Access Journals (Sweden)

    Antonio Garrido

    2012-02-01

    Full Text Available Objectives: to assess the efficacy of thalidomide in the treatment of relapsed or refractory bleeding secondary to gastrointestinal angiodysplasia. Material and methods: we carried out a prospective study of 12 patients with bleeding due to gastrointestinal angiodysplasia refractory to conventional therapy who were treated with thalidomide. For each patient, we considered: age, sex, underlying disease, previous therapies, dose and duration of thalidomide treatment, evolution of haemoglobin levels and adverse effects of treatment. The data obtained were analysed using descriptive statistics with SPSS v. 16. Results: seven men and 5 women with a mean age of 77 years were included in the present study. Five had some underlying pathology and all of them had received prior endoscopic/octreotide treatment. The dose of thalidomide administered was 200 mg/24 h and the duration of the treatment four months, with the exception of two patients in whom treatment was discontinued because of adverse side effects. Mean haemoglobin concentration before onset of treatment was 6.5 g/dL, at two months it was 11.3 g/dL and at the end of treatment 12.1 g/dL. Conclusions: thalidomide is an effective treatment in gastrointestinal bleeding due to angiodysplasia, but it was withdrawn due to side effects in 16% of the patients included in our study.Objetivos: valorar la eficacia de talidomida en la hemorragia recidivante y refractaria por angiodisplasias gastrointestinales. Material y métodos: se realizó un estudio prospectivo de 12 pacientes con hemorragia por angiodisplasias refractarios a la terapia convencional, que recibieron tratamiento con talidomida. Se determinó en cada caso: edad, sexo, patología de base, tratamientos previos, dosis y duración del tratamiento con talidomida, evolución de los valores de hemoglobina y efectos secundarios del tratamiento. Los datos fueron procesados mediante estadística descriptiva con SPSS versión 16. Resultados: se

  4. Acute upper gastrointestinal bleeding in octogenarians: Clinical outcome and factors related to mortality

    Institute of Scientific and Technical Information of China (English)

    George J Theocharis; Vassiliki Arvaniti; Stelios F Assimakopoulos; Konstantinos C Thomopoulos; Vassilis Xourgias; Irini Mylonakou; Vassiliki N Nikolopoulou

    2008-01-01

    AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians.METHODS: We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (>80 years old).RESULTS: Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B147 patients. Co-morbidity was more common in octogenarians (P=0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P=0.05) and more patients died in the group of octogenarians compared to the younger age group (P=0.02). Inability to perform endoscopic examination (P=0.002), presence of high risk for rebleeding stigmata (P=0.004), urea on admission (P=0.036), rebleeding (P=0.004) and presence of severe co-morbidity (P<0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P=0.032).CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.

  5. Pancreatitis-associated pseudoaneurysm of the splenic artery presenting as lower gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Khalife, Mohammad; Faraj, Walid; Mukherji, Deborah; Haydar, Ali

    2012-12-03

    Pancreatitis is a known cause of pseudoaneurysms of the peripancreatic arteries, which can rarely rupture into various adjacent structures and become a source of life-threatening bleeding. The management is challenging and requires an individualised approach and multidisciplinary care. Herein, we present the case of a 24-year-old man in whom a splenic pseudoaneurysm ruptured into the adjacent infected pseudocyst, communicating with the colon by a fistulous tract, causing massive lower gastrointestinal bleeding. This was successfully managed by transcatheter arterial embolisation (TAE).

  6. Recurrent Renal Cell Carcinoma with Synchronous Tumor Growth in Azygoesophageal Recess and Duodenum: A Rare Cause of Anemia and Upper Gastrointestinal Bleeding

    Science.gov (United States)

    Vootla, Vamshidhar R.; Kashif, Muhammad; Niazi, Masooma; Nayudu, Suresh K.

    2015-01-01

    Renal cell carcinoma (RCC) has potential to present with distant metastasis several years after complete resection. The common sites of metastases include the lungs, bones, liver, renal fossa, and brain. RCCs metastasize rarely to the duodenum, and duodenal metastasis presenting with acute gastrointestinal bleed is infrequently reported in literature. We present a case of synchronous presentation of duodenal and azygoesophageal metastasis manifesting as acute upper gastrointestinal bleeding, four years after undergoing nephrectomy for RCC. The patient underwent further workup and was treated with radiation. The synchronous presentation is rare and stresses the importance of searching for recurrence of RCC in patients presenting with acute gastrointestinal bleeding. PMID:26640732

  7. Endoscopic management of acute gastrointestinal bleeding in children: Time for a radical rethink.

    Science.gov (United States)

    Thomson, Mike; Belsha, Dalia

    2016-02-01

    Currently we are no nearer than 10 or 20years ago providing a safe, adequate, and effective round-the-clock endoscopic services for acute life-threatening gastrointestinal bleeding in children. Preventable deaths are occurring still, and it is a tragedy. This is owing to a number of factors which require urgent attention. Skill-mix and the ability of available endoscopists in the UK are woeful. Manpower is spread too thinly and not concentrated in centers of excellence, which is necessary given the relative rarity of the presentation. Adult gastroenterologists are increasingly reticent regarding their help in increasingly litigious times. Recent work on identification of those children likely to require urgent endoscopic intervention has mirrored scoring systems that have been present in adult circles for many years and may allow appropriate and timely intervention. Recent technical developments such as that of Hemospray® may lower the threshold of competency in dealing with this problem endoscopically, thus allowing lives to be saved. Educational courses, mannequin and animal model training are important but so will be appropriate credentialing of individuals for this skill-set. Assessment of competency will become the norm and guidelines on a national level in each country mandatory if we are to move this problem from the "too difficult" to the "achieved". It is an urgent problem and is one of the last emergencies in pediatrics that is conducted poorly. This cannot and should not be allowed to continue unchallenged.

  8. Recurrent severe gastrointestinal bleeding and malabsorption due to extensive habitual megacolon

    Institute of Scientific and Technical Information of China (English)

    Ingo Mecklenburg; Markus Leibig; Christof Weber; Stefan Schmidbauer; Christian Folwaczny

    2005-01-01

    Dilatation of the colon and the rectum, which is not attributable to aganglionosis, is a rare finding and can be the result of intractable chronic constipation. We report a rare case of a 29-year-old male patient with impressive megacolon, in whom Hirschsprung's or Chagas disease was ruled out. In the present case, dilatation of the colon was most likely due to a behavioral disorder with habitual failure of defecation. Chronic stool retention led to a bizarre bulging of the large bowel with displacement of the other abdominal organs and severe occult blood loss. Because of two episodes of life-threatening gastrointestinal bleeding despite conventional treatment of constipation, a surgical approach for bowel restoration was necessary. Temporary loop ileostomy had to be performed for depressurization of the large bowel and the subsequent possibility for effective antegrade colonic lavage to remove impacted stools. Shortly after the operation, the patient was healthy and could easily manage the handling of the ileostomy. However, the course of the megacolon in this young adult cannot be predicted and the follow-up will have to reveal if regression of this extreme colonic distension with reestablishment of regular rectal perception will occur.

  9. Clinical impact of multidetector computed tomography before double-balloon enteroscopy for obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Hsu-Heng Yen; Yang-Yuan Chen; Chia-Wei Yang; Chi-Kuang Liu; Maw-Soan Soon

    2012-01-01

    AIM:To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB).METHODS:A retrospective analysis of prospectively collected cases with DBE and MDCT for overt OGIB was conducted from April 2004 to April 2010 at Changhua Christian Hospital.We evaluated the clinical impact of MDCT on the subsequent DBE examinations and the diagnostic yields of both MDCT and DBE respectively.RESULTS:From April 2004 to April 2010,a total of 75 patients underwent DBE for overt OGIB.Thirty one cases received MDCT followed by DBE for OGIB.The overall diagnostic yields of DBE and MDCT was 93.5% and 45.2%.The MDCT had a high diagnostic yield of tumor vs non-tumor etiology of OGIB (85.7% vs 33.3%,P =0.014).Additionally,the choice of initial route of DBE was correct in those with a positive MDCT vs negative MDCT (100% vs 52.9%,P =0.003).CONCLUSION:This study suggests MDCT as a triage tool may identify patients who will benefit from DBE and aid the endoscopist in choosing the most efficient route.

  10. Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data)

    Institute of Scientific and Technical Information of China (English)

    Stephanos Karagiannis; Spyros Goulas; Georgios Kosmadakis; Petros Galanis; Dimitrios Arvanitis; John Boletis; Evangelos Georgiou; Christos Mavrogiannis

    2006-01-01

    AIM: To investigate the role of wireless capsule endoscopy (WCE) in detection of small bowel (SB) pathology in patients with chronic renal failure (CRF) and obscure bleeding.METHODS: Consecutive CRF patients with obscure bleeding were prospectively studied. Patients with normal renal function and obscure bleeding, investigated during the same period with WCE, were used for the interpretation of results.RESULTS: Seventeen CRF patients (11 overt, 6 occult bleeding) and 51 patients (33 overt, 18 occult bleeding) with normal renal function were enrolled in this study.Positive SB findings were detected in 70.6% of CRF patients and in 41.2% of non-CRF patients (P < 0.05). SB angiodysplasia was identified in 47% of CRF patients and in 17.6% of non-CRF patients. Univariate logistic regression revealed CRF as a significant predictive factor for angiodysplasia (P < 0.05). Therapeutic measures were undertaken in 66% of the patients with the positive findings.CONCLUSION: According to our preliminary results, SB angiodysplasia was found in an increased prevalence among CRF patients with obscure bleeding. WCE is useful in diagnosis of gastrointestinal pathologies and in planning appropriate therapeutic intervention and, therefore, should be included in the work-up of this group of patients.

  11. Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: Endoscopic findings, clinical management and outcome

    Institute of Scientific and Technical Information of China (English)

    Konstantinos C Thomopoulos; Konstantinos P Mimidis; George J Theocharis; Anthie G Gatopoulou; Georgios N Kartalis; Vassiliki N Nikolopoulou

    2005-01-01

    AIM: Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy.The purpose of this study was to describe the causes and clinical outcome of these patients.METHODS: From January 1999 to October 2003, 111patients with acute upper gastrointestinal bleeding (AUGIB)were hospitalized while on oral anticoagulants. The causes and clinical outcome of these patients were compared with those of 604 patients hospitalized during 2000-2001with AUGIB who were not taking warfarin.RESULTS: The most common cause of bleeding was peptic ulcer in 51 patients (45%) receiving anticoagulants compared to 359/604 (59.4%) patients not receiving warfarin (P<0.05). No identifiable source of bleeding could be found in 33 patients (29.7%) compared to 31/604(5.1%) patients not receiving anticoagulants (P= 0.0001).The majority of patients with concurrent use of non-steroidal anti-inflammatory drugs (NSATDs) (26/35, 74.3%) had a peptic ulcer as a cause of bleeding while 32/76 (40.8%)patients not taking a great dose of NSATDs had a negative upper and lower gastrointestinal endoscopy. Endoscopic hemostasis was applied and no complication was reported.Six patients (5.4%) were operated due to continuing or recurrent hemorrhage, compared to 23/604 (3.8%) patients not receiving anticoagulants. Four patients died, the overall mortality was 3.6% in patients with AUGIB due to anticoagulants, which was not different from that in patients not receiving anticoagulant therapy.CONCLUSION: Patients with AUGIB while on long-term anticoagulant therapy had a clinical outcome, which is not different from that of patients not taking anticoagulants.Early endoscopy is important for the management of these patients and endoscopic hemostasis can be safely applied.

  12. Outcome of Acute Upper Gastrointestinal Bleeding in Patients with Coronary Artery Disease: A Matched Case–control Study

    OpenAIRE

    Kessarin Thanapirom; Wiriyaporn Ridtitid; Rungsun Rerknimitr; Rattikorn Thungsuk; Phadet Noophun; Chatchawan Wongjitrat; Somchai Luangjaru; Padet Vedkijkul; Comson Lertkupinit; Swangphong Poonsab; Thawee Ratanachu-ek; Piyathida Hansomburana; Bubpha Pornthisarn; Thirada Thongbai; Varocha Mahachai

    2016-01-01

    Background/Aim: The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients. Patients and Methods: We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecut...

  13. The characteristics of adults with upper gastrointestinal bleeding admitted to Tripoli Medical Center: a retrospective case-series analysis

    OpenAIRE

    Elghuel, Abdulbaset

    2011-01-01

    Background: Acute upper gastrointestinal bleeding (UGIB) is a common reason for hospital admissions worldwide. Aetiological causes of UGIB vary according to geographic region and socioeconomic status. However, despite the implementation of early endoscopy as the standard method for the diagnosis and treatment of UGIB, data on the characteristics of patients with UGIB in Libya are still minimal. In this study, we describe patient demographics, aetiological causes for UGIB, and possible risk fa...

  14. Comparative study of bacterial infection prevalence between cirrhotic patients with and without upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Delvone Almeida

    2001-06-01

    Full Text Available Bacterial infection is a frequent complication in patients with chronic liver disease, mainly during the advanced stages. There is evidence that the main factors that contribute to a predisposition to infection in cirrhotic patients are related to hepatic failure with consequent immunodeficiency. Invasive procedures (diagnostic or therapeutic can predispose to bacterial infections, and upper gastrointestinal bleeding (UGB is considered a potentially important risk factor. A group of cirrhotic patients (child B and C Pugh groups were evaluated retrospectively by chart reviews regarding the prevalence of bacterial infection during hospitalization to determine whether UGB was a risk factor. An infection was considered present if a specific organ system was identified or if fever (>38ºC persisted for more than 24 hours with associated leukocytosis. Spontaneous bacterial peritonitis was based on classical criteria. Eighty-nine patients were evaluated. Fourty-six patients presented with UGB, and 43 patients had no UGB (control. There were infections recorded in 25/46 (54% patients with UGB, and 15/43 (35% in those without UGB (p=0.065. The ratio of the number of infections/admitted patients, was significantly larger in the group with UGB (0.78 ± 0.89 vs. 0.39 ± 0.62; p=0.028 since patients had more than one infection. In the UGB group compared to non UGB group, ascites was more frequent (67% vs. 42%; p=0.027; they were more likely to have undergone endoscopic procedures (p<0.001 and the mean ± SD for platelets count was smaller (96,114 ± 57,563 vs. 145,674 ± 104,083; p=0.007. The results show that UGB is an important contribution to bacterial infection among Child B and C cirrhotic patients.

  15. The value of multidetector-row computed tomography for localization of obscure acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Wei-Chou [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Tsai, Shih-Hung [Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Chang, Wei-Kuo [Division of Gasteroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Liu, Chang-Hsien [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Tung, Ho-Jui [Department of Healthcare Administration, Asia University, Taichung, Taiwan (China); Hsieh, Chung-Bao [Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Huang, Guo-Shu; Hsu, Hsian-He [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Yu, Chih-Yung, E-mail: chougo2002@yahoo.com.tw [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China)

    2011-11-15

    Purpose: There are no simple guidelines on when to perform multidetector-row computed tomography (MDCT) for diagnosis of obscure acute gastrointestinal bleeding (AGIB). We used a risk scoring system to evaluate the diagnostic power of MDCT for patients with obscure AGIB. Materials and methods: Ninety-two patients with obscure AGIB who were referred for an MDCT scan after unsuccessful endoscopic treatment at presentation were studied. We recorded clinical data and calculated Blatchford score for each patient. Patients who required transfusion more than 500 mL of blood to maintain the vital signs were classified as high-risk patients. Two radiologists independently reviewed and categorized MDCT signs of obscure AGIB. Discordant findings were resolved by consensus. One-way ANOVA was used to compare clinical data between two groups; kappa statistics were used to estimate agreement on MDCT findings between radiologists. Results: Of the 92 patients, 62 (67.4%) were classified as high-risk patients. Blatchford scores of high-risk patients were significantly greater than those of low-risk patients. Sensitivity for MDCT diagnosing obscure AGIB was 81% in high-risk patients, as compared with 50% in the low-risk. When used in conjunction with selection of the cut-off value of 13 in Blatchford scoring system, the sensitivity and specificity of MDCT were 70.9% and 73.7%, respectively. Contrast extravasation was the most specific sign of AGIB (k = .87), recognition of which would have improved diagnostic accuracy. Conclusions: With the aid of Blatchford scoring system for evaluating the disease severity, MDCT can localize the bleeders of obscure AGIB more efficiently.

  16. A pedunculated polyp-shaped small-bowel lymphangioma causing gastrointestinal bleeding and treated by double-balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Akihiko Kida; Koichiro Matsuda; Satoshi Hirai; Akiyoshi Shimatani; Yousuke Horita; Katsushi Hiramatsu; Mitsuru Matsuda

    2012-01-01

    We report a rare case of a small-bowel lymphangioma causing massive gastrointestinal (GI) bleeding that we successfully diagnosed and treated using double-balloon enteroscopy (DBE).An 81-year-old woman suffering from repeated GI bleeding of unknown origin underwent a capsule endoscopy at a previous hospital.She was suspected of having bleeding from the jejunum,and was referred to our department for diagnosis and treatment.An oral DBE revealed a 20 mmx 10 mm,regularly surfaced,white to yellowish,elongated,pedunculated jejunal polyp with small erosions at 10 cm distal to the ligament of Treiz.Since no other source of bleeding was identified by endoscopy in the deep jejunum,an endoscopic polypectomy (EP) was performed for this lesion.A subsequent histopathological examination of the resected polyp showed clusters of lymphatic vessels with marked cystic dilatation in the submucosa and the deep layer of the lamina propria mucosae.These characteristics are consistent with the typical features of small-bowel lymphangioma with erosions.Although clipping hemostasis was performed during EP,re-bleeding occurred.Finally,a complete hemostasis was achieved by performing an additional argon plasma coagulation.

  17. Comparison of four technetium-99m radiopharmaceuticals for detection and localization of gastrointestinal bleeding in a sheep model

    International Nuclear Information System (INIS)

    Four Tc-99 radiopharmaceuticals, Tc-99m sulphur colloid, Tc-99m red blood cells (RBCs), Tc-99m mercaptoacetyltriglycine (MAG3), and Tc-99m DTPA, were studied in an experimental animal model for detection and localization of gastrointestinal (GI) bleeding site in both the upper and lower abdomen. With Tc-99m sulphur colloid and Tc-99m RBCs, it was possible to detect and localize the GI bleeding site in the lower abdomen. With Tc-99m MAG3, it was possible to visualize the bleeding site in both the upper and lower abdomen. However, Tc-99m MAG3 is partially excreted by the liver into the bile, hence it will be difficult to use Tc-99m MAG3 to localize the GI bleeding site in the lower abdomen. With Tc-99m DTPA, it was possible to detect and localize the GI bleeding site simultaneously in both upper and lower abdomen. The overall background radioactivity was reduced considerably by diuresis with frusemide and catheterization of the urinary bladder

  18. Detection of gastrointestinal bleeding by means of Tc99m-labelled red cells - methodology and results

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, R.; Kirchmann, K.; Flierdt, E. van de; Langhammer, H.R.; Pabst, H.W.

    1988-12-01

    Tc99m-labelled red cells were applied in 103 investigations of 91 patients to detect and localize occult gastrointestinal (GI) bleeding. In 60 examinations, GI-bleeding was proven. Correct localization of the bleeding site was achieved in 54 investigations. In 3 patients, bleeding from the lower intestinal tract could be positively excluded. These results were obtained in patients representing a negative selection, having undergone repeated endoscopy and angiography without positive result. 40% of all the bleeding sites were detected within 1 h. after tracer application, 25% only after a delay of 6 hrs. or more. To obtain good results, the whole investigation can become very time consuming and has to be performed according to a strict protocol. In addition, a tracer with high specificity to the intravasal space and high long-term stability has to be applied. Those requirements are met best by red cells labelled with Tc99m-according to a mixed in vivo/in vitro protocol.

  19. SKP2 high expression, KIT exon 11 deletions, and gastrointestinal bleeding as predictors of poor prognosis in primary gastrointestinal stromal tumors.

    Directory of Open Access Journals (Sweden)

    Ang Lv

    Full Text Available BACKGROUND AND AIMS: Considering the indication of adjuvant therapy, the recurrence risk for primary gastrointestinal stromal tumor (GIST after surgery needs to be accurately estimated. However, current risk stratification schemes may still have room for improvement. This study seeks to analyze prognostic factors for primary GISTs from 3 aspects, including clinicopathological parameters, immunohistochemical biomarkers, and gene mutational status, and attempts to find novel valuable factors predicting the malignancy potential of GISTs. METHODS: Retrospective data from 114 primary GIST patients after R0 resection were collected. Clinicopathological data was obtained from medical records and re-evaluated. Immunohistochemical analysis was performed using the Tissue Microarray method for Ki67, p16, p27, p53, SKP2, CD133, and actin. KIT gene exons 9, 11, 13, and 17 and PDGFRα gene exons 12 and 18 were tested for mutations using PCR. RESULTS: Univariate analysis revealed the following factors as poor prognostic indicators for relapse-free survival with a median follow-up of 50 months: male gender, gastrointestinal bleeding, mitotic index >5/50HPFs, tumor size >5 cm, non-gastric site, necrosis, epithelioid or mixed cell type, surrounding tissue invasion, Ki67>5%, p16>20%, p53 index >10, SKP2>10%, and KIT exon 11 deletion. Besides mitotic index, tumor size and site, SKP2 high expression (RR = 2.91, 95% CI: 1.41-5.99, P = 0.004 and KIT exon 11 deletion (RR = 2.73, 95% CI: 1.04-7.16, P = 0.041 were also independent risk factors in multivariate analysis, with gastrointestinal bleeding also showing a trend towards significance (RR = 1.88, 95% CI: 0.98-3.64, P = 0.059. In addition, gastrointestinal bleeding and SKP2 high expression showed a good ability to stratify high-risk patients further. CONCLUSION: Our results show that gastrointestinal bleeding, SKP2 high expression, and KIT exon 11 deletions may be useful indicators of high recurrence risk for

  20. Thalidomide for treatment of gastrointestinal bleedings due to angiodysplasia : a case report in acquired von Willebrand syndrome and review of the literature

    NARCIS (Netherlands)

    Engelen, E T; van Galen, K P M; Schutgens, R E G

    2015-01-01

    INTRODUCTION: Acquired von Willebrand syndrome is a rare bleeding disorder and treatment of the associated gastrointestinal (GI) bleeding due to angiodysplasia is challenging. AIM: The aim of this study was to present a new case on the successful use of thalidomide in a patient with acquired von Wil

  1. Determination of frequency and treatment outcome in patients of fundal varices presenting with upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of fundal varices and treatment outcome with histoacryl in patients presenting with upper GI bleeding. Design: Single centre, retrospective study. Place and duration of study: Military Hospital Rawalpindi from Jan 2009 to July 2011. Methods: Total 1327 patients were included in the study. In 41(3.1%) patients fundal varices were diagnosed on upper GI endoscopy. The mean age of the patients was 48.1+-16.96 years. Minimum age was 12 years and maximum age was 85 years. Out of 41 patients 29 (70.73%) were male and 12 (29.3%) were female. GOV1 was seen in 28 (68.3%) patients, GOV2 in 10 (24.4%) patients, IGV1 in 2 (4.87%) patients, and IGV2 in 1 patient (2.43%). Conclusion: The frequency of fundal varices in our study was 3.1%, diagnosed on upper GI endoscopy. N-butyl-2-cyanoacrylate sclerotherapy was found to be highly effective for the treatment of active bleeding gastric varices. (author)

  2. Extensive hemangiomatosis diagnosed by scintigraphy with 99mTc-labeled red blood cells in a patient with lower gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Souza, D.S.F.; Ichiki, W.A.; Borges, A.C.; Coura Filho, G.B.; Vecchia, J.F.; Sapienza, M.T.; Ono, C.R.; Watanabe, T.; Costa, P.L.A.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Inst. de Radiologia. Servico de Medicina Nuclear

    2008-07-01

    Full text: Introduction: The gastrointestinal bleeding may be caused by vascular tumors and other lesions like inflammatory disorders, intestinal obstruction or vascular malformation. The Klippel-Trenaunay syndrome and blue rubber bleb nevus syndrome are hemangiomatosis diseases that may involve the gastrointestinal tract and cause recurrent hemorrhage. The signs and symptoms usually appear at childhood. Case report: male patient, 31 years old, presenting three days of gastrointestinal bleeding and an hemorrhage shock (Hb=3,9). Previous reports of small volume bleeding since childhood and schistossomosis. Dilated veins, hemorrhoid and port wine stain lesions were detected at physical examination in perineal region, penis and scrotum. Inferior limbs were symmetric at inspection. The upper endoscopy showed esophageal varices with no signs of active bleeding. The scintigraphy with {sup 99m}Tc-labeled red blood cells showed active hemorrhage at recto-sigmoid topography during the first hour of study. Extensive and heterogeneous uptake was seen in gluteus, posterior right thigh and scrotum at the second and fifth hours of study. Then the hypothesis of vascular tumor was considered. The magnetic resonance (MR) of pelvis demonstrated extensive hemangiomatosis at the regions described by the scintigraphy. The clinical and imaging findings suggested the diagnosis of Klippel-Trenaunay syndrome. Discussion: The Klippel-Trenaunay syndrome is a rare disease characterized by congenital vascular and lymphatic malformations (port wine stain lesions, congenital varices) and bone growth and soft tissue disorder. Dilated veins may involve abdominal and pelvic structures, with rectal bleeding and haematuria occurring on average of 20%. The clinical investigation must approach the type, the extent and the severity of the malformation, since the morbidity and the mortality depends on the visceral involvement. The Doppler ultrasound, scanometry of lower extremities, MR, angiography and

  3. Endoscopic injection sclerotherapy in non-variceal upper gastrointestinal bleeding. A comparative study of polidocanol and thrombin.

    Science.gov (United States)

    Benedetti, G; Sablich, R; Lacchin, T

    1991-01-01

    To date several agents have been used to achieve haemostasis in patients with non-variceal upper gastrointestinal bleeding using endoscopic sclerotherapy techniques. Polidocanol has been widely used but local complications have been reported after treatment. We have compared the efficacy and safety of thrombin and polidocanol in 82 consecutive patients with ongoing or recent bleeding from duodenal, gastric, or anastomotic ulcers. Primary control of haemostasis from spurting vessels was achieved in 90% of cases using polidocanol and in 86.6% using thrombin. Definitive haemostasis was obtained in 80% of patients in both groups. When a non-bleeding vessel was visible, injection of polidocanol or thrombin effectively prevented rebleeding in 90.9% and 85.7% of cases, respectively. When a non-bleeding sentinel clot was present, injection of polidocanol or thrombin provided definitive haemostasis in 100% and 92.8% of cases, respectively. No statistically significant difference was evident between the two agents. In the polidocanol group, one local haemorrhagic complication was noted. No general or local complications were recorded in the thrombin group.

  4. Scintigraphic diagnosis of lower GI bleeding

    International Nuclear Information System (INIS)

    Abdominal scintigraphy with 99mTc HSA, 99mTc Sn colloid, or 99mTc RBC was performed in 28 patients with melena to detect bleeding and determine the bleeding site in the lower gastrointestinal tract. Active bleedings and/or vascular lesions were identified in 16 patients. They were proved by antiography, endoscopy or barium enema in 14. We concluded that scintigraphy was an accurate and effective method to detect the bleeding and determine the bleeding site in the lower gastrointestinal tract. (author)

  5. The role of computerized tomography in the evaluation of gastrointestinal bleeding following negative or failed endoscopy: A review of current status

    Directory of Open Access Journals (Sweden)

    Stunell H

    2008-01-01

    Full Text Available Gastrointestinal bleeding remains an important cause for emergency hospital admission with a significant related morbidity and mortality. Bleeding may relate to the upper or lower gastrointestinal tracts and clinical history and examination may guide investigations to the more likely source of bleeding. The now widespread availability of endoscopic equipment has made a huge impact on the rapid identification of the bleeding source. However, there remains a large group of patients with negative or failed endoscopy, in whom additional techniques are required to identify the source of bleeding. In the past, catheter angiography and radionuclide red cell labeling techniques were the preferred ′next step′ modalities used to aid in identifying a bleeding source within the gastrointestinal tract. However, these techniques are time-consuming and of limited sensitivity and specificity. In addition, catheter angiography is a relatively invasive procedure. In recent years, computerized tomography (CT has undergone major technological advances in its speed, resolution, multiplanar techniques and angiographic abilities. It has allowed excellent visualization of the both the small and large bowel allowing precise anatomical visualization of many causes of gastrointestinal tract (GIT bleeding. In addition, recent advances in multiphasic imaging now allow direct visualization of bleeding into the bowel. In many centers CT has therefore become the ′next step′ technique in identifying a bleeding source within the GIT following negative or failed endoscopy in the acute setting. In this review article, we review the current literature and discuss the current status of CT as a modality in investigating the patient with GIT bleeding.

  6. Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe, Recurrent Gastrointestinal Bleeding, Leading to a Diagnosis of Cushing Disease

    Science.gov (United States)

    Yee, Brittany; Chi, Nai-Wen; Hansen, Lawrence A.; Lee, Roland R.; U, Hoi-Sang; Savides, Thomas J.; Vinetz, Joseph M.

    2015-01-01

    A 50-year-old male immigrant from Ethiopia presented for consultation after 3 years of hematochezia/melena requiring > 25 units of blood transfusions. Physical examination revealed severe proximal muscle wasting and weakness, central obesity, proptosis, and abdominal striae, accompanied by eosinophilia, elevated hemoglobin A1c, elevated 24-hour urinary cortisol, lack of suppression of 8 am cortisol levels by 1 mg dexamethasone, and inappropriately elevated random adrenocorticotropic hormone (ACTH) level. Histopathological examination of gastrointestinal biopsies showed large numbers of Strongyloides stercoralis, indicating Strongyloides hyperinfection. Treatment with 2 days of ivermectin led to resolution of gastrointestinal bleeding. This syndrome was due to chronic immunosuppression from a pituitary ACTH (corticotroph) microadenoma, of which resection led to gradual normalization of urine cortisol, improved glycemic control, resolution of eosinophilia, and no recurrence of infection. PMID:26195463

  7. Gastrointestinal bleeding due to large bowel infiltration by chronic lymphocytic leukaemia.

    OpenAIRE

    Tucker, J.; Cachia, P. G.

    1986-01-01

    A 66 year old woman with a 9 year history of chronic lymphocytic leukaemia developed intermittent rectal bleeding for 9 months; sigmoidoscopic biopsy proved that this was due to large bowel infiltration by leukaemia. This is a very rare occurrence.

  8. Management of upper gastrointestinal bleeding from portal hypertension: Elective or emergency operation?

    OpenAIRE

    Liu, Sen

    2014-01-01

    Objective : To evaluate the clinical outcome of emergency and elective operation of splenectomy with periesophagogastric devascularization in treating upper gastrointestinal hemorrhage resulted from portal hypertension. Methods : We retrospectively reviewed 219 patients of upper gastrointestinal hemorrhage resulted from portal hypertension treated using emergency or elective operation between Jul 2002 and Aug 2010. The clinical data were collected and analyzed. Results : In the group of elect...

  9. SPECT/CT with a hybrid imaging system in the study of lower gastrointestinal bleeding with technetium-99m red blood cells

    International Nuclear Information System (INIS)

    Aim. Lower gastrointestinal (G I) hemorrhage is a complex clinical problem that requires disciplined evaluation for successful management. This study was conducted to evaluate the applicability of single photon emission computed tomography/computed tomography (SPECT/CT) in patients with acute lower gastrointestinal bleeding undergoing scintigraphy with 99m Tc-labelled red blood cells (RBC), and to assess the additional clinical value of fused images when compared to the standard radionuclide scan. Methods. Twenty-seven patients presenting with acute lower G I tract hemorrhage were studied with conventional dynamic and planar 99m Tc-RBC imaging. In 19 patients with positive findings on scans taken within 6 hours, a SPECT/CT study was immediately performed using a hybrid system composed of a dual-head, variable angle gamma camera and an X-ray tube. The number of patients in whom SPECT/CT changed the scintigraphic interpretation with regard to the presence or site of G I blood loss as confirmed by other diagnostic or therapeutical procedures was recorded. Results. Image fusion was easy and successful in all patients showing perfect correspondence between SPECT and CT data and allowing precise anatomical localization of the sites of 99m Tc-RBC extravasation. SPECT/CT had significant impact on the scintigraphic results in 7/19 patients (36.8%): in 6 patients it precisely localized the bleeding foci whose location could not be identified in standard scans and in one it excluded the presence of an active G I hemorrhage. Conclusion. SPECT/CT with a hybrid system is feasible and useful for facilitating imaging interpretation and improving the accuracy of 99m Tc-RBC scintigraphy in patients with acute lower G I bleeding.

  10. Portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula.

    Science.gov (United States)

    Ding, Pengxu; Li, Zhen; Han, Xin-Wei; Wang, Zhong-Gao; Zhang, Wen-Guang; Fu, Ming-Ti

    2014-07-01

    We present an unusual case of portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula. The thromboses were successfully treated with anticoagulation therapy. The patient was a 37-year-old woman who presented with portal hypertension manifested by gastrointestinal bleeding with no evidence of liver disease. Splenic arteriography confirmed the presence of a high-flow arteriovenous fistulous communication from the splenic artery directly into the splenic vein. The arteriovenous fistula was successfully treated with percutaneous transarterial embolization by embolization coils and the patient achieved effective hemostasis. Low-molecular-weight heparin and warfarin were administrated to prevent thrombosis in the portal venous system after the procedure. Although anticoagulants were immediately administered, thromboses of the portal, mesenteric, and splenic veins were diagnosed by contrast-enhanced computed tomography after 10 days. Complete recanalization of the portal venous system confirmed by contrast-enhanced computed tomography was achieved by administering warfarin orally for 3 months.

  11. Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients

    DEFF Research Database (Denmark)

    Krag, Mette; Perner, Anders; Wetterslev, Jørn;

    2015-01-01

    PURPOSE: To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients. METHODS: We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU......) during a 7-day period. The primary outcome was clinically important GI bleeding in ICU, and the analyses included estimations of baseline risk factors and potential associations with 90-day mortality. RESULTS: A total of 1,034 patients in 97 ICUs in 11 countries were included. Clinically important GI...... replacement therapy (6.9, 2.7-17.5), co-existing coagulopathy (5.2, 2.3-11.8), acute coagulopathy (4.2, 1.7-10.2), use of acid suppressants (3.6, 1.3-10.2) and higher organ failure score (1.4, 1.2-1.5). In ICU, 73 % (71-76 %) of patients received acid suppressants; most received proton pump inhibitors...

  12. Real-Time Bleeding Detection in Gastrointestinal Tract Endoscopic Examinations Video

    Directory of Open Access Journals (Sweden)

    Adam Blokus

    2013-07-01

    Full Text Available The article presents a novel approach to medical video data analysis and recognition of bleedings.Emphasis has been put on adapting pre-existing algorithms dedicated to the detection of bleedings for realtimeusage in a medical doctor’s office during an endoscopic examination. A real-time system for analyzingendoscopic videos has been designed according to the most significant requirements of medical doctors.The main goal of the performed research was to establish the possibility of ensuring the necessaryperformance of a given class of algorithms to introduce the solution into real life diagnostics.The structures of two exemplary algorithms for bleeding detection have been analyzed to distinguish anddiscuss parallelization options. After applying them to the algorithms, the usage of a supercomputermultimedia processing platform allowed to acquire the throughput and latency values required for realtimeusage. Different configurations of the algorithms have been tested and their measured parametershave been provided and discussed.

  13. Severe Gastrointestinal Bleeding in a Patient With Subvalvular Aortic Stenosis Treated With Thalidomide and Octreotide

    DEFF Research Database (Denmark)

    Hvid-Jensen, Helene S; Poulsen, Steen H; Agnholt, Jørgen S

    2015-01-01

    due to hypertrophic subvalvular obstructive cardiomyopathy. Endoscopic procedures with argon beaming were performed without effect on bleeding. The patient was treated with a combination of both thalidomide and octreotide. Within 3 months, the patient recovered from the anemia and was able to undergo...... transcoronary ethanol ablation. No further bleeding episodes occurred, and thalidomide and octreotide were arrested. To our knowledge, this case report is the first to describe how this new drug combination therapy is an effective treatment of GB from angiodysplasias and can be used to bridge to surgical...

  14. 肝硬化并发上消化道出血的急救与护理进展%The Process of First Aid and Nursing for Cirrhosis Complicated Upper Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    梁彩虹

    2014-01-01

    Upper gastrointestinal bleeding is a common clinical acute disease, and a major cause of mortality in patients with cirrhosis. This article would summarize the process of first aid and nursing for cirrhosis complicated upper gastrointestinal bleeding, investigate the aspects of first aid, medication nursing, diet nursing and psychological nursing for cirrhosis complicated upper gastrointestinal bleeding, in order to predictably observe the condition change of patients under the premise of actively cooperation of rescue, reduce the occurrence of secondary hepatic encephalopathy and infection after bleeding, prevent shock caused by hemorrhoea, and reduce the rebleeding rate of gastrointestinal bleeding and mortality as possible, to improve the quality of living of patients.%上消化道出血是临床常见急性病症,也是肝硬化患者的主要死亡原因之一。本文对肝硬化并发上消化道出血的急救与护理进展进行综述,讨论肝硬化并发上消化道出血的急救、用药护理、饮食护理、心理护理等方面内容,旨在积极配合抢救的前提下,同时预见性地观察患者病情变化,减少出血后继发肝性脑病和感染的发生,防止大出血而出现休克,尽可能降低消化道出血再出血率和死亡率,提高患者的生存质量。

  15. Localization of bleeding using 4-row detector-CT in patients with clinical signs of acute gastrointestinal hemorrhage

    International Nuclear Information System (INIS)

    Purpose: There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy. Materials and methods: 58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment. Results: 20 of the 58 patients (34%) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100% correlation regarding the bleeding site. In 38 of the 58 patients (66%), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53%) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention. (orig.)

  16. Massive Lower Gastrointestinal Bleeding from Meckel’s Diverticulum with Heterotopic Pancreas: Case Report and a Brief Review of the Literature

    Directory of Open Access Journals (Sweden)

    Xing Yang

    2013-05-01

    Full Text Available Context Heterotopic pancreas is defined as pancreatic tissue found out of the pancreas proper with no vascular or anatomical connection. It is a rare clinical entity and can be found at any portion of the alimentary system. Case report We describe a case of Meckel’s diverticulum with heterotopic pancreas who presented massive lower gastrointestinal bleeding. Conclusion Lower gastrointestinal bleeding due to Meckel’s diverticulum with heterotopic pancreas is extremely difficult to make a definitive diagnosis preoperatively especially when it onsets rapidly.

  17. [Intravesical active prostate bleeding diagnosed in B-mode ultrasound].

    Science.gov (United States)

    Kirchgesner, T; Danse, E; Tombal, B

    2013-09-01

    Hematuria is one of the most frequent minor complications after prostatic biopsy. We would like to report the case of a 68-year-old patient with massive hematuria after prostatic biopsy and intravesical active prostate bleeding diagnosed in B-mode ultrasonography. PMID:24034804

  18. c-KIT positive Gastrointestinal Stromal Tumor presenting with acute bleeding in a patient with neurofibromatosis type 1: a case report

    OpenAIRE

    Aboutaleb, Esam; Kothari, Manish; Damrah, Osama; Canelo, Roben

    2009-01-01

    Background Gastrointestinal stromal tumours are rare (GIST). However, the incidence of GIST among neurofibromatosis type 1 (NF-1) patients is approximately 3.9-25%. GIST can present clinically in different ways such as abdominal pain, gastrointestinal bleeding and obstruction. Case report We present 51 year female patient admitted with Background of neurofibromatosis type 1 admitted with melena. OGD has been done and showed duodenitis with large volume fresh blood in distal duodenum but no ob...

  19. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Zhi-yu LI; Bin LI; Yu-lian WU; Qiu-ping XIE

    2013-01-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic.In cases where gastrointestinal (GI) bleeding is present,however,the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment.A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article.The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography.After embolization,the bleeding stopped and stabilized for the entire follow-up period without any severe complications.In conclusion,embolization of the splenic artery is a simple,safe,and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  20. Novel approaches to upper gastrointestinal conditions: a focus on bleeding and malignancy

    NARCIS (Netherlands)

    I.L. Holster (Ingrid)

    2014-01-01

    markdownabstract__Abstract__ Gastrointestinal (GI) conditions account for substantial burden and use of healthcare resources. It is estimated that GI conditions are responsible for 15-20% of general practitioner visits, hospital admissions, and drug use. Many of those conditions are related to the

  1. Peptic ulcers accompanied with gastrointestinal bleeding, pylorus obstruction and cholangitis secondary to choledochoduodenal fistula: A case report

    Science.gov (United States)

    XI, BIN; JIA, JUN-JUN; LIN, BING-YI; GENG, LEI; ZHENG, SHU-SEN

    2016-01-01

    Peptic ulcers are an extremely common condition, usually occurring in the stomach and proximal duodenum. However, cases of peptic ulcers accompanied with multiple complications are extremely rare and hard to treat. The present case reinforces the requirement for the early recognition and correct treatment of peptic ulcers accompanied with multiple complications. A 67-year-old man presented with recurrent abdominal pain, fever and melena. The laboratory results showed anemia (hemoglobin 62 g/l) and hypoproteinemia (23 g/l). Abdominal imaging examinations revealed stones in the gallbladder and right liver, with air in the dilated intrahepatic and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography failed due to a deformed pylorus. The patient was finally diagnosed with peptic ulcers accompanied with gastrointestinal (GI) bleeding, pylorus obstruction and cholangitis secondary to a choledochoduodenal fistula during an emergency pancreatoduodenectomy, which was performed due to a massive hemorrhage of the GI tract. The patient recovered well after the surgery. PMID:26870237

  2. Regional and temporal variations in coding of hospital diagnoses referring to upper gastrointestinal and oesophageal bleeding in Germany

    Directory of Open Access Journals (Sweden)

    Garbe Edeltraut

    2011-08-01

    Full Text Available Abstract Background Health insurance claims data are increasingly used for health services research in Germany. Hospital diagnoses in these data are coded according to the International Classification of Diseases, German modification (ICD-10-GM. Due to the historical division into West and East Germany, different coding practices might persist in both former parts. Additionally, the introduction of Diagnosis Related Groups (DRGs in Germany in 2003/2004 might have changed the coding. The aim of this study was to investigate regional and temporal variations in coding of hospitalisation diagnoses in Germany. Methods We analysed hospitalisation diagnoses for oesophageal bleeding (OB and upper gastrointestinal bleeding (UGIB from the official German Hospital Statistics provided by the Federal Statistical Office. Bleeding diagnoses were classified as "specific" (origin of bleeding provided or "unspecific" (origin of bleeding not provided coding. We studied regional (former East versus West Germany differences in incidence of hospitalisations with specific or unspecific coding for OB and UGIB and temporal variations between 2000 and 2005. For each year, incidence ratios of hospitalisations for former East versus West Germany were estimated with log-linear regression models adjusting for age, gender and population density. Results Significant differences in specific and unspecific coding between East and West Germany and over time were found for both, OB and UGIB hospitalisation diagnoses, respectively. For example in 2002, incidence ratios of hospitalisations for East versus West Germany were 1.24 (95% CI 1.16-1.32 for specific and 0.67 (95% CI 0.60-0.74 for unspecific OB diagnoses and 1.43 (95% CI 1.36-1.51 for specific and 0.83 (95% CI 0.80-0.87 for unspecific UGIB. Regional differences nearly disappeared and time trends were less marked when using combined specific and unspecific diagnoses of OB or UGIB, respectively. Conclusions During the study

  3. Diagnosis agreement between capsule endoscopy and double-balloon enteroscopy in obscure gastrointestinal bleeding at a referral center

    Directory of Open Access Journals (Sweden)

    Enrique Pérez-Cuadrado-Robles

    2015-08-01

    Full Text Available Background and aim: Capsule endoscopy and double-balloon enteroscopy are well-recognized procedures in obscure gastrointestinal bleeding, with many factors that may influence their diagnosis yield. The aim of the present study was to characterize the degree of agreement between both techniques with focus on the type of lesion in a large cohort of patients at a referral center. Material and method: One thousand two hundred and nine capsules were administered in 1,078 patients and 381 enteroscopies were performed in 361 patients with obscure-gastrointestinal bleeding from 2004 to 2014. Results: Both procedures were carried out in 332 patients (mean age: 65.22 ± 15.41, 183 men and they have a similar diagnosis yield (70.5% vs. 69.6%, p = 0.9. Overall enteroscopy diagnosis yield was higher within patients with a previous positive capsule endoscopy (79.3% vs. 27.9%, p < 0.001. The degree of agreement was very good for polyps (0.89 [95% CI: 0.78-0.99], good for vascular lesions (0.66 [95% CI: 0.55-0.77] and tumors (0.66 [95% CI: 0.55-0.76] and moderate for ulcers (0.56 [95% CI: 0.46-0.67]. Diverticula (0.39 [95% CI: 0.29-0.5] achieved a fair agreement. The results of CE and DBE differed in 73 patients (22%. Conclusions: The present study confirms that although overall diagnostic yield by capsule endoscopy and double-balloon enteroscopy is similar, there are many factors which can modify these values, mainly the type of lesion.

  4. Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting

    Institute of Scientific and Technical Information of China (English)

    Robert A Enns; Yves M Gagnon; Alan N Barkun; David Armstrong; Jamie C Gregor; Richard N Fedorak

    2006-01-01

    AIM: To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death.METHODS: We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals.Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used x2 goodness-of-fit tests to assess the degree of calibration,and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system.RESULTS: For rebleeding, the x2 goodness-of-fit test indicated an acceptable fit for the model [x2 (8) = 12.83,P = 0.12]. For surgical procedures [x2 (8) = 5.3, P = 0.73]and death [x2 (8) = 3.78, P = 0.88], the tests showed solid correspondence between observed proportions and predicted probabilities. The AUC was 0.59 (95% CI:0.55-0.62) for the outcome of rebleeding and 0.60 (95% CI: 0.54-0.67) for surgical procedures, representing a poor discriminative ability of the scoring system. For the outcome of death, the AUC was 0.73 (95% CI: 0.69-0.78),indicating an acceptable discriminative ability.CONCLUSION: The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures.

  5. Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting

    Directory of Open Access Journals (Sweden)

    C Mel Wilcox

    2009-03-01

    Full Text Available C Mel Wilcox1, Byron L Cryer2, Henry J Henk3, Victoria Zarotsky3, Gergana Zlateva41University of Alabama, Birmingham, AL, USA; 2University of Texas Southwestern Medical School, Dallas, TX; 3i3 Innovus, Eden Prairie, MN, USA; 4Pfizer, Inc., New York, NY, USA Objectives: To compare the short-term mortality rates of gastrointestinal (GI bleeding to those of acute myocardial infarction (AMI by estimating the 30-, 60-, and 90-day mortality among hospitalized patients.Methods: United States national health plan claims data (1999–2003 were used to identify patients hospitalized with a GI bleeding event. Patients were propensity-matched to AMI patients with no evidence of GI bleed from the same US health plan.Results: 12,437 upper GI-bleed patients and 22,847 AMI patients were identified. Propensity score matching yielded 6,923 matched pairs. Matched cohorts were found to have a similar Charlson Comorbidity Index score and to be similar on nearly all utilization and cost measures (excepting emergency room costs. A comparison of outcomes among the matched cohorts found that AMI patients had higher rates of 30-day mortality (4.35% vs 2.54%; p < 0.0001 and rehospitalization (2.56% vs 1.79%; p = 0.002, while GI bleed patients were more likely to have a repeat procedure (72.38% vs 44.95%; p < 0.001 following their initial hospitalization. The majority of the difference in overall 30-day mortality between GI bleed and AMI patients was accounted for by mortality during the initial hospitalization (1.91% vs 3.58%.Conclusions: GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization.Keywords: gastrointestinal, bleeding, mortality, acute myocardial infarction, claims analysis

  6. Impact of proton pump inhibitor treatment on gastrointestinal bleeding associated with non-steroidal anti-inflammatory drug use among post-myocardial infarction patients taking antithrombotics

    DEFF Research Database (Denmark)

    Schjerning Olsen, Anne-Marie; Lindhardsen, Jesper; Gislason, Gunnar H;

    2015-01-01

    STUDY QUESTION: What is the effect of proton pump inhibitors (PPIs) on the risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated with non-steroidal anti-inflammatory drugs (NSAIDs)? METHODS: This was a nationwide cohort study based on linked...

  7. Hemospray application in nonvariceal upper gastrointestinal bleeding: results of the Survey to Evaluate the Application of Hemospray in the Luminal Tract

    NARCIS (Netherlands)

    Smith, L.A.; Stanley, A.J.; Bergman, J.J.; Kiesslich, R.; Hoffman, A.; Tjwa, E.T.; Kuipers, E.J.; Holstein, C.S. von; Oberg, S.; Brullet, E.; Schmidt, P.N.; Iqbal, T.; Mangiavillano, B.; Masci, E.; Prat, F.; Morris, A.J.

    2014-01-01

    BACKGROUND: Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe. GOALS: We present the operating characteristics and performance of TC-325 in the largest registry to date of patients presenting with NVUGIB in everyday c

  8. Brunner’s Gland Hamartoma: A Rare Cause of Gastrointestinal Bleeding – Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    David R Stolpman

    2002-01-01

    Full Text Available An unusual cause of upper gastrointestinal bleeding is described in a previously healthy 45-year-old man who was admitted to hospital with weakness and fatigue, and had experienced an episode of melena two days before admission. His medical and surgical history was unremarkable. Upon admission to hospital, he showed evidence of iron-deficiency anemia, with a hemoglobin concentration of 61 g/L (normal range 135 to 175 g/L, a mean corpuscular volume of 73 fL (normal range 85.0 to 95.0 fL and a ferritin concentration of 1.0 µg/L (normal range in males 15 to 400 µg/L. Upper gastrointestinal endoscopy revealed a 3.5 cm ulcerated submucosal mass in the third portion of the duodenum, for which mucosal biopsies were nondiagnostic. A subsequent endoscopic ultrasound revealed a 2.7×4.0 cm hyperechoic, cystic, submucosal tumour in the third portion of the duodenum. Endoscopic ultrasound-guided fine needle aspiration revealed no malignant cells. The patient eventually underwent a resection of the third portion of his duodenum. Surgical pathology revealed that this tumour was a Brunner’s gland hamartoma, 4.5 cm in its greatest dimension.

  9. New Evidence on the Impact of Antithrombotics in Patients Submitted to Small Bowel Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Pedro Boal Carvalho

    2014-01-01

    Full Text Available Objectives. Small bowel capsule endoscopy (SBCE plays a decisive role in the obscure gastrointestinal bleeding (OGIB diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE. Methods. Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential, P1 (uncertain bleeding potential: erosions, and P2 (high bleeding potential: angioectasias, ulcers, and tumors. We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE. Results. One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4% were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11, P=0.026. We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE. Conclusions. Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions.

  10. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding? ¿Tiene aún sentido la enteroscopia intraoperatoria en pacientes con hemorragia gastrointestinal de origen oscuro?

    Directory of Open Access Journals (Sweden)

    Pedro Monsanto

    2012-04-01

    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  11. Dieulafoy Lesion in the Ascending Colon Presenting with Gastrointestinal Bleeding and Severe Anemia Complicated by a Coexisting Severe Resistant Chronic Idiopathic Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Sherif Ali Eltawansy

    2014-01-01

    Full Text Available Background. GI (gastrointestinal bleeding can be due to a variety of etiologies ranging from being common like bleeding peptic ulcer disease or esophageal varices. One of the rarely documented causes is the Dieulafoy lesion which is known as an abnormally large ectatic artery that penetrates the gut wall, occasionally eroding through the mucosa causing massive bleeding. In addition to that, we refer to the uncommon presentation of Dieulafoy lesion itself as it is well known to be found in the stomach, esophagus, duodenum, and jejunum but not the ascending colon as in our case. The patient had a coexisting ITP (idiopathic thrombocytopenic purpura that was resistant to different therapies. Case Report. We report a case of a 48-year-old Egyptian female known for chronic ITP resistant to treatment. The patient presented with bright red bleeding per rectum and severe life threatening anemia. Endoscopic study showed a Dieulafoy lesion. Endoscopic clipping was successful in controlling the bleeding. Conclusion. Dieulafoy lesion is a rare reason for GI bleeding and can present in common or unexpected places. Also extreme caution should be used in patients with bleeding tendency due to different reasons, like ITP in our case.

  12. Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding

    DEFF Research Database (Denmark)

    Laursen, Stig B; Dalton, Harry R; Murray, Iain A;

    2015-01-01

    be managed as outpatients. Some investigators therefore have proposed extending the definition of low-risk patients by using a higher GBS cut-off value, possibly with an age adjustment. We compared 3 thresholds of the GBS and 2 age-adjusted modifications to identify the optimal cut-off value or modification......BACKGROUND & AIMS: Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could....... METHODS: We performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients...

  13. High-altitude gastrointestinal bleeding: An observation in Qinghai-Tibetan railroad construction workers on Mountain Tanggula

    Institute of Scientific and Technical Information of China (English)

    Tian-Yi Wu; Shou-Quan Ding; Jin-Liang Liu; Jian-Hou Jia; Rui-Chen Dai; Dong-Chun Zhu; Bao-Zhu Liang; De-Tang Qi; Yong-Fu Sun

    2007-01-01

    AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis.METHODS: From 2001 to October 2003, we studied GIB in 13 502 workers constructing the railroad on Mountain Tanggula which is 4905 m above the sea level. The incidence of GIB in workers at different altitudes was recorded. Endoscopy was performed when the workersevacuated to Golmud (2808 m) and Xining (2261 m).The available data on altitude GIB were analyzed.RESULTS: The overall incidence of GIB was 0.49% in 13502 workers. The incidence increased with increasing altitude. The onset of symptoms in most patients was within three weeks after arrival at high altitude. Bleeding manifested as hematemesis, melaena or hematochezia,and might be occult. Endoscopic examination showed that the causes of altitude GIB included hemorrhage gastritis, gastric ulcer, duodenal ulcer, and gastric erosion. Experimental studies suggested that acute gastric mucosal lesion (AGML) could be induced by hypoxic and cold stress, which might be the pathogenesis of altitude GIB. Those who consumed large amount of alcohol, aspirin or dexamethasone were at a higher risk of developing GIB. Persons who previously suffered from peptic ulcer or high-altitude polycythemia were also at risk of developing GIB. Early diagnosis, evacuation, and treatment led to early recovery.CONCLUSION: GIB is a potentially life threatening disease, if it is not treated promptly and effectively. Early diagnosis, treatment and evacuation lead to an early recovery. Death due to altitude GIB can be avoided if early symptoms and signs are recognized.

  14. Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Kyriakos Neofytou

    2014-01-01

    Full Text Available Duodenal metastasis from renal cell carcinoma is rare, and even rarer is a massive gastrointestinal bleeding from such tumours. Coeliac occlusive disease, although rarely symptomatic, can lead to ischaemic changes with anastomotic dehiscence and leaks when a patient undergoes pancreatoduodenectomy. A 41-year-old man with known metastasis to the adrenal glands and the second part of the duodenum close to the ampulla of Vater from clear cell renal cell carcinoma was admitted to our department due to massive gastrointestinal bleeding from the duodenal metastasis. Endoscopic control of the bleed was not possible, while the bleeding vessel embolization was able to control the haemorrhage only temporarily. An angiography during the embolization demonstrated the presence of stenosis of the coeliac artery and also hypertrophic inferior pancreaticoduodenal arteries supplying the proper hepatic artery via the gastroduodenal artery (GDA. The patient underwent emergency pancreatoduodenectomy with preservation of the gastroduodenal artery. The patient had an uneventful recovery and did not experience further bleeding. Also the blood flow to the liver was compromised as shown by the normal liver function tests (LFTs postoperatively. To the best of our knowledge, this is the first report of a preservation of the GDA during an emergency pancreatoduodenectomy.

  15. Significance of Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs in patients with bleeding from upper part of the gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    Golubović Gradimir

    2007-01-01

    Full Text Available Background/Aim. Helicobacter pylori (H. pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs use are considered to be the most important risk factors having influence on the onset of bleeding gastroduodenal lesions. Whether there is an interaction between H. pylori infection and the use of NSAIDs in the development of peptic ulcer disease is still controversial. The aim of the present study was to evaluate the prevalence of NSAIDs use and H. pylori infection in patients presented with bleeding gastroduodenal lesions. Methods. During the period from January 2003 - December 2003 we prospectively obtained data of all the patients (n=106 presented with signs of upper gastrointestinal bleeding. All the patients were admitted to the intensive care unit, with the endoscopy performed within 12 hours after admission. Histologic analysis was used for the detection of H. pylori infection. The NSAIDs and aspirin use data were obtained by anamnesis. Results. The results of our study revealed that the most common sources of upper gastrointestinal bleeding were duodenal (57 patients, 53.77% and ventricular (36 patients, 33.96% ulcers. The majority of the examined cases were associated with both H. pylori infection and NSAIDs use. A statistically significant difference among the studied groups of patients was proven. Conclusion. The majority of bleeding gastroduodenal lesions were associated with the coexistence of H. pylori infection and NSAIDs use, while their independent influences were statistically less important. Eradication of H. pylori infection in patients using NSAIDs might prevent upper gastrointestinal hemorrhage and reduce peptic ulcer bleeding risk. .

  16. Comparison of AIMS65 Score and Other Scoring Systems for Predicting Clinical Outcomes in Koreans with Nonvariceal Upper Gastrointestinal Bleeding

    Science.gov (United States)

    Park, Sung Min; Yeum, Seok Cheon; Kim, Byung-Wook; Kim, Joon Sung; Kim, Ji Hee; Sim, Eun Hui; Ji, Jeong-Seon; Choi, Hwang

    2016-01-01

    Background/Aims The AIMS65 score has not been sufficiently validated in Korea. The objective of this study was to compare the AIMS65 and other scoring systems for the prediction of various clinical outcomes in Korean patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). Methods The AIMS65 score, clinical and full Rockall scores (cRS and fRS) and Glasgow-Blatchford (GBS) score were calculated in patients with NVUGIB in a single center retrospectively. The performance of these scores for predicting mortality, rebleeding, transfusion requirement, and endoscopic intervention was assessed by calculating the area under the receiver-operating characteristic curve. Results Of the 523 patients, 3.4% died within 30 days, 2.5% experienced rebleeding, 40.0% required endoscopic intervention, and 75.7% needed transfusion. The AIMS65 score was useful for predicting the 30-day mortality, the need for endoscopic intervention and for transfusion. The fRS was superior to the AIMS65, GBS, and cRS for predicting endoscopic intervention and the GBS was superior to the AIMS65, fRS, and cRS for predicting the transfusion requirement. Conclusions The AIMS65 score was useful for predicting the 30-day mortality, transfusion requirement, and endoscopic intervention in Korean patients with acute NVUGIB. However, it was inferior to the GBS and fRS for predicting the transfusion requirement and endoscopic intervention, respectively. PMID:27377742

  17. The emergency treatment and nursing of acute upper gastrointestinal bleeding%急性上消化道出血的急救与护理体会

    Institute of Scientific and Technical Information of China (English)

    朱承菊

    2011-01-01

    目的 探讨急性上消化道大出血的临床特点和护理对策.方法 总结分析186例急性上消道大出血的临床资料.结果 186例急性上消化道大出血,通过护理干预,痊愈157例,好转22例,死亡2例.结论 急性上消化道大出血临床常见,加强临床护理,预防各种并发症的发生,将大大降低病死率.%Objective To investigate the clinical features and nursing of acute upper gastrointestinal bleeding. Methods 168 patients with acute upper gastrointestinal bleeding were involved in our study, the clinical data was investigated With strict analysis. Results Among all the 168 patients, 157 patients recovered, 22 patients improved, 5 were sent to surgical treatment and 2 patients died. Conclusions Acute upper gastrointestinal bleeding is one of the most common medical emergencies. Intensive clinical nursing can prevent complications reduce the rate of fatality greatly.

  18. Intra-Arterial Treatment in Patients with Acute Massive Gastrointestinal Bleeding after Endoscopic Failure: Comparisons between Positive versus Negative Contrast Extravasation Groups

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Wei Chou; Liu, Chang Hsien; Hsu, Hsian He; Huang, Guo Shu; Hsieh, Tasi Yuan; Tsai, Shin Hung; Hsieh, Chung Bao; Yu, Chin Yung [Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (China); Tung, Ho Jui [Asia University, Taichung, Taiwan (CN)

    2011-10-15

    To determine whether treatment outcome is associated with visualization of contrast extravasation in patients with acute massive gastrointestinal bleeding after endoscopic failure. From January 2007 to December 2009, patients that experienced a first attack of acute gastrointestinal bleeding after failure of initial endoscopy were referred to our interventional department for intra-arterial treatment. We enrolled 79 patients and divided them into two groups: positive and negative extravasation. For positive extravasation, patients were treated by coil embolization; and in negative extravasation, patients were treated with intra-arterial vasopressin infusion. The two groups were compared for clinical parameters, hemodynamics, laboratory findings, endoscopic characteristics, and mortality rates. Forty-eight patients had detectable contrast extravasation (positive extravasation), while 31 patients did not (negative extravasation). Fifty-six patients survived from this bleeding episode (overall clinical success rate, 71%). An elevation of hemoglobin level was observed in the both two groups; significantly greater in the positive extravasation group compared to the negative extravasation group. Although these patients were all at high risk of dying, the 90-day mortality rate was significantly lower in the positive extravasation than in the negative extravasation (20% versus 42%, p < 0.05). A multivariate analysis suggested that successful hemo stasis (odds ratio [OR] = 28.66) is the most important predictor affecting the mortality in the two groups of patients. Visualization of contrast extravasation on angiography usually can target the bleeding artery directly, resulting in a higher success rate to control of hemorrhage.

  19. Observational study of upper gastrointestinal tract bleeding events in patients taking duloxetine and nonsteroidal anti-inflammatory drugs: a case-control analysis

    Directory of Open Access Journals (Sweden)

    Li H

    2014-10-01

    Full Text Available Hu Li, Yingkai Cheng, Jonna Ahl, Vladimir SkljarevskiNeurosciences, Eli Lilly and Company, Indianapolis, IN, USAPurpose: To determine whether the concomitant use of duloxetine with prescription nonsteroidal anti-inflammatory drugs (NSAIDs or aspirin was associated with an increased risk for upper gastrointestinal (UGI bleeding compared with taking these analgesics alone.Methods: Truven Health Analytics MarketScan Research Databases were examined for hospital admissions of adult patients indexed from January 1, 2007–December 31, 2011. Cases were patients with UGI hemorrhage or peptic ulcer disease. Controls were randomly selected from the remaining admissions to match 10:1 with cases based on age, sex, and admission date. Prescription medication exposure groups of interest were: 1 no exposure to duloxetine, NSAIDs or aspirin; 2 duloxetine only; 3 NSAIDs or aspirin only; 4 duloxetine plus NSAIDs or aspirin. Logistic regression and relative excess risk due to interaction was utilized to estimate any increased risk of UGI bleeding for patients prescribed these medications across these groups.Results: There were 33,571 cases and 335,710 controls identified. Comparing exposure group 2 and group 4, the adjusted odds ratio was 1.03 (95% confidence interval [CI], 0.94, 1.12, and the adjusted relative excess risk due to interaction was 0.352 (95% CI: –0.18, 0.72 for risk of UGI bleeding, neither of which support an increased risk or an interaction between duloxetine and prescription NSAID or aspirin for these events.Conclusion: There was no evidence of an increased risk for UGI bleeding when duloxetine was taken with prescription NSAIDs or aspirin. In addition, there was no evidence of an interaction between duloxetine and prescription NSAIDs or aspirin for an increased risk of these events.Keywords: duloxetine, upper gastrointestinal bleeding, NSAIDs, aspirin

  20. Gastrointestinal events with clopidogrel

    DEFF Research Database (Denmark)

    Grove, Erik Lerkevang; Würtz, Morten; Schwarz, Peter;

    2013-01-01

    Clopidogrel prevents cardiovascular events, but has been linked with adverse gastrointestinal (GI) complications, particularly bleeding events.......Clopidogrel prevents cardiovascular events, but has been linked with adverse gastrointestinal (GI) complications, particularly bleeding events....

  1. Evaluation of Superselective Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate in Treating Lower Gastrointestinal Bleeding: A Retrospective Study on Seven Cases

    Science.gov (United States)

    Zhao, Yuan; Li, Gang; Yu, Xiang

    2016-01-01

    Background. To investigate the safety and efficacy of superselective transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) in treating lower gastrointestinal bleeding caused by angiodysplasia. Methods. A retrospective study was performed to evaluate the clinical data of the patients with lower gastrointestinal bleeding caused by angiodysplasia. The patients were treated with superselective TAE with NBCA between September 2013 and March 2015. Angiography was performed after the embolization. The clinical signs including melena, anemia, and blood transfusion treatment were evaluated. The complications including abdominal pain and intestinal ischemia necrosis were recorded. The patients were followed up to evaluate the efficacy in the long run. Results. Seven cases (2 males, 5 females; age of 69.55 ± 2.25) were evaluated in the study. The embolization was successfully performed in all cases. About 0.2–0.8 mL (mean 0.48 ± 0.19 mL) NCBA was used. Immediate angiography after the embolization operation showed that the abnormal symptoms disappeared. The patients were followed up for a range of 2–19 months and six patients did not reoccur. No serious complications, such as femoral artery puncture point anomaly, vascular injury, and intestinal necrosis perforation were observed. Conclusion. For the patients with refractory and repeated lower gastrointestinal hemorrhage due to angiodysplasia, superselective TAE with NBCA seem to be a safe and effective alternative therapy when endoscopy examination and treatment do not work. PMID:27528867

  2. Nursing Care of Upper Gastrointestinal Bleeding after Endoscopic Treatment%上消化道大出血内镜治疗后的护理

    Institute of Scientific and Technical Information of China (English)

    贺娟

    2014-01-01

    目的:探讨上消化道大出血患者的内镜下治疗后的护理。方法分析35例消化道大出血患者内镜治疗后的护理要点。结果显效21例,有效8例,无效10例。结论胃镜下止血术配合有效护理治疗上消化道大出血效果显著。%Objective To explore the nursing digestion tract bleeding patients after endoscopic treatment. Methods Analysis of nursing of 35 cases of gastrointestinal bleedingafter endoscopic treatment. Results The effect of 21 cases,effective in 8 cases,invalid 10 cases. Conclusion Endoscopic hemostasis with effective nursing care in the treatment of massive hemorrhage of upper gastrointestinal tract effect.

  3. 56例上消化道出血患者的护理体会%Nursing Gastrointestinal Bleeding in Patients on 56 Cases

    Institute of Scientific and Technical Information of China (English)

    孙丽霞

    2015-01-01

    Objective To evaluate the nursing care of patients with gastrointestinal bleeding.Methods56 cases of upper gastrointestinal bleeding in patients with February 2011~October 2011 in our hospital were retrospectively analyzed data.ResultsThe patients were closely observed, strict care, cure 46 cases, surgical therapy in 5 cases, 5 cases improved.Conclusion The clinical nursing observation is an important guarantee of clinical diagnosis and treatment.%目的:探讨上消化道出血患者的护理体会。方法对2011年2月~2011年10月我院收治的56例上消化道出血患者进行回顾性资料分析。结果通过对患者进行密切的观察、严密的护理等,治愈46例,转外科治疗5例,好转5例。结论临床护理观察是临床诊断治疗的一项重要保障。

  4. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department

    Directory of Open Access Journals (Sweden)

    José Manuel Recio-Ramírez

    2015-05-01

    Full Text Available Objectives: To assess the ability of the Glasgow Blatchford Score (GBS system to identify the need for urgent upper gastrointestinal endoscopy (UGIE in patients with upper gastrointestinal bleeding (UGIB. Methods: An observational, retrospective study was carried out in all patients attended at the ER for suspected UGIB in one year. Patients were split into two categories -high-risk (>2 and low-risk (≤2- by means of the GBS system. Results: A total of 60 patients were included. Of these, 46 were classified as "high-risk" (> 2 and 14 as "low-risk" (≤ 2 subjects. The characteristics of patients in the low-risk group included: Mean age: 46.6 ± 13.7 (18-88 years. Males/females: 7/7. Urgent endoscopy revealed: normal (50%; n = 7; esophagitis (21.4%; n = 3; gastritis (14.2%; n = 2; Mallory-Weiss syndrome (7.1%; n = 1; non-bleeding varices (7.1%; n = 1. The characteristics of patients in the high-risk group included: Mean age: 68.7 ± 19.8 (31-91 years. Males/females: 30/16. Digestive endoscopy revealed: Gastric/duodenal ulcer (56.52%; n = 26; normal (17.39%; n = 8; esophagitis (8.69%; n = 4; gastritis (8.69%; n = 4; angioectasia (4.34%; n = 2; bleeding varices (4.34%; n = 2. Low-risk patients exhibited no lesions requiring urgent management during endoscopy, and the sensitivity of the GBS scale for high-risk UGIB detection was found to be 100% (95% CI: 86.27%, 99.71%, with a specificity of 48.28% (95% CI: 29.89, 67.1%. Conclusions: The GBS scale seems to accurately identify patients with low-risk UGIB, who may be managed on an outpatient basis and undergo delayed upper GI endoscopy at the outpatient clinic.

  5. Occult gastrointestinal bleeding in high-risk intensive care unit patients receiving antacid prophylaxis: frequency and significance.

    Science.gov (United States)

    Derrida, S; Nury, B; Slama, R; Marois, F; Moreau, R; Soupison, T; Sicot, C

    1989-02-01

    Gastroccult reagent was used every 4 h to detect blood in gastric juice in 41 ICU patients at risk of GI bleeding (GB) and receiving antacid prophylaxis (gastric pH greater than 3.5). Of the present patients, 27% (11/41) had at least one episode of occult GB (three consecutive positive determinations; a total of 14 episodes). Endoscopy identified acute gastroduodenal mucosal lesions (stress ulcers) as the most frequent lesion in this group (eight patients). Sepsis was the most frequent underlying condition associated with occult GB due to stress ulcer. Hematemesis occurred in 36% (4/11) of patients with occult GB and was due to stress ulcer in three patients and to benign gastric tumor in one. No overt GB occurred in the absence of previous occult GB. We conclude that: a) risk of GB persists in critically ill ICU patients in spite of antacid prophylaxis (gastric pH greater than 3.5); b) high-risk patients can be identified through periodic testing for the presence of blood in gastric juice using the reagent; c) when occult GB occurs, treatment should be based on the endoscopy results. In the absence of acute gastroduodenal mucosal lesions, antacid prophylaxis should not be modified, and specific treatment of the identified lesion(s) should be initiated. In the presence of stress lesions, antacid prophylaxis should be reinforced if the pH of the gastric content is less than 3.5 and a septic complication should be actively sought if the pH is greater than 3.5. PMID:2783669

  6. Hepatobiliary fascioliasis with multiple aneurysms and active bleeding: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Soo Young; Kim Jae Woon; Jang, Jae Cheon [Dept. of Radiology, College of Medicine, Yeungnam University, Daegu (Korea, Republic of)

    2015-04-15

    A 52-year-old woman visited our institution with upper abdominal pain which had lasted for the past two days. Laboratory tests revealed mild leukocytosis, decreased serum hemoglobin, and peripheral blood eosinophilia. CT scans showed multiple ill-defined, hypodense lesions in the peripheral areas of both hepatic lobes and active bleeding with a subcapsular hematoma in the right hepatic lobe. Angiography also showed active bleeding in the right hepatic lobe with multiple aneurysms, so a transarterial coil embolization was performed to stop the bleeding. The endoscopic retrograde cholangiopancreatography revealed several moving flat flukes in the common bile duct, which were pathologically confirmed as Fasciola hepatica.

  7. Mesenteric pseudoaneurysm in a 12-year-old girl with abdominal tuberculosis presenting with massive lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    We report a case of a 12-year-old girl with a mesenteric pseudoaneurysm and abdominal tuberculosis presenting with massive lower gastrointestinal hemorrhage requiring multiple blood transfusions. The pseudoaneurysm was treated successfully with transarterial microcoil embolization. Pseudoaneurysms are a rare and life-threatening complication of tuberculosis and understanding the imaging characteristics and treatment options will help to guide appropriate therapy. (orig.)

  8. Mesenteric pseudoaneurysm in a 12-year-old girl with abdominal tuberculosis presenting with massive lower gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Corby, Rodney; Cranford, Caroline; Ha, Thuong Van; Yousefzadeh, David [University of Chicago Hospitals, Department of Radiology, Chicago, IL (United States)

    2006-05-15

    We report a case of a 12-year-old girl with a mesenteric pseudoaneurysm and abdominal tuberculosis presenting with massive lower gastrointestinal hemorrhage requiring multiple blood transfusions. The pseudoaneurysm was treated successfully with transarterial microcoil embolization. Pseudoaneurysms are a rare and life-threatening complication of tuberculosis and understanding the imaging characteristics and treatment options will help to guide appropriate therapy. (orig.)

  9. Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists

    Science.gov (United States)

    Fortinsky, Kyle J.; Razik, Roshan; Spiegle, Gillian; Gallinger, Zane R.; Grover, Samir C.; Pavenski, Katerina; Weizman, Adam V.; Kwapisz, Lukasz; Mehta, Sangeeta; Gray, Sarah

    2016-01-01

    Introduction. There is limited data evaluating physician transfusion practices in patients with acute upper gastrointestinal bleeding (UGIB). Methods. A web-based survey was sent to 500 gastroenterologists and hepatologists across Canada. The survey included clinical vignettes where physicians were asked to choose transfusion thresholds. Results. The response rate was 41% (N = 203). The reported hemoglobin (Hgb) transfusion trigger differed by up to 50 g/L. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean Hgb of 86.7 g/L versus 71.0 g/L; p iron to patients with UGIB who are anemic upon discharge. Conclusions. The transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB. PMID:27446847

  10. Gastrointestinal inflammation and associated immune activation in schizophrenia

    OpenAIRE

    Severance, Emily G.; Alaedini, Armin; Yang, Shuojia; Halling, Meredith; Gressitt, Kristin L.; Stallings, Cassie R.; Origoni, Andrea E.; Vaughan, Crystal; Khushalani, Sunil; Leweke, F. Markus; Dickerson, Faith B.; Yolken, Robert H.

    2012-01-01

    Immune factors are implicated in normal brain development and in brain disorder pathogenesis. Pathogen infection and food antigen penetration across gastrointestinal barriers are means by which environmental factors might affect immune-related neurodevelopment. Here, we test if gastrointestinal inflammation is associated with schizophrenia and therefore, might contribute to bloodstream entry of potentially neurotropic milk and gluten exorphins and/or immune activation by food antigens. IgG an...

  11. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience

    Science.gov (United States)

    Mohammed, Noor; Rehman, Amer; Swinscoe, Mark Thomas; Mundre, Pradeep; Rembacken, Bjorn

    2016-01-01

    Introduction: Patients with gastrointestinal bleeding admitted out of hours or at the weekends may have an excess mortality rate. The literature reports around this are conflicting. Aims and methods: We aimed to analyze the outcomes of emergency endoscopies performed out of hours and over the weekends in our center. We retrospectively analyzed data from April 2008 to June 2012. Results: A total of 507 ‘high risk’ emergency gastroscopies were carried out over the study period for various indications. Patients who died within 30 days of the index procedure [22 % (114 /510)] had a significantly higher Rockall score (7.6 vs. 6.0, P < 0.0001), a higher American Society of Anesthesiologists (ASA) status (3.5 vs. 2.7, P < 0.001), and a lower systolic blood pressure (BP) at the time of the examination (94.8 vs 103, P = 0.025). These patients were significantly older (77.7 vs. 67.5 years, P = 0.006), and required more blood transfusion (5.9 versus 3.8 units). Emergency out-of-hours endoscopy was not associated with an increased risk of death [relative risk (RR) 1.09, 95 % confidence interval (CI) 1.12 – 1.95]. Whether the examination was carried out by a senior specialist registrar (senior trainee) or a consultant made no difference to the survival of the patient (RR 0.98, CI 0.77 – 1.32). Conclusion: Higher pre-endoscopy Rockall score and ASA status contributed significantly to the 30-day mortality following upper gastrointestinal bleeding, whereas lower BP tended towards significance. Outcomes did not vary with the time of the endoscopy nor was there any difference between a consultant and a senior specialist registrar led service. PMID:27004244

  12. Hombre de 75 años con edemas y sangrado digestivo inferior A 75 years old man with edema and inferior gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Alberto Carlos Reino Buelvas

    2004-02-01

    Full Text Available Se presenta el caso de un hombre de 75 años, quien consultó por edemas generalizados originados en un síndrome nefrótico, secundario a una glomerulopatía clasificada como de cambios mínimos. Se le iniciaron esteroides con mejoría de su proteinuria, pero al disminuir las dosis de éstos, recayó, por lo que requirió nueva hospitalización en la que se le documentaron trombosis venosa profunda y sangrado por tracto gastrointestinal inferior. Se le implantó un filtro de vena cava inferior y se le practicó una colonoscopia, en la que se encontró poliposis coli. Al estudio histológico se reportó un linfoma no Hodgkin compatible con un linfoma del manto (poliposis linfomatoide versus linfoma marginal tipo MALT de bajo grado. The case of a 75 year old man is presented. He consulted because of generalized edema and the diagnosis of nephrotic syndrome was done. Histologic study of a renal biopsy reported a glomerulopathy of minimal changes. Treatment with steroids improved of proteinuria, but on reducing the doses, proteinuria returned. In a second hospitalization deep venous thrombosis and gastrointestinal bleeding were diagnosed. A cava vein filter was implanted, colonoscopy was performed and Polyposis Coli was found. A non Hodgkin lymphoma compatible with MANTLE CELL lymphoma (lymphomatous polyposis vs MALT lymphoma was reported in the colonic biopsy.

  13. Transcatheter artery embolization guided by MSCTA in emergency treatment of massive gastrointestinal bleeding%MSCTA指导下急诊动脉栓塞治疗消化道大出血

    Institute of Scientific and Technical Information of China (English)

    陈光斌; 李江山; 唐先志; 张自力; 敖锋

    2012-01-01

    Objective To investigate the clinical value of transcatheter arterial embolization guided by MSCTA in emergency of massive gastrointestinal bleeding. Methods Fourteen patients with massive gastrointestinal bleeding were examined with MSCTA at the same time of anti-shock treatment. Emergency arterial embolization was performed after locating of the bleeding site and bleeding artery by MSCTA. In the course of artery embolization, gelfoam particles were used with super-selective catheterization technique. Results After embolization, bleeding stopped immediately in 12 patients. For 2 patients with continuous bleeding, emergent surgical operation was performed in one patient, and the other with venous hemorrhage was cured with endoscopy. Conclusion Transcatheter arterial embolization guided by MSCTA is simple, rapid, accurate and safe for the treatment of massive gastrointestinal bleeding.%目的 探讨MSCTA指导下行急诊动脉栓塞治疗消化道大出血的临床价值.方法 对14例消化道大出血病例,术前在抗休克治疗同时急诊行MSCTA检查,明确出血部位或出血动脉后行急诊动脉栓塞术,超选择插管至出血动脉支,并以明胶海绵颗粒进行栓塞.结果 动脉栓塞后,12例患者有效控制了出血,休克得到纠正.1例明确出血部位及性质后行急诊手术治疗,1例疑静脉出血,后行急诊内镜治疗.结论 MSCTA指导下行急诊动脉栓塞术治疗消化道大出血简便迅速、准确性高、安全性好、并发症少.

  14. Analysis of the causes of liver cirrhosis complicated with upper gastrointestinal bleeding in 126 patients and nursing care%肝硬化并发上消化道出血126例诱因分析及护理

    Institute of Scientific and Technical Information of China (English)

    孙娟; 习羽

    2012-01-01

    目的:探讨肝硬化患者并发上消化道出血的诱因并提出护理对策.方法:对126例肝硬化患者进行上消化道出血诱因分析,并给予抢救配合、病情观察、心理护理、用药护理等针对性护理措施.结果:本组98例出血停止,7例放弃治疗出院,6例死于多脏器功能衰竭.结论:针对肝硬化患者发生上消化道出血的诱因给予针对性护理,可有效减少并发症发生,降低病死率.%Objective: To analyze the causes of liver cirrhosis complicated with upper gastrointestinal bleeding and put forward nursingcountermeasures. Methods: 126 liver cirrhosis patients complicated with upper gastrointestinal bleeding were given emergency treatment,close observation, psychological care and medication care according to the analysis of the causes. Results: The bleeding of 98 patients wasstopped; 7 patients abandoned treatment; 6 patients died of multiple organ failure. Conclusion: The appropriate nursing measures aimingat the causes of upper gastrointestinal bleeding due to liver cirrhosis can effectively reduce the occurrence of complications and fatalityrate.

  15. Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey

    Institute of Scientific and Technical Information of China (English)

    Fabrizio Parente; Andrea Anderloni; Stefano Bargiggia; Venerina Imbesi; Emilio Trabucchi; Cinzia Baratti; Silvano Gallus; Gabriele Bianchi Porro

    2005-01-01

    AIM: To prospectively assess the impact of time of endoscopy and endoscopist's experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered.RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience.Univariate analysis showed that higher endoscopist's experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.8±0.6 vs 3.0±1.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy.On multivariate analysis, endoscopist's experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for

  16. Intraabdominal Intravascular Papillary Endothelial Hyperplasia (Masson’s Tumor: A Rare and Novel Cause of Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Michael C. Meadows

    2010-03-01

    Full Text Available Intravascular papillary endothelial hyperplasia (IPEH, or Masson’s tumor, a rare benign vascular lesion, occurs mainly in the head, neck, and hands in the human population. Aberrant tumor locations have been rarely reported. We present a case of a patient with chronic abdominal pain and melena of variable severity due to a Masson’s tumor, with no apparent Masson’s tumor-associated comorbidities, along with a comprehensive review of the literature. Using PubMed, a search engine provided by the U.S. National Library of Medicine and the National Institutes of Health, we searched for all reports of Masson’s tumor limited within the abdominal cavity. Furthermore, keywords such as ‘intravascular papillary endothelial hyperplasia’, ‘renal’, ‘gastrointestinal’, ‘hepatic’ and ‘intraabdominal’ were used to facilitate the search. We thus found fourteen cases of intraabdominal Masson’s tumors published. Six (42.9% of these were located in the renal vein, 4 (28.6% were reported in the gastrointestinal tract, 1 (7.1% in the adrenal gland, 1 (7.1% in the liver, and 1 (7.1% instance with multiple lesion sites including the renal hilum and retroperitoneum. Among these patients, 9 (64.3% were female and 5 (35.7% male, with a mean age of 38.9 years (7–69. IPEH is a reactive process, having three subtypes, all involving the proliferation of epithelial cells around a thrombus in the setting of venous stasis. In its pure form, the organized thrombus is solely localized within the vascular lumen. Mixed-form IPEH is formed in preexisting vascular lesions (such as arteriovenous malformation, hemangioma, pyogenic granuloma, etc.. The rarest form is the extravascular variety, which arises in hematomas often from recent trauma to the area. In its pure form, IPEH has a zero recurrence rate when an R0 resection is performed; all mixed and extravascular forms show the highest recurrence rates. The exact histogenesis of these epithelial cells

  17. 消化道出血患者药物治疗体会%Experience of drug treatment in patients with gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    杨倩

    2014-01-01

    目的:研究消化道出血患者的病因与药物治疗效果。方法回顾性分析2010年3月~2013年3月我院收治的消化道出血患者136例的临床资料。观察及分析患者的发病原因,以及泮托拉唑钠、奥曲肽与氨甲苯酸联合治疗的临床效果。结果136例患者的病因依次为消化性溃疡、急性胃黏膜病变、肝硬化食管静脉曲张破裂与胃癌。发病诱因为饮食不当、饮酒、药物、精神因素与劳累等因素。实施泮托拉唑钠、奥曲肽、氨甲苯酸联合治疗消化性溃疡的优良率为95.9%,治疗急性胃黏膜病变的优良率为93.3%,治疗肝硬化食管静脉曲张破裂的优良率为90.9%,治疗胃癌的优良率为100%。结论消化道出血疾病的病因是消化性溃疡,诱因常是口服刺激性的药物。采用泮托拉唑钠、奥曲肽、氨甲苯酸联合治疗消化道出血具有较高的应用价值,值得临床进一步推广应用。%Objective To study the etiology and clinical efficacy of drug treatment on patients with gastrointestinal hemorrhage. Methods Clinical data of 136 cases with gastrointestinal bleeding from March 2010 to March 2013 in our hospital were retrospectively analyzed.Aetiological agent and clinical efficacy of pantoprazole sodium, octreotide combined with aminomethylbenzoic acid treatment were observed and analyzed. Results The causes of 136 cases of patients were peptic ulcer, acute gastric mucosal lesion, cirrhosis esophageal varices and gastric cancer. The predisposing factors were improper diet, alcohol, drugs, mental factors and fatigue factors. The excellent and good rate of implementation of pantoprazole sodium, omeprazole, combined with aminomethylbenzoic acid for peptic ulcer was 95.9%, the excellent and good rate of treatment of acute gastric mucosal lesion was 93.3%, the excellent and good rate for liver cirrhosis with esophageal varices was 90.9%, and the excellent and good rate of gastric cancer was

  18. 非静脉曲张性上消化道出血内镜下止血的护理配合%Nursing cooperation during endoscopic treatment of non-varicose upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    尹玲; 陈先红

    2012-01-01

    目的:总结内镜下注射组织粘合剂、局部注射止血合剂和电凝三联疗法治疗非静脉曲张性上消化道出血的治疗和护理效果.方法:对273例非静脉曲张性上消化道出血患者进行内镜下三联疗法止血,术前、术中、术后给予了相应的护理措施.结果:273例患者中,无效4例,内镜下止血成功269例,有效治疗率为98.53%.结论:三联疗法是非静脉曲张性上消化道出血内镜下紧急止血的有效方法,而有效的护理措施是内镜下止血的重要保障.%Objective: To discuss nursing cooperation during endoscopic treatment of non -varicose upper gastrointestinal bleeding. Methods: Triple therapy ( injection of tissue adhesive and hemostatic mixture + electric coagulation ) was done in 273 non - varicose upper gastrointestinal bleeding patients with the cooperation of doctors and nurses. Results: The triple therapy was effective for 269 non - varicose upper gastrointestinal bleeding patients and the success rate of hemostasis was 98. 5%. Conclusion:The triple therapy was effective for the non - varicose upper gastrointestinal bleeding patients. The cooperation and nursing play an important part during the procedure.

  19. Study on the improvement of the compliance of prevention of falls in patients with gastrointestinal bleeding with the development of the quality control circle%开展品管圈活动提高消化道出血患者预防跌倒依从性研究

    Institute of Scientific and Technical Information of China (English)

    顾弘; 何红梅

    2016-01-01

    Objective:To explore the effect of improvement of the compliance of prevention of falls in patients with gastrointestinal bleeding with the development of the quality control circle.Methods:We set up the quality control circle and established the theme of the activities with "to improve the compliance of patients with digestive tract hemorrhage".According to the quality control circle activity steps,we carried out the activities,and analyzed the factors that influence the compliance of patients to prevent falls, formulated and implemented countermeasures according to the reasons.Results:The compliance of prevention of falls of patients with gastrointestinal bleeding was improved from 29% to 68.7% through the quality control circle.Conclusion:Carrying out quality control circle activities can effectively improve the compliance of prevention of falls of patients with gastrointestinal bleeding.%目的:探讨品管圈活动提高消化道出血患者预防跌倒依从性的效果。方法:成立品管圈,确立“提高消化道出血患者预防跌倒依从性”活动主题,按照品管圈活动步骤开展活动,分析影响患者预防跌倒依从性的因素,针对原因拟定并实施对策。结果:品管圈活动使消化道出血患者预防跌倒依从性从29%提高到68.7%。结论:开展品管圈活动可有效提高消化道出血患者预防跌倒依从性。

  20. 肝癌介入治疗病人围术期合并上消化道出血的护理%The nursing methods for liver cancer interventional treatment patients with upper gastrointestinal bleeding in the perioperative

    Institute of Scientific and Technical Information of China (English)

    龚美霞; 洪侠; 徐艳莉; 陈川

    2011-01-01

    Objective:To study the nursing methods for liver cancer interventions! Treatment patients with upper gastrointestinal bleeding in the periopera-tive. Methods:To analyzing the nursing experience of 42 liver cancer interventional treatment patients with upper gastrointestinal bleeding in January 2005 -December 2010 and summarizing the care nursing experience points. Results:Thirty - nine of forty - two patients survived after clinical rescue and nursing, while there were 3 cases of death. Conclusions: liver interventional perioperative with upper gastrointestinal bleeding is in critical need of professional and careful nursing, and has a bit inadvertent, serious consequences.%目的:探讨介入治疗肝癌病人围术期合并上消化道出血的护理方法.方法:分析2005年1月~2010年12月42例肝癌介入治疗病人围术期合并上消化道出血的护理经验,总结其护理要点.结果:42例病人经临床抢救及护理,存活39例,死亡3例.结论:肝癌介入治疗围术期合并上消化道出血病情危重,需要专业和细心的护理,稍有不慎,后果严重.

  1. Volcano-like intermittent bleeding activity for seven years from an arterio-enteric fistula on a kidney graft site after pancreas-kidney transplantation: a case report

    Science.gov (United States)

    2010-01-01

    Introduction We report the first case of a patient who underwent simultaneous kidney and pancreas transplantation and who then suffered from repeated episodes of severe gastrointestinal bleeding over a period of seven years. Locating the site of gastrointestinal bleeding is a challenging task. This case illustrates that detection of an arterio-enteric fistula can be very difficult, especially in technically-challenging situations such as cases of severe intra-abdominal adhesions. It is important to consider the possibility of arterio-enteric fistulas in cases of intermittent bleeding episodes, especially in transplant patients. Case presentation A 40-year-old Caucasian man received a combined pancreas-kidney transplantation as a result of complications from diabetes mellitus type I. Thereafter, he suffered from intermittent clinically-relevant episodes of gastrointestinal bleeding. Repeat endoscopic, surgical, scintigraphic, and angiographic investigations during his episodes of acute bleeding could not locate the bleeding site. He finally died in hemorrhagic shock due to arterio-enteric bleeding at the kidney graft site, which was diagnosed post-mortem. Conclusions In accordance with the literature, we suggest considering the removal of any rejected transplant organs in situations where arterio-enteric fistulas seem likely but cannot be excluded by repeat conventional or computed tomography-angiographic methods. Arterio-enteric fistulas may intermittently bleed over many years. PMID:21059222

  2. Volcano-like intermittent bleeding activity for seven years from an arterio-enteric fistula on a kidney graft site after pancreas-kidney transplantation: a case report

    Directory of Open Access Journals (Sweden)

    Schölmerich Jürgen

    2010-11-01

    Full Text Available Abstract Introduction We report the first case of a patient who underwent simultaneous kidney and pancreas transplantation and who then suffered from repeated episodes of severe gastrointestinal bleeding over a period of seven years. Locating the site of gastrointestinal bleeding is a challenging task. This case illustrates that detection of an arterio-enteric fistula can be very difficult, especially in technically-challenging situations such as cases of severe intra-abdominal adhesions. It is important to consider the possibility of arterio-enteric fistulas in cases of intermittent bleeding episodes, especially in transplant patients. Case presentation A 40-year-old Caucasian man received a combined pancreas-kidney transplantation as a result of complications from diabetes mellitus type I. Thereafter, he suffered from intermittent clinically-relevant episodes of gastrointestinal bleeding. Repeat endoscopic, surgical, scintigraphic, and angiographic investigations during his episodes of acute bleeding could not locate the bleeding site. He finally died in hemorrhagic shock due to arterio-enteric bleeding at the kidney graft site, which was diagnosed post-mortem. Conclusions In accordance with the literature, we suggest considering the removal of any rejected transplant organs in situations where arterio-enteric fistulas seem likely but cannot be excluded by repeat conventional or computed tomography-angiographic methods. Arterio-enteric fistulas may intermittently bleed over many years.

  3. Therapeutic barium enema for bleeding colonic diverticula:Four case series and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Jun-ichi Iwamoto; Yuji Mizokami; Koichi Shimokobe; Takeshi Matsuoka; Yasushi Matsuzaki

    2008-01-01

    The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.

  4. Fístula colecistocólica: una causa poco frecuente de hemorragia digestiva baja Cholecistocolic fistula: an uncommon cause of lower gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    M. Ostiz

    2012-12-01

    Full Text Available La fístula colecistocólica es un tipo poco común de fístula bilioentérica que tiene una presentación clínica variable y que generalmente aparece como complicación de la enfermedad litiásica biliar. Puede manifestarse en forma de dolor abdominal, náuseas, pérdida de peso, diarrea con o sin esteatorrea asociada, clínica dispéptica y más raramente como hemorragia digestiva baja, colangitis de repetición o incluso como un ileo biliar. Las técnicas más útiles para el diagnóstico son el TC abdominal, los estudios baritados y la colangiopancreatografía retrógrada endoscópica (CPRE. Describimos el caso de una mujer de edad avanzada, pluripatológica, con fístula colecistocólica, que se presentó en forma de hemorragia digestiva baja. Fue estudiada mediante colonoscopia, TC abdominal y enema de bario. Durante el ingreso requirió transfusión de 4 concentrados de hematíes, desestimándose el tratamiento invasivo debido a su comorbilidad de base. Evolucionó favorablemente, con resolución espontanea del cuadro. Dos meses después permanecía asintomática.Cholecystocolic fistula is an uncommon biliary-enteric fistula with a variable clinical presentation that usually appears as a rare complication of gallstone disease. It can present with abdominal pain, nausea, weight loss, diarrhoea with or without associated steatorrhea, and dyspeptic symptoms. Rare cases have been reported with lower gastrointestinal haemorrhage and even with a gallstone ileous. The most useful techniques for diagnosis are CT, barium studies, and ERCP. We report a case of a cholecistocolic fistula in an eldery woman with multiple medical comorbidities that presented as lower gastrointestinal bleeding. She was explored with colonoscopy, abdominal CT and barium enema. She required a total of 4 units of whole blood and because of her comorbidities a decision was made not to proceed with invasive treatment. She had a good evolution and was asymptomatic two months

  5. Large Duodenal Gastrointestinal Stromal Tumor Presenting with Acute Bleeding Managed by a Whipple Resection. A Review of Surgical Options and the Prognostic Indicators of Outcome

    Directory of Open Access Journals (Sweden)

    Norman Oneil Machado

    2011-03-01

    Full Text Available Context Duodenal gastrointestinal stromal tumors (GISTs are uncommon and constitute a relatively small subset of GISTs which presents a unique dilemma having various surgical options. A case of a large ulcerating duodenal GIST arising from the second and third parts of the duodenum and involving the pancreas which was managed by a Whipple resection is presented. The literature is also reviewed to present the current status on surgical options, outcome, prognostic indicators and the role of imatinib mesylate in its management. Case report A 58-year-old patient presented with acute gastrointestinal bleeding which was diagnosed to be due to a duodenal GIST following CT scan and endoscopic biopsy. The mass which measured about 10x9 cm originated from the 2nd part and extended into the 3rd part of the duodenum. He underwent a Whipple resection, and histopathology confirmed a duodenal GIST having a greater than 10 mitotic count per fifty high power field and areas of necrosis. Postoperatively, he received imatinib mesylate 400 mg bid; however, 4 months later, he presented with multiple disseminated peritoneal metastases and succumbed to the disease 2 months later. Conclusion GISTs of the duodenum which are small in size and do not involve the papilla of Vater are better resolved using a limited resection of the duodenum since the outcome in terms of operative risk or disease recurrence is not influenced in these cases. However, large tumors with more extensive involvement would require a pancreaticoduodenectomy to achieve adequate tumor clearance. Even though duodenal GISTs have a relatively better prognosis as compared to GISTs at other sites, their aggressiveness ranges from small indolent tumors to aggressive sarcomas. Following tumor resection, a recurrence rate of about 40% has been reported. A more favorable prognosis in duodenal GISTs is attributed to a lower prevalence of P53 loss, the duodenal location of the tumor, a smaller size of the

  6. 不明原因消化道出血45例分析%Analysis of 45 cases of obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    鞠香丽; 徐秀英

    2015-01-01

    Objective To investigate the etiology of obscure gastrointestinal bleeding ( OGIB) and the value of cap-sule endoscopy in the diagnosis of OGIB .Methods The data of 45 cases of OGIB who were defined no clear hemor-rhage by recepting endoscopy and colonoscopy inspection and furtherly finished capsule endoscopy examination in the First Affiliated Hospital of China Medical University from Jan .2004 to Aug .2013 were analyzed retrospectively .Re-sults Forty-two cases of OGIB patients were proved to have small intestinal lesions , there were 29 cases of small bowel vascular malformations , 2 cases of small bowel inflammation , 1 case of small bowel ascariasis , 1 case of small bowel ul-cer, 1 case of small bowel polyps , 1 case of duodenal vascular malformation , 2 cases of small bowel vascular malforma-tion with small bowel mucosa lesions , 2 cases of small bowel vascular malformation associated with small bowel ascaria -sis, 1 case of small bowel vascular malformation with small bowel ulcer , small bowel lymphangiectasia , 1 case of small bowel vascular malformation with small bowel erosion and 1 case of ileal diverticula with ileal lymphangiectasia .The most common cause of OGIB was small bowel vascular malformations (83.33%, 35/42).Conclusion Capsule endos-copy can provide more direct clues to discover the cause of OGIB and guide clinical treatment .%目的:探讨不明原因消化道出血( obscure gastrointestinal bleeding , OGIB)的病因及胶囊内镜在其诊断方面的应用价值。方法回顾性分析中国医科大学附属第一医院2004年1月-2013年8月45例经胃镜、结肠镜检查未发现出血灶并进一步行胶囊内镜的OGIB患者的临床资料。结果入选的45例OGIB患者中共有42例检出小肠病变,其中单纯小肠血管畸形29例,小肠炎症2例,小肠蛔虫病1例,小肠溃疡1例,小肠息肉1例,十二指肠血管畸形1例,小肠血管畸形伴小肠黏膜下病变2例,

  7. Incidence and predictors of upper gastrointestinal bleeding in patients receiving low-dose aspirin for secondary prevention of cardiovascular events in patients with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    William Ng; Xi Cheng; Chu-Pak Lau; Wai-Man Wong; Wai-Hong Chen; Hung-Fat Tse; Pui-Yin Lee; Kam-Chuen Lai; Sheung-Wai Li; Matthew Ng; Kwok-Fai Lam

    2006-01-01

    AIM: The use of low-dose aspirin to prevent cardiovascular disease events is well established. However,the incidence and predictors of upper gastrointestinal bleeding (UGIB) with its use are unknown. We studied prospectively the incidence and outcome of peptic ulceration in low-dose aspirin users.METHODS: A total of 991 patients with coronary artery disease (CAD) on low-dose aspirin were prospectively followed-up for two years for the occurrence and clinical features of first hospitalized episode of UGIB.RESULTS: UGIB had a bimodal presentation with 45% occurring within four months of aspirin initiation and had an overall prevalence of 1.5% per year. There was no UGIB-related death. Hypertension (OR = 4.6, 95%CI 1.5 - 14.7, P = 0.009), history of peptic ulceration (OR = 3.1,95%CI 1.1 - 9.0, P = 0.039), tertiary education (OR =3.08, 95%CI 1.1 - 9.0, P = 0.039) and higher lean body mass (P = 0.016) were independent factors associated with UGIB. Use of nitrate did not reduce UGIB.CONCLUSION: The incidence of UGIB in patients with CAD on long-term low-dose aspirin is low, but is accompanied with significant morbidity. With prolonged use of aspirin, UGIB continues to be a problem for those with risk factors and especially in patients with a history of peptic ulcers, in which UGIB tends to occur early after aspirin therapy.

  8. Etiology of gastrointestinal bleeding in elderly patients and nursing strategies%3042例上消化道出血患者病因分析及护理对策

    Institute of Scientific and Technical Information of China (English)

    贺冬梅; 余莲英; 沈爱萍

    2012-01-01

    目的 探讨3042例上消化道出血患者的病因,并提出护理对策.方法 回顾性分析本院1991年3月~2009年3月3042例上消化道出血住院患者的病因,并提出对策.结果 消化性溃疡出血为上消化道出血的主要病因,占46.96%,其中十二指肠溃疡呈下降趋势;急性胃黏膜病变为上消化道出血的第2病因,占28.76%,呈上升趋势;年龄<60岁组患者十二指肠溃疡是上消化道出血的主要病因(占44.35%),年龄≥60岁组患者急性胃黏膜病变为上消化道出血的主要病因(41.21%).结论 消化性溃疡出血与急性胃黏膜病是上消化道出血的主要病因,其中十二指肠溃疡呈下降趋势,其也是年龄< 60岁组患者的主要病因;急性胃黏膜病变呈上升趋势,其也是年龄≥60岁患者的主要病因.在护理工作中,应针对不同年龄患者病因与疾病谱变化情况,开展针对性的健康教育,促进患者行为改变,从而达到防病、治病的目的.%Objective To explore the etiology of gastrointestinal bleeding in elderly patients and propose nursing strategies gastrointestinal bleeding. Method The histories of 3 042 inpatients with upper gastrointestinal bleeding in our hospital between March 1991 to March 2009 were retrospectively analyzed for detection of the etiological factors. Results The main etiological factors included peptic ulcer bleeding (46.96%) and acute gastric mucosal lesion (28.76%) gastrointestinal bleeding; duodenal ulcer (44.35%) in those aged less than 60 years group and the acute gastric mucosal lesion (41.21%) in those aged more than 60 years. Conclusions Acute gastric mucosal lesion and peptic ulcer bleeding are major etiological factors for upper gastrointestinal bleeding in elderly patients. In our nursing work, health education should be done according to the etiological factors and the disease spectrum change to reduce the incidence and mortality from upper gastrointestinal bleeding.

  9. Decreased plasma ADAMTS-13 activity as a predictor of postoperative bleeding in cyanotic congenital heart disease

    Directory of Open Access Journals (Sweden)

    Rosangela P.S. Soares

    2013-04-01

    Full Text Available OBJECTIVE: To analyze the preoperative plasma antigenic concentration and activity of von Willebrand factor and its main cleaving protease ADAMTS-13 in pediatric patients with cyanotic congenital heart disease undergoing surgical treatment and investigate possible correlations with postoperative bleeding. METHODS: Plasma antigenic concentrations (von Willebrand factor:Ag and ADAMTS-13:Ag were measured using enzyme-linked immunoassays. Collagen-binding assays were developed to measure biological activities (von Willebrand factor:collagen binding and ADAMTS-13 activity. The multimeric structure of von Willebrand factor was analyzed using Western immunoblotting. Demographic, diagnostic, and general and specific laboratory data and surgery-related variables were subjected to univariate, bivariate, and multivariate analysis for the prediction of postoperative bleeding. RESULTS: Forty-eight patients were enrolled, with ages ranging from 9 months to 7.6 years (median 2.5 years. The plasma concentrations of von Willebrand factor:Ag and ADAMTS-13:Ag were decreased by 65 and 82%, respectively, in the patients compared with the controls (p<0.001. An increased density of low-molecular-weight fractions of von Willebrand factor, which are suggestive of proteolytic degradation (p = 0.0081, was associated with decreased ADAMTS-13 activity, which was likely due to ADAMTS-13 consumption (71% of controls, p = 0.0029 and decreased von Willebrand factor:collagen binding (76% of controls, p = 0.0004. Significant postoperative bleeding occurred in 13 patients. The preoperative ADAMTS-13 activity of <64.6% (mean level for the group, preoperative activated partial thromboplastin time, and the need for cardiopulmonary bypass were characterized as independent risk factors for postoperative bleeding, with respective hazard ratios of 22.35 (95% CI 1.69 to 294.79, 1.096 (95% CI 1.016 to 1.183, and 37.43 (95% CI 1.79 to 782.73. CONCLUSION: Low plasma ADAMTS-13

  10. 研究分析消化内科对上消化道出血的临床诊治%Research and analysis of digestion Department of internal medicine on clinical diagnosis and treatment of upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    翟兆锋

    2015-01-01

    Objective To analyze and study in Gastroenterology, clinical treatment of upper gastrointestinal bleeding. Methods By choosing the period March 2011 to March 2014, the digestive tract on 88 cases of bleeding in our hospital patients, including 7 cases of peptic ulcer perforation, and the remaining 81 cases before taking conventional drug therapy, compared to patients treated with therapy after upper gastrointestinal bleeding. Results The patients treated were cured by surgery peptic ulcer perforation, the effective rate was 100%;patients treated by conventional drugs, the average bleeding time was (30.3±8.9) hours, bleeding effective rate of 98.4%. Conclusion The effective drug treatment and necessary surgery for upper gastrointestinal bleeding with good clinical diagnosis and treatment effects.%目的:分析和研究消化内科中,对上消化道出血的临床诊治。方法通过选取2011年3月~2014年3月我院收治的88例上消化道出血患者,其中7例行消化性溃疡穿孔手术,余下81例采取常规治疗,对比患者治疗前与治疗后的上消化道出血情况。结果通过消化性溃疡穿孔手术进行治疗的患者均痊愈,有效率为100%;通过常规药物进行治疗的患者,平均止血时间为(30.3±8.9)h,止血有效率为98.4%。结论通过有效的药物治疗和必要的手术治疗,对于上消化道止血具有良好的疗效。

  11. Otorrhagia bleeding due to leech bite

    OpenAIRE

    Narges Askari; Afrooz Eshaghian

    2012-01-01

    Leeches are blood-sucking hermaphroditic parasites that attach to vertebrate hosts, bite through the skin, and suck out blood. When leeches feed, they secrete an anticoagulant (hirudin), which helps them get a full meal of blood. This is the first report of leech removal from external auditory canal. Previous leech involvement cases were explained in nasopharynx, larynx, pharynx, eye, and gastrointestinal tract. Prominent sign of all cases was active bleeding from the leech attachment site; t...

  12. Gastrointestinal tract radionuclide activity on In-111 labeled leukocyte imaging: clinical significance in patients with fever of unknown origin

    International Nuclear Information System (INIS)

    To determine the frequency and clinical significance of indium-111 labeled leukocyte activity in the gastrointestinal (GI) tract of patients with fever of unknown origin, we reviewed 312 leukocyte studies involving 271 patients. Radionuclide activity was noted in the bowel in 59 cases. Of these, only 27 were due to the infection or inflammatory disease that caused the patient's fever. The 32 false-positive results were due primarily to swallowed leukocytes or bleeding. In two cases, no explanation was found for the activity in the GI tract. We conclude that bowel activity on In-111 labeled leukocyte scans in patients with fever of unknown origin often does not correlate with the true cause of the patient's fever

  13. Upper gastrointestinal bleeding: risk factors for mortality in two urban centers in Latin America Hemorragia digestiva alta: factores de riesgo para mortalidad en dos centros urbanos de América Latina

    Directory of Open Access Journals (Sweden)

    C. H. Morales Uribe

    2011-01-01

    Full Text Available Objective: to describe the experience with upper gastrointestinal bleeding (UGIB in two major Latin American hospitals; its main cuses, treatment and prognosis, while exploring some risk factors associated with death. Design: prospective cohort study. Patients and methods: We included 464 patients older than 15 years of age from two reference centers. We studied some demographic variables, history, clinical presentation, treatment and mortality. We explored the association betwen those variables and death. Results: The mean age was 57.9 years, and the male: female ratio was 1.4:1. Three hundred and fifty nine patients (77.4% were seen for gastrointestinal bleeding (outpatients bleeding and 105 patients (22.6% were inpatients seen for UGIB. A total of 71.6% of patients admitted with the diagnosis of upper GI bleeding underwent upper GI emdoscopy (EGD within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 40.9%, erosive disease (162 patients, 34.9% and variceal bleeding (47 patients, 10.1%. Forty four patients died (9.5%. Patient who presented with bleeding due to other causes during hospitalization has a higher mortality risk than those whose complaints were related to gastrointestinal bleeding (RR 2.4, 95% CI 1.2-4.6. An increasing number of comorbidities such as those described in the Rockall Score, were also associated with a higher risk of mortality (RR 2.5 95% CI 1.1-5.4. Conclusion: Intrahospital upper GI bleeding and the presence of comorbilities ares risk factors for a fatal outcome. Identifying patients with a higher risk would help improve the management of patients with UGIB.Objetivo: presentar la experiencia con la hemorragia de vías digestivas alta (HDA en dos hospitales centros de referencia de un país latinoamericano, las principales causas, tratamiento, pronóstico y explorar algunos factores de riesgo asociados con la mortalidad. Diseño: estudio de cohortes prospectivo. Pacientes y métodos: se

  14. Direct Economic Burden and Impacts of Hospitalized Patients with Upper Gastrointestinal Bleeding%上消化道出血住院患者直接经济负担及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    林毅

    2014-01-01

    Objective:To assess the direct economic burden and impacts of hospitalized patients with upper gastrointestinal bleeding and to lay the technical foundation for economic control and treatment improving of upper gastrointestinal bleeding. Method:Collected the direct economic burden for patients with upper gastrointestinal bleeding with a kind of table made by authors and analyzed the main influencing factors with a multiple linear regression analysis. Result:The average direct economic burden per case was 13 184.85 yuan RMB,while the drug consumption account for about 57.24%. The main influencing factors were treatment,etiological diagnosis and days stay in hospital.Conclusion:The direct economic burden for the hospitalized patients with upper gastrointestinal bleeding could be reduced by rational medication,cutting down the cost of medicine,controlling the average day stay in hospital. And making a definite etiologic diagnosis as soon as possible is also helpful.%目的:了解上消化道出血住院患者的直接经济负担,探讨其构成特点及影响因素,为优化上消化道出血的治疗方案,减轻患者经济负担提供依据和参考。方法:通过自制表格收集患者的直接经济负担情况,应用多元回归模型分析直接经济负担的影响因素。结果:上消化道出血住院患者的人均直接经济负担为13184.85元,药物费所占比例最高,达57.24%。主要影响因素为治疗方式、病因诊断和住院天数。结论:合理用药、控制药品比例,缩短平均住院天数是降低上消化道住院患者经济负担的重要手段。尽早发现、明确上消化道出血病因也有利于降低上消化道出血住院患者的经济负担。

  15. Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding

    Institute of Scientific and Technical Information of China (English)

    Young-Seok Cho; Hiun-Suk Chae; Hyung-Keun Kim; Jin-Soo Kim; Byung-Wook Kim; Sung-Soo Kim; Sok-Won Han; Kyu-Yong Choi

    2008-01-01

    AIM: To compare the hemostatic efficacy and safety of two mechanical endoscopic methods: endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP) in patients with actively bleeding Mallory-Weiss syndrome (MWS).METHODS: A prospective randomized study to compare the efficacy and safety of EHP with EBL was performed from January 2002 to August 2005. Forty-one patients with active bleeding from MWS were treated with EHP (n = 21) or EBL (n = 20).RESULTS: There were no significant differences between groups with respect to clinical and endoscopic characteristics. The mean number of hemoclips applied was 3.2 ± 1.5 and the mean number of bands applied was 1.2 ± 0.4. Primary hemostasis was achieved in all patients. Recurrent bleeding was observed in one patient from the EHP group and two from the EBL group. Patients with recurrent bleeding were treated by the same modality as at randomization and secondary hemostasis was achieved in all. There were no significant differences between the two groups in total transfusion amount or duration of hospital stay. No complications or bleeding-related death resulted.CONCLUSION: EHP and EBL are equally effective and safe for the management of active bleeding in patients with Mallory-Weiss syndrome, even in those with shock or comorbid diseases.

  16. Management of patients with ulcer bleeding.

    Science.gov (United States)

    Laine, Loren; Jensen, Dennis M

    2012-03-01

    This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy. PMID:22310222

  17. 老年人上消化道出血的原因和临床特点分析%Clinical Characteristics and Analysis Causes of Upper Gastrointestinal Bleeding in Elderly

    Institute of Scientific and Technical Information of China (English)

    王红霞

    2015-01-01

    目的探讨老年上消化道出血的原因和特点。方法回顾分析363例患者的临床资料。结果363例患者经治疗,死亡19例,其中食管静脉曲张破裂出血17例,肾功能衰竭1例,恶性肿瘤1例,其余患者均治愈出院。结论临床医师应了解老年人上消化道出血的病因及特点,有针对性的预防和治疗,提高其生活质量。%Objective To explore the characteristics and reasons of the aged patients with upper gastrointestinal hemorrhage. Methods A retrospective analysis of the clinical data of 363 patients with. Results 363 patients were treated, 19 cases of death, including esophageal variceal bleeding in 17 cases, 1 cases of renal failure, 1 cases of malignant tumor, the other patients were cured and discharged. Conclusion Clinicians should be aware of the elderly upper gastrointestinal bleeding causes and characteristics, targeted prevention and treatment, improve the quality of life.

  18. Evidence-based nursing in the application of liver cirrhosis upper gastrointestinal bleeding nursing research%循证护理在肝硬化上消化道出血护理中的应用研究

    Institute of Scientific and Technical Information of China (English)

    党惠枝; 黄彬彬

    2014-01-01

    Objective:Analysis and Discussion of evidence-based nursing care of patients with gastrointestinal bleeding clinical application results in cirrhosis.Methods:Choose January 201 2 gastrointestinal bleeding were randomly divided into an upper level in March 201 3 in our hospital treated 5 6 cases of liver cirrhosis in the observation group and control group 28 cases,Evidence-based nursing observation group,the control group received routine care,And to compare the effects of treatments.Result:Ob-servation group hemostasis success rate(70.7%)、Discharge time(8.4 ± 2.4d)、Patient satisfaction(80.5 %)etc Were significantly better than the control group(P<0.05). Conclusion:Upper gastrointestinal bleeding in cirrhosis of the line of evidence - based care,which can effectively improve the success rate of bleeding,shorter hospital stays,improve the therapeutic effect.%目的:分析探讨循证护理在肝硬化上消化道出血患者临床护理中的应用效果.方法:选择2011年1月-2013年5月在我院接受治疗的56例肝硬化上消化道出血患者随机平分为观察组、对照组各28例,观察组给予循证护理,对照组给予常规护理,并对护理效果进行比较.结果:观察组止血成功率(85.7%)、出院时间(8.4±2.4d)、患者满意度(96.4%)等均明显优于对照组(P<0.05).结论:对肝硬化上消化道出血行循证护理,可有效提高止血成功率、缩短住院时间,提高治疗效果.

  19. 老年晚期癌症临终患者并发消化道出血的相关因素分析%Related factor analysis in elderly advanced cancer hospice inpatients with gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    余敏; 姜宏宁; 余永春; 龙霖梓

    2014-01-01

    Objective To investigate related factors of gastrointestinal bleeding in elderly advanced cancer hospice inpatients , in order to facilitate better control. Methods A retrospective investigation of the clinical data of the elderly advanced cancer hospice inpatients was done , 85 cases with gastrointestinal bleeding (experimentalgroup) were compared with 294 cases with non-gastrointestinal bleeding cases (control group). Results Multivariate logistic stepwise regression analysis showed:HP infection [odds ratios (OR) = 3.241,95% confidence interval (CI) 1.792~5.863], non-steroidal anti-inflammatory drugs (OR=3.080,95%CI 1.725~5.497), long-term heart and lung disease (OR=2.323,95%CI 1.315~4.105), stress (OR=1.858,95%CI 1.054 ~ 3.274), albumin (OR =0.760,95%CI 0.679~0.851), enteral nutrition (OR=0.499,95%CI 0.679~0.851) on gastrointestinal bleeding in elderly advanced cancer hospice inpatients were significant (P<0.05). Conclusions We should strengthen the surveillance of elderly advanced cancer hospice inpatients with gastrointestinal bleeding , to improve the quality of life,and according to the risk factors,the early diagnosis and treatment must be regarded.%目的:探讨老年晚期癌症临终患者发生消化道出血的相关因素,以利于合理防治。方法:回顾性调查老年晚期癌症临终住院患者,对85例并发消化道出血病例(观察组)与294例未并发消化道出血病例(对照组)进行比较分析。结果:因素Logistic 逐步回归分析显示:幽门螺杆菌感染[比值比(OR)=3.241,95%置信区间(CI)为1.792~5.863]、非甾体类消炎药的应用(OR=3.080,95%CI为1.725~5.497)、长期心肺疾病(OR=2.323,95%CI 为1.315~4.105)、应激状态(OR=1.858,95% CI 为1.054~3.274)、血白蛋白(OR=0.760,95% CI 为0.679~0.851)、肠内营养(OR=0.499,95%CI 为0.279~0.892)与老年晚期癌症临终患

  20. 上消化道出血相关因素分析及防护对策探讨%The Approach in Correlation Factor and Protection Strategy of Upper Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    郑桃晓; 钟渠; 张刚琴

    2009-01-01

    目的:分析上消化道出血相关因素,制定预防和护理对策.方法:对120例上消化道出血病人相关因素进行总结分析,提出对策.结果:本病相关因素最多的分别是发病原因系十二指肠溃疡和胃溃疡;有发病诱因,主要是饮食不当、饮酒、药物和劳累;中青年、农村和农民发生率各占72.5%、69.17%和57.50%;中度出血35.00%;出血发生24小时后就诊68.33%.结论:本病应从个人、家庭、社会和早期诊治四方面预防,并通过系统护理,促进疾病康复.%Objective To formulate strategy of preservation and attendance by analyzing correlation factor of upper gastrointestinal bleedng.Methods The correlation factors of upper gastrointestinal bleeding were summarized and analyzed in 120 patients and the strategy were ferred by combining close factors.Results the intimate correlation factors were duodenal ulcer and gastric ulcer,which were 46.67% and 20.00%,respectively.The motivation morbility were 87.50% included improper diet,drinking wine,drug,exertion and so on.The incidence rate was 72.50% in theMiddle- Age and young.The incidence rate were 69.17% and 57.50% in village and in the farmer,respectively,midrange bleeding was 35.00%.The patients with upper gastrointestinal bleeding were 68.33%,who visited after 24h.Conclusion upper gastrointestinal should he precluded development by oneself,family,society,morning diagnose and concentrating,and he promoted habilitation by general duty nursing,psych,body position,food and drink,medication,discharge health guidance et cetera.

  1. Transfusion requirements in patients with gastrointestinal bleeding: a study in a Blood Unit at a referral hospital Requerimientos transfusionales en pacientes con hemorragia digestiva: estudio en una Unidad de Sangrantes de un hospital de referencia

    Directory of Open Access Journals (Sweden)

    A. Garrido

    2006-10-01

    Full Text Available Objectives: 1. To study transfusion requirements in the Department of Gastroenterology of a Tertiary Referral Hospital, and their evolution over the last seven years. 2. To analyze risk factors associated with greater erythrocyte transfusion requirements. Patients and methods: erythrocyte transfusion requirements were compared for patients admitted to the Department of Gastroenterology at Hospital Virgen del Rocío, Seville, from 1999 to 2005. Clinical data of interest have been analyzed in order to determine factors associated with greater transfusion requirements. Results: 1,611 patients with a mean age of 60.45 years (59.7-61.2 were included in this study; 76.41% were males. Gastric ulcers were the cause of bleeding in 18.4% of cases (with 69% requiring transfusions; duodenal ulcers caused 22.2% of cases (with 52.9% requiring transfusions, and portal hypertension caused 33.6% of cases (with 90.2% requiring transfusions. Upper and lower gastrointestinal bleeding of unknown origin requires transfusions in 88.9 and 96.2% of cases, respectively. A multivariate logistic regression analysis showed that clinical presentations such as hematemesis (odds ratio = 3.12, hematochezia (odds ratio = 33.17, gastrointestinal hemorrhage of unknown origin (odds ratio = 6.57, and hemorrhage as a result of portal hypertension (odds ratio = 3.43 were associated with greater transfusion requirements for erythrocyte concentrates. No significant differences were observed between the percentages of patients who received transfusions from 1999 to 2005. Conclusions: 1. No differences have been observed between the percentages of patients who received transfusions over the last seven years at our Department of Gastroenterology. 2. Patients presenting with hematemesis or hematochezia, in addition to those with bleeding of unknown origin or from portal hypertension, are prone to have greater transfusion requirements.

  2. Analysis of the Etiology of 135 Cases with Acute Upper Gastrointestinal Bleeding in Non Elderly Patients%135例非老年急性上消化道出血患者的病因分析

    Institute of Scientific and Technical Information of China (English)

    许田英; 葛彦成

    2014-01-01

    目的:分析探讨非老年患者上消化道出血的原因及相关因素。方法对我院2009年~2012年间收治的135例非老年上消化道出血患者的临床资料进行回顾性分析,并与同期住院86例老年患者的出血原因进行比较。结果在135例非老年上消化道出血病例中,饮酒、精神因素、不当饮食为主要相关诱发因素,老年组中以服用非甾体药物为主要诱因。而非老年组中最常见的出血病因为十二指肠溃疡占34.81%(47/135),第二位是食管胃底静脉曲张破裂占18.52%(25/135),其他常见的病因还有急性胃黏膜病变15.56%(21/135),胃溃疡11.58%(16/135),消化道肿瘤7.41%(10/135)等。其中十二指肠溃疡、食管胃底静脉曲张发病率明显高于老年组,而胃溃疡、消化道肿瘤发病率低于老年组患者(P<0.05)。结论与老年组有所不同,非老年上消化道出血诱因多与饮酒、精神因素、不当饮食有关,十二指肠溃疡、食管胃底黏膜曲张破裂是致出血的主要病因,且发病率男性多于女性。%Objective To investigate the cause of upper gastrointestinal bleeding and relevant factors in non elderly patients. Methods Clinical data of 135 non elderly patients with upper gastrointestinal bleeding during 2009 and 2012 in our hospital and 86 cases of elderly patients at the same period were retrospectively analyzed. The causes of acute gastrointestinal bleeding were compared. Results Drinking wines, mental factors and improper diets in non elderly patients were main inducements leading to gastrointestinal hemorrhage. The inducement of the elderly group was NSAID drug. The most common cause of gastrointestinal hemorrhage in the non elderly group was the duodenal ulcer accounted for 34.81%(47/135), the second was the esophageal gastric fundus varicosity burst accounted for 18.82%(25/135). Other causes were acute gastric mucosal lesion 15.56%(21/135), gastric ulcer 11.58%(16/135) and

  3. Evidence supporting the use of recombinant activated factor VII in congenital bleeding disorders

    Directory of Open Access Journals (Sweden)

    Pär I Johansson

    2010-06-01

    Full Text Available Pär I Johansson, Sisse R OstrowskiCapital Region Blood Bank, Section for Transfusion Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkBackground: Recombinant activated factor VII (rFVIIa, NovoSeven® was introduced in 1996 for the treatment of hemophilic patients with antibodies against coagulation factor VIII or IX.Objective: To review the evidence supporting the use of rFVIIa for the treatment of patients with congenital bleeding disorders.Patients and methods: English-language databases were searched in September 2009 for reports of randomized controlled trials (RCTs evaluating the ability of rFVIIa to restore hemostasis in patients with congenital bleeding disorders.Results: Eight RCTs involving 256 hemophilic patients with antibodies against coagulation factors, also known as inhibitors, were identified. The evidence supporting the use of rFVIIa in these patients was weak with regard to dose, clinical setting, mode of administration, efficacy, and adverse events, given the limited sample size of each RCT and the heterogeneity of the studies.Conclusion: The authors suggest that rFVIIa therapy in hemophilic patients with inhibitors should be based on the individual’s ability to generate thrombin and form a clot, and not on the patient’s weight alone. Therefore, assays for thrombin generation, such as whole-blood thromboelastography, have the potential to significantly improve the treatment of these patients.Keywords: hemophilia, inhibitors, coagulation factor VIII, coagulation factor IX, rFVIIa, NovoSeven, FEIBA, hemostasis, RCT

  4. 舒适护理在上消化道出血患者中的应用效果%Application Effect of Comfortable Nursing in Patients with Upper Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    杨月; 翟晶岩

    2015-01-01

    目的观察并分析舒适护理在上消化道出血患者中的应用效果。方法取100例上消化道出血患者并均分为两组,两组患者均接受常规治疗与护理,观察组同时开展舒适护理服务,评估两组治疗情况、护理满意度。结果与对照组相比,观察组治疗总有效率更高,止血时间以及住院时间更短,组间差异显著而具有统计学意义(<0.05)。结论在上消化道出血临床治疗过程中开展舒适护理有利于改善临床疗效,促进患者康复,值得临床推广使用。%Objective To observe and analyze the application ef ect of comfortable nursing in patients with upper gastrointestinal bleeding. Methods 100 patients with upper gastrointestinal hemor hage and were divided into two groups, two groups of patients were accepted routine treatment and nursing, the observation group of comfortable nursing service at the same time, the evaluation of two groups of treatment and nursing satisfaction. Results Compared with control group and observation group total ef ective rate is higher, the bleeding time and shorter hospitalization time, significant dif erence between groups with statistical significance ( < 0.05). Conclusion In the process of upper gastrointestinal hemor hage clinical treatment in comfortable nursing to improve clinical curative ef ect, promote patients recover, worthy of clinical use.

  5. Tissue factor activated thromboelastography correlates to clinical signs of bleeding in dogs

    DEFF Research Database (Denmark)

    Wiinberg, Bo; Jensen, Asger Lundorff; Rozanski, Elizabeth;

    2009-01-01

    The ability of a laboratory assay to correlate to clinical phenotype is crucial for the accurate diagnosis and monitoring of haemostasis and is therefore challenging with currently used routine haemostasis assays. Thromboelastography (TEG) is increasingly used to evaluate haemostasis in humans...... and may well be of value in the workup of dogs suspected of having a haemostatic disorder. This study was undertaken to evaluate prospectively how tissue factor (TF) activated TEG correlated to clinical signs of bleeding in dogs, compared to a routine coagulation profile. A prospective case-control study...... was performed over a 2 year period from 2004-2006. Eligible dogs were those where the primary clinician requested a coagulation profile to evaluate haemostasis. The dogs were simultaneously evaluated with a TF-activated TEG assay. Twenty-seven dogs, characterised as hypo-coagulable based on the TEG parameter G...

  6. Localization of bleeding using 4-row detector-CT in patients with clinical signs of acute gastrointestinal hemorrhage; Blutungslokalisation mittels 4-Zeilen-Spiral-CT bei Patienten mit klinischen Zeichen einer akuten gastrointestinalen Haemorrhagie

    Energy Technology Data Exchange (ETDEWEB)

    Ko, H.S.; Tesdal, K.; Dominguez, E.; Kaehler, G.; Sadick, M.; Dueber, C.; Diehl, S. [Universitaetsklinikum Heidelberg (Germany). Kinderklinik

    2005-12-15

    Purpose: There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy. Materials and methods: 58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment. Results: 20 of the 58 patients (34%) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100% correlation regarding the bleeding site. In 38 of the 58 patients (66%), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53%) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention. (orig.)

  7. Evaluación económica del tratamiento con ácido acetilsalicílico más esomeprazol comparado con clopidogrel en la prevención de la hemorragia gastrointestinal Economic evaluation of the treatment of aspirin plus esomeprazole compared to clopidogrel in gastrointestinal bleeding prevention

    Directory of Open Access Journals (Sweden)

    Carme Piñol

    2006-02-01

    Full Text Available Objetivo: Evaluar la eficiencia del ácido acetilsalicílico (AAS más esomeprazol frente a clopidogrel en la prevención de la hemorragia gastrointestinal. Métodos: Análisis coste-efectividad (árbol de decisión de 2 ramas: AAS más esomeprazol y clopidogrel respecto a la evitación de casos de hemorragia gastrointestinal en 2 años, y análisis de sensibilidad. Resultados: El coste total del tratamiento con AAS más esomeprazol (2.865 S por paciente libre de hemorragia fue inferior al clopidogrel (2.965 S. El tratamiento con AAS resultó dominante. En todos los análisis de sensibilidad la combinación siguió siendo dominante. Al sustituir esomeprazol 40 mg por omeprazol 40 mg, el coste del tratamiento combinado descendió hasta 1.934S/por episodio evitado. Conclusiones: La asociación de esomeprazol y AAS es más coste-efectiva que clopidogrel en la prevención de la hemorragia gastrointestinal. La combinación con omeprazol resulta aún más coste-efectiva.Objective: To evaluate the use of aspirin plus esomeprazole vs. clopidogrel in the prevention of gastrointestinal bleeding. Methods: We performed a cost-effectiveness analysis (two-branch decision tree: aspirin plus esomeprazole or clopidogrel of prevention of gastrointestinal bleeding over a 2-year period, as well as sensitivity analyses. Results: The total cost of aspirin plus esomeprazole treatment (2,865S/patient free of hemorrhage was lower than that of clopidogrel (2,965S. Aspirin treatment was dominant. The combination continued to be dominant in all sensitivity analyses. When esomeprazole 40 mg was substituted by omeprazole 40 mg, the cost of combination therapy decreased to 1,934 S/prevented hemorrhage. Conclusions: The association of esomeprazole and aspirin is more cost-effective than clopidogrel in preventing gastrointestinal bleeding. Aspirin plus omeprazole was even more cost-effective.

  8. Clinical analysis on old and young patients with upper gastrointestinal bleeding%老年与青年患者上消化道出血的临床分析研究

    Institute of Scientific and Technical Information of China (English)

    孟祥俭; 邬颖华

    2011-01-01

    目的 探讨老年与青年患者上消化道出血的临床特征.方法 回顾性分析2007年3月~2010年3月在我科住院救治的148例上消化道出血并经胃镜或CT检查的临床病历资料.结果 老年与青年组上消化道出血均有明显的诱因,两组患者都存在饮食不当的病史,40.54%的老人有非甾体类药物史,而60.81%青年人有酗酒史;两组患者的临床表现差异无统计学意义;老年组上消化道出血以胃溃疡占首位(50.00%),其次是胃癌(13.51%);青年组以十二指肠溃疡多见(52.70%),其次是胃粘膜病变(28.38%);老年组患者常合并基础疾病高血压、冠心病、肝硬化分别为52.7%、28.38%、13.51%,86.49%有并发症.结论 老年患者与青年患者上消化道出血的发病诱因、出血原因以及伴发疾病等均有各自的特点;消化性溃疡是不同年龄组上消化道出血的主要原因.%Objective To study the clinical characteristics of upper gastrointestinal hemorrhage on old and young pa tients. Methods We evaluated the records of 148 patients who presented to our hospital with upper gastrointestinal bleeding be tween March 2007 and March 2010, All cases of upper gastrointestinal hemorrhage were undergone emergent gastroscopic examina tion and CT imaging. Results There were significant incentives on old and young groups with a history of improper diet, There were 40. 54% of the elder patients with non-steroidal drug history, and 60. 81% of young patients with history of alcohol abuse. The clinical manifestations of the two groups were not significantly different; 50 percent of elderly patients with gastric ulcers, and 13. 51 percent of patients with stomach cancer, 52. 70% of patients were duodenal ulcer in young group, followed by 28. 38% of gastric mucosal lesions; Elderly patients is often associated with basic diseases of hypertension, coronary heart disease, liver cir rhosis by 52.7% , 28. 38% , 13. 51% and 86.49%. Conclusion Elderly

  9. Radionuclide localization of lower gastrointestinal hemorrhage

    International Nuclear Information System (INIS)

    The authors prospectively evaluated the usefulness of abdominal radionuclide scintigraphy using /sup 99m/Tc-labeled red cells as a means of monitoring for intermittent gastrointestinal bleeding over a 24-hour period in both control and actively bleeding populations. Of 32 patients with documented hemorrhage, 29 had positive scintiscans (sensitivity, 91%; 9% false negatives). Of 18 nonbleeding patients, 17 had negative scintiscans (specificity, 95%; 5% false positives). 12 of 29 patients bled from 6 to 24 hours after the study was begun. Scintiscans were positive in patient with transfusion requirements of greater than or equal to 500 ml/24 hr. The authors conclude that abdominal scintigraphy with /sup 99m/Tc-labeled red cells is an effective method of detecting gastrointestinal bleeding

  10. 小儿十二指肠溃疡合并急性上消化道大出血的手术治疗%Emergency surgery for fatal upper gastrointestinal tract bleeding caused by duodenal ulcer in children

    Institute of Scientific and Technical Information of China (English)

    孙晓毅; 余东海

    2010-01-01

    Objective To retrospectively review the emergency surgeries for fatal bleeding caused by duodenal ulcer in children. Methods Four male patients aged 2. 5 to 4 years old were en-rolled in this study. Urgent operations were performed on the 4 patients due to an unexpected heavy bleeding during medical treatment of ulcer disease. Intraoperative inspection revealed the ulcer lesions located at the superior wall of duodenal bulb on one patient,at the anterior wall on another patient,and at the posterior wall on the other two patients. Blood spewed from the ulcer or seeped from the edge of the ulcer. Hemostatic suturing to the bleeding lesion was performed under direct vision. After complete hemostasis was achieved,the duodenal stump was closed,and subtotal gastric resection and Billroth Ⅱ gastrojejunostomy were performed. Results The four patients were recovered uneventful-ly. They were followed up for 1-5 years. No recurrence of preoperative gastrointestinal symptoms and ulcers or bleeding was noted on the 4 patients. Their hemoglobin,serum total protein and albumin were stayed at the normal levels. Their diet and growth were normal Conclusions The duodenal ul-cer complicated with uncontrollable bleeding in children is extremely rare. The bleeding is usually caused by arteries eroded by the ulcerations located at the posterior wall of duodenal bulb. Emergency operation is required to stop bleeding. After hemostasis was achieved,the ulcer lesion can be left out. Billroth Ⅱ gastrojejunostomy is performed to reconstruct the gastrointestinal continuity. Different from the gastrectomy scope on adults,subtotal gastric resection can get good results on pediatric patients.%目的 报道4例小儿十二指肠溃疡合并致命性上消化道大出血病例的手术抢救以及预后.方法 2002至2008年间收治的4例男性十二指肠溃疡合并急性上消化道大出血患儿,年龄2.5~4岁,均在内科治疗溃疡病期间发生不可控制的大出血而紧急手

  11. Plasminogen activator inhibitor with very long half-life (VLHL PAI-1) can reduce bleeding in PAI-1-deficient patients.

    Science.gov (United States)

    Jankun, Jerzy; Skrzypczak-Jankun, Ewa

    2013-08-01

    This review summarizes our current knowledge of plasminogen activator inhibitor (PAI-1) deficiency and proposes some novel treatments for this condition. PAI-1 is a fast acting inhibitor of tissue and urokinase plasminogen activators (tPA and uPA). PAI-1 controls/slows clot lysis triggered by tPA activated plasminogen. PAI-1 deficiency was once considered to be an extremely rare disorder characterized by frequent and prolonged bleeding episodes. PAI-1 deficiency is now thought to be more frequent than initially reported and is known to be caused by mutations in the PAI-1 gene that produce a dysfunctional PAI-1 protein or slow the secretion of PAI-1 into the circulation. PAI-1 deficiency is characterized by hyperfibrinolysis that results in frequent bleeding episodes. Patients with this condition form normal blood clots that are quickly lysed by unopposed tPA-activated plasmin. Spontaneous bleeding is rare in PAI-1 deficient patients, but moderate hemorrhaging of the knees, elbows, nose, and gums can be triggered by mild trauma. Additionally, prolonged bleeding after surgery is common and menstrual bleeding may be severe. Moderate PAI-1 deficiency is associated with a lifelong bleeding tendency, but severe deficiencies can be life-threatening. The diagnosis of this disorder remains challenging due to the lack of a clear definition of PAI-1 deficiency as well as a lack of standardized tests. Patients with mild PAI-1 deficiency may be treated with antifibrinolytic agents (ε-aminocaproic acid or tranexamic acid); however, not all patients respond well to these treatments. These patients may be treated with wild-type PAI-1; however, this molecule quickly converts into its inactive form. We propose to use PAI-1 with an extended half-life to treat these patients. PMID:23988002

  12. Anthelmintic activity of albendazole against gastrointestinal nematodes in calves.

    Science.gov (United States)

    Benz, G W; Ernst, J V

    1977-09-01

    Anthelmintic activities of albendazole were evaluated in a controlled experiment. Forty calves experimentally infected with gastrointestinal nematodes were allotted to 4 groups. Calves in group 1 were used as nonmedicated controls; calves in groups 2, 3, and 4 were given (by oral route) a suspension containing albendazole at dose concentrations of 2.5, 5.0, and 7.5 mg/kg of body weight on the 35th day after administration of infective nematode larvae. In groups 2, 3, and 4 calves, average overall reductions (based on geometric means) were 77.1, 93.6, and 98.1%, respectively. These reductions were highly significant (P less than 0.01) in calves given doses of 5.0 and 7.5 mg/kg, and were significant (P less than 0.05) in calves given the 2.5-mg/kg dose. Ostertagia ostertagi, Trichostrongylus axei, Cooperia onchophora, Cooperia punctata, and Oesophagostomum radiatum removals at the 5.0- and 7.5-mg/kg dose levels were all highly significant (P less than 0.01); whereas, removals of Haemonchus contortus were not significant, even at the 7.5-mg/kg dose level. PMID:921039

  13. 放射性核素胃肠显像对消化道出血的诊断价值%The Clinical Evaluation of Radionuclide imaging for Unexplained Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    沈永年; 金惠明; 佘亚雄

    1988-01-01

    本文报告44例原因不明的消化道出血病例,经放射性核素腹部扫描或r照相,结果22例阳性,其中16例经手术探查,证实为美克尔憩室9例,回盲部肉瘤1例,回盲部恶性淋巴瘤1例,食道裂孔疝2例,慢性肠套叠、肠重复畸形、坏死性小肠炎各1例.检查结果表明:放射性核素腹部照相对小儿消化道出血病因诊断是有用的过筛试验方法,对美克尔憩室具有诊断价值.%The clinical use of ~(99m)Tc digestive tract imaging for unexplained gastrointestinal bleeding in 44 cases are reported.22 in 44 cases were positive,i.e.,radioactive concentrated on the bleeding area,and 16 patients underwent surgery;they involve:Meckel's diverticulum in 9,Malignant lymphoma 1,sarcoma 1,necrotizing enterocolitis 1,chronic intussusception 1,bowel duplication 1,and hiatus hernia 2.Gastrointestinal imaging with ~(99m)Tc is proved to be a simple,noninvasive,highly specific and accurate method for the diagnosis of Meckel's diverticulum.It is also a valuable tool for the differential diagnosis of the malignant tumor,inflammatory bowel disease,and bowel developmental anomaly.

  14. 克罗恩病并发急性下消化道大出血的护理%Nursing of Crohn's disease complicated with acute lower gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    苏润婵; 黄美娟; 张萍

    2010-01-01

    Objective To explore the clinical features and nursing strategies of the Crohn's disease(CD) comphcated with acute lower gastrointestinal bleeding. Methods The clinical and nursing data of the CD admitted to our hospital with acute lower gastrointestinal bleeding in patients with 13 cases from 1998 to 2007 were collected and retrospectively analyzed to explore the nursing strategy. Results Four cases of thirteen patients improved after surgery, 9 cases received conservative therapy, 3 cases died. Conclusions Careful medical treatment and nursing during the conservative treatment can effectively control the progression of the disease and reduce mortality.%目的 探讨克罗恩病(Crohn's disease,CD)并发急性下消化道大出血患者的临床特点及护理对策.方法 1998-2007年我院收治的克罗恩病并发急性下消化道大出血患者13例,对其临床及护理资料进行回顾性分析,探讨其护理对策.结果 13例患者中4例接受手术治疗后好转,9例采取保守治疗,其中3例死亡.结论 内科保守治疗过程中精心的治疗与护理,可以有效控制病情发展,降低病死率.

  15. Circumventing furin enhances factor VIII biological activity and ameliorates bleeding phenotypes in hemophilia models

    Science.gov (United States)

    Siner, Joshua I.; Samelson-Jones, Benjamin J.; Crudele, Julie M.; French, Robert A.; Lee, Benjamin J.; Zhou, Shanzhen; Merricks, Elizabeth; Raymer, Robin; Camire, Rodney M.; Arruda, Valder R.

    2016-01-01

    Processing by the proprotein convertase furin is believed to be critical for the biological activity of multiple proteins involved in hemostasis, including coagulation factor VIII (FVIII). This belief prompted the retention of the furin recognition motif (amino acids 1645–1648) in the design of B-domain–deleted FVIII (FVIII-BDD) products in current clinical use and in the drug development pipeline, as well as in experimental FVIII gene therapy strategies. Here, we report that processing by furin is in fact deleterious to FVIII-BDD secretion and procoagulant activity. Inhibition of furin increases the secretion and decreases the intracellular retention of FVIII-BDD protein in mammalian cells. Our new variant (FVIII-ΔF), in which this recognition motif is removed, efficiently circumvents furin. FVIII-ΔF demonstrates increased recombinant protein yields, enhanced clotting activity, and higher circulating FVIII levels after adeno-associated viral vector–based liver gene therapy in a murine model of severe hemophilia A (HA) compared with FVIII-BDD. Moreover, we observed an amelioration of the bleeding phenotype in severe HA dogs with sustained therapeutic FVIII levels after FVIII-ΔF gene therapy at a lower vector dose than previously employed in this model. The immunogenicity of FVIII-ΔF did not differ from that of FVIII-BDD as a protein or a gene therapeutic. Thus, contrary to previous suppositions, FVIII variants that can avoid furin processing are likely to have enhanced translational potential for HA therapy. PMID:27734034

  16. The risk factors and outcomes of gastrointestinal bleeding in acute ischaemic stroke%缺血性脑卒中并发消化道出血危险因素及预后分析

    Institute of Scientific and Technical Information of China (English)

    邓晓风

    2012-01-01

    Objective Gastrointestinal(GI) bleeding is one of most serious complications after acute stage of ischemic stroke. This study is to investigate the risk factors as well as the prognosis of those cases with GI bleeding following acute stroke. Methods From Mar 2008 to Aug 2010, we prospectively collected ischemic stroke patients with or without GI bleeding in our intensive care unit grouped as research group and controls. A six month follow-up was conducted. Comparison was done between groups on the aspect of demography, predisposing factors and prognosis. Results Overall 3. 5% of GI bleeding was observed a-mong those ischemic stroke patients. The four major risk factors were coma ( 0R5.0 95% CI 1.4 ~ 17. 5 ) , incontinence ( OR5. 8 95% CI 1. 5 - 22. 2 ) , history of peptic ulcer or GI bleeding ( OR5. 2 95% CI 1. 3 ~ 21.1) and history of stroke ( OR3. 6 95% CI 1. 0 ~ 12. 7)respectively. During the follow-up, higher mortality rate was detected in research group (45. 5% ) especially those with sever GI bleeding (50% ) than that in controls (10% ). Conclusion Although GI bleeding is not a relative common complication after acute ischemic stroke, we should notice that it is associated with increased death risk. Thus we should be focused more attention on those risk factors.%目的 消化道出血是脑卒中后最严重的并发症之一.本研究探讨比较了其危险因素及相关预后.方法 收集2008年3月~2010年8月,我院重症监护室收治的脑梗死并发上消化道出血的患者(研究组)以及未并发上消化道出血的脑梗死患者(对照组),并进行6个月的随访.比较相关人口学数据、危险因素及相关预后.结果 研究发现,脑梗死并发消化道出血发生率为3.5%,其高危因素主要为昏迷(OR5.0 95% CI 1.4 ~ 17.5)、大小便失禁(OR5.8 95% CI1.5 ~22.2)、消化道溃疡或出血病史(OR5.2 95%CI 1.3 ~21.1)以及既往卒中病史(OR3.6 95%CI 1.0 ~ 12.7).在6个月的随访

  17. A Review on the Anti-Inflammatory Activity of Pomegranate in the Gastrointestinal Tract

    OpenAIRE

    Elisa Colombo; Enrico Sangiovanni; Mario Dell'Agli

    2013-01-01

    Several biological activities of pomegranate have been widely described in the literature, but the anti-inflammatory effect in the gastrointestinal tract has not been reviewed till now. The aim of the present paper is to summarize the evidence for or against the efficacy of pomegranate for coping with inflammatory conditions of the gastro-intestinal tract. The paper has been organized in three parts: (1) the first one is devoted to the modifications of pomegranate active compounds in the gast...

  18. Clinical Analysis of the Value of Octreotide in the Treatment of Gastrointestinal Bleeding Portal Hypertension%奥曲肽治疗门静脉高压性消化道出血的临床价值分析

    Institute of Scientific and Technical Information of China (English)

    徐瑛

    2014-01-01

    目的探讨奥曲肽治疗门静脉高压性消化道出血的临床价值。方法选取2008年7月~2012年9月我院确诊治疗的门静脉高压性消化道出血患者94例,依据随机分配原则分为奥曲肽组和对照组,两组患者均给予常规垂体后叶素治疗,奥曲肽组在此治疗基础上同时给予奥曲肽治疗,对比分析两组患者治疗情况和治疗后不良反应发生情况。结果奥曲肽组患者止血、住院时间均明显短于对照组,胃液pH值明显高于对照组,差异有统计学意义(P<0.05);奥曲肽组患者治疗总有效率明显高于对照组,差异有统计学意义(P<0.05);奥曲肽组患者治疗后不良反应率明显低于对照组,差异有统计学意义(P<0.05)。结论奥曲肽治疗可有效缓解患者出血症状,缩短患者出血时间,有利于加快患者的恢复,提高治疗效果和降低不良反应的发生,值得临床作进一步推广。%Objective To study the clinical value of octreotide in treatment of portal hypertension gastrointestinal bleeding. Methods 94 patients with Portal hypertensive gastrointestinal bleeding from July 2008 to September 2012 were chosen as research subjects, they were assignment into octreotide group and control group based on the principles of random. Two groups of patients were given routine vasopressin treatment. On the basis of the treatment, the octreotide group was given the peptide at the same time. Two groups were compared with the treatment and adverse reactions after treatment. Results The time of stop bleeding, length of hospital stay in octreotide group were significantly shorter than the control group, pH value of the gastric juice was signifi-cantly higher than the control group, the difference was statistically significant (P<0.05); The total effective rate of octreotide group was significantly higher than the control group, the difference was statistically significant (P<0.05); The rate of

  19. Inhibitory effect of pinaverium bromide on gastrointestinal contractile activity in conscious dogs.

    Science.gov (United States)

    Itoh, Z; Takahashi, I

    1981-01-01

    The inhibitory effect of 4-(6-bromoveratryl)-4-(2-[2-(6,6-dimethyl-2-norpinyl)-ethoxy]-ethyl)-morpholinium hydroxide (pinaverium bromide), a quaternary ammonium derivative, on the contractile activity of the gastrointestinal tract from the stomach to the colon was investigated in six conscious dogs. Gastrointestinal motor activity was monitored by means of chronically implanted force transducers. Pinaverium bromide was continuously administered i.v. for 30 min in doses of 10 and 20 mg/kg/h during both the digestive and interdigestive states. It was found that pinaverium bromide strongly inhibited gastrointestinal contractile activity during both the digestive and interdigestive states; contractions in the stomach were most strongly inhibited; however, those in the small and large bowels were also significantly inhibited. No significant side effects in the circulatory and respiratory systems and the gastrointestinal tract such as nausea, vomiting or diarrhea were observed during and after the infusion of this agent. PMID:7197953

  20. Bleeding Disorders

    Science.gov (United States)

    ... times I'd miss work and skip the gym because I felt so lousy. So I decided ... cell called platelets. Your body also needs blood proteins called clotting factors. In people with bleeding disorders, ...

  1. The value of RI scintigraphy and angiography in small intestinal bleeding; Report of eight cases

    Energy Technology Data Exchange (ETDEWEB)

    Kurosawa, Susumu; Kuwata, Hajime; Kushibiki, Kyoko; Akimoto, Kimihiko; Hashimoto, Toshiyuki; Kojima, Toshiya (Showa General Hospital, Kodaira, Tokyo (Japan))

    1991-07-01

    We retrospectively reviewed eight cases of small intestinal bleeding and assessed the value of RI scintigraphy and angiography in diagnosing the bleeding site. The patients' average age was 56.2 years. Chief complaint was melena of variable degree. In most cases neither upper endoscopy nor colonoscopy was diagnostic. RI scientigraphy (Tc-99 labeled human serum albumin) showed 75% of positive rate whereas angiography showed 66.7% (4/6) of positive rate. All four cases of leiomyosarcoma and leiomyoma demonstrated hypervascular stain and/or extra-vasation in angiography whereas RI scintigraphy failed to detect active gastrointestinal bleeding in 2 of the 4 cases. Therefore angiography was considered useful for the detection of bleeding from leiomyoma and leiomyosarcoma which are often hypervascular. Scintigraphy is thought of most value in the demonstration of small amount of bleeding with minimum vascular abnormality. (author).

  2. Selective serotonin reuptake inhibitors and the risk of bleeding

    Directory of Open Access Journals (Sweden)

    Padma L

    2013-06-01

    Full Text Available Background: Selective serotonin reuptake inhibitors (SSRIs are commonly prescribed agents for various conditions in general psychiatry. There is a strong consensus that blockade of serotonin reuptake affects primary hemostasis, namely platelet activity, thus resulting in a bleeding tendency. Considering that SSRIs are commonly prescribed, this study was conducted to assess if they were associated with an increased risk of bleeding. Methods: This was a prospective, open-label study of 30 patients attending the Psychiatry out-patient department, Dr. B. R. Ambedkar Medical College, Bangalore who satisfied DSM-IV criteria for a primary diagnosis of depression, treated with SSRIs. Bleeding time, clotting time, prothrombin time, partial thromboplastin time and platelet count were assessed at baseline and at the end of 6 weeks of treatment or occurrence of bleeding symptom. Results: The patients aged between 18-55 years of whom 21 were females, were treated with an SSRI (fluoxetine 12, escitalopram 12 and sertraline 6 patients. Six patients had overt symptoms of bleeding (upper gastrointestinal bleeding (hematemesis 4; epistaxis 2 and petechiae 2 of whom one patient gave a history of both hematemesis and petechiae and another of hematemesis and epistaxis. The average day after treatment beginning, on which patients reported with bleeding was 30.33 (26-40 days. There was a significant increase in the bleeding time (p=0.028 and clotting time (p=0.042, implying derangement in platelet aggregation. There was no significant change in the other parameters. Conclusion: Treatment with SSRIs increases the risk of bleeding. However, large, randomized controlled trials are required to re-affirm these findings. [Int J Basic Clin Pharmacol 2013; 2(3.000: 272-274

  3. Effect of Comfortable Nursing on Quality of Life of Patients With Upper Gastrointestinal Bleeding%舒适护理对上消化道出血患者生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    张毅宇

    2015-01-01

    目的:探讨舒适护理对上消化道出血患者生活质量的影响。方法选取我院200例上消化道出血患者,随机分为观察组和对照组,每组患者均为100例,对照组采用常规护理,观察组采用舒适护理,比较两组患者的护理效果。结果观察组护理后的SAS评分低于对照组(P<0.05),护理后生活质量方面的评分均高于对照组(P<0.05)。结论舒适护理可大大改善患者的各项综合要求,提高生理和心理上的舒适度,改善生活质量。%Objective To explore the effect of comfortable nursing on quality of life of patients with upper gastrointestinal bleeding.Methods 200 cases of elderly patients with upper gastrointestinal bleeding were divided into the observation group(n=50)and the control group(n=50),the control group was given routine nursing,the observation group was given comfortable nursing,nursing effects were compared between two groups.Results Anxiety (SAS)score after nursing in the observation group care were significantly lower than those in the control group(P<0.05),life quality score in the observation group were significantly higher than those in the control group(P<0.05).Conclusion Comfortable nursing can greatly improve the comprehensive needs of the patients,improve the physiological and psychological comfort,and improve the quality of life.

  4. Scintigraphic localisation of colonic bleeding; Scintigrafisk lokalisasjon av colonbloedning

    Energy Technology Data Exchange (ETDEWEB)

    Aspevik, Ranveig K.; Miskowiak, Jerzy; I Bud, Margreta

    2001-07-01

    Background. Endoscopy and occasionally X-ray studies are used to discover the focus of a gastrointestinal bleeding. Material and methods. We describe a case of severe gastrointestinal bleeding where these methods failed. Scintigraphy after labelling of erythrocytes with 99m technetium was performed in a continuos manner for 60 minutes. Scintigrams were also taken three, ten and 23 hours after the injection. Results. No bleeding was revealed after 60 minutes but two hours later a slight radioactivity was encountered in the right part of the abdomen and the later images localised the bleeding in the right colon. The bleeding ceased after right-sided hemicolectomy. Interpretation. Scintigraphy is of value in localisation of gastrointestinal bleeding and should be performed in a continuos manner until the bleeding focus is localised. Secretion of unbound technetium through the mucosa of the stomach and its presence in the urinary tract should be taken in account.

  5. Transjugular intrahepatic portosystemic shunt in patients with active variceal bleeding due to portal hypertension and portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Hyun Woong; Ryeom, Hun Kyu; Lee, Sang Kwon; Lee, Jong Min; Kim, Young Sun; Suh, Kyung Jin; Kim, Tae Hun; Kim, Yong Joo [Kyungpook National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-10-01

    To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with active variceal bleeding due to liver cirrhosis and pre-existing portal vein thrombosis. Of a total of 123 patients who underwent TIPS, 14 patients with intractable variceal bleeding due to portal hypertension and portal vein thrombosis were included in this study. Noncavernomatous portal vein occlusion was seen in eight patients, and complete portal vein occlusion with cavernomatous trans-formation in six. For all patients, the methods used for TIPS placement were the same as those used in patients with patents portal veins. In seven of eight patients with noncavernomatous occlusion, right hepatic vein-right portal vein shunting was performed; in one with knoncavernomatous occlusion, a shunt was created between the right hepatic and left portal vein. In five of six patients with cavernomatous occlusion, the right hepatic and main portal vein were connected via a collateral vein. The procedures were technically successful in all except one patient. Immediate hemostatis was achieved after all technically successful procedures, and no significant complications were encountered. Minor complications were noted in six patients (three biliary tree punctures, one transperitoneal puncture, one splenic vein perforation, one hepatic subcapsular hematoma). TIPS is a technically feasible and hemodynamically effective procedure, even in patients with active variceal bleeding due to cirrhosis and complete portal vein occlusion.

  6. Heterotopic Ileal Pancreas with Lipoma and Coexisting Fibromatosis Associated with a Rare Case of Gastrointestinal Bleeding. A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Panagiotis Fikatas

    2008-09-01

    Full Text Available Context The development of pancreatic tissue outside the confines of the main gland represents a congenital abnormality referred to as heterotopic pancreas. This is a rare pathological and surgical entity which remains mostly asymptomatic. Case report We present the case of a 28- year-old male, who was admitted to hospital because of a history of blood in bowel movements. After a normal gastroscopy and colonoscopy, Tc99m-tagged red blood cells scintigraphy showed enrichment in the right lower abdomen. At double-balloon endoscopy, a intraluminal polypoid mass 8 cm in diameter was revealed 120 cm from the ileocecal valve. The initial macroscopic diagnosis was a gastrointestinal stromal tumor. During surgery, the diagnosis of heterotopic pancreas with lipoma and fibromatosis was made. To our knowledge this is the first case of ileal heterotopic pancreatic tissue and lipoma described to date in the literature. Conclusion Ileal heterotopic pancreas is a rare entity with potentially life-threatening complications, local excision being the appropriate indicated treatment.

  7. Management of dabigatran-induced bleeding with continuous venovenous hemodialysis.

    Science.gov (United States)

    Paul, Suman; Hamouda, Danae; Prashar, Rohini; Mbaso, Chiamaka; Khan, Abdur; Ali, Abdulmonam; Shah, Sarthi; Assaly, Ragheb

    2015-06-01

    Dabigatran, a direct thrombin inhibitor, is increasingly used for stroke prevention in patients with non-valvular atrial fibrillation. Dabigatran has a stable pharmacokinetic profile with minimum drug interactions, and requires no routine laboratory evaluation to measure level of anticoagulation. This provides a huge advantage over warfarin, and has the potential to improve patient compliance. The disadvantages of dabigatran are the lack of a reversal agent to counter dabigatran-related bleeding and the absence of a widely available laboratory test that can quantify the extent of coagulopathy in dabigatran overdose. Hemodialysis can rapidly lower dabigatran levels and assist in controlling bleeding secondary to dabigatran overdose. However, in cases in which hemodynamic instability precludes the use of hemodialysis, alternative methods have to be utilized to control dabigatran-associated bleeding. Here we document a case of massive gastrointestinal bleeding secondary to dabigatran use that was successfully managed by continuous venovenous hemodialysis (CVVHD), along with supportive care with blood product transfusions. CVVHD reduces thrombin time and activated partial thrombin time, and causes a parallel decrease in amount of active bleeding. Finally, we show that compared to the rapid lowering of elevated thrombin time observed in hemodialysis, CVVHD requires several days to reduce thrombin time to normal range. PMID:25633777

  8. Periesophageal Pseudoaneurysms: Rare Cause of Refractory Bleeding Treated with Transarterial Embolization

    Science.gov (United States)

    Shah, Rachit D.; Komorowski, Daniel J.; Smallfield, George B.

    2016-01-01

    A 43-year-old female with history of systemic lupus erythematosus, prior cytomegalovirus esophagitis treated with ganciclovir, and long segment Barrett's esophagus (Prague class C8 M9) with high grade dysplasia treated with radiofrequency ablation presented to the hospital with hematemesis. An upper gastrointestinal endoscopy showed multiple esophageal ulcers with active arterial spurting which could not be controlled with endoscopic interventions including placement of hemostatic clips. An emergent angiogram demonstrated actively bleeding saccular dilations (pseudoaneurysms) in the esophageal branches of the lower thoracic aorta as well as left gastric artery for which gelfoam and coil embolization was initially successful. Due to recurrence of massive bleeding, she subsequently underwent emergent esophagectomy and bipolar exclusion. Pathology demonstrated submucosal hemorrhage, esophagitis with dysplastic Barrett's mucosa, and an ulcer containing cytomegaloviral inclusions. We report the first case of arterial bleeding from periesophageal pseudoaneurysms as well as use of angiographic embolization for arterial bleeding in the esophagus.

  9. Acute respiratory failure and active bleeding are the important fatality predictive factors for severe dengue viral infection.

    Directory of Open Access Journals (Sweden)

    Kamolwish Laoprasopwattana

    Full Text Available To determine the outcome of severe dengue viral infection (DVI and the main dengue fatality risk factors.The medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Patients who had dengue hemorrhagic fever (DHF grades III-IV, organ failure (cardiovascular, respiratory, liver, renal or hematologic, impaired consciousness, or aspartate aminotransferase more than 1,000 units/L, were classified as having severe DVI. To determine the fatality risk factors of severe DVI, the classification trees were constructed based on manual recursive partitioning.Of the 238 children with severe DVI, 30 (12.6% died. Compared to the non-fatal DVI cases, the fatal cases had higher rates of DHF grade IV (96.7% vs 24.5%, repeated shock (93.3% vs 27.9%, acute respiratory failure (ARF (100% vs 6.7%, acute liver failure (ALF (96.6% vs 6.3%, acute kidney injury (AKI (79.3% vs 4.5%, and active bleeding requiring blood transfusion (93.3% vs 5.4%, all p<0.01. The combined risk factors of ARF and active bleeding considered together predicted fatal outcome with sensitivity, specificity, and negative and positive predictive values of 0.93 (0.78-0.99, 0.97 (0.93-0.99, 0.99 (0.97-1.00, and 0.82 (0.65-0.93, respectively. The likelihood ratios for a fatal outcome in the patients who had and did not have this risk combination were 32.4 (14.6-71.7 and 0.07 (0.02-0.26, respectively.Severe DVI patients who have ARF and active bleeding are at a high risk of death, while patients without these things together should survive.

  10. Anthelmintic activity of medicinal plants extract against gastrointestinal nematodes in naturally infected goats

    International Nuclear Information System (INIS)

    At present, goat farming, either as a full-time or part-time activity, is in increasingly being recognized as an economically beneficial livestock enterprise in tropical and sub tropical countries. Despite this popularity of goat industry, several constraints have limited the full potential of this farming activity in these countries. Among the multitude of impediments, which limit the development of the goat industry, gastrointestinal nematode infection represents a major constraint in Sri Lanka like in other parts of the tropics. Recent studies in Sri Lanka have shown, gastrointestinal nematode infections decrease the productivity, particularly weight gain in meat goats in the dry zone. The work done in dry zone of Sri Lanka has indicated that an overwhelming majority (99%) of goats were affected by a moderate to high gastrointestinal nematode infection. Successful control gastrointestinal nematodiasis infection is important for the sustainable productivity of the goat industry. The control of gastrointestinal nematodiasis is usually performed using synthetic anthelmintics. The appearance of nematode resistance to these anthelmintics and several other factors highlight the need to developing alternatives. This stimulated the research of alternatives, such as medicinal plants to control gastrointestinal nematodiasis. According to circumstances and depending on their efficacy, naturally produced plant anthelmintics offer an alternative that can overcome some of these problems and is both sustainable and environmentally acceptable. Fifteen plant extracts were screened using an in vitro larval migration inhibition (LMI) assay. Out of the fifteen crude extracts Azadiractha indica (neem) seed (NS), Areca catechu(areca-nut) unripe fruit kernel(AUFK), Adhatoda vasica (pavatta-adathoda) leaves (PL), caused a significant(P 0.05). ANUFK and PL extracts at the dose rates used was effective in controlling the GI nematodiasis in goats. ANUFK and PL could be used in control

  11. Tc-99m sulfur colloid scanning in blunt trauma: detection of abdominal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bronfman, H.J.; Kunkel, B.K.; Rabin, H.S.

    1981-11-01

    Tc-99m sulfur colloid scintigraphy can detect and locate active lower gastrointestinal bleeding. The same principles apply to the detection and location of active intra-abdominal or pelvic hemorrhage following blunt abdominal trauma. We report two patients with abdominal bleeding who were correctly diagnosed by this method. As part of the routine examination of all patients having Tc-99m sulfur colloid liver-spleen scans for trauma, 500,000-count images should be made of the rest of the abdomen and pelvis.

  12. Tc-99m sulfur colloid scanning in blunt trauma: detection of abdominal bleeding

    International Nuclear Information System (INIS)

    Tc-99m sulfur colloid scintigraphy can detect and locate active lower gastrointestinal bleeding. The same principles apply to the detection and location of active intra-abdominal or pelvic hemorrhage following blunt abdominal trauma. We report two patients with abdominal bleeding who were correctly diagnosed by this method. As part of the routine examination of all patients having Tc-99m sulfur colloid liver-spleen scans for trauma, 500,000-count images should be made of the rest of the abdomen and pelvis

  13. Endoscopic management of diverticular bleeding.

    Science.gov (United States)

    Rustagi, Tarun; McCarty, Thomas R

    2014-01-01

    Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB) with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70-80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  14. Endoscopic Management of Diverticular Bleeding

    Directory of Open Access Journals (Sweden)

    Tarun Rustagi

    2014-01-01

    Full Text Available Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70–80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  15. Bruising of the esophagus as a cause of gastrointestinal bleeding in a case of heatstroke Hematomas esofágicos como causa de hemorragia digestiva en un caso de golpe de calor

    Directory of Open Access Journals (Sweden)

    A. J. Lucendo Villarín

    2005-08-01

    Full Text Available Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.Las alteraciones de la coagulación son una complicación frecuente en el golpe de calor grave, y pueden ser causa de hemorragia digestiva. Presentamos el caso de un varón de 26 años que fue admitido en nuestro hospital por un cuadro de hipertermia, asociado con encefalopatía y coagulación intravascular diseminada tras exposición solar prolongada. Presentó hematemesis por la que fue diagnosticado de múltiples hematomas esofágicos que ocupaban los tercios superior e inferior del órgano, en ausencia de otras lesiones en estómago y duodeno. Tras el tratamiento de soporte y la resolución de la patología subyacente, desaparecieron las lesiones endoscópicas, normalizándose la mucosa esofágica.

  16. Acquired haemophilia complicated with gastrointestinal bleeding and spontaneous iliopsoas muscle haematoma in a woman with chronic C hepatitis under treatment with pegylated IFN alpha 2a and ribavirin.

    Science.gov (United States)

    Boţianu, Ana-Maria; Demian, Smaranda; Macarie, Ioan; Georgescu, Dan; Oltean, Galafteon; Băţagă, Simona

    2012-03-01

    Acquired haemophilia A is a very rare (1-2 cases per million people) but often life-threatening haemorrhagic disorder characterized by antibodies directed against coagulation factor VIII. We report the case of a 55-year old woman under treatment with Pegylated alpha 2a interferon (IFN) and Ribavirin for chronic viral C hepatitis, who developed a progressive severe haemorrhagic syndrome diagnosed as acquired haemophilia based on supplementary laboratory data (prolonged activated partial thromboplastin time, extremely low factor VIII level - 1%, high titre of factor VIII inhibitor - 30 Bethesda U/ml).The onset was insidious, about three months before presenting to our unit. Antiviral therapy had been stopped three weeks before current admission. Emergency intensive treatment included: haemostatic agents - rFVII (Novoseven), FEIBA (Factor VIII Inhibitor Bypassing Activity), vitamin K, adrenostazin, cryoprecipitate, fresh frozen plasma, as well as immunosuppressive therapy (high dose corticotherapy and cyclophoshamide), immunoglobulins (Humaglobin), prophylactic PPI and antibiotics. The evolution was slowly favourable with the remission of the haemorrhagic syndrome and regression of the iliopsoas muscle haematoma. Clinicians should be aware that acquired forms of haemophilia do exist, representing a rare diagnosis and a therapeutic challenge. To our knowledge, this is the first reported case of acquired haemophilia in Romania, in a patient with chronic viral C hepatitis under antiviral treatment. PMID:22457865

  17. Acquired haemophilia complicated with gastrointestinal bleeding and spontaneous iliopsoas muscle haematoma in a woman with chronic C hepatitis under treatment with pegylated IFN alpha 2a and ribavirin.

    Science.gov (United States)

    Boţianu, Ana-Maria; Demian, Smaranda; Macarie, Ioan; Georgescu, Dan; Oltean, Galafteon; Băţagă, Simona

    2012-03-01

    Acquired haemophilia A is a very rare (1-2 cases per million people) but often life-threatening haemorrhagic disorder characterized by antibodies directed against coagulation factor VIII. We report the case of a 55-year old woman under treatment with Pegylated alpha 2a interferon (IFN) and Ribavirin for chronic viral C hepatitis, who developed a progressive severe haemorrhagic syndrome diagnosed as acquired haemophilia based on supplementary laboratory data (prolonged activated partial thromboplastin time, extremely low factor VIII level - 1%, high titre of factor VIII inhibitor - 30 Bethesda U/ml).The onset was insidious, about three months before presenting to our unit. Antiviral therapy had been stopped three weeks before current admission. Emergency intensive treatment included: haemostatic agents - rFVII (Novoseven), FEIBA (Factor VIII Inhibitor Bypassing Activity), vitamin K, adrenostazin, cryoprecipitate, fresh frozen plasma, as well as immunosuppressive therapy (high dose corticotherapy and cyclophoshamide), immunoglobulins (Humaglobin), prophylactic PPI and antibiotics. The evolution was slowly favourable with the remission of the haemorrhagic syndrome and regression of the iliopsoas muscle haematoma. Clinicians should be aware that acquired forms of haemophilia do exist, representing a rare diagnosis and a therapeutic challenge. To our knowledge, this is the first reported case of acquired haemophilia in Romania, in a patient with chronic viral C hepatitis under antiviral treatment.

  18. Recombinant activated factor VII in the treatment of intractable non-surgical bleeding following major vascular procedures

    Directory of Open Access Journals (Sweden)

    Končar Igor B.

    2008-01-01

    Full Text Available INTRODUCTION A recombinant form of activated factor VII (rFVIIa is a haemostatic drug that is approved for use in haemophiliacs with antibodies to factor VIII or factor IX. Most recent studies and clinical experience have shown that rFVIIa (NovoSeven ®, Novo Nordisk A/S, Denmark gives extreme haemostatic effect in patients with severe "non-haemophilic" bleeding produced after trauma and major surgery. OBJECTIVE We present our preliminary experience of the use of rFVIIa in vascular surgery when conventional haemostatic measures are inadequate. METHOD There were 32 patients divided into five groups: Group I - 14 patients with ruptured abdominal aortic aneurysms; Group II - 10 patients with thoracoabdominal aortic aneurysms; Group III - 5 patients with retroperitoneal tumors involving great abdominal vessels; Group IV - 2 patients with portal hypertension and Group V - one patient with iatrogenic injury of brachial artery and vein during fibrinolytic treatment, because of myocardial infarction. RESULTS Clinical improvement was detected following treatment in 29 patients. Bleeding was successfully controlled as evidenced by improved haemodynamic parameters and decreased inotropic and transfusion requirements. CONCLUSION In vascular patients more liberal use of rFVIIa is limited, because no randomized controlled trial has proved its efficacy and safety in such patients; while also keeping in mind that the price of a 4.8 mg of rFVIIa is $4,080. We recommend the use of rFVIIa in vascular surgery only during and after operative treatment of thoracoabdominal aortic aneurysms, ruptured abdominal aortic aneurysms, retroperitoneal tumors involving the aorta and/or inferior vena cava, as well as portal hypertension, when non-surgical massive uncontrolled bleeding are present.

  19. Post-metallic stent placement bleeding caused by stent-induced ulcers

    Institute of Scientific and Technical Information of China (English)

    Chun-Tao Wai; Christopher Khor; Siew-Eng Lim; Khek-Yu Ho

    2005-01-01

    Placement of self-expandable metal stents (SEMS) is an effective mode of palliative treatment for patients with malignant gastrointestinal obstruction. Gastrointestinal mucosal bleeding complicates about 5% of placement of SEMS but is not well described. We report three cases of gastrointestinal bleeding post-SEMS placement and suggest that bleeding is caused by direct mucosal infringement by the sharp edges of the ends of the stents.

  20. Endovascular Treatment of Active Splenic Bleeding After Colonoscopy: A Systematic Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Corcillo, Antonella, E-mail: antonella.corcillo@chuv.ch [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Medecine Interne (Switzerland); Aellen, Steve, E-mail: steve.aellen@hopitalvs.ch; Zingg, Tobias [Centre Hospitalier Universitaire Vaudois (CHUV), Service de Chirurgie Viscerale (Switzerland); Bize, Pierre [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Radiologie Interventionnelle (Switzerland); Demartines, Nicolas [Centre Hospitalier Universitaire Vaudois (CHUV), Service de Chirurgie Viscerale (Switzerland); Denys, Alban [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Radiologie Interventionnelle (Switzerland)

    2013-10-15

    Purpose: Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures. Methods: We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reported case of PSAE) was performed and the three types of treatment compared. Results: All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST. Conclusion: We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic

  1. Endovascular Treatment of Active Splenic Bleeding After Colonoscopy: A Systematic Review of the Literature

    International Nuclear Information System (INIS)

    Purpose: Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures. Methods: We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reported case of PSAE) was performed and the three types of treatment compared. Results: All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST. Conclusion: We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic

  2. Evaluation of Aryoseven Safety (Recombinant Activated Factor VII) in Patients with Bleeding Disorders (An Observational Post-Marketing Surveillance Study)

    Science.gov (United States)

    Toogeh, Gholamreza; Abolghasemi, Hassan; Eshghi, Peyman; Managhchi, Mohammadreza; Shaverdi-niasari, Mohammadreza; Karimi, Katayoon; Roostaei, Samin; Emran, Neda; Abdollahi, Alireza

    2016-01-01

    Background: Recombinant activated factor VII induces hemostasis in patients with coagulopathy disorders. AryoSeven™ as a safe Iranian Recombinant activated factor VII has been available on our market. This study was performed to establish the safety of AryoSeven on patients with coagulopathy disorder. Methods: This single-center, descriptive, cross sectional study was carried out in Thrombus and Homeostasis Research Center ValiAsr Hospital during 2013-2014. Fifty one patients with bleeding disorders who received at least one dose of Aryoseven were enrolled. Patients’ demographic data and adverse effect of drug and reaction related to Aryoseven or previous usage of Recombinant activated FVII were recorded in questionnaires. Finally data were analyzed to compare side effects of Aryoseven and other Recombinant activated FVII brands. Results: Aryoseven was prescribed for 51 Patients. Of all participants with mean age 57.18+21.38 yr, 31 cases were male and 26 subjects had past history of recombinant activated FVII usage. Glanzman was the most frequent disorder followed by congenital FVII deficiency, hemophilia with inhibitors, factor 5 deficiency, acquired hemophilia, hemophilia A with inhibitor, and hemophilia A or B with inhibitor. The majority of bleeding episodes had occurred in joints. Three patients (5.9%) complained about adverse effects of Aryoseven vs. 11.5 % about adverse effects of other brands. However this difference was not significant, statistically. Conclusion: Based on monitor patients closely for any adverse events, we concluded that Aryoseven administration under careful weighing of benefit versus potential harm may comparable with other counterpart drugs. PMID:27799968

  3. Topical tranexamic acid as a novel treatment for bleeding peptic ulcer: A randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Mandana Rafeey

    2016-01-01

    Full Text Available Background: Peptic ulcers are among the most common causes of upper gastrointestinal (GI bleeding in children. The standard care for GI bleeding is endoscopy for diagnostic and therapeutic purposes. We aimed to assess the effect of topical tranexamic acid (TXA via endoscopic procedures in children with GI bleeding caused by bleeding ulcers. Procedure: In this randomised controlled trial, 120 children were evaluated by diagnostic procedures for GI bleeding, of which 63 (30 girls, 33 boys aged 1-month to 15 years were recruited. The patients were randomly divided into case and control groups. In the case group, TXA was administered directly under endoscopic therapy. In the control group, epinephrine (1/10,000 was submucosally injected to the four quadrants of ulcer margins as the routine endoscopic therapy. In both groups, the patients received supportive medical therapy with intravenous fluids and proton pump inhibitor drugs. Results: The mean ± standard deviation age of the children was 5 ± 2.03 years. Rebleeding occurred in 15 (11.4% and 21 (9.8% patients in the case and control groups, respectively (P = 0.50. The frequency of blood transfusion episodes (P = 0.06 and duration of hospital stay (P = 0.07 were not statistically different between the groups. Conclusion: Using topical TXA via endoscopic procedures may be effective in cases of GI bleedings caused by active bleeding ulcers. In order to establish this therapeutic effect, a large number of clinical studies are needed.

  4. Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia

    DEFF Research Database (Denmark)

    Vinholt, Pernille J; Alnor, Anne; Nybo, Mads;

    2016-01-01

    platelet transfusion within 30 days were registered. Of 197 patients enrolled, 56 (28%) experienced bleeding. In multivariate analyses, predictors of bleeding were infection (adjusted odds ratio (OR) = 2.65 and 95% confidence interval (95% CI) 1.04-6.74); treatment with platelet inhibitors, heparin...... platelet transfusion but not bleeding. Bleeding risk factors were previous haematuria or gastrointestinal bleeding, infection, antiplatelet or anticoagulant treatment, high urea nitrogen, low haemoglobin or high creatinine.......Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer...

  5. Tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Gluud, Lise Lotte; Klingenberg, Sarah Louise; Langholz, Ebbe

    2012-01-01

    Tranexamic acid reduces haemorrhage through its antifibrinolytic effects. In a previous version of the present review, we found that tranexamic acid may reduce mortality. The present review includes updated searches of randomised trials on tranexamic acid versus placebo, cimetidine or lansoprazole....

  6. Angiographic evaluation and management of acute gastrointestinal hemorrhage

    Institute of Scientific and Technical Information of China (English)

    T Gregory Walker; Gloria M Salazar; Arthur C Waltman

    2012-01-01

    Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require emergency angiography and transcatheter treatment.Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography.Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding,as determined by the available clinical,endoscopic and imaging data.If a hemorrhage source is identified,superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications.This is now wellrecognized as a viable and safe alternative to emergency surgery.In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding.One must be aware of the various side effects and potential complications associated with this treatment,however,and recognize the high re-bleeding rate.In this article we review the current role of angiography,transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.

  7. 老年上消化道出血患者近期预后多因素分析%Risk factors for short-term prognosis in elderly patients with upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    陈宁

    2008-01-01

    Eighty-five elderly patients treated for the upper gastrointestinal bleeding(UGB)in our hospital between January 2000 and December 2002 were divided into death or survival group.Their clinical characteristics,risk factors,treatment and complications were retrospectively analyzed.Eighteen patients died of UGB within 30 days.Univariate analysis indicated that documented diabetes,cardiovascular disease,cerebrovascular disease,gastric ulcer,hemoglobin,arrhythmia,stomach cancer,multiple organ dysfunction syndrome(MODS),and shock were significantly associated with inhospital mortality within 30 days(P<0.05 or P<0.01).Stomach cancer,MODS,and shock entered into the Logistic regression model.These findings demonstrate that stomach cancer,MODS,and shock might be independent risk factors for short-term prognosis in elderly UGB patients.%将2000年1月至2007年12月期间收住我院≥60岁的上消化道出血患者85例分为病死组(18例,出血30 d内死亡)与存活组(67例),对比分析患者的病史、临床表现、并发症等特点,探讨近期死亡的影响因素.结果 显示病死组心脑血管病、糖尿病、胃溃疡、血红蛋白、心律失常、胃癌、多器官功能障碍综合征(MODS)、休克者比例较多(P<0.05或P<0.01),最终进入logistic回归模型的因素有胃癌、MODS、休克.提示胃癌、MODS、休克并存是≥60岁老年上消化道出血患者近期预后的独立危险因素.

  8. Bleeding Disorders Treatment Options

    Science.gov (United States)

    ... Pictures Young Voices Compendium of Assessment Tools Educational Games Video Library Find a Treatment Centre Haemophilia Journal About Bleeding Disorders Bleeding Disorders The Clotting Process Drugs That Can Cause Bleeding Hemophilia How Do You ...

  9. Multicentre, open-label, randomised, parallel-group, superiority study to compare the efficacy of octreotide therapy 40 mg monthly versus standard of care in patients with refractory anaemia due to gastrointestinal bleeding from small bowel angiodysplasias: a protocol of the OCEAN trial

    Science.gov (United States)

    van Geenen, E J M; Drenth, J P H

    2016-01-01

    Introduction Gastrointestinal angiodysplasias are an important cause of difficult-to-manage bleeding, especially in older patients. Endoscopic coagulation of angiodysplasias is the mainstay of treatment, but may be difficult for small bowel angiodysplasias because of the inability to reach them for endoscopic intervention. Some patients are red blood cell (RBC) transfusion dependent due to frequent rebleeding despite endoscopic treatment. In small cohort studies, octreotide appears to decrease the number of bleeding episodes in patients with RBC transfusion dependency due to gastrointestinal angiodysplasias. This trial will assess the efficacy of octreotide in decreasing the need for RBC transfusions and parenteral iron in patients with anaemia due to gastrointestinal bleeding of small bowel angiodysplasias despite endoscopic intervention. Study design Randomised controlled, superiority, open-label multicentre trial. Participants 62 patients will be included with refractory anaemia due to small bowel angiodysplasias, who are RBC transfusion or iron infusion dependent despite endoscopic intervention and oral iron supplementation. Intervention Patients will be randomly assigned (1:1) to standard care or 40 mg long-acting octreotide once every 4 weeks for 52 weeks, in addition to standard care. The follow-up period is 8 weeks. Main outcome measures The primary outcome is the difference in the number of blood and iron infusions between the year prior to inclusion and the treatment period of 1 year. Important secondary outcomes are the per cent change in the number of rebleeds from baseline to end point, adverse events and quality of life. Ethics and dissemination The trial received ethical approval from the Central Committee on Research Involving Human Subjects and from the local accredited Medical Research Ethics Committee of the region Arnhem-Nijmegen, the Netherlands (reference number: 2014-1433). Results will be published in a peer-reviewed journal and

  10. Colonic Dieulafoy’s Lesion: A Rare Cause of Lower Gastrointestinal Hemorrhage and Review of Endoscopic Management

    Directory of Open Access Journals (Sweden)

    Christopher Ma

    2014-01-01

    Full Text Available Dieulafoy’s lesions are a rare cause of gastrointestinal hemorrhage. Extragastric Dieulafoy’s lesions are even more uncommon. We report the case of a 75-year-old woman who presented with gastrointestinal bleeding from a transverse colonic Dieulafoy’s lesion. She presented with two episodes of melena followed by one episode of fresh blood per rectum. In addition, there was associated presyncope and anemia (hemoglobin 69 g/L in the setting of supratherapeutic warfarin anticoagulation (INR 6.2 for nonvalvular atrial fibrillation. Esophagogastroduodenoscopy was negative for an upper GI source of bleeding but on colonoscopy an actively oozing Dieulafoy’s lesion was identified in the transverse colon. Bipolar cautery and hemostatic endoclips were applied to achieve hemostasis. Clinicians should consider this rare entity as a potential cause of potentially life-threatening lower gastrointestinal bleeding and we review the endoscopic modalities effective for managing colonic Dieulafoy’s lesions.

  11. 2056例上消化道出血病因构成及相关因素分析%Analysis of etiological and related factors responsible for upper gastrointestinal bleeding in 2 056 patients

    Institute of Scientific and Technical Information of China (English)

    蔡玲; 张玫; 赵丹丹; 赵曲川; 牛小羽

    2015-01-01

    Objective To investigate the etiology and related factors of upper gastrointestinal bleeding(UGIB) in the past 10 years. Methods The data of 2 056 patients receiving emergency treatment for UGIB in a single medical center between January 2005 and December 2014 were collected.Etiological analysis was done based on age, gender and time period.Results 1) UGIB occurred more often in men than in women with a ratio of 2.87 ∶1.00.Gender composition was no significant difference between the first and later 5 years.2) Proportion of young and middle-aged patients decreased, as compared with that of the elderly group(P<0.01).3) Etiological analysis of UGIB was different between the first and later 5 years.No matter the young and middle-aged or the elderly group, peptic ulcer ranked first, esophageal gastric varices fell(P<0.004).Reflux esophagitis and acute gastric mucosal lesions in the elderly group rate rose (P<0.004).4) Duodenal ulcer was the main cause of UGIB in the young and middle-aged patients, whereas gastric ulcer and gastric carcinoma accounted for more at elderly people.5 ) Percentage of patients taking nonsteroidal anti-inflamatory drugs ( NSAIDs ) and anticoagulation drugs was 2.67%in the young and middle-aged group and 24.55%in the elderly group(P<0.01).6) Within five years UGIB hospital mortality from 4.51% to 1.24%(P<0.01), which cirrhosis, systemic disease mortality decreased significantly, acute gastric mucosal lesions significantly increased(P<0.01).Conclusion In the past 10 years, primary etiological analysis of UGIB was peptic ulcer, but the proportion had been declining.Reflux esophagitis is another important etiology of UGIB.With the increasing number of the elderly patients, acute gastric mucosal lesions bleeding due to NSAIDs and anticoagulation drugs increased.%目的:回顾性分析近10年来上消化道出血( upper gastrointestinal bleeding,UGIB)的病因构成及与相关因素的关系。方法收集2005年1月至2014年12

  12. Role of endoscopy in the management of acute diverticular bleeding

    Institute of Scientific and Technical Information of China (English)

    Charalampos Pilichos; Emmanouil Bobotis

    2008-01-01

    Colonic diverticulosis is one of the most common causes of lower gastrointestinal bleeding. Endoscopy is not only a useful diagnostic tool for localizing the bleeding site, but also a therapeutic modality for its management. To date, haemostatic methods have included adrenaline injection, mechanical clipping, thermal and electrical coagulation or combinations of them. The results of all published data are herein reviewed.

  13. Physical Activity and Gastrointestinal Cancers: Primary and Tertiary Preventive Effects and Possible Biological Mechanisms

    Directory of Open Access Journals (Sweden)

    Karen Steindorf

    2015-07-01

    Full Text Available Gastrointestinal cancers account for 37% of all cancer deaths worldwide, underlining the need to further investigate modifiable factors for gastrointestinal cancer risk and prognosis. This review summarizes the corresponding evidence for physical activity (PA, including, briefly, possible biological mechanisms. Despite high public health relevance, there is still a scarcity of studies, especially for tertiary prevention. Besides the convincing evidence of beneficial effects of PA on colon cancer risk, clear risk reduction for gastroesophageal cancer was identified, as well as weak indications for pancreatic cancer. Inverse associations were observed for liver cancer, yet based on few studies. Only for rectal cancer, PA appeared to be not associated with cancer risk. With regard to cancer-specific mortality of the general population, published data were rare but indicated suggestive evidence of protective effects for colon and liver cancer, and to a lesser extent for rectal and gastroesophageal cancer. Studies in cancer patients on cancer-specific and total mortality were published for colorectal cancer only, providing good evidence of inverse associations with post-diagnosis PA. Overall, evidence of associations of PA with gastrointestinal cancer risk and progression is promising but still limited. However, the already available knowledge further underlines the importance of PA to combat cancer.

  14. Otorrhagia bleeding due to leech bite

    Directory of Open Access Journals (Sweden)

    Narges Askari

    2012-01-01

    Full Text Available Leeches are blood-sucking hermaphroditic parasites that attach to vertebrate hosts, bite through the skin, and suck out blood. When leeches feed, they secrete an anticoagulant (hirudin, which helps them get a full meal of blood. This is the first report of leech removal from external auditory canal. Previous leech involvement cases were explained in nasopharynx, larynx, pharynx, eye, and gastrointestinal tract. Prominent sign of all cases was active bleeding from the leech attachment site; that stopped with leech removal. A 24-year-old man was presented to Al-Zahra hospital with left otorrhagia and otalgia from 2 days ago. After suction of ear a small soft foreign body was seen in the external ear near the tympanic membrane, then the ear filled with glycerine phenice, the patient explained decreased movement of foreign body. Four hours later the bloody discharge stopped and otalgia decreased. After suction of clots, a leech was extruded from external auditory canal by alligator. Leech infestation is a rare cause of otorrhagia and should be suspected in the endemic region in all of unusual bleeding; it can be diagnosed and treated by exact inspection and removal.

  15. Factors Associated With Major Bleeding Events

    Science.gov (United States)

    Goodman, Shaun G.; Wojdyla, Daniel M.; Piccini, Jonathan P.; White, Harvey D.; Paolini, John F.; Nessel, Christopher C.; Berkowitz, Scott D.; Mahaffey, Kenneth W.; Patel, Manesh R.; Sherwood, Matthew W.; Becker, Richard C.; Halperin, Jonathan L.; Hacke, Werner; Singer, Daniel E.; Hankey, Graeme J.; Breithardt, Gunter; Fox, Keith A. A.; Califf, Robert M.

    2014-01-01

    Objectives This study sought to report additional safety results from the ROCKET AF (Rivaroxaban Once-daily oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation). Background The ROCKET AF trial demonstrated similar risks of stroke/systemic embolism and major/nonmajor clinically relevant bleeding (principal safety endpoint) with rivaroxaban and warfarin. Methods The risk of the principal safety and component bleeding endpoints with rivaroxaban versus warfarin were compared, and factors associated with major bleeding were examined in a multivariable model. Results The principal safety endpoint was similar in the rivaroxaban and warfarin groups (14.9 vs. 14.5 events/100 patient-years; hazard ratio: 1.03; 95% confidence interval: 0.96 to 1.11). Major bleeding risk increased with age, but there were no differences between treatments in each age category (<65, 65 to 74, ≥75 years; pinteraction = 0.59). Compared with those without (n = 13,455), patients with a major bleed (n = 781) were more likely to be older, current/prior smokers, have prior gastrointestinal (GI) bleeding, mild anemia, and a lower calculated creatinine clearance and less likely to be female or have a prior stroke/transient ischemic attack. Increasing age, baseline diastolic blood pressure (DBP) ≥90 mm Hg, history of chronic obstructive pulmonary disease or GI bleeding, prior acetylsalicylic acid use, and anemia were independently associated with major bleeding risk; female sex and DBP <90 mm Hg were associated with a decreased risk. Conclusions Rivaroxaban and warfarin had similar risk for major/nonmajor clinically relevant bleeding. Age, sex, DBP, prior GI bleeding, prior acetylsalicylic acid use, and anemia were associated with the risk of major bleeding. (An Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non

  16. Duodenal Bleeding from Metastatic Renal Cell Carcinoma

    Science.gov (United States)

    Rustagi, Tarun; Rangasamy, Priya; Versland, Mark

    2011-01-01

    Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC) and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested. PMID:21577373

  17. Duodenal Bleeding from Metastatic Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Tarun Rustagi

    2011-04-01

    Full Text Available Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.

  18. Duodenal bleeding from metastatic renal cell carcinoma.

    Science.gov (United States)

    Rustagi, Tarun; Rangasamy, Priya; Versland, Mark

    2011-04-20

    Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC) and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.

  19. Evidence supporting the use of recombinant activated factor VII in congenital bleeding disorders

    DEFF Research Database (Denmark)

    Johansson, Pär I; Ostrowski, Sisse R

    2010-01-01

    Recombinant activated factor VII (rFVIIa, NovoSeven) was introduced in 1996 for the treatment of hemophilic patients with antibodies against coagulation factor VIII or IX.......Recombinant activated factor VII (rFVIIa, NovoSeven) was introduced in 1996 for the treatment of hemophilic patients with antibodies against coagulation factor VIII or IX....

  20. Update on the endoscopic management of peptic ulcer bleeding

    NARCIS (Netherlands)

    I.L. Holster (Ingrid); E.J. Kuipers (Ernst)

    2011-01-01

    textabstractUpper gastrointestinal bleeding is the most common gastrointestinal emergency, with peptic ulcer as the most common cause. Appropriate resuscitation followed by early endoscopy for diagnosis and treatment are of major importance in these patients. Endoscopy is recommended within 24 h of

  1. Aero-Effected Distributed Adaptive Control of Flexible Aircraft Using Active Bleed Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The proposed research focuses on the development of a new adaptive control methodology for active control of wing aerodynamic shape to effect distributed...

  2. Activation of intestinal epithelial Stat3 orchestrates tissue defense during gastrointestinal infection.

    Directory of Open Access Journals (Sweden)

    Nadine Wittkopf

    Full Text Available Gastrointestinal infections with EHEC and EPEC are responsible for outbreaks of diarrheal diseases and represent a global health problem. Innate first-line-defense mechanisms such as production of mucus and antimicrobial peptides by intestinal epithelial cells are of utmost importance for host control of gastrointestinal infections. For the first time, we directly demonstrate a critical role for Stat3 activation in intestinal epithelial cells upon infection of mice with Citrobacter rodentium - a murine pathogen that mimics human infections with attaching and effacing Escherichia coli. C. rodentium induced transcription of IL-6 and IL-22 in gut samples of mice and was associated with activation of the transcription factor Stat3 in intestinal epithelial cells. C. rodentium infection induced expression of several antimicrobial peptides such as RegIIIγ and Pla2g2a in the intestine which was critically dependent on Stat3 activation. Consequently, mice with specific deletion of Stat3 in intestinal epithelial cells showed increased susceptibility to C. rodentium infection as indicated by high bacterial load, severe gut inflammation, pronounced intestinal epithelial cell death and dissemination of bacteria to distant organs. Together, our data implicate an essential role for Stat3 activation in intestinal epithelial cells during C. rodentium infection. Stat3 concerts the host response to bacterial infection by controlling bacterial growth and suppression of apoptosis to maintain intestinal epithelial barrier function.

  3. Persistence of anticancer activity in berry extracts after simulated gastrointestinal digestion and colonic fermentation.

    Directory of Open Access Journals (Sweden)

    Emma M Brown

    Full Text Available Fruit and vegetable consumption is associated at the population level with a protective effect against colorectal cancer. Phenolic compounds, especially abundant in berries, are of interest due to their putative anticancer activity. After consumption, however, phenolic compounds are subject to digestive conditions within the gastrointestinal tract that alter their structures and potentially their function. However, the majority of phenolic compounds are not efficiently absorbed in the small intestine and a substantial portion pass into the colon. We characterized berry extracts (raspberries, strawberries, blackcurrants produced by in vitro-simulated upper intestinal tract digestion and subsequent fecal fermentation. These extracts and selected individual colonic metabolites were then evaluated for their putative anticancer activities using in vitro models of colorectal cancer, representing the key stages of initiation, promotion and invasion. Over a physiologically-relevant dose range (0-50 µg/ml gallic acid equivalents, the digested and fermented extracts demonstrated significant anti-genotoxic, anti-mutagenic and anti-invasive activity on colonocytes. This work indicates that phenolic compounds from berries undergo considerable structural modifications during their passage through the gastrointestinal tract but their breakdown products and metabolites retain biological activity and can modulate cellular processes associated with colon cancer.

  4. Clinical Characteristics of Patients with Myocardial Infarction and Gastrointestinal Bleeding%伴消化道出血的急性心肌梗死患者的临床特点研究

    Institute of Scientific and Technical Information of China (English)

    张慧平; 赵迎; 艾虎; 孙福成; 李康; 郑耐心

    2011-01-01

    疗困难,且多预后不良.%Objective To investigate the clinical characteristics and prognosis of patients with acute myocardial infarction ( AMI ) and gastrointestinal bleeding ( GIB ).Methods All 427 patients with AMI were divided into MI group ( n = 404 ,without GIB ).MI - GIB group ( n = 15, AMI followed by GIB ) group and GIB - MI group ( n =8, GIB followed by AMI )group.the clinical characteristics and combined end points of one - year cardiovascular death and hospitalization for recurrent angina pectoris , non - deadly MI, heart failure and stroke were analyzed.Results ( 1 ) Compared with MI group , the percentage of the patients with a history of GIB was higher in both MI - GIB and CJIB - MI groups ( 13.3% , 12.5% vs.5.2%), and the percentage of non - ST - elevation MI was higher in GIB - MI group ( 62.5% vs.43.6% ), but with no statistical differences ( P >0.05 ).( 2 ) The estimated glomerular filtration rate ( eGFR ) in MI - GIB group was significantly lower than that in MI group [( 57.I ±23.5 ) ml · min-1 · 1.73 m -2 vs.( 74.6 ±26.4 ) ml · min-1 · 1.73 m-2, P <0.05].Logostic regression analysis with eGFR revealed that the hazard ratio for patients' development of GIB after AMI was 0.975 [95% CI ( 0.957,0.995 ), P <0.05].( 3 ) The ratio of adopting anti - platelet and anti - coagulant medications in GIB - MI group and the ratio of aspirin usage in MI - GIB group was significant lower as compared with in MI group, respectively ( P < 0.05 ).The level of hemoglohin in GIB - MI group was significantly lower than that in MI - GIB group [( 7.2 ± 1.3 ) g/dl vs.( 11.3 ±2.5 ) g/dl,P <0.01], but the ratio of blood transfusion was significantly higher ( 75.0% vs.26.7% , P < 0.05 ).The ratio of percutane ous coronary intervention ( PCI ) or thrombolytic therapy in GIB - MI group was lower than that in MI group, but with no statistical differences ( 53.3% vs.76.0% , P >0.05 ); while the ratio of adopting PCI or thrombolytic

  5. Peri-operative nursing of infants with cavernous transformation of the portal vein and gastrointestinal bleeding undergoing distal splenorenal shunt%小儿门静脉海绵样变并消化道出血行远端脾肾分流术的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    刘新文; 何小琼; 甘红霞

    2014-01-01

    Objective To summarize the nursing of infants with cavernous transformation of the portal vein (CTPV) and gastrointestinal bleeding undergoing distal splenorenal shunt.Methods 3 cases of infants with CTPV and gastrointestinal bleeding were given with preoperative nursing for upper gastrointestinal bleeding,strengthening nutritional support; strengthening prevention measures of thrombosis and bleeding complications,monitoring of urine and urine gravity,completing the artery piezometer tube care,paying attention to the discharge guidance and follow-up work.Results The platelet increased in 3 cases post-operation.1 cases occurred abdominal bleeding,but improved after symptomatic treatment.1 case occurred leakage on the site of venous indwelling needle during intravenous infusion of high nutrient solution.3 cases of children received 3 months to 3 years follow-up after discharge,no complications such as liver,kidney and blood clots occurred.Conclusions Infants with CTPV and gastrointestinal bleeding undergoing distal splenorenal shunt is very rare in clinic.Good perioperative care and strengthening the observation of the postoperative complications,attaching great importance to the discharge guidance and follow-up work,are the assurances of successful treatment.%目的 总结门静脉海绵样变并消化道出血患儿行远端脾肾分流术的护理要点.方法 对3例门静脉海绵样变并消化道出血患儿术前做好上消化道出血的护理,加强营养支持;术后加强血栓和出血等并发症的防范工作,监测尿量和尿密度,做好动脉测压管的护理,重视出院指导和随访工作.结果 本组3例患儿术后均出现不同程度的血小板增高,1例患儿出现腹腔少量出血,经对症处理后好转,1例患儿输注静脉高营养液发生静脉留置针处渗漏;3例患儿出院后跟踪随访3个月~3年,无肝、肾功能异常及血栓等并发症发生.结论 小儿门静脉海绵样变脾肾分流术临床非常少

  6. 医疗失效模式与效应分析在消化道出血患者预防跌倒中的应用%Application of hospital failure mode and effect analysis on fall prevention of patients with gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    陈伟焕; 吕萍

    2016-01-01

    Objective To explore the application value of hospital failure mode and effect analysis (HFMEA) on the fall prevention of patients with gastrointestinal bleeding.Methods Since October 2013, the HFMEA nursing has been carried out in the nursing department of our hospital, failure mode and potential risk of fall have been analyzed in the patients with gastrointestinal bleeding, and corresponding improvement measures have been made. For retrospective analysis, 162 patients with gastrointestinal bleeding who were in our hospital from February 2014 to August 2015 were selected as research group, received HFMEA. Another 119 patients with gastrointestinal bleeding who were in our hospital from November 2012 to January 2014 were selected as control group, received conventional care. The compliance of fall prevention, the incidence of the falls, and the satisfaction with the nursing care were compared between two groups.Results In the research group, the incidence of falls was obviously lower, while the compliance of fall prevention, the awareness of the fall risk factors, and the satisfaction with the nursing care were obviously higher than those of the control group, the difference was statistically significant (P<0.05). ConclusionThe employment of HFMEA in the assessment and analysis of the fall risk in the patients with gastrointestinal bleeding, and the following corresponding improvement measures can significantly improve the compliance of fall prevention, reduce the fall rate, and raise the degree of patients' satisfaction to the nursing care.%目的:探讨医疗失效模式与效应分析(HFMEA)在消化道出血患者预防跌倒中的应用价值。方法自2013年10月起我院护理部实施HFMEA指导护理,对消化道出血患者跌倒进行失效模式与潜在风险原因分析,并采取针对性的改善措施。回顾性分析2014年2月~2015年8月我院消化道出血住院患者162例患者作为研究组,行HFMEA;另选取2012年11

  7. Applications of Evidence-based Nursing and Foreseeing Nursing in Emergency Treatment of Upper Gastrointestinal Bleeding%循证护理与预见性护理在上消化道出血急救中的应用分析

    Institute of Scientific and Technical Information of China (English)

    金艳瑜; 丛薇; 王沙沙; 刘婷婷; 李玉娇; 卢菲

    2015-01-01

    Objective Applications of Evidence-based Nursing and Foreseeing Nursing in Emergency Treatment of Upper Gastrointestinal Bleeding,for clinical reference.Methods From March 2012 to September 2014,We selected 100 patients with upper gastrointestinal hemorrhage patients in the study. The patients were randomly divided into two groups, each group 50 cases, Foreseeing Nursing in control group, Evidence-based Nursing in experimental group, Two groupsupper gastrointestinal hemorrhage patients were compared in nursing effect and the bleeding time. Results The results of the two groups of patients with hemorrhage of upper digestive tract bleeding time there are significant differences,P0.05.Conclusion In the case of patients with upper gastrointestinal hemorrhage,Effect of the implementation of evidence-based nursing and Foreseeing Nursing care of patients with the same,Nurses can according to the actual situation, choose the most suitable care programmes.%目的:分析循证护理与预见性护理在上消化道出血急救中的应用,为临床提供参考。方法选取我院收治的100例上消化道出血患者作为观察对象,收治时间为2012年3月~2014年9月,将患者随机分成两组,每组50例,对照组采取预见性护理,实验组采取循证护理,观察比较两组上消化道出血患者护理后的疗效及止血时间。结果两组上消化道出血患者止血时间的比较结果存在显著差异,P<0.05;两组上消化道出血患者总有效率的比较结果不存在显著差异,P>0.05。结论对上消化道出血患者而言,对其实施循证护理与预见性护理的效果相当,护理人员可以根据实际情况选择最合适的护理方案。

  8. Effects of motilin and ursodeoxycholic acid on gastrointestinal myoelectric activity of different origins in fasted rats

    Institute of Scientific and Technical Information of China (English)

    Ping Fang; Lei Dong; Jin-Yan Luo; Xiao-Long Wan; Ke-Xin Du; Ning-Li Chai

    2004-01-01

    AIM: To investigate gastrointestinal migrating myoelectric complex (MMC) and the effects of porcine motilin and ursodeoxycholic acid (UDCA) on MMC of gastrointestinaltract of different origins in fasted rats. METHODS: Three bipolar silver electrodes were chronically implanted on the antrum, duodenum and jejunum. Seven days later 24 experimental rats were divided into 2 groups.One group was injected with porcine motilin via sublingual vein at a dose of 20 μg/kg, the other group was perfused into stomach with UDCA. The gastrointestinal myoelectric activity was recorded 1 h before and 2 h after the test substance infusions into the rats.RESULTS: In all fasted rats a typical pattern of MMC was observed. Among the totally 68 activity fronts recorded in fasted rats under control, 67% started in duodenum, and 33% in antrum. MMC cycle duration and duration of phase Ⅲ of antral origin were longer than those of duodenal origin. Administration of 20 μg/kg porcine motilin induced a premature antral phase Ⅲ of antral origin. But perfusion into stomach with UDCA resulted in shorter MMC cycle duration, longer duration of phase Ⅲ of duodenal origin,which were followed with shorter cycle duration and duration of antral phase Ⅲ.CONCLUSION: In fasted rats, MMC could originate from antrum and duodenum respectively. The characteristics of MMC of different origins may contribute to the large variations within subjects. The mechanisms of different origins of phase Ⅲ may be different. Porcine motilin and UDCA could affect MMC of different origins of the gastrointestinal tract in fasted state, respectively.

  9. Embolization for gastrointestinal hemorrhages

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, S.C.; Goerich, J.; Rilinger, N.; Aschoff, A.J.; Vogel, J.; Brambs, H.J. [Dept. of Diagnostic Radiology, University of Ulm (Germany); Siech, M. [Dept. of Abdominal Surgery, University of Ulm (Germany)

    2000-05-01

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83 %). In one case (3 %) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14 %) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14 %, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. (orig.)

  10. Sequential thrombosis and bleeding in a woman with a prolonged activated partial thromboplastin time

    Directory of Open Access Journals (Sweden)

    Pearce Michael I

    2011-10-01

    Full Text Available Abstract Simultaneous or sequential haemorrhage and thrombosis in the presence of a prolonged activated partial thromboplastin time (aPTT is a rare occurrence: we describe the case a 37 year old lady who developed post-delivery deep vein thrombosis treated with low molecular heparin and warfarin followed a week later by extensive bruising over legs and forearms, a significant drop in haemoglobin and a very prolonged aPTT. Further tests revealed an acquired factor VIII inhibitor at 35 Bethesda Units. We discuss the clinical and laboratory implications and provide a literature review of simultaneous thrombophilia and haemophilia in the presence of a prolonged aPTT.

  11. Outcome Following a Negative CT Angiogram for Gastrointestinal Hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Victoria, E-mail: drvictoriac@gmail.com; Tse, Donald, E-mail: donald.tse@gmail.com; Dixon, Shaheen, E-mail: shaheen7noorani@gmail.com [John Radcliffe Hospital, Department of Radiology, Level 2 (United Kingdom); Shrivastava, Vivek, E-mail: vivshriv@yahoo.com [Hull Royal Infirmary, Department of Radiology (United Kingdom); Bratby, Mark, E-mail: mark.bratby@ouh.nhs.uk; Anthony, Suzie, E-mail: suzie.anthony@ouh.nhs.uk; Patel, Rafiuddin, E-mail: rafiuddin.patel@ouh.nhs.uk; Tapping, Charles, E-mail: charles.tapping@ouh.nhs.uk; Uberoi, Raman, E-mail: raman.uberoi@orh.nhs.uk [John Radcliffe Hospital, Department of Radiology, Level 2 (United Kingdom)

    2015-04-15

    ObjectiveThis study was designed to evaluate the role of a negative computed tomography angiogram (CTA) in patients who present with gastrointestinal (GI) hemorrhage.MethodsA review of all patients who had CTAs for GI hemorrhage over an 8-year period from January 2005 to December 2012 was performed. Data for patient demographics, location of hemorrhage, hemodynamic stability, and details of angiograms and/or the embolization procedure were obtained from the CRIS/PACS database, interventional radiology database, secure electronic medical records, and patient’s clinical notes.ResultsA total of 180 patients had 202 CTAs during the 8-year period: 87 CTAs were performed for upper GI hemorrhage (18 positive for active bleeding, 69 negative) and 115 for lower GI hemorrhage (37 positive for active bleeding, 78 negative); 58.7 % (37/63) of patients with upper GI bleed and 77.4 % (48/62) of patients with lower GI bleed who had an initial negative CTA did not rebleed without the need for radiological or surgical intervention. This difference was statistically significant (p = 0.04). The relative risk of rebleeding, following a negative CTA, in lower GI bleeding versus upper GI bleeding patients is 0.55 (95 % confidence interval 0.32–0.95).ConclusionsPatients with upper GI bleed who had negative CTAs usually require further intervention to stop the bleeding. In contrast, most patients presenting with lower GI hemorrhage who had a negative first CTA were less likely to rebleed.

  12. Safety and efficacy of recombinant activated factor VII: a randomized placebo-controlled trial in the setting of bleeding after cardiac surgery

    DEFF Research Database (Denmark)

    Gill, Ravi; Herbertson, Mike; Vuylsteke, Alain;

    2009-01-01

    BACKGROUND: Blood loss is a common complication of cardiac surgery. Evidence suggests that recombinant activated factor VII (rFVIIa) can decrease intractable bleeding in patients after cardiac surgery. Our objective was to investigate the safety and possible benefits of rFVIIa in patients who bleed...... after cardiac surgery. METHODS AND RESULTS: In this phase II dose-escalation study, patients who had undergone cardiac surgery and were bleeding were randomized to receive placebo (n=68), 40 microg/kg rFVIIa (n=35), or 80 microg/kg rFVIIa (n=69). The primary end points were the number of patients....../kg, 14%; P=0.25; 80 microg/kg, 12%; P=0.43). After randomization, significantly fewer patients in the rFVIIa group underwent a reoperation as a result of bleeding (P=0.03) or required allogeneic transfusions (P=0.01). CONCLUSIONS: On the basis of this preliminary evidence, rFVIIa may be beneficial for...

  13. Study on the Mechanism of Thalidomide for the Treatment of Gastrointestinal Bleeding Caused by Gastrointestinal Vascular Malformation%沙利度胺治疗胃肠道血管畸形所致消化道出血的机制研究

    Institute of Scientific and Technical Information of China (English)

    刘旭明; 杜爱民

    2014-01-01

    [Objective]To explore the action mechanism of thalidomide for the treatment of gastrointestinal bleeding caused by gastrointestinal vascular malformation (GIVM ) .[Methods]The expression of Ang‐2 ,Notchl and DLL4 in intestinal mucosa of 90 patients with gastrointestinal bleeding caused by GIVM and 30 healthy per‐sons were detected by using immunohistochemical method .RT‐PCR and Western blot were used to detect the im‐pact of 50mg/L ,100mg/L and 200mg/L thalidomide on the mRNA and protein expression of Ang‐2 ,Notchl and DLL4 gene in HUVEC cells .[Results]Compared with solvent control group ,the mRNA expression of Notch1 in 50mg/L thalidomide group was reduced ,and the mRNA expression of Ang‐2 and Notch1 in 100mg/L thalidomide group were reduced ,and there was significant difference( P <0 .05) .The mRNA expression of Ang‐2 ,Notch1 and DLL4 in 200mg/L thalidomide group were reduced ,and there was significant difference( P <0 .05) .Com‐pared with solvent control group ,the protein expression of Ang‐2 and Notch1 in 50mg/L thalidomide group were reduced ,and the protein expression of Ang‐2 ,Notch1 and DLL4 in 100mg/L and 200mg/L thalidomide group were reduced ,and there was significant difference( P <0 .05) .The expression of Ang‐2 in vasodilation distortion tissues of GIVM was increased obviously ,and the expression of DLL4 and Notchl in the diseased tissues was also increased obviously .The expression of Ang‐2 ,Notchl and DLL4 in non‐diseased tissues of GIVM patients and normal intestinal mucosa tissues of healthy persons were weakly positive (+ ) or negative .[Conclusion]GIVM is closely associated with the expression of Ang‐2 ,DLL4 and Notchl .Thalidomide can inhibit the mRNA and protein expression of Ang‐2 ,DLL4 and Notchl .%【目的】探讨沙利度胺治疗胃肠道血管畸形所致消化道出血的作用机制。【方法】采用免疫组化法检测90例GIVM 所致消化道出血患者,及30例健康人肠

  14. 奥美拉唑与雷尼替丁治疗急性上消化道出血的荟萃分析%Meta analysis of efficacy and safety of omeprazole versus ranitidine in the treatment of upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    曲连悦; 姜明燕

    2014-01-01

    目的:系统评价奥美拉唑与雷尼替丁治疗上消化道出血的疗效和安全性。方法电子检索PubMed、MEDLINE、The Cochrane Library、CNKI、VIP、CBM等数据库,收集奥美拉唑治疗上消化道出血的随机对照试验( RCT),检索时限均至2013年6月。采用RevMan软件进行Meta分析。结果纳入25项研究,共2497例患者(试验组1230例,对照组1267例)。根据干预措施的不同,将研究分为注射剂型、口服剂型及序贯治疗3个亚组分别进行Meta分析,结果显示:与雷尼替丁相比,奥美拉唑治疗上消化道出血的止血率分别为OR=5.39,95%CI=(4.18,6.96),P <0.05;OR =6.27,95%CI =(3.65,10.77),P <0.05;OR =3.69,95%CI =(2.65,5.15),P<0.05。二者不良反应发生率的Meta结果为OR=0.49,95%CI=(0.24,1.01),P=0.05。未见严重不良反应。结论与雷尼替丁相比,奥美拉唑治疗上消化道出血具有止血迅速、不良反应少等优点,是治疗上消化道出血安全、有效的药物。%Objective To estimate the efficacy and safety of omeprazole and ranitidine in the treatment of up-per gastrointestinal bleeding. Methods The studies which were about the omeprazole in the treatment of upper gastro-intestinal bleeding were collected by electronic retrieval PubMed,MEDLINE and The Cochrane Library,CNKI,VIP, CBM until June 2013. Revman 5. 0 software and publication bias were analyzed by funnel plots. Results 25 studies were selected,of which a total of 2 497 patients ( treatment group was 1 230 cases and control group was 1 267 cases) . According to different interventions, the research was divided into injection dosage forms, oral dosage forms and se-quential treatment forms. Meta analysis indicated that compared with ranitidine,the bleeding rate of omeprazole in the treatment of upper gastrointestinal bleeding OR =5. 39,95% CI = (4. 18,6. 96),P <0. 05;OR =6. 27,95% CI =(3. 65,10. 77),P<0. 05;OR=3. 69,95%CI=(2. 65,5. 15),P<0. 05 respectively

  15. 循证护理与预见性护理在上消化道出血急救中的应用价值分析%An analysis on Application Value of Evidence-based Nursing and Predictive Nursing During the First Aid for Upper Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    罗明春

    2015-01-01

    Objective:To observe the nursing effect of evidence‐based nursing and predictive nursing during the first aid for upper gastrointestinal bleeding and investigate more scientific nursing mode for upper gastrointestinal bleeding .Methods:Select 100 cases of patients with digestive system disease and accepted first aid for upper gastroin‐testinal bleeding from degestive system department in our hospital during the period from January 2013 to June 2014 , randomly divide them into two nursing groups ,and name them observation group and control group respective .Dur‐ing the first aid for first aid for upper gastrointestinal bleeding for the 50 cases of the patients in the observation group ,the patients were intervened with evidence‐based nursing while the control group were nursed with predictive nursing .Exam and make follow‐up after treatment ,observe nursing effect ,mainly the bleeding times ,haemostasis time and the occurance of symptom of the patients and learn the post‐treatment living habits through follow‐ups , conclude the overall effective rate and patients’ satisfaction degree .Results:Both the 50 cases of patients in the control group or the 50 ones in the observation group had shown the the two nursing effect has their advantages respectively , during the first aid for upper gastrointestinal bleeding ,the bleeding times ,haemostasis time and the occurance of symptoms were obviously lower in the control group ,overall effective rate and patients’ satisfaction degree of the ob‐servation group were all a little higher than that in the control group ,as for the improvement of living habits after the patients left hospital ,the control group was better ,the observation group can keep taking medicine om time .Conclu‐sion:Both evidence‐based nursing and predictive nursing are good nursing mode for the first aid for upper gastrointes‐tinal bleeding ,the joint application would achieve much better nursing effect ,assure the life quality

  16. Radiological study of gastrointestinal motor activity after acute cisplatin in the rat. Temporal relationship with pica.

    Science.gov (United States)

    Cabezos, Pablo Antonio; Vera, Gema; Castillo, Mónica; Fernández-Pujol, Ramón; Martín, María Isabel; Abalo, Raquel

    2008-08-18

    Nausea and vomiting are amongst the most severe dose-limiting side effects of chemotherapy. Emetogenic activity in rats can only be evaluated by indirect markers, such as pica (kaolin intake), or delay in gastric emptying. The aim of this work was to study, by radiological methods, the alterations in gastrointestinal motility induced by acute cisplatin in the rat, and to compare them with the development of pica. Rats received cisplatin (0-6 mg kg(-1)) at day 0. In the pica study, individual food ingestion and kaolin intake were measured each day (from day -3 to day 3). In the radiological study, conscious rats received an intragastric dose of medium contrast 0, 24 or 48 h after cisplatin injection, and serial X-rays were taken 0-24 h after contrast. Cisplatin dose-dependently induced both gastric stasis and stomach distension, showing a strict temporal relationship with the induction of both acute and delayed pica. Radiological methods, which are non-invasive and preserve animals' welfare, are useful to study the effect of emetogenic drugs in the different gastrointestinal regions and might speed up the search for new anti-emetics. PMID:18579450

  17. Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage

    International Nuclear Information System (INIS)

    Introduction: A pilot study to evaluate helical computer tomography (CT) as a diagnostic tool for acute lower gastrointestinal tract (GIT) bleeding. CT was compared to conventional angiography (CA) and colonoscopy for the diagnosis and detection of bleeding site in suspected cases of acute lower GIT bleeding. Methods: Seven patients presenting with acute lower GIT bleeding, between June and November 2002, underwent CT examinations. All of these seven patients underwent CA following CT. Emergency colonoscopies were performed on five patients investigated with both CT and CA. Median delay from the most recent episode of hematochezia to CT was two and a half hours, to CA was 3 h, and to colonoscopy was 4 h. None of the patients underwent nuclear medicine (NM) bleeding studies. Results: Haemoglobin drop in all patients was greater than 15 g/L in the first 24 h of presentation. The mean age was 68.86 years (range, 49-83 years). Comparing CT and CA, there were four concordant and three discordant results. Both modalities had concordant findings of two active bleeding sites, one non-bleeding rectal tumour, and one negative case result. In three patients, the source of bleeding was found on CT whereas CA was negative. Emergency colonoscopies performed in all of these three patients confirmed blood in the colon/ileum. Conclusion: Early experience suggests that CT is a safe, convenient and accurate diagnostic tool for acute lower GIT haemorrhage. It raises questions regarding the sensitivity of CA. A new management algorithm for acute lower GIT haemorrhage using CT as the pre-CA screening tool is being proposed based on the preliminary findings. Positive CT will allow directed therapeutic angiography, while negative CT will triage patients into alternative management pathways

  18. Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Sabharwal, Rohan [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia); Vladica, Philip [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia)]. E-mail: rpvl@imag.wsahs.nsw.gov.au; Chou, Roger [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia); Law, W. Phillip [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia)

    2006-05-15

    Introduction: A pilot study to evaluate helical computer tomography (CT) as a diagnostic tool for acute lower gastrointestinal tract (GIT) bleeding. CT was compared to conventional angiography (CA) and colonoscopy for the diagnosis and detection of bleeding site in suspected cases of acute lower GIT bleeding. Methods: Seven patients presenting with acute lower GIT bleeding, between June and November 2002, underwent CT examinations. All of these seven patients underwent CA following CT. Emergency colonoscopies were performed on five patients investigated with both CT and CA. Median delay from the most recent episode of hematochezia to CT was two and a half hours, to CA was 3 h, and to colonoscopy was 4 h. None of the patients underwent nuclear medicine (NM) bleeding studies. Results: Haemoglobin drop in all patients was greater than 15 g/L in the first 24 h of presentation. The mean age was 68.86 years (range, 49-83 years). Comparing CT and CA, there were four concordant and three discordant results. Both modalities had concordant findings of two active bleeding sites, one non-bleeding rectal tumour, and one negative case result. In three patients, the source of bleeding was found on CT whereas CA was negative. Emergency colonoscopies performed in all of these three patients confirmed blood in the colon/ileum. Conclusion: Early experience suggests that CT is a safe, convenient and accurate diagnostic tool for acute lower GIT haemorrhage. It raises questions regarding the sensitivity of CA. A new management algorithm for acute lower GIT haemorrhage using CT as the pre-CA screening tool is being proposed based on the preliminary findings. Positive CT will allow directed therapeutic angiography, while negative CT will triage patients into alternative management pathways.

  19. Antioxidant activity and nutrient release from polyphenol-enriched cheese in a simulated gastrointestinal environment.

    Science.gov (United States)

    Lamothe, Sophie; Langlois, Ariane; Bazinet, Laurent; Couillard, Charles; Britten, Michel

    2016-03-01

    Green tea polyphenols are recognized for their antioxidant properties and their effects on lipid digestion kinetics. Polyphenols are sensitive to degradation in the intestinal environment. Interactions with dairy proteins could modulate the stability and biological activity of polyphenols during digestion. The objective of this study was to evaluate the release of nutrients (polyphenols, fatty acids and peptides) and the antioxidant activity in polyphenol-enriched cheese containing different levels of calcium in a simulated gastrointestinal environment. The relationship between cheese matrix texture, matrix degradation and nutrient release during digestion was also studied. Green tea extract was added to milk at 0% or 0.1%, and cheeses were produced on a laboratory scale. The level of available calcium was adjusted to low (Ca(low)), regular (Ca(reg)) or high (Ca(high)) during the salting step of the cheese-making process. Cheeses were subjected to simulated digestion. The rate and extent of fatty acid release were 21% lower for Ca(low) cheese than for Ca(reg) and Ca(high) cheeses. The greater adhesiveness of Ca(low) cheese, which resulted in lower rates of matrix degradation and proteolysis, contributed to the reduced rate of lipolysis. The presence of green tea extract in cheese reduced the release of free fatty acids at the end of digestion by 7%. The addition of green tea extract increased cheese hardness but did not influence matrix degradation or proteolysis profiles. The formation of complexes between tea polyphenols and proteins within the cheese matrix resulted in a more than twofold increase in polyphenol recovery in the intestinal phase compared with the control (tea polyphenol extract incubated with polyphenol-free cheese). Antioxidant activity was 14% higher in the digest from polyphenol-enriched cheese than in the control. These results suggest that cheese is an effective matrix for the controlled release of nutrients and for the protection of green

  20. Efficacy of somatostatin combined with vasopressin for treating cirrhosis combined upper gastrointestinal bleeding%生长抑素联合垂体后叶素治疗肝硬化上消化道出血的疗效观察

    Institute of Scientific and Technical Information of China (English)

    张道铭

    2015-01-01

    目的:探讨生长抑素联合垂体后叶素对肝硬化合并上消化道出血的疗效。方法选取2012年1月~2014年1月在我院就诊的42例肝硬化合并上消化道出血的患者随机分为对照组(20例)及观察组(22例)。对照组给予垂体后叶素持续静脉滴注,观察组予以生长抑素+垂体后叶素持续静脉滴注治疗,观察并比较两组的临床疗效。结果对照组总有效率为70.0%,观察组总有效率为90.9%,两组比较差异具有统计学意义(P<0.05)。结论生长抑素联合垂体后叶素治疗肝硬化合并上消化道出血疗效显著。%Objective To investigate the efficacy of somatostatin combined with vasopressin for treating cirrhosis combined upper gastrointestinal bleeding. Methods Selected 42 cases of cirrhosis with gastrointestinal bleeding from January 2012 to January 2014 in on our hospital, All cases were randomLy divided into control group (20 cases) and the observation group (22 cases). The control group were given continuous intravenous infusion of vasopressin, and the observation group were added the intravenous somatostatin + vasopressin infusion therapy, observe and compare the clinical efficacy of the two groups. Results The total effective rate was 70.0% in the control group, so that was 90.9%in the treatment group, the difference compared between the two groups was statistically significant (P<0.05). Conclusion The combined pituitary hormone somatostatin treatment of upper gastrointestinal bleeding with cirrhosis has significant effect.

  1. Sandostatin therapy of acute oesophageal variceal bleeding.

    Science.gov (United States)

    McKee, R F

    1993-01-01

    This communication deals with the emergency control of variceal bleeding rather than the prevention of rebleeding. The current main options of oesophageal tamponade, emergency sclerotherapy and drug therapy are discussed, with particular reference to the use of somatostatin. Sandostatin (Sandoz, Basel), a synthetic long-acting somatostatin analogue, was found to reduce transhepatic venous gradient by 30% with no effect on systemic haemodynamics in a study of 16 stable cirrhotic patients. In a trial comparing intravenous infusion of Sandostatin (SMS) to oesophageal tamponade (OT) in active variceal bleeding, 18 of 20 bleeds in the SMS group and 19 of 20 bleeds in the OT group were controlled at 4 h. Ten in the SMS group and 14 in the OT group had no further bleeding during the 48-hour study period. Thus SMS may be useful in the temporary control of active variceal bleeding. PMID:8359565

  2. Anatomically realistic multiscale models of normal and abnormal gastrointestinal electrical activity.

    Science.gov (United States)

    Cheng, Leo K; Komuro, Rie; Austin, Travis M; Buist, Martin L; Pullan, Andrew J

    2007-03-01

    One of the major aims of the International Union of Physiological Sciences (IUPS) Physiome Project is to develop multiscale mathematical and computer models that can be used to help understand human health. We present here a small facet of this broad plan that applies to the gastrointestinal system. Specifically, we present an anatomically and physiologically based modelling framework that is capable of simulating normal and pathological electrical activity within the stomach and small intestine. The continuum models used within this framework have been created using anatomical information derived from common medical imaging modalities and data from the Visible Human Project. These models explicitly incorporate the various smooth muscle layers and networks of interstitial cells of Cajal (ICC) that are known to exist within the walls of the stomach and small bowel. Electrical activity within individual ICCs and smooth muscle cells is simulated using a previously published simplified representation of the cell level electrical activity. This simulated cell level activity is incorporated into a bidomain representation of the tissue, allowing electrical activity of the entire stomach or intestine to be simulated in the anatomically derived models. This electrical modelling framework successfully replicates many of the qualitative features of the slow wave activity within the stomach and intestine and has also been used to investigate activity associated with functional uncoupling of the stomach.

  3. Anatomically realistic multiscale models of normal and abnormal gastrointestinal electrical activity

    Institute of Scientific and Technical Information of China (English)

    Leo K Cheng; Rie Komuro; Travis M Austin; Martin L Buist; Andrew J Pullan

    2007-01-01

    One of the major aims of the Tnternational Union of Physiological Sciences (IUPS) Physiome Project is to develop multiscale mathematical and computer models that can be used to help understand human health.We present here a small facet of this broad plan that applies to the gastrointestinal system. Specifically,we present an anatomically and physiologically based modelling framework that is capable of simulating normal and pathological electrical activity within the stomach and small intestine. The continuum models used within this framework have been created using anatomical information derived from common medical imaging modalities and data from the Visible Human Project. These models explicitly incorporate the various smooth muscle layers and networks of interstitial cells of Cajal (ICC) that are known to exist within the walls of the stomach and small bowel. Electrical activity within individual ICCs and smooth muscle cells is simulated using a previously published simplified representation of the cell level electrical activity. This simulated cell level activity is incorporated into a bidomain representation of the tissue, allowing electrical activity of the entire stomach or intestine to be simulated in the anatomically derived models. This electrical modelling framework successfully replicates many of the qualitative features of the slow wave activity within the stomach and intestine and has also been used to investigate activity associated with functional uncoupling of the stomach.

  4. Impact of estradiol-valerate dienogest on work productivity and activities of daily living in European and Australian women with heavy menstrual bleeding

    Directory of Open Access Journals (Sweden)

    Wasiak R

    2012-07-01

    Full Text Available Radoslaw Wasiak,1 Anna Filonenko,2 David J Vanness,3 Kim U Wittrup-Jensen,2 Donald E Stull,1 Steven Siak,1 Ian Fraser41Centre for Health Economics and Science Policy, United BioSource Corporation, London, United Kingdom; 2Global Health Economics and Outcomes Research, Bayer Healthcare Pharmaceuticals, Berlin, Germany; 3University of Wisconsin, Madison, WI, USA; 4Department of Obstetrics and Gynaecology, University of Sydney, Sydney, NSW, AustraliaBackground: The purpose of this study was to quantify the impact of estradiol valerate-dienogest (E2V/DNG; Qlaira®/Natazia® on work productivity and activities of daily living in European and Australian women with heavy menstrual bleeding.Methods: Women aged 18–54 years with a confirmed diagnosis of heavy menstrual bleeding and no recognizable pathology were recruited across nine European countries (the Czech Republic, Finland, Germany, Hungary, The Netherlands, Poland, Sweden, UK, and Ukraine and Australia. The women were randomized to receive either E2V/DNG (n = 149 or placebo (n = 82 for seven treatment cycles (196 days. The outcomes assessed included work productivity (ie, productivity while at work and activities of daily living, measured on a Likert scale from 0 to 10 (with higher values denoting higher impairment levels at baseline and at the end of the third and seventh cycles (days 84 and 196. The equivalent monetary value associated with the changes in work productivity and activities of daily living was also calculated.Results: Across all the countries, greater improvements from baseline to the end of treatment were observed with E2V/DNG treatment than placebo in work productivity (46.0% versus 15.1% and activities of daily living (55.6% versus 30.8%. In 2008, savings associated with improvements in work productivity and activities of daily living due to E2V/DNG treatment (net of placebo improvement were estimated to be between US$22–62 and US$18–56 per month (in purchasing power

  5. Anti-Helicobacter pylori activity of plant extracts traditionally used for the treatment of gastrointestinal disorders

    Directory of Open Access Journals (Sweden)

    Laura Lúcia Cogo

    2010-06-01

    Full Text Available The antibacterial activity of plant extracts obtained from Bixa orellana L., Chamomilla recutita L., Ilex paraguariensis A. St.-Hil., Malva sylvestris L., Plantago major L. and Rheum rhaponticum L. has been evaluated against two reference strains and eleven clinical isolates of Helicobacter pylori. All the plant species chosen are used in popular Brazilian cuisine and folk medicine in the treatment of gastrointestinal disorders. Initial screening was made by the disk diffusion test and then minimum inhibitory concentration was determined by the agar dilution method. The results presented in this work demonstrated that among the plant preparations analyzed, B. orellana L., C. recutita L., I. paraguariensis A. St.-Hil. and M. sylvestris L. were capable of inhibiting the in vitro growth of H. pylori.

  6. Anti-Helicobacter pylori activity of plant extracts traditionally used for the treatment of gastrointestinal disorders.

    Science.gov (United States)

    Cogo, Laura Lúcia; Monteiro, Cristina Leise Bastos; Miguel, Marilis Dallarmi; Miguel, Obdulio Gomes; Cunico, Miriam Machado; Ribeiro, Marcelo Lima; de Camargo, Eloá Ramalho; Kussen, Gislene Maria Botão; Nogueira, Keite da Silva; Costa, Libera Maria Dalla

    2010-04-01

    The antibacterial activity of plant extracts obtained from Bixa orellana L., Chamomilla recutita L., Ilex paraguariensis A. St.-Hil., Malva sylvestris L., Plantago major L. and Rheum rhaponticum L. has been evaluated against two reference strains and eleven clinical isolates of Helicobacter pylori. All the plant species chosen are used in popular Brazilian cuisine and folk medicine in the treatment of gastrointestinal disorders. Initial screening was made by the disk diffusion test and then minimum inhibitory concentration was determined by the agar dilution method. The results presented in this work demonstrated that among the plant preparations analyzed, B. orellana L., C. recutita L., I. paraguariensis A. St.-Hil. and M. sylvestris L. were capable of inhibiting the in vitro growth of H. pylori.

  7. Anti-Helicobacter pylori activity of plant extracts traditionally used for the treatment of gastrointestinal disorders.

    Science.gov (United States)

    Cogo, Laura Lúcia; Monteiro, Cristina Leise Bastos; Miguel, Marilis Dallarmi; Miguel, Obdulio Gomes; Cunico, Miriam Machado; Ribeiro, Marcelo Lima; de Camargo, Eloá Ramalho; Kussen, Gislene Maria Botão; Nogueira, Keite da Silva; Costa, Libera Maria Dalla

    2010-04-01

    The antibacterial activity of plant extracts obtained from Bixa orellana L., Chamomilla recutita L., Ilex paraguariensis A. St.-Hil., Malva sylvestris L., Plantago major L. and Rheum rhaponticum L. has been evaluated against two reference strains and eleven clinical isolates of Helicobacter pylori. All the plant species chosen are used in popular Brazilian cuisine and folk medicine in the treatment of gastrointestinal disorders. Initial screening was made by the disk diffusion test and then minimum inhibitory concentration was determined by the agar dilution method. The results presented in this work demonstrated that among the plant preparations analyzed, B. orellana L., C. recutita L., I. paraguariensis A. St.-Hil. and M. sylvestris L. were capable of inhibiting the in vitro growth of H. pylori. PMID:24031496

  8. Plasticity in gastrointestinal morphology and enzyme activity in lactating striped hamsters (Cricetulus barabensis).

    Science.gov (United States)

    Zhang, Ji-Ying; Zhao, Xiao-Ya; Wen, Jing; Tan, Song; Zhao, Zhi-Jun

    2016-05-01

    In small mammals, marked phenotypic plasticity of digestive physiology has been shown to make it easier for them to cope with energetically stressful periods, such as lactation. It has been proposed that the capacity of the gut to digest and absorb food is not the limiting factor to sustained energy intake (SusEI) during peak lactation. In this study, plasticity in energy intake and gastrointestinal morphology was examined in striped hamsters at different stages of reproduction and when raising litters of different sizes. Mechanisms associated with digestive enzymes and neuroendocrine hormones underpinning the plasticity were also examined. Females significantly increased energy intake, digestibility, digestive tract mass and the activity of stomach pepsin and small intestine maltase, sucrase and aminopeptidase in peak lactation compared with the non-productive and post-lactating periods. Further, females raising large litters significantly increased energy intake, digestibility, gastrointestinal mass and activity of digestive enzymes, and weaned heavier offspring compared with those nursing small and medium litters, indicating that the significant plasticity of digestive physiology increased reproductive performance. Agouti-related protein (AgRP) mRNA expression in the hypothalamus was up-regulated significantly in females raising large litters relative to those raising small litters. Serum leptin levels, and mRNA expression of hypothalamus neuropeptide Y (NPY) and the anorexigenic neuropeptides pro-opiomelanocortin (POMC) and cocaine- and amphetamine-regulated transcript (CART) did not differ among females raising small, medium and large litters. Leptin levels in lactation may only reflect a state of energy balance rather than being the prime driver of hyperphagia. Some hypothalamic neuropeptides, such as NPY, POMC and CART, may be involved in the limits to the SusEI during lactation. PMID:26944487

  9. [Direct oral anticoagulant associated bleeding].

    Science.gov (United States)

    Godier, A; Martin, A-C; Rosencher, N; Susen, S

    2016-07-01

    Direct oral anticoagulants (DOAC) are recommended for stroke prevention in atrial fibrillation and for the treatment of venous thromboembolism. However, they are associated with hemorrhagic complications. Management of DOAC-induced bleeding remains challenging. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. Therapeutic options also include antidotes: idarucizumab, antidote for dabigatran, has been approved for use whereas andexanet alpha, antidote for anti-Xa agents, and aripazine, antidote for all DOAC, are under development. Other options include hemodialysis for the treatment of dabigatran-associated bleeding and administration of oral charcoal if recent DOAC ingestion. DOAC plasma concentration measurement is necessary to guide DOAC reversal. We propose an update on DOAC-associated bleeding, integrating the availability of dabigatran antidote and the critical place of DOAC concentration measurements. PMID:27297642

  10. A case-control study on non-steroidal anti-inflammatory drugs(NSAIDs)induced and NSAIDs unrelated peptic ulcer with upper gastrointestinal bleeding%NSAIDs相关性消化性溃疡出血与非NSAIDs消化性溃疡出血的临床对照研究

    Institute of Scientific and Technical Information of China (English)

    宗晔; 赵海英; 王青釭; 吴咏冬; 张澍田

    2012-01-01

    目的 探讨非甾体类抗炎药(NSAIDs)相关性溃疡出血与非NSAIDs消化性溃疡出血的差异.方法 通过临床对照研究,比较46例NSAIDs相关性溃疡出血与88例非NSAIDs消化性溃疡出血的临床资料.结果 NSAIDs组年龄显著高于非NSAIDs组,女性患者比率高于非NSAIDs组;NSAIDs组具有心脑血管和/或风湿免疫性疾病的患者多于非NSAIDs组,而既往具有消化性溃疡病史的患者低于非NSAIDs组;NSAIDs组上腹痛症状显著低于非NSAIDs组;NSAIDs组发病时血糖高于非NSAIDs组;NSAIDs组胃溃疡比率显著高于非NSAIDs组.以上差异均有统计学意义(P<0.05).结论 NSAIDs相关性溃疡出血发病年龄、性别、临床表现及溃疡的发生部位与非NSAIDs溃疡患者均有差异,熟悉NSAIDs相关性溃疡出血的特点有利于临床诊治.%Objective To explore the difference in clinical characteristics between non - steroidal anti - inflammatory drugs ( NSAIDs ) induced and NSAIDs unrelated peptic ulcer with upper gastrointestinal bleeding. Methods The case - control study was used to analyze the clinical data of forty - six patients with NSAIDs induced and eighty - eight patients with NSAIDs unrelated peptic ulcer with upper gastrointestinal bleeding. Results The age range of patients in NSAIDs induced group was older than that of NSAIDs unrelated group. Female patients in NSAIDs induced group were more than those in NSAIDs unrelated group. More patients in NSAIDs induced group had the history of cardio - cerebral - vascular diseases or rheumatic diseases, fewer patients in NSAIDs induced group had the history of peptic ulcer and epigastric pain. The level of blood sugar in NSAIDs induced group was higher than that of NSAIDs unrelated group. The number of patients with gastric ulcer in NSAIDs induced group was more than that of NSAIDs unrelated group. Their difference was significant( P < 0. 05 ). Conclusion There was significant difference between NSAIDs induced group and

  11. Comparative in vitro fermentation activity in the canine distal gastrointestinal tract and fermentation kinetics of fiber sources

    NARCIS (Netherlands)

    Bosch, G.; Pellikaan, W.F.; Rutten, P.G.P.; Poel, van der A.F.B.; Verstegen, M.W.A.; Hendriks, W.H.

    2008-01-01

    The current study aimed to evaluate the variation in fermentation activity along the distal canine gastrointestinal tract (GIT, Exp. 1). It also aimed to assess fermentation kinetics and end product profiles of 16 dietary fibers for dog foods using canine fecal inoculum (Exp. 2). For Exp. 1, digesta

  12. Antimutagenic activity of green tea and black tea extracts studied in a dynamic in vitro gastrointestinal model

    NARCIS (Netherlands)

    Krul, C.A.M.; Luiten-Schuite, A.; Tenfelde, A.; Ommen, B. van; Verhagen, H.; Havenaar, R.

    2001-01-01

    An in vitro gastrointestinal model, which simulates the conditions in the human digestive tract, was used to determine potential antimutagenic activity of extracts of black tea and green tea. In this paper, results are presented on the availability for absorption of potential antimutagenic compounds

  13. The missense Thr211Pro mutation in the factor X activation peptide of a bleeding patient causes molecular defect in the clotting cascade.

    Science.gov (United States)

    Ding, Qiulan; Shen, Yiping; Yang, Likui; Wang, Xuefeng; Rezaie, Alireza R

    2013-07-01

    Factor X (FX) is a vitamin K-dependent coagulation zymogen, which upon activation to factor Xa assembles into the prothrombinase complex to activate prothrombin to thrombin. FX can be activated by either factor VIIa-tissue factor or factor IXa-factor VIIIa in extrinsic and intrinsic pathways, respectively. In this study, we identified a bleeding patient with moderate FX deficiency who exhibits a clotting defect only in the intrinsic pathway. Exome sequencing revealed that the patient carries a novel homozygous missense mutation that results in substitution of Thr211 with Pro in the activation peptide of FX. Thr211 is the site of an O-linked glycosylation in the activation peptide of FX. We postulated that the lack of this post-translational modification specifically impacts the activation of FX by intrinsic Xase, thereby impairing thrombin generation in the subject. To test this hypothesis, we expressed both wild-type FX and FX containing this mutation in mammalian cells and following the purification of the zymogens to homogeneity characterized their properties in both purified and plasma-based assay systems. Analysis of the results suggests that Thr211 to Pro substitution renders the FX mutant a poor substrate for both physiological activators, however, at physiological concentration of the substrate, the clotting defect manifest itself only in the intrinsic pathway, thus explaining the bleeding phenotype for the patient carrying this mutation. PMID:23677006

  14. Therapeutic angiography for giant bleeding gastro-duodenal artery pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    Ram; Elazary; Mahmoud; Abu-Gazala; Avraham; Schlager; Noam; Shussman; Avraham; I; Rivkind; Allan; I; Bloom

    2010-01-01

    We present the case of an 18-year-old female transferred to our center from an outside hospital due to persistent gastrointestinal bleeding. Two weeks prior to her transfer she underwent duodenal omentopexy for a perforated duodenal peptic ulcer. The patient underwent a computed tomography angiogram which identified the source of bleeding as a giant gastroduodenal artery (GDA) pseudoaneurysm. The patient was taken to interventional radiology where successful microcoil embolization was performed. We present ...

  15. Nursing care of 37 cases with upper gastrointestinal bleeding in severe craniocerebral injury%重型颅脑损伤并应激性消化道出血37例护理

    Institute of Scientific and Technical Information of China (English)

    张丽宁

    2014-01-01

    目的:重型颅脑损伤常有严重并发症发生,本文就重型颅脑损伤合并应激性消化道出血的护理做一简单阐述,以期对临床护理工作有所帮助。%Severe craniocerebral injury often have serious complications.In this text the nursing care of patients with severe craniocerebral injury combine with stress gastrointestinal hemorrhage do a simple set,in order to help clinical nursing work.

  16. Matrix Effects on the Stability and Antioxidant Activity of Red Cabbage Anthocyanins under Simulated Gastrointestinal Digestion

    Directory of Open Access Journals (Sweden)

    Anna Podsędek

    2014-01-01

    Full Text Available Red cabbage is, among different vegetables, one of the major sources of anthocyanins. In the present study an in vitro digestion method has been used to assay the influence of the physiological conditions in the stomach and small intestine, as well as faecal microflora on anthocyanins stability in red cabbage and anthocyanin-rich extract. The recovery of anthocyanins during in vitro gastrointestinal digestion was strongly influenced by food matrix. The results showed that other constituents present in cabbage enhanced the stability of anthocyanins during the digestion. The amount of anthocyanins (HPLC method and antioxidant capacity (ABTS and FRAP assays strongly decreased after pancreatic-bile digestion in both matrices but total phenolics content (Folin-Ciocalteu assay in these digestions was higher than in initial samples. Incubation with human faecal microflora caused further decline in anthocyanins content. The results obtained suggest that intact anthocyanins in gastric and products of their decomposition in small and large intestine may be mainly responsible for the antioxidant activity and other physiological effects after consumption of red cabbage.

  17. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  18. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  19. Anthelmintic Activity of a Herbal Formulation Against Gastrointestinal Nematodes of Sheep

    Directory of Open Access Journals (Sweden)

    Muhammad Arfan Zaman*§, Zafar Iqbal, Muhammad Nisar Khan and Ghulam Muhammad1

    2012-01-01

    Full Text Available This study was carried out to evaluate the anthelmintic activity of a herbal formulation (HF based on aqueous extracts of leaves of Azadirachta indica and Nicotiana tabacum, flowers of Calotropis procera and seeds of Trachyspermum ammi. In vitro, eggs and adult Haemonchus contortus were exposed to different concentrations of HF following the standard procedures of egg hatch test (EHT; 50 to 0.024414 mg ml-1 and adult motility assay (AMA; 200-0.1953125mg ml-1, respectively. The reference drugs used in the study were oxfendazole (0.0056704 to 0.0000027 mg ml-1 and levamisole (1.50 mg ml-1 for EHT and AMA, respectively. In vivo, pre and post-treatment (4 mg, 2 mg and 500 µg kg-1 body weight fecal egg counts were determined following standard fecal egg count reduction test in sheep naturally parasitized with mixed species of gastrointestinal nematodes. In EHT, LC50 values of HF and oxfendazole (reference drug were 275.1 and 0.016 µg ml-1, respectively. In AMA, 100% mortality of H. contortus was observed 6 hr post-exposure to 3.125-200 mg ml-1 concentrations of HF and 2 hr post-exposure to levamisole. In vivo, maximum (96.2% fecal egg count (EPG reduction was recorded in sheep treated with HF @ 4 mg kg-1 body weight; whereas, 89.3% reduction in EPG was recorded in sheep treated with levamisole @ 7.5 mg kg-1 body weight. A graded dose response was noted in all the tests used in the present study to evaluate the anthelmintic activity of HF. Therefore, HF seems to be promising as an anthelmintic for animals. Large scale trials on efficacy and safety, however, are recommended before the HF is considered for commercialization in crude form.

  20. Mechanisms of electrical activation and conduction in the gastrointestinal system: lessons from cardiac electrophysiology

    Directory of Open Access Journals (Sweden)

    Gary eTse

    2016-05-01

    Full Text Available The gastrointestinal (GI tract is an electrically excitable organ system containing multiple cell types, which coordinate electrical activity propagating through this tract. Disruption in its normal electrophysiology is observed in a number of GI motility disorders. However, this is not well characterized and the field of GI electrophysiology is much less developed compared to the cardiac field. The aim of this article is to use the established knowledge of cardiac electrophysiology to shed light on the mechanisms of electrical activation and propagation along the GI tract, and how abnormalities in these processes lead to motility disorders and suggest better treatment options based on this improved understanding. In the first part of the article, the ionic contributions to the generation of GI slow wave and the cardiac action potential (AP are reviewed. Propagation of these electrical signals can be described by the core conductor theory in both systems. However, specifically for the GI tract, the following unique properties are observed: changes in slow wave frequency along its length, periods of quiescence, synchronization in short distances and desynchronization over long distances. These are best described by a coupled oscillator theory. Other differences include the diminished role of gap junctions in mediating this conduction in the GI tract compared to the heart. The electrophysiology of conditions such as gastroesophageal reflux disease and gastroparesis, and functional problems such as irritable bowel syndrome are discussed in detail, with reference to ion channel abnormalities and potential therapeutic targets. A deeper understanding of the molecular basis and physiological mechanisms underlying GI motility disorders will enable the development of better diagnostic and therapeutic tools and the advancement of this field.

  1. [Obscure digestive bleeding by ileal carcinoid tumor].

    Science.gov (United States)

    Nelly Manrique, María; Frisancho, Oscar; Zumaeta, Eduardo; Palomino, Américo; Rodriguez, César

    2011-01-01

    The patient is an 82 year-old female with a history of osteoarthritis, hypothyroidism and anemia for 14 years (receiving blood transfusions). She was admited to our hospital with a nine months history of malaise, anorexia, fatigue and weakness, associated with intermitten episodes of abdominal pain. She was diagnosed anemia and occult blood positive stools. Physical examination revealed a patient in generally fair condition, obese, with mild edema of lower limbs, no changes in the evaluation of chest, cardiovascular, abdomen, etc. Laboratory data was unremarkable, except for iron deficiency anemia. The upper endoscopy showed duodenal ulcer scar, fundic polyposis and chronic gastritis. Colonoscopy revealed some diverticula, a small sessile polyp and internal hemorrhoids. The diagnosis of obscure gastrointestinal bleeding was made. The CT scan of the abdomen showed gallstones and fatty liver; a radiograph of intestinal transit detected a lesion apparently protruded intestinal loop for distal jejunum; enteroscopy was performed (with one team ball) anterograde and retrograde achieving assess distal jejunum and distal ileum without observing any injuries. The study of capsule endoscopy showed a polypoid tumor intestinal with evidence of having bleeding. Surgery detected the tumor in proximal ileum. The surgical specimen findings showed three tumors 0.7 mm, 10 mm and 15 mm on the proximal ileum. The microscopic examination revealed that these lesions were neuroendocrine tumors (carcinoid). The Ileal carcinoid tumor may rarely presented with obscure gastrointestinal bleeding. PMID:21544161

  2. Evaluación económica del tratamiento con ácido acetilsalicílico más esomeprazol comparado con clopidogrel en la prevención de la hemorragia gastrointestinal Economic evaluation of the treatment of aspirin plus esomeprazole compared to clopidogrel in gastrointestinal bleeding prevention

    OpenAIRE

    Carme Piñol

    2006-01-01

    Objetivo: Evaluar la eficiencia del ácido acetilsalicílico (AAS) más esomeprazol frente a clopidogrel en la prevención de la hemorragia gastrointestinal. Métodos: Análisis coste-efectividad (árbol de decisión de 2 ramas: AAS más esomeprazol y clopidogrel) respecto a la evitación de casos de hemorragia gastrointestinal en 2 años, y análisis de sensibilidad. Resultados: El coste total del tratamiento con AAS más esomeprazol (2.865 S por paciente libre de hemorragia) fue inferior al clopidogrel ...

  3. 幽门螺杆菌感染与冠心病患者上消化道出血的相关性研究%Correlation between Helicobacter py lori infection and upper gastrointestinal bleeding of coronary heart disease patients

    Institute of Scientific and Technical Information of China (English)

    李忠明; 夏平达; 周琴

    2015-01-01

    OBJECTIVE To explore the correlation between the Helicobacter pylori infection and upper gastrointes‐tinal bleeding of the coronary heart disease (CHD) patients so as to reduce the incidence of upper gastrointestinal bleeding in the CHD patients .METHODS Totally 58 CHD patients with upper gastrointestinal bleeding who were treated in the hospital from Jan 2013 to Dec 2014 were assigned as the observation group ,meanwhile ,79 CHD pa‐tients without gastrointestinal bleeding were set as the control group .A retrospective survey was conducted to ob‐serve the basic data of the two groups of patients ,the positive rate of H .pylori was tested by using 14C urea breath test ,and the concentrations of the plasma total cholesterol (TC) ,triglyceride (TG) ,high density lipopro‐tein (HDL) cholesterol ,low density lipoprotein (LDL) cholesterol ,and C‐reactive protein (CRP) were deter‐mined .RESULTS As compared with the family history ,smoking history ,drinking history ,complication of chronic disease ,and body mass index (BMI) ,there was no significant difference between the two groups ;there was no significant difference in the concentration of TG ,TC ,HDL or LDL between the two groups ;the concentration of CRP of the observation group was (57 .13 ± 2 .27)mg/L ,significantly higher than (31 .45 ± 2 .41)mg/L of the control group(P<0 .05);the positive rate of the 14 C urea breast test of the observation group was 67 .24% ,sig‐nificantly higher than 6 .33% of the control group(P<0 .05) .CONCLUSION The upper gastrointestinal bleeding of the CHD patients is under the joint effect of multiple factors ,the H .pylori infection is an independent risk factor and shows certain association .It is necessary for the hospital to reduce the incidence of H .pylori infection in the CHD patients so as to improve the prognosis of the patients .%目的:探讨并分析幽门螺杆菌(Hp)感染与冠心病(CHD)患者上消化道出血的相关性,以降低CHD患者上消

  4. 老年晚期癌症临终患者并发消化道出血的相关因素分析%Analysis of the Related Factors of the Elderly Patients With Terminal Cancer in the Dying Patients Complicated With Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    刘磊

    2016-01-01

    目的:对老年晚期癌症临终患者并发消化道出血的相关原因进行分析。方法选取我院收治的晚期癌症患者200例,将出现消化道出血的患者设为实验组(80例),将未出现消化道出血的患者设为对照组(120例),观察患者消化道出血原因。结果患者出现消化道出血主要与患者的年龄、性别、肠内营养情况、血红蛋白水平、血白蛋白水平、非甾体类消炎药应用、幽门螺旋杆菌感染、应激状态、长期心肺疾病存在具有一定关系。结论对于老年晚期癌症患者给予肠内营养支持,严密监测幽门螺旋感染以及降低非甾体类抗炎药物的使用有助于降低患者消化道出血,提高患者生活质量。%Objective The related factors of elderly patients with advanced cancer patients dying of hemorrhage of digestive tract were analyzed. Methods 200 cases of advanced cancer patients admitted to our hospital, patients with gastrointestinal bleeding design into experimental group (80 cases), will not appear digestive tract hemorrhage patients as control group (120 cases) was patients with digestive tract hemorrhage reason. Results The patients with digestive tract hemorrhage mainly with the patient's age, gender, enteral nutrition, hemoglobin level, blood albumin level, non steroidal anti-inlfammatory drugs application, Helicobacter pylori infection, stress, long-term cardiopulmonary disease exists, there is a certain relation between. Conclusion For the elderly patients with advanced cancer given enteral nutrition support, close monitoring of helicobacter pylori infection and reduce the use of non steroidal anti-inflammatory drugs help lower gastrointestinal bleeding in patients with, improve the quality of life of the patients.

  5. Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia A pilot study

    OpenAIRE

    Ladas, Spiros D.; Polymeros, Dimitrios; Pagonis, Thomas; Triantafyllou, Konstantinos; Paspatis, Gregorios; Hatziargiriou, Maria; Raptis, Sotirios A.

    2004-01-01

    AIM: Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron, but patients usually face a two-month recovery period from post-haemorrhage anaemia. This prospective, randomised, open, pilot study was designed to investigate whether recombinant human erythropoietin (Epoetin) therapy accelerate haematocrit increase in the post-bleeding recovery period.

  6. Esophageal Dieulafoy's lesion: an exceedingly rare cause of massive upper GI bleeding.

    Science.gov (United States)

    Malliaras, George P; Carollo, Andrea; Bogen, Gregg

    2016-01-01

    Dieulafoy's lesion, a dilated aberrant submucosal vessel which erodes the overlying epithelium, is a relatively rare but potentially fatal cause of gastrointestinal (Gl) bleeding. The esophagus is a very rare location for the lesion. Here we present a case of massive upper GI bleeding, secondary to this remarkably rare occurrence, which was amendable to endoscopic intervention. PMID:27302497

  7. Low-Dose Aspirin-Associated Upper and Mid Gastrointestinal Tract Damage and Gene Polymorphism.

    Science.gov (United States)

    Shiotani, Akiko; Fujita, Yoshihiko; Nishio, Kazuto

    2015-01-01

    The risk of gastrointestinal (GI) bleeding is increased in association with the use of low-dose aspirin (LDA). There are few studies of the association between genetic polymorphisms and the risks of aspirin-induced ulcer or its complications. Individuals with two single nucleotide polymorphisms (SNPs) of cyclooxygenase-1 (COX-1), A-842G and C50T, exhibit increased sensitivity to aspirin and lower prostaglandin synthesis capacity but the polymorphism lacked statistical significance in relation to an association with bleeding peptic ulcer. In our previous Japanese study, SLCO1B1 521TT genotype and the SLCO1B1 *1b haplotype were significantly associated with the risk of peptic ulcer and ulcer bleeding in patients taking LDA, especially in the patients with angiotensin converting enzyme inhibitor (ACEI), angiotensin type 1 receptor blocker (ARB), or statin co-treatment. Protonpump inhibitors (PPIs) are recommended for patients who require antiplatelet therapy and have a history of upper GI bleeding. The interaction between PPIs and consequent impaired effectiveness of clopidogrel has caused concern regarding the effect of genetic polymorphisms of the CYP2C19 which mediates conversion of clopidogrel to its active metabolite. The later recent genome-wide analysis of SNPs indicated the association of several SNPs with small bowel bleeding in Japanese patients taking LDA. The data are still lacking and further prospective studies are needed to identify the specific gene polymorphisms as risk or protective factors for GI bleeding associated with LDA. PMID:26369686

  8. Happy ending of life-threatening upper GI bleeding

    Science.gov (United States)

    Islam, Quazi Tarikul; Siddiqui, Mahmudur Rahman; Rahman, Md Anisur; Ahmed, Syed Salahuddin

    2011-01-01

    Strongyloides stercoralis is an intestinal nematode in humans, and estimated about tens of millions of people are infected worldwide. This parasite is endemic in tropical or temperate and subtropical climates like Bangladesh. The authors report a 33-year-old man who presented with recurrent life-threatening upper gastrointestinal bleeding from gastric infection by S stercoralis. PMID:22673715

  9. Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

    OpenAIRE

    Ignacio Couto-Worner; Benito González-Conde; Emilio Estévez-Prieto; Pedro Alonso-Aguirre

    2013-01-01

    Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting,...

  10. Variceal bleeding from ileum identified and treated by single balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Mario Traina; Ilaria Tarantino; Luca Barresi; Filippo Mocciaro

    2009-01-01

    We report a case of acute uncontrolled gastrointestinal bleeding in a patient with liver cirrhosis. The upper and lower endoscopy were negative for bleeding lesions. We decided to perform the examination of the small bowel using single-balloon enteroscopy. The lower enteroscopy revealed signs of bleeding from varices of the ileum. In this report, we showed that the injection of a sclerosant solution can be accomplished using a freehand technique via the single balloon enteroscopy.

  11. In–vitro antimicrobial activity screening of some ethnoveterinary medicinal plants traditionally used against mastitis, wound and gastrointestinal tract complication in Tigray Region, Ethiopia

    Directory of Open Access Journals (Sweden)

    Shewit Kalayou

    2012-07-01

    Conclusions: It can be concluded that many of the tested plants have antibacterial activity and supports the traditional usage of the plants for mastitis, wound and gastrointestinal complications treatment. Further studies into their toxicity and phytochemistry is advocated.

  12. Active bleeding from a periampullary duodenal diverticulum that was difficult to diagnose but successfully treated using hemostatic forceps: a case report

    Directory of Open Access Journals (Sweden)

    Nishiyama Noriko

    2012-10-01

    Full Text Available Abstract Introduction Although duodenal diverticula are common, periampullary duodenal diverticula are rare. Periampullary duodenal diverticula are usually asymptomatic and may be difficult to diagnose and treat. However, they may present with massive bleeding, requiring prompt diagnosis. Case presentation We report the case of a 71-year-old Asian woman with bleeding from a periampullary duodenal diverticulum. She presented with severe anemia and tarry stools. Two examinations using a forward-viewing endoscope did not identify the source of the bleeding. However, examination using a side-viewing endoscope found an exposed bleeding vessel overlying the bile duct within a periampullary diverticulum of the descending part of the duodenum. The bleeding was successfully controlled by using hemostatic forceps. Conclusions Bleeding periampullary duodenal diverticula are rare, and a bleeding point in the mucosa overlying the bile duct within a large periampullary duodenal diverticulum is very rare. Identification of a bleeding point within a duodenal diverticulum often requires repeated examination and may require the use of a side-viewing endoscope. Use of hemostatic forceps to control bleeding from a periampullary duodenal diverticulum is very rare but, for bleeding lesions overlying the bile duct within a periampullary duodenal diverticulum, is the best way to prevent obstructive jaundice.

  13. Management of bleeding complications in patients with cancer on DOACs.

    Science.gov (United States)

    Schulman, Sam; Shrum, Jeffrey; Majeed, Ammar

    2016-04-01

    There has been a concern that major bleeding events (MBE) on direct-acting oral anticoagulants (DOACs) will be more difficult to manage than on vitamin K antagonists. Patients with cancer and DOAC-associated bleeding may be even more of a challenge to manage. We therefore reviewed the literature on bleeding in patients with cancer on DOACs. In addition, we performed an analysis of individual patient data from 5 phase III trials on treatment with dabigatran with focus on those with cancer. In 6 randomized trials the risk of MBE in patients with cancer was similar on treatment with DOACs compared to vitamin K antagonists. Bleeding was in the majority of patients managed with supportive therapy alone. In the individual patient data analysis there were no significant differences in use of hemostatic products, transfusion of red cells, effectiveness of management, bleeding-related mortality or 30-day all-cause mortality between patients with cancer treated with dabigatran or with warfarin. Local hemostatic therapy, including resection of the cancer site was more common in patients with gastrointestinal bleeding with cancer than among those without cancer. We conclude that management of bleeding in patients with cancer and on a DOAC does not pose a greater challenge than management of bleeding in patients without cancer. PMID:27067968

  14. [OMEPRAZOL VS RANITIDINE IN UPPER DIGESTIVE BLEEDING

    Science.gov (United States)

    Regis R, Regina; Bisso A, Aland; Rebaza, Segundo

    1999-01-01

    Pectic ulcer is the most frequent cause of gastrointestinal bleeding. The homeostatic mechanism of bleeding, and coagulation, does not happen with values of pH less than 5,0. Therefore neutralization of gastric acidity (pH more than 5,0) is a recourse of control, improve the evolution and healing of peptic ulcer and to avoid a new bleeding. The aim of this study was to compare the results of treatment with omeprazole and ranitidine, in 57 patients admitted at emergency room of the Hospital Central de la Polic a Nacional del Per with endoscopic diagnosis of peptic ulcer, using Forrest classification. Patients received omeprazole 40 mg in bolus IV, followed by continuos infusion of 8 mg/hour for 72 hours (group A) or ranitidine 50 mg IV each 8 hours for 72 hours (group B). A new endoscopy was made 72 hours after admission demostrated a succesful therapy in both group. Bleeding stopped in 26/27 patients in group A (96,2%) and in 23/30 patients in group B (76,6%) (pomeprazole IV is more effective than ranitidine IV in the control of UGB because of peptic ulcer and provides a faster healing. PMID:12181579

  15. Physical Activity Participation and Bleeding Characteristics in Chinese Patients with Severe Hemophilia A%体力活动状况对中国重型血友病A患者出血频率影响的观察

    Institute of Scientific and Technical Information of China (English)

    李含; 孙竞

    2012-01-01

    Objective To study the effect of the physical activity on the bleeding characteristics. Methods Physical activities of 45 patients (ages 16-48 years) were assessed by IPAQ and the relationship between physical activity and bleeding characteristics was analysed. Results There were no significant differences in bleeding frequency and proportion of bleeds due to traumatic reasons among the patients with three levels of physical activity. No differences in physical activity levels were noted among the patients with the bledding frequency ?,1 ~4 and >4. Conclusion The physical activity was not related with total bleeding frequency and traumatic bleeding.%目的 分析中国重型血友病A患者体力活动对出血频率的影响.方法 采用国际体力活动问卷(IPAQ)评估45例重型血友病A患者(年龄16 ~48岁)体力活动状况,并分析体力活动与出血频率的关系.结果不同体力活动剧烈程度的患者之间出血频率和创伤出血比例无显著差异(P值分别为0.646和0.666);出血次数≤1次、1~4次和>4次的患者之间体力活动水平无显著差异(P=0.334).结论 体力活动强度对重型血友病A患者出血频率及外伤出血次数无明显影响.

  16. 护理干预脑出血并发消化道出血40例疗效分析%Nursing Intervention Cerebral Hemorrhage Complicated Analysis of 40 Patients with Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    向旭平

    2012-01-01

      目的探讨护理干预脑出血患者并发消化道出血后的措施及其预后的影响。方法 对40例脑出血并发消化道出血实施护理干预后的病例资料进行回顾性分析,总结其干预成效。结果 40例患者消化道出血总治愈率为95%(38例),其中在1周内痊愈者32例(80%),2例病情未得到控制而死亡。结论 脑出血后并消化道出血者应早期预防,采取积极的护理措施,是保证治疗效率的关键,同时能预防并发症,减少病死率和致残率,提高治愈率。%  Objective Investigate the nursing intervention in patients with cerebral hemorrhage complicated by measures and its prognostic impact of gastrointestinal bleeding. Methods Were retrospectively analyzed 40 cases of cerebral hemorrhage complicated by gastrointestinal bleeding after the application of nursing intervention on clinical data and summary of the intervention effectiveness. Results 40 cases of gastrointestinal bleeding in patients with total cure rate was 95% (38 cases), which recovered within 1 week in 32 cases (80%), two cases of the disease is not brought under control and death. Conclusion After intracerebral hemorrhage and gastrointestinal bleeding early prevention, to take active care measures, to ensure that the treatment efficiency, and can prevent complications, reduce mortality and morbidity, improve the cure rate.

  17. [Possibilities and limits of endoscopic therapy in hemorrhage of the gastrointestinal tract].

    Science.gov (United States)

    Fleig, W E

    1987-04-01

    Most of the hemostatic modalities currently used for endoscopic therapy of gastrointestinal bleeding are based on the principle of thermic coagulation of protein. Injection of vasoactive and sclerosing agents is also widely used, while the application of various other methods is rather limited. There are specific benefits and drawbacks inherent with each of the treatment modalities. The efficacy of laser photocoagulation in stopping upper gastrointestinal bleeding has been demonstrated in several controlled trials; however, effects on survival are controversial. None of the other methods used has been evaluated sufficiently by controlled clinical trials up to date. Depending on the availability at a local institution, each of the various methods may be used for an attempt of endoscopic hemostasis when Forrest type I and II (visible vessel) lesions are detected at emergency endoscopy. However, patients suffering from lesions, which are notable for their high risk of recurrent bleeding like ulcers with a spurting artery, with a visible vessel and lesions at the posterior wall of the duodenum, should be transferred to the surgeon for operative treatment in the absence of active bleeding immediately after successful endoscopic treatment. In the future, patients requiring surgery despite effective endoscopic hemostasis might be identified with high accuracy by checking the coagulated or injected ulcer base with an endoscopic Doppler device. PMID:3495714

  18. Lower gastrointestinal endoscopies results

    Directory of Open Access Journals (Sweden)

    Ahmet Bozdağ

    2014-12-01

    Full Text Available Objectives: Endoscopic examinations have great potential in early diagnosis of colorectal adenomas and carcinomas with reducing to colorectal cancer incidence and mortality. We aimed to evaluate for diagnostic purposeful lower gastrointestinal endoscopic procedures in the second step state hospital retrospectively Methods: Between June 2010 and June 2013, we evaluated 278 patients with rectal bleeding, constipation and abdominal pain detected by lower gastrointestinal endoscopic procedures retrospectively. Results: The mean age of the patients was 54.8 ± 16.8 (15-90 year, respectively. 172 (61.9% of the patients were male and 106 (38.1% of the patients were female. 116 (41.7% of the patients was performed rectosigmoidoscopy and 162 (58.3% of the patients was performed colonoscopy. 51(18.3% of our patients were normal. 10 (3.6% of patients had colorectal cancer, 11(3.9% of patients had inflammatory bowel disease, 8 (2.9% of patients had parasitosis, 31(11.1% of patients had colorectal polyps, 12 (4.3% , in patients had diverticular disease, 2 (0.7% patients had rectal ulcer, 25 (9% patients had anal fissure and 159 (57.2% of the patients had hemorrhoidal disease. Conclusion: Lower gastrointestinal endoscopy is a method been the gold standard with a low complication rate and that can be easily applied in the evaluation to pathology of colorectal and anal canal. J Clin Exp Invest 2014; 5 (4: 580-582

  19. Changes of gastrointestinal myoelectric activity and bile acid pool size after cholecystectomy in guinea pigs

    Institute of Scientific and Technical Information of China (English)

    Xue-Mei Zhang; Lei Dong; Li-Na Liu; Bi-Xia Chang; Qian He; Qian Li

    2005-01-01

    AIM: To investigate the bile acid pool size after cholecystectomy whether or not correlated to the gastrointestinal migrating myoelectric complex (MMC) in guinea pigs.METHODS: Gallbladder motilities were assessed before cholecystectomy. Furthermore, we continuously monitored interdigestive gastrointestinal motilities using bipolar electrodes in conscious guinea pigs before and after surgery at 4 wk in standard diet group and high cholesterol diet (cholesterol gallstone) group. Total bile acid pool sizes were measured by isotope dilution method at meantime.RESULTS: After cholecystectomy, there were parallel falls in duration of phase Ⅰ, Ⅱ, Ⅲ and MMC cycle duration but increase in amplitude in the guinea pigs with normal gallbladder function, and in the guinea pigs with cholesterol stones. However, There were not significantly differences. On the other hand, the bile acid pool was definitely small in the GS guinea pigs compared to normal guinea pigs and became slightly smaller after cholecystectomy. Similarly, bile acid in gallbladder bile, fecal bile acid was slightly increased in GS guinea pigs after cholecystectomy, to the same degree as normal. These differences, however, were not significant.CONCLUSION: It is concluded that in the guinea pigs with normal gallbladder function, and in the guinea pigs with cholesterol stones: (1) Cholecystectomy produce a similar but less marked trend in bile acid pool; and (2) MMC are linked to enterohepatic circulation of bile acids, rather than surgery, which is consistent with changes of the bile acid pool size. As a result, gastrointestinal dyskinesia is not involved in occurrence of postcholecystectomy syndrome.

  20. Modern issues on the treatment of peptic ulcer bleedings

    Directory of Open Access Journals (Sweden)

    Potakhin S.N.

    2014-03-01

    Full Text Available Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.

  1. Changes in bleeding patterns in von Willebrand disease after institution of long-term replacement therapy : results from the von Willebrand Disease Prophylaxis Network

    NARCIS (Netherlands)

    Holm, Elena; Abshire, Thomas C; Bowen, Joel; Álvarez, M Teresa; Bolton-Maggs, Paula; Carcao, Manuel; Federici, Augusto B; Gill, Joan Cox; Halimeh, Susan; Kempton, Christine; Key, Nigel S; Kouides, Peter; Lail, Alice; Landorph, Andrea; Leebeek, Frank; Makris, Michael; Mannucci, Pier; Mauser-Bunschoten, Eveline P; Nugent, Diane; Valentino, Leonard A; Winikoff, Rochelle; Berntorp, Erik

    2015-01-01

    Clinically, the leading symptom in von Willebrand disease (VWD) is bleeding, chiefly of mucosal type, for example, epistaxis, gingival, or gastrointestinal bleeding, and menorrhagia. In severe forms of VWD with secondary deficiency of factor VIII, spontaneous joint bleeding, resembling that observed

  2. Shedding of Clostridium difficile, fecal beta-lactamase activity, and gastrointestinal symptoms in 51 volunteers treated with oral cefixime.

    OpenAIRE

    Chachaty, E; Bourneix, C; Renard, S; Bonnay, M.; Andremont, A

    1993-01-01

    Microbial changes including the shedding of Clostridium difficile, fecal beta-lactamase activity, and gastrointestinal symptoms were assessed in 51 healthy volunteers given 200 mg of cefixime twice daily for 8 days. The number of organisms of the family Enterobacteriaceae (means +/- standard deviations) dropped from 6.9 +/- 1.1 to 3.9 +/- 1.8 log CFU/g of feces (P < 0.01), whereas counts of enterococci rose from 7.0 +/- 1.5 to 9.0 +/- 1.0 log CFU/g of feces (P < 0.01). Both counts returned to...

  3. Uso de fator VII recombinante ativado para tratamento e profilaxia de grandes sangramentos Use of recombinant activated factor VII for treatment and prophylaxis of major bleeding

    Directory of Open Access Journals (Sweden)

    Flávio Augusto Henriques Vince

    2009-09-01

    pacientes. Dessa forma, o recente aumento do uso de rFVIIa em situações ainda não aprovadas levou ao crescente questionamento sobre eficácia e segurança desta específica medicação em tais situações.INTRODUCTION: Recombinant activated factor VII (rFVIIa is a protein produced by genetic engineering, the structure is very similar to the structure of intrinsic activated factor VII (FVII. Its action is based on knowledge of the coagulation mechanism in vivo by acting in direct activation of factor X independent resulting in formation of thrombin at the injury site and thereby contributing to the formation of stable fibrin clots without the action of factor VIII and factor IX. METHODS: Was conducted extensive review of the literature in order to determine the new findings related to the use of recombinant activated factor VII in patients with severe bleeding. RESULTS: It was found that the use of rFVIIa started in the 80's for prophylaxis and treatment of bleeding in patients with a history of hemophilia A or B with inhibitors to factor VIII and IX, factor VII deficiency and Glanzmann's thrombasthenia refractory to replacement platelet. In 1999 its use was expanded to other clinical situations and thus began to be published several studies showing the efficacy of rFVIIa as a pro-hemostatic agent in patients with bleeding disorders or other previously healthy patients with a history of acute bleeding of major consequence. Trauma is the leading cause of mortality worldwide and uncontrolled bleeding the main challenge in caring for these patients. It is common for the association of trauma with coagulopathy, requiring in some cases specific therapy to treat it. At this point in adjuvant therapy with rFVIIa should be considered. Other common causes of bleeding are the heart, gynecologic/obstetric surgeries and diseases involving the liver. The coagulopathy in these cases is deficiency of factors dependent on vitamin K, and the FVII factor with smaller half life. CONCLUSION

  4. Oral High-Dose Ankaferd Administration Effects on Gastrointestinal System

    OpenAIRE

    Akbal, Erdem; Köklü, Seyfettin; Astarcı, Hesna Müzeyyen; Koçak, Erdem; Karaca, Gökhan; Beyazıt, Yavuz; Topcu, Güler; Acar, Bilgehan; Ergün, Dilek; Haznedaroğlu, İbrahim Celalettin

    2013-01-01

    Background and aims: Ankaferd Blood Stopper (ABS) is a herbal extract obtained from five different plants. It has a therapeutic potential for the management of external hemorrhage and controlling gastrointestinal bleeding. However, ABS's effects are not unknown on gastrointestinal systems. The aim of this study was to assess the effect of short- and long-term systemic exposure and gastrointestinal safety following the oral administration of high-dose ABS in rats. Methods: Eighteen healthy adu...

  5. Gastric variceal bleeding due to pancreatitis-induced splenic vein thrombosis.

    Science.gov (United States)

    Gotto, Antonio; Lieberman, Michael; Pochapin, Mark

    2014-03-24

    Obscure gastrointestinal bleeding is a common clinical scenario. In the upper gastrointestinal tract, gastric varices can be frequently overlooked on endoscopy, particularly if not suspected or volume depleted. We report a case of suspected gastrointestinal bleeding in a patient with a childhood history of pancreatitis, who also experienced severe epigastric pain while in hospital. After transfer to an academic medical centre, the presence of gastric varices was identified and presumed to be due to splenic vein thrombosis. Pancreatitis is the most common cause of splenic vein thrombosis and accords with the patient's history, even though it occurred many years previously. This case highlights the importance of recognising pancreatitis-induced splenic vein thrombosis as a possible aetiology for upper gastrointestinal bleeding.

  6. The use of hemospray in portal hypertensive bleeding; a case series.

    Science.gov (United States)

    Smith, L A; Morris, A J; Stanley, A J

    2014-02-01

    Hemospray is a haemostatic agent licensed for endoscopic haemostasis of non-variceal upper gastrointestinal bleeding (NVUGIB) in Europe and Canada. Hemospray has been shown to be safe and effective in achieving haemostasis in bleeding peptic ulcers in a prospective clinical study and several further case series have described the use of hemospray in other non-variceal causes of gastrointestinal bleeding. Portal hypertensive gastropathy and colopathy are common in patients with portal hypertension. As hemospray is an easy to apply, non-contact method, which can cover large areas of mucosa, it may be of benefit in acute non-variceal portal hypertensive bleeding. We present data from the first four consecutive patients presenting to our institution with acute haemorrhage secondary to non-variceal diffuse portal hypertensive bleeding treated with hemospray.

  7. Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

    Directory of Open Access Journals (Sweden)

    Ignacio Couto-Worner

    2013-09-01

    Full Text Available Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.

  8. Bleeding during Pregnancy

    Science.gov (United States)

    ... have placenta accreta, you are at risk of life-threatening blood loss during delivery. Your ob-gyn will plan your ... to be done right after delivery to prevent life-threatening blood loss. Can bleeding be a sign of preterm labor? ...

  9. High prevalence of ulcer bleeding risk factors in dual antiplatelet-treated patients after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Berit Elin S; Hansen, Jane M; Junker, Anders B;

    2015-01-01

    INTRODUCTION: Dual antiplatelet therapy is standard treatment following percutaneous coronary intervention (PCI) and stenting. However, such therapy increases the risk of upper gastrointestinal bleeding (UGIB). The risk factors of UGIB are well-documented and proton pump inhibitor (PPI) treatment...

  10. Application of double-balloon enteroscopy in jejunal diverticular bleeding

    Institute of Scientific and Technical Information of China (English)

    Tsung-Hsing; Chen; Cheng-Tang; Chiu; Chen-Ming; Hsu

    2010-01-01

    AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezi...

  11. Transcatheter arterial embolization in gastric cancer patients with acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Joo; Shin, Ji Hoon; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Song, Ho-Young; Sung, Kyu-Bo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea)

    2009-04-15

    The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure. (orig.)

  12. A rare case of splenic lymphoma in a patient with polymyositis manifesting as gastric variceal bleeding.

    Science.gov (United States)

    Parekh, Ravish; Walia, Sandeep; Zalawadia, Ashish; Siddiqui, Yousuf

    2015-04-01

    We report an unusual case of upper gastrointestinal bleeding due to isolated gastric variceal bleeding in a patient with splenomegaly who was subsequently diagnosed with diffuse large B-cell lymphoma. The patient is a 47-year-old male with a history of polymyositis who presented to the emergency room with complaints of lightheadedness and melena for 2 days. On initial presentation, the patient had positive orthostatic vital signs. He was found to be anemic with presenting hemoglobin of 5.8 g/dl (compared with 13.4 g/dl 4 months prior to presentation). The patient was aggressively resuscitated with intravenous fluid and blood transfusions. An emergency esophagogastroduodenoscopy was performed which showed isolated gastric varices in the fundus of the stomach, with no active bleeding or high-risk stigmata. Abdominal computed tomography revealed focal splenic vein thrombosis and splenomegaly with ill-defined hypodensities. Portal and superior mesenteric veins were patent. Mild edema was seen surrounding the spleen and non-specific abdominal lymphadenopathy was also reported. A surgical consultation recommended an urgent splenectomy. Pathology of the removed spleen revealed diffuse large B-cell lymphoma. Positron emission tomography-computed tomography revealed lymphomatous disease in the thorax, abdomen, pelvis and bone marrow. The patient was subsequently started on chemotherapy.

  13. Localization of lower gastrointestinal hemorrhage. Experience with red blood cells labeled in vitro with technetium Tc 99m

    International Nuclear Information System (INIS)

    Seventy-six patients clinically suspected of having lower gastrointestinal bleeding were studied by scintigraphy utilizing red blood cells labeled in vitro with technetium Tc 99m. Sixteen patients required emergency surgery; bleeding was accurately localized in 15 (94%). One patient (6%) had a normal scan. A 20-month mean follow-up of the 16 patients showed no recurrent bleeding. Of 60 patients not requiring emergency surgery, bleeding was localized in 11, but the bleeding ceased. Forty-nine of the 60 patients had normal scans and had no further hemorrhaging during hospitalization. A 21-month mean follow-up of 38 of the 49 patients showed no further bleeding episodes or surgical procedures in 29 patients; however, eight patients required surgical procedures, including seven for gastrointestinal malignancies. Scanning of red blood cells labeled in vitro with 99mTc is accurate and efficacious in localization of bleeding sites that require emergency surgery for lower gastrointestinal hemorrhage

  14. Antagonistic activities of some Bifidobacterium sp. strains isolated from resident infant gastrointestinal microbiota on Gram-negative enteric pathogens.

    Science.gov (United States)

    Delcaru, Cristina; Alexandru, Ionela; Podgoreanu, Paulina; Cristea, Violeta Corina; Bleotu, Coralia; Chifiriuc, Mariana Carmen; Bezirtzoglou, Eugenia; Lazar, Veronica

    2016-06-01

    The gastrointestinal microbiota contributes to the consolidation of the anti-infectious barrier against enteric pathogens. The purpose of this study was to investigate the influence of Bifidobacterium sp. strains, recently isolated from infant gastrointestinal microbiota on the in vitro growth and virulence features expression of enteropathogenic bacterial strains. The antibacterial activity of twelve Bifidobacterium sp. strains isolated from human feces was examined in vitro against a wide range of Gram negative pathogenic strains isolated from 30 infant patients (3 days to 5 years old) with diarrhea. Both potential probiotic strains (Bifidobacterium longum, Bifidobacterium pseudocatenulatum, Bifidobacterium catenulatum, Bifidobacterium breve, Bifidobacterium ruminantium) and enteropathogenic strains (EPEC, EIEC, Klebsiella pneumoniae, Salmonella sp., Yersinia enterocolitica, Pseudomonas aeruginosa) were identified by MALDI-TOF and confirmed serologically when needed. The bactericidal activity, growth curve, adherence to the cellular HEp-2 substratum and production of soluble virulence factors have been assessed in the presence of different Bifidobacterium sp. cultures and fractions (whole culture and free-cell supernatants). Among the twelve Bifidobacterium sp. strains, the largest spectrum of antimicrobial activity against 9 of the 18 enteropathogenic strains was revealed for a B. breve strain recently isolated from infant intestinal feces. The whole culture and free-cell supernatant of B. breve culture decreased the multiplication rate, shortened the log phase and the total duration of the growth curve, with an earlier entrance in the decline phase and inhibited the adherence capacity to a cellular substratum and the swimming/swarming motility too. These results indicate the significant probiotic potential of the B. breve strain. PMID:26921694

  15. Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods

    Science.gov (United States)

    Kataoka, Yosuke; Tsuji, Yosuke; Sakaguchi, Yoshiki; Minatsuki, Chihiro; Asada-Hirayama, Itsuko; Niimi, Keiko; Ono, Satoshi; Kodashima, Shinya; Yamamichi, Nobutake; Fujishiro, Mitsuhiro; Koike, Kazuhiko

    2016-01-01

    Endoscopic submucosal dissection (ESD) has become widely accepted as a standard method of treatment for superficial gastrointestinal neoplasms because it enables en block resection even for large lesions or fibrotic lesions with minimal invasiveness, and decreases the local recurrence rate. Moreover, specimens resected in an en block fashion enable accurate histological assessment. Taking these factors into consideration, ESD seems to be more advantageous than conventional endoscopic mucosal resection (EMR), but the associated risks of perioperative adverse events are higher than in EMR. Bleeding after ESD is the most frequent among these adverse events. Although post-ESD bleeding can be controlled by endoscopic hemostasis in most cases, it may lead to serious conditions including hemorrhagic shock. Even with preventive methods including administration of acid secretion inhibitors and preventive hemostasis, post-ESD bleeding cannot be completely prevented. In addition high-risk cases for post-ESD bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing. Although there have been many reports about associated risk factors and methods of preventing post-ESD bleeding, many issues remain unsolved. Therefore, in this review, we have overviewed risk factors and methods of preventing post-ESD bleeding from previous studies. Endoscopists should have sufficient knowledge of these risk factors and preventive methods when performing ESD.

  16. The DREAM complex in anti-tumor activity of imatinib mesylate in gastrointestinal stromal tumors (GISTs)

    Science.gov (United States)

    DeCaprio, James A.; Duensing, Anette

    2014-01-01

    Purpose of review Although most gastrointestinal stromal tumors (GISTs) respond well to treatment with the small molecule kinase inhibitor imatinib mesylate (Gleevec), the majority of patients achieve disease stabilization and complete remissions are rare. Furthermore, discontinuation of treatment in the presence of residual tumor mass almost inevitably leads to tumor progression. These observations suggest that a subset of tumor cells not only persists under imatinib treatment, but remains viable. The current article reviews the molecular basis for these findings and explores strategies to exploit them therapeutically. Recent findings Although imatinib can induce apoptosis in a subset of GIST cells, it can induce a reversible exit from the cell division cycle and entry into G0, a cell cycle state called quiescence, in the remaining cells. Mechanistically, this process involves the DREAM complex, a newly identified key regulator of quiescence. Interfering with DREAM complex formation either by siRNA-mediated knockdown or by pharmacological inhibition of the regulatory kinase DYRK1A was shown to enhance imatinib-induced GIST cell death. Summary Targeting the DREAM complex and imatinib-induced quiescence could provide opportunities for future therapeutic interventions toward more efficient imatinib responses. PMID:24840522

  17. Activity of luxabendazole against liver flukes, gastrointestinal roundworms, and lungworms in naturally infected sheep.

    Science.gov (United States)

    Kassai, T; Takáts, C; Fok, E; Redl, P

    1988-01-01

    The anthelmintic potential of luxabendazole was investigated in sheep harboring mixed naturally acquired helminth infections. Results were assessed by comparing worm counts of the treated groups (seven animals each) on days 7-8 posttreatment with those of the nontreated control group, except for protostrongylid lungworms, for which the changes in pre- and posttreatment group mean larval counts/g feces were assessed for intensity effect. A single oral treatment at doses of 10.0 or 12.5 mg/kg body wt removed 97.6% of the adult Fasciola hepatica and 63.2%-83.8% of the Dicrocoelium dendriticum. Luxabendazole at 7.5, 10.0, and 12.5 mg/kg proved 100% effective in removing adult worms of the genera Haemonchus, Ostertagia, Trichostrongylus, Cooperia and Nematodirus as well as tissue-associated larval stages of gastrointestinal nematodes of the abomasal mucosa. The drug showed an intensity effect of 79.7%-87.6% against Strongyloides papillosus. Luxabendazole removed all Dictyocaulus filaria and reduced the fecal excretion of larvae of protostrongylid species (Protostrongylus rufescens, Neostrongylus linearis, Cystocaulus ocreatus, Muellerius capillaris) by 97.8%-99.6%. The efficacy of luxabendazole compared favorably with that of Diplin Kombi (oxyclozanide and levamisole), which was used as a reference drug.

  18. 麒麟心痛舒对非ST段抬高型急性冠脉综合征合并消化道出血患者的疗效观察%An observation on therapeutic effect of Qilin Xintongshu pill for treatment of patients with non-ST segment elevation acute coronary syndromes accompanied by gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    李景君; 孙红娟; 陶愈婷; 王国蕾; 黄积存; 李亮; 苏会钦

    2014-01-01

    Objective To observe the therapeutic effect of Qilin Xintongshu pill for treatment of patients with non-ST segment elevation acute coronary syndromes(NSTE-ACS)accompanied by gastrointestinal bleeding (GIB). Methods A prospective randomized controlled trial was conducted. A total of 67 hospitalized patients in Cardiovascular Department of Qionghai City Hospital of Traditional Chinese Medicine were divided into therapy group(35 cases)and control group(32 cases). Both groups were given conventional medical treatment(except anti-coagulative agent). In the therapy group,the patients received Qilin Xintongshu pill(the ingredients consisting of panax pseudo-ginsen,dragon's blood,immature orange fruit,etc.)oral administration,once 5 mg and 3 times a day,while in the control group,the patients accepted clopidogrel orally,once 75 g and once a day,the therapeutic course in both groups being 30 days. The major cardiovascular events(such as death,a newly-happened myocardial infarction(MI),MI secondary,obstinately ischemia)and incidence of massive hemorrhage of gastrointestinal tract were compared between the two groups,and the adverse events were observed. Results After treatment,the incidence of cardiovascular events and massive hemorrhage of gastrointestinal tract in the therapy group were decreased significantly compared to those in the control group 〔incidence of cardiovascular events:8.57%(3/35)vs. 28.13%(9/32), incidence of massive hemorrhage of gastrointestinal tract:2.86%(1/35)vs. 21.88%(7/32),both P<0.05〕. Adverse events were not observed in both groups,and the examinations of blood,urine,liver and renal functions were of no abnormalities before and after treatment. Conclusion Qilin Xintongshu pill can effectively reduce the incidences of cardiovascular events and massive hemorrhage of gastrointestinal tract in patients with NSTE-ACS accompanied by GIB in the therapeutic course of 30 days,therefore this traditional Chinese herbal medicine is an ideal agent for

  19. Investigating obscure gastrointestinal bleeding : capsule endoscopy or double balloon enteroscopy?

    NARCIS (Netherlands)

    Westerhof, J.; Weersma, R. K.; Koornstra, J. J.

    2009-01-01

    The possibility to visualise the small bowel has dramatically improved with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). CE and DBE have become standard practice in investigating suspected diseases of the small bowel. An important reason to perform small bowel inv

  20. Is tranexamic acid effective for acute upper gastrointestinal bleeding?

    Directory of Open Access Journals (Sweden)

    Sebastián Flores

    2015-12-01

    Full Text Available La hemorragia digestiva alta corresponde a una emergencia médico-quirúrgica debido a la alta morbilidad y mortalidad que conlleva. El ácido tranexámico, un antifibrinolítico, podría ayudar a lograr un control precoz del sangrado, sin embargo existe controversia sobre su real utilidad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cinco revisiones sistemáticas que en conjunto incluyen ocho estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el ácido tranexámico probablemente disminuye el resangrado y la mortalidad, y no aumenta los efectos adversos tromboembólicos en pacientes con hemorragia digestiva alta.

  1. Systematic review: tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Klingenberg, S.L.; Langholz, S.E.; Gluud, Lise Lotte

    2008-01-01

    were unclearly reported. Data from three of the included trials suggested that tranexamic acid did not significantly increase the risk of thromboembolic disease. CONCLUSIONS: The present review suggests that tranexamic acid may reduce all-cause mortality. However, because of limitations in the internal...

  2. Is tranexamic acid effective for acute upper gastrointestinal bleeding?

    OpenAIRE

    Sebastián Flores; Carolina Avilés; Gabriel Rada

    2015-01-01

    La hemorragia digestiva alta corresponde a una emergencia médico-quirúrgica debido a la alta morbilidad y mortalidad que conlleva. El ácido tranexámico, un antifibrinolítico, podría ayudar a lograr un control precoz del sangrado, sin embargo existe controversia sobre su real utilidad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cinco revisiones sistemáticas que en conjunto incluyen ocho estudios aleatorizados. Realizam...

  3. Upper gastrointestinal bleeding risk scores: Who, when andwhy?

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Gastric cancer (GC) is one of the most common carcinomaand the second leading cause of cancer-relateddeaths worldwide. Helicobacter pylori (H. pylori ) infectioncauses a series of precancerous lesions like gastritis,atrophy, intestinal metaplasia and dysplasia, and is thestrongest known risk factor for GC, as supported byepidemiological, preclinical and clinical studies. However,the mechanism of H. pylori developing gastric carcinomahas not been well defined. Among infected individuals,approximately 10% develop severe gastric lesions suchas peptic ulcer disease, 1%-3% progresses to GC.The outcomes of H. pylori infection are determined bybacterial virulence, genetic polymorphism of hosts aswell as environmental factors. It is important to gainfurther understanding of the pathogenesis of H. pyloriinfection for developing more effective treatments forthis common but deadly malignancy. The recent findingson the bacterial virulence factors, effects of H. pylorion epithelial cells, genetic polymorphism of both thebacterium and its host, and the environmental factorsfor GC are discussed with focus on the role of H. pyloriin gastric carcinogenesis in this review.

  4. Story: A Bleeding Watermelon

    Directory of Open Access Journals (Sweden)

    Nor bzang

    2010-12-01

    Full Text Available A Bleeding Watermelon was written by Norsang (Nor bzang;b. 1988, a native of Dpa ris (Rab rgyas (Huazangsi 华藏寺 Township, Tianzhu 天祝 Tibetan Autonomous County,Gansu 甘肃 Province. Norsang writes: I heard that a university student opened an elevator door in a campus building still under construction. The elevator shaft was empty and he fell to his death. Many people had questions about his death. This inspired me to write this story.

  5. Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding

    Institute of Scientific and Technical Information of China (English)

    Ahmet Karaman; Mevlut Baskol; Sebnem Gursoy; Edip Torun; Alper Yurci; Banu Demet Ozel; Kadri Guven; Omer Ozbakir; Mehmet Yucesoy

    2011-01-01

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

  6. Laparoscopic resection of bleeding gastric polyps.

    Science.gov (United States)

    Siu, W T; Leong, H T; Li, M K

    1997-03-01

    Gastric polyps account for a small proportion of gastric neoplasms. Many of them presented with acute or chronic bleeding. Endoscopic polypectomy is the preferred treatment modality. However, endoscopic polypectomy is often incomplete and impossible for large polyps. Large and intramural polyps require laparotomy and excision. From June to October 1995, four patients with bleeding gastric polyps received laparoscopic resection in our unit. All were women, aged 40-78, with polyps 2-6 cm in diameter. One patient underwent emergency surgery for active bleeding. The others received elective operations. Operating time ranged from 90 to 120 min. There was no perioperative morbidity or mortality. Full diet was resumed by the 4th postoperative day. The average postoperative hospital stay was 5. 3 days (4-7). Laparoscopic resection of gastric polyp is a preferable treatment option when endoscopic treatment fails.

  7. Effects of dates pulp extract and palm sap (Phoenix dactylifera L.) on gastrointestinal transit activity in healthy rats.

    Science.gov (United States)

    Souli, Abdellaziz; Sebai, Hichem; Rtibi, Kaïs; Chehimi, Latifa; Sakly, Mohsen; Amri, Mohamed; El-Benna, Jamel

    2014-07-01

    The current study was performed to measure the chemical composition and the effects of dates pulp extract and palm sap on gastrointestinal transit (GIT) activity in healthy adult rats. In this respect, male Wistar rats fasted for 24 hours were used and received per orally (p.o.) sodium chloride (NaCl) (0,9%) (control group) or various doses of dates pulp extract (150 and 300 mg/kg, body weight [b.w.]) and palm sap (0.4 and 4 mL/kg, b.w.). Two other groups of rats (batch tests) received, respectively, clonidine (an alpha-2 adrenergic agonist, 1 mg/kg, b.w.) and yohimbine (an alpha-2 adrenergic antagonist, 2mg/kg, b.w.). Chemical analysis showed that the dates pulp extract is more rich in sugars and minerals, especially potassium and sucrose, as compared with palm sap composition. On the other hand, in vivo study showed that the aqueous dates pulp extract significantly, and dose dependently, increased the GIT activity while the palm sap slightly increased it. Moreover, a converse effect has been observed using clonidine (decreased 68%) and yohimbine (increased 33%) on the GIT activity. These findings suggest that dates pulp extract and palm sap have a stimulating effect on GIT activity in rats and confirm their use in traditional Tunisian medicine for the treatment of constipation.

  8. Phytase transgenic corn in nutrition of laying hens: residual phytase activity and phytate phosphorus content in the gastrointestinal tract.

    Science.gov (United States)

    Gao, C Q; Ji, C; Zhao, L H; Zhang, J Y; Ma, Q G

    2013-11-01

    The residual activities of transgenic corn-derived and 2 commercial microbial phytases (PA and PB) along the gastrointestinal tract (GIT) of laying hens were compared to evaluate their relative resistance to hydrolysis in the GIT when added to P-deficient diets. The treatments consisted of a negative control (NC) diet containing 0.10 nonphytate P and an NC diet supplemented with transgenic corn-derived phytase (TCDP), PA, and PB at 500 to 5,000 FTU/kg of diet, respectively. Seven diets were fed to Hy-Line Brown laying hens (n = 504; 8 replicates of 9 hens per treatment) for 21 d. At the end of the experiment, the hens were killed and digesta samples from the crop, proventriculus and gizzard, jejunum, and ileum were collected and analyzed for residual phytase activities and phytate P content. Phytase activity in the transgenic corn was determined to be 8,980 FTU/kg of DM. The residual phytase activities along the GIT had increased (P corn is as efficacious as the commercial microbial phytases (PA and PB) in P-deficient diets for the improvement of phytate P digestibility, which would eliminate the need for supplemental phytase and corn separately in laying hen diets.

  9. Ovicidal and larvicidal activity of extracts of Opuntia ficus-indica against gastrointestinal nematodes of naturally infected sheep.

    Science.gov (United States)

    Féboli, Aline; Laurentiz, Antonio C; Soares, Suelen C S; Augusto, Jeferson G; Anjos, Luciano A; Magalhães, Lizandra G; Filardi, Rosemeire S; Laurentiz, Rosangela S

    2016-08-15

    This study describes the in vitro anthelmintic activity of extracts from Opuntia ficus indica against gastrointestinal nematodes of sheep. The anthelmintic activity was evaluated by inhibition of egg hatching, larval development and larval migration assays. The residual aqueous fractions from cladodes and fruits showed higher ovicidal activity with EC50 values of 7.2mg/mL and 1.5mg/mL, respectively. The aqueous, hexane, and ethyl acetate fractions from fruits and the aqueous fraction from cladodes inhibited 100% of larval development at the lowest concentration tested (1.56mg/mL). The crude cladode and fruit ethanolic extracts inhibited larval migration and showed EC50 values of 0.74mg/mL and 0.27mg/mL, respectively. Phytochemical screening detected high concentrations of alkaloids, tannins, flavonoids, and saponins in the fruits and cladodes. The results demonstrated that O. ficus exhibits anthelmintic activity in vitro, suggesting that, beyond its nutritional potential, this plant can also be an ally for parasite control in sheep.

  10. Ovicidal and larvicidal activity of extracts of Opuntia ficus-indica against gastrointestinal nematodes of naturally infected sheep.

    Science.gov (United States)

    Féboli, Aline; Laurentiz, Antonio C; Soares, Suelen C S; Augusto, Jeferson G; Anjos, Luciano A; Magalhães, Lizandra G; Filardi, Rosemeire S; Laurentiz, Rosangela S

    2016-08-15

    This study describes the in vitro anthelmintic activity of extracts from Opuntia ficus indica against gastrointestinal nematodes of sheep. The anthelmintic activity was evaluated by inhibition of egg hatching, larval development and larval migration assays. The residual aqueous fractions from cladodes and fruits showed higher ovicidal activity with EC50 values of 7.2mg/mL and 1.5mg/mL, respectively. The aqueous, hexane, and ethyl acetate fractions from fruits and the aqueous fraction from cladodes inhibited 100% of larval development at the lowest concentration tested (1.56mg/mL). The crude cladode and fruit ethanolic extracts inhibited larval migration and showed EC50 values of 0.74mg/mL and 0.27mg/mL, respectively. Phytochemical screening detected high concentrations of alkaloids, tannins, flavonoids, and saponins in the fruits and cladodes. The results demonstrated that O. ficus exhibits anthelmintic activity in vitro, suggesting that, beyond its nutritional potential, this plant can also be an ally for parasite control in sheep. PMID:27514886

  11. Splenic artery embolization for the treatment of bleeding gastric varices secondary to splenic vein thrombosis.

    Science.gov (United States)

    Stone, Patrick A; Phang, David; Richmond, Bryan; Gill, Gurpreet; Campbell, John E

    2014-04-01

    Splenic vein thrombosis can lead to gastric varices. Subsequent upper gastrointestinal bleeding may ensue related to the change in venous outflow to the portal system. Vascular surgeons are infrequently asked to assist in the management of this entity. However, with many vascular surgeons providing diverse endovascular-based interventions, understanding catheter-based solutions is imperative. This report presents a case in which arterial embolization was used to treat gastric variceal bleeding.

  12. Endoscopic treatment of gastric varices bleeding with the use of n-butyl-2 cyanoacrylate

    OpenAIRE

    Kozieł, Sławomir; Kobryń, Konrad; Paluszkiewicz, Rafał; Krawczyk, Marek; Wróblewski, Tadeusz

    2015-01-01

    Introduction Oesophageal varices and gastric varices are naturally-formed, pathological portosystemic shunts that occur in patients with portal hypertension. Gastric varices are responsible for about 10% of variceal bleeding; however, they are also the cause of massive haemorrhage, often with dramatic progress. Aim To assess the results of endoscopic treatment of gastrointestinal bleeding from oesophageal and gastric varices using tissue glue Histoacryl. Material and methods From January 2013...

  13. Abnormal uterine bleeding.

    Science.gov (United States)

    Whitaker, Lucy; Critchley, Hilary O D

    2016-07-01

    Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. A structured approach for establishing the cause using the Fédération International de Gynécologie et d'Obstétrique (FIGO) PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system will facilitate accurate diagnosis and inform treatment options. Office hysteroscopy and increasing sophisticated imaging will assist provision of robust evidence for the underlying cause. Increased availability of medical options has expanded the choice for women and many will no longer need to recourse to potentially complicated surgery. Treatment must remain individualised and encompass the impact of pressure symptoms, desire for retention of fertility and contraceptive needs, as well as address the management of AUB in order to achieve improved quality of life. PMID:26803558

  14. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Arpad; Ivanecz; Marko; Sremec; Davorin; ?erani?; Stojan; Potr?; Pavel; Skok

    2014-01-01

    Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidenceof bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.

  15. The Role of Emergency Endoscopy in Small Bowel Bleeding: A Review

    Directory of Open Access Journals (Sweden)

    Enrique Pérez-Cuadrado-Robles

    2016-03-01

    Full Text Available There is no consensus on the timing and management of emergency overt obscure gastrointestinal bleeding. Emergency capsule endoscopy and balloon-assisted enteroscopy have a high diagnostic and therapeutic yield in these situations. Most lesions detected by small bowel endoscopy are amenable to endoscopic haemostasis, although some lesions still require surgery or interventional radiology. The management of these patients is varied, and doubt persists about which technique should be preferred as first-line treatment. This narrative review analyses the usefulness and impact of small bowel endoscopic techniques in the emergency setting for severe overt obscure gastrointestinal bleeding.

  16. Treatment of iron deficiency anemia associated with gastrointestinal tract diseases

    Institute of Scientific and Technical Information of China (English)

    Ulas; D; Bayraktar; Soley; Bayraktar

    2010-01-01

    The gastrointestinal (GI) tract is a common site of bleeding that may lead to iron deficiency anemia (IDA). Treatment of IDA depends on severity and acuity of patients’ signs and symptoms. While red blood cell transfusions may be required in hemodynamically unstable patients, transfusions should be avoided in chronically anemic patients due to their potential side effects and cost. Iron studies need to be performed after episodes of GI bleeding and stores need to be replenished before anemia develops. Oral ...

  17. Periampullary Dieulafoy’s Lesion: An Unusual Cause of Ga strointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Surinder S Rana

    2010-05-01

    Full Text Available Context Dieulafoy’s lesion is an unusual cause of gastrointestinal bleeding with the most common location being the stomach. A periampullary location is rare for a bleeding Dieulafoy’s lesion. Case report We present the case of a 52-year-old female who presented with intermittent painless melena. Her upper gastrointestinal endoscopy and colonoscopy were normal. She was a diagnostic challenge as no definite lesion could be identified on capsule endoscopy. However, as there was presence of fresh blood in the proximal jejunum, a push enteroscopy was performed which revealed the presence of fresh blood in the duodenum and proximal jejunum. But no bleeding lesion could be identified. A side view endoscopy was performed which revealed a bleeding periampullary Dieulafoy’s lesion. Immediate hemostasis was achieved with an injection of adrenalin. Other episodes of bleeding occurred and the patient was finally treated surgically. Conclusion A periampullary Dieulafoy’s lesion presenting with obscure gastrointestinal bleed is a diagnostic challenge and can be missed on capsule endoscopy.

  18. Shedding of Clostridium difficile, fecal beta-lactamase activity, and gastrointestinal symptoms in 51 volunteers treated with oral cefixime.

    Science.gov (United States)

    Chachaty, E; Bourneix, C; Renard, S; Bonnay, M; Andremont, A

    1993-07-01

    Microbial changes including the shedding of Clostridium difficile, fecal beta-lactamase activity, and gastrointestinal symptoms were assessed in 51 healthy volunteers given 200 mg of cefixime twice daily for 8 days. The number of organisms of the family Enterobacteriaceae (means +/- standard deviations) dropped from 6.9 +/- 1.1 to 3.9 +/- 1.8 log CFU/g of feces (P < 0.01), whereas counts of enterococci rose from 7.0 +/- 1.5 to 9.0 +/- 1.0 log CFU/g of feces (P < 0.01). Both counts returned to their initial levels 50 days after the cessation of treatment. Cefixime did not significantly modify the frequency of fecal excretion of Pseudomonas aeruginosa, Staphylococcus spp., yeasts, or members of the Enterobacteriaceae resistant to ceftazidime or ampicillin. The proportion of subjects shedding C. difficile rose from 6% before treatment to 57% (P < 0.01) at the end of treatment but returned to 8% 50 days thereafter. No case of pseudomembranous colitis was observed. Stool changes occurred in 13 volunteers during treatment (25%) and in 2 others more than 10 days after the end of treatment (4%). These changes were not significantly associated with the shedding of toxigenic strains of C. difficile or with the presence of toxin A in feces. By contrast, during treatment, stool changes occurred in 8 of the 18 volunteers (44%) who had antibiotic activity in their feces but in only 5 of the 33 (15%) for whom no such activity was found (P < 0.05). The absence of antibiotic activity in the feces was itself linked with the presence of beta-lactamase activity in the feces. Since we had found earlier that fecal beta-lactamase activity afforded protection against alteration in stool consistency during treatments with oral cephalosporins, the present study confirmed our previous preliminary results in this respect. PMID:8363371

  19. Coronary interventions in patients with bleeding and bleeding tendency

    Institute of Scientific and Technical Information of China (English)

    Thach Nguyen; Lan Nguyen

    2007-01-01

    @@ In general, percutaneous coronary intervention (PCI)is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thrombotic formation caused by introduction and manipulation of devices in the vascular system.

  20. Use of whole gut perfusion to investigate gastrointestinal blood loss in patients with iron deficiency anaemia.

    OpenAIRE

    Ferguson, A; Brydon, W G; Brian, H; Williams, A.; Mackie, M J

    1996-01-01

    Iron deficiency anaemia may be due to occult bleeding into the gut. However, although clinical investigations may show a high frequency of gastrointestinal tract disease in these patients, the cause-effect relationship between the lesions detected and anaemia remain uncertain. This study aimed to establish whether lesions detected by endoscopy or imaging of the gastrointestinal tract in patients with unexplained iron deficiency anaemia are bleeding continuously. Routine clinical tests were pe...

  1. Gastrointestinal motility and functional gastrointestinal diseases.

    Science.gov (United States)

    Kusano, Motoyasu; Hosaka, Hiroko; Kawada, Akiyo; Kuribayashi, Shiko; Shimoyama, Yasuyuki; Zai, Hiroaki; Kawamura, Osamu; Yamada, Masanobu

    2014-01-01

    Digestive tract motility patterns are closely related to the pathophysiology of functional gastrointestinal diseases (FGID), and these patterns differ markedly between the interdigestive period and the postprandial period. The characteristic motility pattern in the interdigestive period is so-called interdigestive migrating contraction (IMC). IMCs have a housekeeping role in the intestinal tract, and could also be related to FGID. IMCs arising from the stomach are called gastrointestinal IMCs (GI-IMC), while IMCs arising from the duodenum without associated gastric contractions are called intestinal IMCs (I-IMC). It is thought that I-IMCs are abnormal in FGID. Transport of food residue to the duodenum via gastric emptying is one of the most important postprandial functions of the stomach. In patients with functional dyspepsia (FD), abnormal gastric emptying is a possible mechanism of gastric dysfunction. Accordingly, delayed gastric emptying has attracted attention, with prokinetic agents and herbal medicines often being administered in Japan to accelerate gastric emptying in patients who have anorexia associated with dyspepsia. Recently, we found that addition of monosodium L-glutamate (MSG) to a high-calorie liquid diet rich in casein promoted gastric emptying in healthy men. Therefore, another potential method of improving delayed gastric emptying could be activation of chemosensors that stimulate the autonomic nervous system of the gastrointestinal tract, suggesting a role for MSG in the management of delayed gastric emptying in patients with FD.

  2. Stem cell factor-mediated wild-type KIT receptor activation is critical for gastrointestinal stromal tumor cell growth

    Institute of Scientific and Technical Information of China (English)

    Chen-Guang Bai; Xiao-Wei Hou; Feng Wang; Cen Qiu; Yan Zhu; Ling Huang; Jing Zhao

    2012-01-01

    AIM:To clarify the biological role of stem cell factor (SCF)-mediated wild-type KIT receptor activation in gastrointestinal stromal tumor (GIST) growth.METHODS:The co-expression of wild-type KIT receptor and SCF was evaluated in 51 GIST samples using mutation analysis and immunohistochemistry,and the results were correlated with clinicopathological parameters,including the mitotic count,proliferative index (Ki-67 immunohistochemical staining),mitotic index (phospho-histone H3 immunohistochemical staining)and apoptotic index (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling).Using primary cultured GIST cells,the effect of SCF-mediated wild-type KIT receptor activation was determined by western blotting,methyl thiazolyl tetrazolium (MTT),and apoptosis assays.RESULTS:We found that wild-type KIT receptor and SCF protein were expressed in 100% and 76.5% of the 51 GIST samples,respectively,and the co-expression of wild-type KIT receptor and SCF was associated with known indicators of poor prognosis,including larger tumor size (P =0.0118),higher mitotic count (P =0.0058),higher proliferative index (P =0.0012),higher mitotic index (P =0.0282),lower apoptosis index (P =0.0484),and increased National Institutes of Health risk level (P =0.0012).We also found that the introduction of exogenous SCF potently increased KIT kinase activity,stimulated cell proliferation (P < 0.01) and inhibited apoptosis (P < 0.01) induced by serum starvation,while a KIT immunoblocking antibody suppressed proliferation (P =0.01) and promoted apoptosis (P < 0.01)in cultured GIST cells.CONCLUSION:SCF-mediated wild-type KIT receptor activation plays an important role in GIST cell growth.The inhibition of SCF-mediated wild-type KIT receptor activation may prove to be particularly important for GIST therapy.

  3. Heterotopic pancreas in the gastrointestinal tract

    OpenAIRE

    Yuan, Zhou; Chen, Jie; Zheng, Qi; Huang, Xin-yu; Yang, Zhe; Tang, Juan

    2009-01-01

    Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 60-year-old man with carcinoid syndrome caused by heterotopic pancreatic tissue in the duodenum is described, along...

  4. Presacral retroperitoneal hematoma after blunt trauma presents with rectal bleeding - A case report

    DEFF Research Database (Denmark)

    Dich, Sanne Jensen; El-Hussuna, Alaa Abdul-Hussein Hmood

    2016-01-01

    INTRODUCTION: We present a case of a presacral hematoma, which penetrated into the rectum resulting in rectal bleeding. This is an unusual presentation of a presacral hematoma. PRESENTATION OF THE CASE: A 76-year-old woman, using warfarin anticoagulant prophylaxis, presented with a rectal bleed t......: Rectal bleed after trauma, in a patient receiving anticoagulant treatment, should raise suspicion of a penetrating hematoma, and such patients should be managed at highly specialized facilities....... in the gastrointestinal tract. In this report the patient's anticoagulant treatment has likely contributed to bleeding and the formation of the hematoma. To our knowledge, this is the first case report of a presacral hematoma acutely penetrating into the rectum and causing lower gastrointestinal bleeding. CONCLUSION......INTRODUCTION: We present a case of a presacral hematoma, which penetrated into the rectum resulting in rectal bleeding. This is an unusual presentation of a presacral hematoma. PRESENTATION OF THE CASE: A 76-year-old woman, using warfarin anticoagulant prophylaxis, presented with a rectal bleed two...

  5. In vitro anthelmintic activity of the Zizyphus joazeiro bark against gastrointestinal nematodes of goats and its cytotoxicity on Vero cells.

    Science.gov (United States)

    Gomes, Danilo Cavalcanti; de Lima, Hélimar Gonçalves; Vaz, Ariádne Vieira; Santos, Nathália Silva; Santos, Francianne Oliveira; Dias, Êuder Reis; Botura, Mariana Borges; Branco, Alexsandro; Batatinha, Maria José Moreira

    2016-08-15

    This study examined the in vitro effect of the Zizyphus joazeiro bark against gastrointestinal nematodes of goats and its cytotoxicity on Vero cells. The ovicidal activity of the crude hydroethanolic extract (CE), its partitioned hexane (HE) and aqueous extract (AE) and saponins fraction (SF), including betulinic acid (BA), a biogenetic compound from this plant found in HE, were investigated using the inhibition of egg hatch assay (EHA). Thereafter, the extracts and the SF were evaluated through the larval motility assay (LMA) and larval migration inhibition assay (LMIA). The AE and SF promoted a complete inhibition of the egg hatch, and the effective concentration to inhibit 50% (EC50) values was 1.9 and 1.3mg/mL, respectively. The highest percentages of inhibition in EHA observed after treatments with CE, HE and BA corresponded to 79, 48 and 17%, respectively. The extracts and SF did not show larvicidal activity in LMA and LMIA. The AE and SF demonstrated cytotoxic effects in 3-4,5-dimethylthiazol-2-yl, 2,5diphenyltetrazolium bromide (MTT) and trypan blue tests; however, SF was more toxic (50% inhibitory concentration, IC50=0.20mg/mL). The chemical characterization of the SF was made through Proton Nuclear Magnetic Resonance ((1)H NMR) and Electrospray Ionization Mass Spectrometry (ESI-MS) analyses, which led to the identification of two saponins known as Joazeiroside B and Lotoside A. The results obtained from the research of this saponin content provide important information about the biological activity, especially the anthelmintic effect present in the plant investigated. That also suggests the types of bioactive compounds that may be responsible for this antiparasitic activity exhibited by the plant extracts. PMID:27514875

  6. In vitro ovicidal and larvicidal activity of condensed tannins on gastrointestinal nematode infestations in sheep (Ovis aries

    Directory of Open Access Journals (Sweden)

    Eidi Yoshihara

    2014-12-01

    Full Text Available Infestations of gastrointestinal parasitic nematodes in sheep result in significant costs to farmers. These infestations are controlled using synthetic anthelmintic treatments, which can result in the development of anthelmintic resistance in nematodes. The use of plants rich in condensed tannins (CTs is a promising alternative for controlling infestations of harmful parasites in sheep, and could allow reduction of the chemical products used. This study investigated the in vitro effect of CTs from Acacia mearnsii extract (AE on egg hatching and motility of third-stage larvae. Egg-hatching rate was measured after incubation with extracts for 48 h at 27 °C. The egg hatch test was performed with dilutions of 0.09, 0.19, 0.39, 0.78, 1.56, 3.12, 6.25, 12.5, 25, 50, and 100 mg mL-1. Distilled water was used as the negative control. The corresponding egg hatching inhibition percentages were 22.3, 32.3, 39.2, 49.1, 56.7, 59.0, 62.3, 77.3, 92.7, 98.3, and 100%. The concentration required to inhibit egg hatching in 50% of eggs (LC50 was 2.85 mg mL-1. The inhibition achieved with the negative control was 7.06%. A larval migration inhibition test was carried out after incubation with the extracts for 48 h at 27 oC, with AE and distilled water used in dilutions of 3.12, 6.25, 12.5, 25, 50, and 100 mg mL-1. The corresponding percentages of migration inhibition were 16.5, 37.0, 56.3, 79.4, 91.8, and 97.1%. The concentration required to inhibit migration of 50% of larvae (LC50 was 12.45 mg mL-1. The inhibition achieved with the negative control was 8.53%. The in vitro ovicidal and larvicidal activity of CTs from AE indicate the anthelmintic effect of AE, suggesting the potential of CT extracts to be used as alternatives for controlling gastrointestinal nematode infestations in small ruminants.

  7. Functional role of the Ca2+-activated Cl− channel DOG1/TMEM16A in gastrointestinal stromal tumor cells

    International Nuclear Information System (INIS)

    DOG1, a Ca2+-activated Cl− channel (CaCC), was identified in 2004 to be robustly expressed in gastrointestinal stromal tumors (GIST). It was rapidly included as a tumor marker in routine diagnostics, but the functional role remained unknown. CaCCs are important regulators of normal physiological functions, but also implicated in tumorigenesis, cancer progression, metastasis, cell migration, apoptosis, proliferation and viability in several malignancies. We therefore investigated whether DOG1 plays a role in the three latter in GIST by utilizing in vitro cell model systems. Confocal microscopy identified different subcellular localizations of DOG1 in imatinib-sensitive and imatinib-resistant cells. Electrophysiological studies confirmed that DOG1-specific pharmacological agents possess potent activating and inhibiting properties. Proliferation assays showed small effects up to 72 h, and flow cytometric analysis of adherent cells with 7-AAD/Annexin V detected no pharmacological effects on viable GIST cells. However, inhibition of DOG1 conveyed pro-apoptotic effects among early apoptotic imatinib-resistant cells. In conclusion, DOG1 generates Cl− currents in GIST that can be regulated pharmacologically, with small effects on cell viability and proliferation in vitro. Inhibition of DOG1 might act pro-apoptotic on some early apoptotic GIST cell populations. Further studies are warranted to fully illuminate the function of DOG1 and its potential as therapeutic target. - Highlights: • Subcellular DOG1 localization varies between GIST cells. • DOG1 in GIST is voltage- and Ca2+-activated. • Known TMEM16A modulators, like A01 and Eact, modulate DOG1. • DOG1 has small effects on cell viability and proliferation in vitro. • DOG1 impact early apoptotic GIST cells to undergo late apoptosis

  8. Vitamin K deficiency bleeding of the newborn

    Science.gov (United States)

    Vitamin K deficiency bleeding of the newborn (VKDB) is a bleeding disorder in babies. It most often ... A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting. Babies often ...

  9. Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

    Energy Technology Data Exchange (ETDEWEB)

    So, Young Ho; Choi, Young Ho [Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Song, Soon Young [Hanyang University Hospital, Seoul (Korea, Republic of)

    2012-01-15

    The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; {+-} 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

  10. GASTROINTESTINAL STROMAL TUMOR (GIST

    Directory of Open Access Journals (Sweden)

    Luigi eTornillo

    2014-11-01

    Full Text Available Gastrointestinal stromal tumors are the most frequent mesenchymal tumors of the gastrointestinal tract. The discovery that these tumors, formerly thought of smooth muscle origin, are indeed better characterized by specific activating mutation in genes coding for the receptor tyrosine kinases CKIT and PDGFRA and that these mutations are strongly predictive for the response to targeted therapy with receptor tyrosine kinase inhibitors has made GISTs the typical example of the integration of basic molecular knowledge in the daily clinical activity. The information on the mutational status of these tumors is essential to predict (and subsequently to plan the therapy. As resistant cases are frequently wild-type, other possible oncogenic events, defining other entities, have been discovered (e.g. succinil dehydrogenase mutation/dysregulation, insuline growth factor expression, mutations in the RAS-RAF-MAPK pathway. The classification of disease must nowadays rely on the integration of the clinico-morphological characteristics with the molecular data.

  11. Clinical analysis of capsule endoscopy nine cases of unexplained gastrointestinal bleeding stranded stomach, small intestine%胶囊内镜检查不明原因消化道出血滞留胃、小肠的9例临床分析

    Institute of Scientific and Technical Information of China (English)

    罗山铖; 赵伟; 杜志强; 杨小东; 樊芳

    2014-01-01

    Objective to analyze retrospectively capsule endoscopy in our hospital stay in patients with stomach, small intestine, and analyze the reasons put forward corresponding countermeasures. Methods a retrospective analysis of the author's Hospital in december 2010 - december 2013 application capsule endoscopy does not name the reason 130 cases of gastrointestinal bleeding patients. the results of 130 patients in a total of nine patients had stomach, small intestine retention, retention rate was 6.9%, gastric retention seven cases, two cases removed by endoscopy, one case of combined surgical removal, four cases of the use of drugs, equipment, etc. into the small intestine, intestinal stranded two cases, one case removed through surgery, anal discharge after one case in february. Conclusion capsule endoscopy capsule endoscopy retention is the more serious complications, preoperative patient rigorous screening, routine gastroscopy, attention bowel preparation, real-time monitoring guidance. retention in the stomach more than one hour to take a drug or device into the small intestine, small intestine stranded in the absence of obstruction occurs feasible to observe, if the obstruction should prompt surgical treatment.%目的:回顾性分析我院行胶囊内镜检查滞留在胃、小肠的患者,分析原因,提出相应的对策。方法回顾性分析笔者医院2010年12月至2013年12月应用胶囊内镜检查130例不名原因消化道出血患者。结果130例患者中共有9例患者出现胃、小肠滞留,滞留率为6.9%,胃内滞留7例,2例通过胃镜取出,1例手术合并取出,4例使用药物、器械等送入小肠,小肠滞留 2例,1例通过手术取出,1例 2月后肛门排出。结论胶囊内镜滞留是胶囊内镜检查中比较严重的并发症,术前对患者进行严格筛查,常规胃镜检查,重视肠道准备,实时监测指导。滞留胃内超过1小时采取药物或器械送入小肠,滞留小肠若

  12. Acute variceal bleeding: general management

    Institute of Scientific and Technical Information of China (English)

    David Patch; Lucy Dagher

    2001-01-01

    @@ TREATMENT STRATEGIES FOR ACUTE VARICEAL BLEEDING Backgound Acute variceal bleeding has a significant mortality which ranges form 5% to 50% in patients with cirrhosis[1].Overall survival is probably improving,because of new therapeutic approaches,and improved medical care.However,mortality is still closely related to failure to control hacmorrhage or carly rebleeding,which is a distinct characteristic of portal hypertensive bleeding and occures in as many as 50% of patients in the first days to 6 weeks after admission et al[2].

  13. Kronisk pancreatitis og øvre gastrointestinal blødning

    DEFF Research Database (Denmark)

    Larsen, H C; Bak, Martin

    1995-01-01

    A 46 year-old woman with a history of chronic pancreatitis, upper epigastric pain and upper gastrointestinal bleeding of obscure origin is presented. A haemoductal pancreatitis was the source of bleeding due to erosion of the splenic artery with bleeding into a pancreatic pseudocyst communicating...... with the pancreatic duct. This case was special, because there was no aneurysmal dilatation of the splenic artery. This rare entity must always be considered in the diagnosis of gastrointestinal haemorrhage of obscure origin. The appropriate investigation to confirm the diagnosis is visceral angiography, if necessary...

  14. Anti-infective activities of lactobacillus strains in the human intestinal microbiota: from probiotics to gastrointestinal anti-infectious biotherapeutic agents.

    Science.gov (United States)

    Liévin-Le Moal, Vanessa; Servin, Alain L

    2014-04-01

    A vast and diverse array of microbial species displaying great phylogenic, genomic, and metabolic diversity have colonized the gastrointestinal tract. Resident microbes play a beneficial role by regulating the intestinal immune system, stimulating the maturation of host tissues, and playing a variety of roles in nutrition and in host resistance to gastric and enteric bacterial pathogens. The mechanisms by which the resident microbial species combat gastrointestinal pathogens are complex and include competitive metabolic interactions and the production of antimicrobial molecules. The human intestinal microbiota is a source from which Lactobacillus probiotic strains have often been isolated. Only six probiotic Lactobacillus strains isolated from human intestinal microbiota, i.e., L. rhamnosus GG, L. casei Shirota YIT9029, L. casei DN-114 001, L. johnsonii NCC 533, L. acidophilus LB, and L. reuteri DSM 17938, have been well characterized with regard to their potential antimicrobial effects against the major gastric and enteric bacterial pathogens and rotavirus. In this review, we describe the current knowledge concerning the experimental antibacterial activities, including antibiotic-like and cell-regulating activities, and therapeutic effects demonstrated in well-conducted, placebo-controlled, randomized clinical trials of these probiotic Lactobacillus strains. What is known about the antimicrobial activities supported by the molecules secreted by such probiotic Lactobacillus strains suggests that they constitute a promising new source for the development of innovative anti-infectious agents that act luminally and intracellularly in the gastrointestinal tract.

  15. Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Khalid Mumtaz; Shahid Majid; Hasnain A Shah; Kashif Hameed; Ashfaq Ahmed; Saeed Hamid; Wasim Jafri

    2007-01-01

    AIM: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC)sclerotherapy of gastric varix (GV).METHODS: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed.RESULTS: The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-Ⅰ) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-Ⅰ ) in 16 (32%), and GOV on greater curvature (GOV-Ⅱ) in 15 (30%). IGV- Ⅰ was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P <0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7(57%). Three patients died after repeat sclerotherapy,one during transjugular intrahepatic portosysternic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50).CONCLUSION: GV can be seen in 15% of patients with portal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding.In hospital mortality of patients with bleeding GV is 6%.

  16. Bleeding in the Digestive Tract

    Science.gov (United States)

    ... lining of the esophagus, stomach, or duodenum. The bacteria Helicobacter pylori (H. pylori) and use of nonsteroidal ... paleness shortness of breath vomit that looks like coffee grounds weakness A person with acute bleeding may ...

  17. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2012-01-01

    Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved...

  18. Fibrinogen concentrate in bleeding patients

    DEFF Research Database (Denmark)

    Wikkelsø, Anne; Lunde, Jens; Johansen, Mathias;

    2013-01-01

    Hypofibrinogenaemia is associated with increased morbidity and mortality, but the optimal treatment level, the use of preemptive treatment and the preferred source of fibrinogen remain disputed. Fibrinogen concentrate is increasingly used and recommended for bleeding with acquired haemostatic...

  19. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

    Science.gov (United States)

    Gralnek, Ian M; Dumonceau, Jean-Marc; Kuipers, Ernst J; Lanas, Angel; Sanders, David S; Kurien, Matthew; Rotondano, Gianluca; Hucl, Tomas; Dinis-Ribeiro, Mario; Marmo, Riccardo; Racz, Istvan; Arezzo, Alberto; Hoffmann, Ralf-Thorsten; Lesur, Gilles; de Franchis, Roberto; Aabakken, Lars; Veitch, Andrew; Radaelli, Franco; Salgueiro, Paulo; Cardoso, Ricardo; Maia, Luís; Zullo, Angelo; Cipolletta, Livio; Hassan, Cesare

    2015-10-01

    or ongoing active UGIH. In selected patients, pre-endoscopic infusion of erythromycin significantly improves endoscopic visualization, reduces the need for second-look endoscopy, decreases the number of units of blood transfused, and reduces duration of hospital stay (strong recommendation, high quality evidence). MR7. Following hemodynamic resuscitation, ESGE recommends early (≤ 24 hours) upper GI endoscopy. Very early (management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). However, in patients with clinical evidence of rebleeding following successful initial endoscopic hemostasis, ESGE recommends repeat upper endoscopy with hemostasis if indicated. In the case of failure of this second attempt at hemostasis, transcatheter angiographic embolization (TAE) or surgery should be considered (strong recommendation, high quality evidence). MR14. In patients with NVUGIH secondary to peptic ulcer, ESGE recommends investigating for the presence of Helicobacter pylori in the acute setting with initiation of appropriate antibiotic therapy when H. pylori is detected. Re-testing for H. pylori should be performed in those patients with a negative test in the acute setting. Documentation of successful H. pylori eradication is recommended (strong recommendation, high quality evidence). MR15. In patients receiving low dose aspirin for secondary cardiovascular prophylaxis who develop peptic ulcer bleeding, ESGE recommends aspirin be resumed immediately following index endoscopy if the risk of rebleeding is low (e. g., FIIc, FIII). In patients with high risk peptic ulcer (FIa, FIb, FIIa, FIIb), early reintroduction of aspirin by day 3 after index endoscopy is recommended, provided that adequate hemostasis has been established (strong recommendation, moderate quality evidence).

  20. Assessing the zearalenone-binding activity of adsorbent materials during passage through a dynamic in vitro gastrointestinal model

    NARCIS (Netherlands)

    Avantaggiato, G.; Havenaar, R.; Visconti, A.

    2003-01-01

    A novel approach is presented herein to study the intestinal absorption of mycotoxins by using a laboratory model that mimics the metabolic processes of the gastrointestinal (GI) tract of healthy pigs. This model was used to evaluate the small-intestinal absorption of zearalenone from contaminated w

  1. Massive alimentary tract bleeding due to cytomegalovirus infection in an elderly patient

    Directory of Open Access Journals (Sweden)

    Bora Koc

    2014-09-01

    Full Text Available In recent years, cytomegalovirus (CMV has been recognized as an important common pathogen in immunocompromized patients. This is due to the increasing number of immunosuppressive medications, intensive cancer chemotherapy use, recurrent transplantations, progressively aging population, and the higher number of human immunodeficiency virus infections. Cytomegalovirus infection especially interests the gastrointestinal tract, anywhere, from the mouth to the anus. Namely, the most commonly affected area is the colon, followed by duodenum, stomach, esophagus and small intestine. The most frequent manifestations of CMV colitis are: diarrhea, fever, gastrointestinal bleeding and abdominal pain. We report here the case of an 82-year-old woman, who was treated for non-Hodgkin lymphoma; she was admitted to the emergency department for abdominal pain and diffuse arthralgia, following massive upper- and lower- gastrointestinal bleeding, due to duodenal and colonic ulcers related to CMV infection.

  2. Massive Alimentary Tract Bleeding due to Cytomegalovirus Infection in an Elderly Patient.

    Science.gov (United States)

    Koc, Bora; Bircan, Huseyin Yuce; Altaner, Semsi; Cinar, Ozlem; Ozcelik, Umit; Yavuz, Alpaslan; Kemik, Ozgur

    2014-08-13

    In recent years, cytomegalovirus (CMV) has been recognized as an important common pathogen in immunocompromized patients. This is due to the increasing number of immunosuppressive medications, intensive cancer chemotherapy use, recurrent transplantations, progressively aging population, and the higher number of human immunodeficiency virus infections. Cytomegalovirus infection especially interests the gastrointestinal tract, anywhere, from the mouth to the anus. Namely, the most commonly affected area is the colon, followed by duodenum, stomach, esophagus and small intestine. The most frequent manifestations of CMV colitis are: diarrhea, fever, gastrointestinal bleeding and abdominal pain. We report here the case of an 82-year-old woman, who was treated for non-Hodgkin lymphoma; she was admitted to the emergency department for abdominal pain and diffuse arthralgia, following massive upper- and lower- gastrointestinal bleeding, due to duodenal and colonic ulcers related to CMV infection. PMID:25276331

  3. Endoscopic hemoclip treatment for bleeding peptic ulcer

    Institute of Scientific and Technical Information of China (English)

    Yung Chih Lai; Sien Sing Yang; Chi Hwa Wu; Tzen Kwan Chen

    2000-01-01

    AIM To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment. We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and reclipping was performed if necessary and feasible.RESULTS Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively. In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively. Hemostasis reached 100% in patients without shock regardless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2- 5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8 ). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device,the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.

  4. Vascular gastric anomalies as a cause of relapsing bleeding

    Directory of Open Access Journals (Sweden)

    Golubović Gradimir

    2008-01-01

    Full Text Available Background. Although relatively rare, gastric vascular anomalies can be recognized as a source of both chronic and acute blood loss, most often presenting as long term iron deficiency anemia, rarely as severe acute gastrointestinal bleeding. Case report. We present five patients with various gastric vascular anomalies, diagnosed during the year of 2003. in the Clinical Hospital Center Zemun. The diagnosis was based on endoscopic appearances, clinical history and characteristic histological findings. Gastric vascular anomalies presented in our review were: portal hypertensive gastropathy, gastric antral vascular ectasia, angiodysplasia, hereditary hemorrhagic telangiectasia and Dieulafoy lesion. The used treatment modalities included surgery and various endoscopic techniques (schlerotherapy, argon plasma coagulation. Conclusion. Patients presented with chronic iron deficiency anemia or acute and recurrent gastrointestinal hemorrhage should be considered as having one of gastric vascular anomalies.

  5. Uso de octreotida na hemorragia digestiva alta secundária à hipertensão portal em pacientes pediátricos: experiência de um serviço terciário Uso de octreotide en la hemorragia digestiva alta secundaria a hipertensión portal en pacientes pediátricos: experiencia de un servicio terciario Octreotide for acute gastrointestinal bleeding secondary to portal hypertension in pediatric patients: experience of a tertiary center

    Directory of Open Access Journals (Sweden)

    Daniela Gois Meneses

    2011-12-01

    ños, variación de 7 meses a 18,9 años, en el periodo de 1998 a 2006, en un hospital terciario universitario. El diagnóstico de hipertensión portal fue establecido por ultrasonografía y la cirrosis fue confirmada por la histología y clasificada respecto a la gravedad por el escore Child-Pugh. RESULTADOS: Las causas de la hipertensión portal fueron obstrucción extrahepática de la vena porta en 11/17 casos (64,7% y cirrosis hepática en 6/17 (35,3%. El sangramiento fue controlado en 14/17 pacientes (82,3%. El tiempo de infusión de la droga necesario para control del sangramiento fue semejante entre cirróticos y no cirróticos, pero la caída en los niveles de hemoglobina, el volumen transfusional requerido y el tiempo de internación fueron superiores en los pacientes con cirrosis, aunque sin diferencia estadística. Esas mismas variables no se modificaron respecto a los dos distintos esquemas de infusión de la droga: con dosis de ataque o iniciando con dosis de mantenimiento. Fracaso terapéutico fue observado con mayor frecuencia entre los pacientes cirróticos (33,3%. Hiperglucemia fue el único efecto secundario detectado durante la infusión. CONCLUSIONES: La administración de octreotide en niños y adolescentes con sangramiento digestivo por hipertensión portal fue segura y efectiva en el control del sangramiento agudo, independiente de la causa de la hipertensión portal y del esquema de infusión.OBJECTIVE: To describe clinical data of children and adolescents with portal hypertension, during with and without liver cirrhosis, treated with octreotide during episodes of acute upper gastrointestinal bleeding. METHODS: Retrospective and descriptive study of 26 episodes of gastrointestinal bleeding in 17 patients (mean age: 8.6 years; range: seven months to 18.9 years assisted at a tertiary university hospital from 1996 to 2006. Portal hypertension diagnosis was based on ultrasonography. Liver cirrhosis was confirmed by histology and hepatic function was

  6. Diagnosis, Treatment, and Outcome in Patients with Bleeding Peptic Ulcers and Helicobacter pylori Infections

    Directory of Open Access Journals (Sweden)

    Ting-Chun Huang

    2014-01-01

    Full Text Available Upper gastrointestinal (UGI bleeding is the most frequently encountered complication of peptic ulcer disease. Helicobacter pylori (Hp infection and nonsteroidal anti-inflammatory drug (NSAID administration are two independent risk factors for UGI bleeding. Therefore, testing for and diagnosing Hp infection are essential for every patient with UGI hemorrhage. The presence of the infection is usually underestimated in cases of bleeding peptic ulcers. A rapid urease test (RUT, with or without histology, is usually the first test performed during endoscopy. If the initial diagnostic test is negative, a delayed 13C-urea breath test (UBT or serology should be performed. Once an infection is diagnosed, antibiotic treatment is advocated. Sufficient evidence supports the concept that Hp infection eradication can heal the ulcer and reduce the likelihood of rebleeding. With increased awareness of the effects of Hp infection, the etiologies of bleeding peptic ulcers have shifted to NSAID use, old age, and disease comorbidity.

  7. Diagnosis, treatment, and outcome in patients with bleeding peptic ulcers and Helicobacter pylori infections.

    Science.gov (United States)

    Huang, Ting-Chun; Lee, Chia-Long

    2014-01-01

    Upper gastrointestinal (UGI) bleeding is the most frequently encountered complication of peptic ulcer disease. Helicobacter pylori (Hp) infection and nonsteroidal anti-inflammatory drug (NSAID) administration are two independent risk factors for UGI bleeding. Therefore, testing for and diagnosing Hp infection are essential for every patient with UGI hemorrhage. The presence of the infection is usually underestimated in cases of bleeding peptic ulcers. A rapid urease test (RUT), with or without histology, is usually the first test performed during endoscopy. If the initial diagnostic test is negative, a delayed (13)C-urea breath test (UBT) or serology should be performed. Once an infection is diagnosed, antibiotic treatment is advocated. Sufficient evidence supports the concept that Hp infection eradication can heal the ulcer and reduce the likelihood of rebleeding. With increased awareness of the effects of Hp infection, the etiologies of bleeding peptic ulcers have shifted to NSAID use, old age, and disease comorbidity.

  8. Gastroscopy-related adverse cardiac events and bleeding complications among patients treated with coronary stents and dual antiplatelet therapy

    OpenAIRE

    Egholm, Gro; Thim, Troels; Madsen, Morten; Sørensen, Henrik Toft; Pedersen, Jan Bech; Eggert Jensen, Svend; Jensen, Lisette Okkels; Kristensen, Steen Dalby; Bøtker, Hans Erik; Maeng, Michael

    2016-01-01

    Background and study aims: Dual antiplatelet therapy (DAPT) is recommended following percutaneous coronary intervention (PCI) with drug-eluting stent (DES). DAPT is a risk factor for gastrointestinal bleeding. We aimed to quantify (1) the rate of gastroscopy within 12 months after PCI, (2) the rate of adverse cardiac events and gastroscopy-related bleeding complications within 30 days of gastroscopy, and (3) the association between antiplatelet therapy and these events. Patients and methods: ...

  9. In vitro activity of essential oils of Lippia sidoides and Lippia gracilis and their major chemical components against Thielaviopsis paradoxa, causal agent of stem bleeding in coconut palms

    Directory of Open Access Journals (Sweden)

    Rejane Rodrigues da Costa e Carvalho

    2013-01-01

    Full Text Available Essential oils of Lippia sidoides, Lippia gracilis and their main chemical components were investigated for in vitro control of Thielaviopsis paradoxa. Mycelial growth and a number of pathogen conidia were inhibited by the essential oil of L. sidoides at all concentrations tested (0.2; 0.5; 1.0; 3.0 µL mL-1. L. sidoides oil contained 42.33% thymol and 4.56% carvacrol, while L. gracilis oil contained 10% thymol and 41.7% carvacrol. Mycelial growth and conidial production of T. paradoxa were completely inhibited by thymol at a 0.3 µL m-1 concentration. The results suggest that thymol could potentially be used for controlling coconut stem bleeding.

  10. Association of upper gastrointestinal symptoms with functional and clinical characteristics in the elderly

    Institute of Scientific and Technical Information of China (English)

    Alberto Pilotto; Stefania Maggi; Marianna Noale; Marilisa Franceschi; Giancarlo Parisi; Gaetano Crepaldi

    2011-01-01

    AIM: To evaluate the prevalence of upper gastrointestinal symptoms and their association with clinical and functional characteristics in elderly outpatients. METHODS: The study involved 3238 outpatients ≥ 60 years consecutively enrolled by 107 general practitioners. Information on social, behavioral and demographic characteristics, function in the activities of daily living (ADL), co-morbidities and drug use were collected by a structured interview. Upper gastrointestinal symptom data were collected by the 15-items upper gastro-intestinal symptom questionnaire for the elderly, a validated diagnostic tool which includes the following five symptom clusters: (1) abdominal pain syndrome; (2) reflux syndrome; (3) indigestion syndrome; (4) bleeding; and (5) non-specific symptoms. Presence and severity of gastrointestinal symptoms were analyzed through a logistic regression model. RESULTS: 3100 subjects were included in the final analysis. The overall prevalence of upper gastrointestinal symptoms was 43.0%, I.e. Cluster (1) 13.9%, (2) 21.9%, (3) 30.2%, (4) 1.2%, and (5) 4.5%. Upper gastrointestinal symptoms were more frequently reported by females (P < 0.0001), with high number of co-morbidities (P < 0.0001), who were taking higher number of drugs (P < 0.0001) and needed assistance in the ADL. Logistic regression analysis demonstrated that female sex (OR = 1.39, 95% CI: 1.17-1.64), disability in the ADL (OR = 1.47, 95% CI: 1.12-1.93), smoking habit (OR = 1.29, 95% CI: 1.00-1.65), and body mass index (OR = 1.06, 95% CI: 1.04-1.08), as well as the presence of upper (OR = 3.01, 95% CI: 2.52-3.60) and lower gastroenterological diseases (OR = 2.25, 95%CI: 1.70-2.97), psychiatric (OR = 1.60, 95% CI: 1.28-2.01) and respiratory diseases (OR = 1.25, 95% CI: 1.01-1.54) were significantly associated with the presence of upper gastrointestinal symptoms. CONCLUSION: Functional and clinical characteristics are associated with upper gastrointestinal symptoms. A multidimensional

  11. Recombinant coagulation factor VIIa labelled with the fac-99 mTc(CO)3-core: synthesis and in vitro evaluation of a putative new radiopharmaceutical for imaging in acute bleeding lesion

    DEFF Research Database (Denmark)

    Madsen, Jacob; Christensen, Jesper B.; Olsen, Ole H.;

    2011-01-01

    Coagulation in blood is initiated when coagulation factor VII (FVII) binds to exposed TF and is activated to FVIIa, and the TF/ FVIIa complex may therefore provide a marker of vascular injury potentially applicable in diagnostic imaging of acute gastrointestinal (GI) bleeding. Methods: Recombinant...... yield and in 495% radiochemical purity. Pull down experiments showed that the biological activity (binding to tissue factor and to anti-FVII antibody) of the radiolabelled product remained intact in the formulation mixture as well as in human serum. By computer modeling analysis, two candidate sites for...

  12. Gastrointestinal transit measurements in mice with 99mTc-DTPA-labeled activated charcoal using NanoSPECT-CT

    OpenAIRE

    Padmanabhan, Parasuraman; Grosse, Johannes; Asad, Abu Bakar Md Ali; Radda, George K.; Golay, Xavier

    2013-01-01

    Background Gastrointestinal (GI) disorders are commonly associated with chronic conditions such as diabetes, obesity, and hypertension. Direct consequences are obstipation or diarrhea as opposite aspects of the irritable bowel syndrome, and more indirectly, alteration of appetite, feeling of fullness, flatulence, bloatedness, and eventually leading to altered absorption of nutrients. Moreover, GI retention and passage times have been recognized as important factors in determining the release ...

  13. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B.

    2012-01-01

    serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result in faster discharge and reduced need for transfusions. Endoscopic hemostasis remains indicated for high-risk lesions. Clips, thermocoagulation, and epinephrine injection are effective......Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved......-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  14. N-butyl cyanoacrylate embolotherapy for acute gastroduodenal ulcer bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Ho; Kim, Ji Hoon; Koh, Young Hwan; Han, Dae Hee; Cha, Joo Hee; Seong, Chang Kyu; Song, Chi Sung [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

    2007-01-15

    Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding.

  15. N-butyl cyanoacrylate embolotherapy for acute gastroduodenal ulcer bleeding

    International Nuclear Information System (INIS)

    Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding

  16. In-vitro antimicrobial activity screening of some ethnoveterinary medicinal plants traditionally used against mastitis, wound and gastrointestinal tract complication in Tigray Region, Ethiopia

    Institute of Scientific and Technical Information of China (English)

    Shewit Kalayou; Mekonnen Haileselassie; Gebremedhin Gebre-egziabher; Tsegay Tikue; Samson Sahle; Habtamu Taddele; Mussie Ghezu

    2012-01-01

    Objective:To screen the antibacterial activity of nine ethnoveterinary plants traditionally used for the treatment of mastitis, wound and gastrointestinal complications. Methods:Hydroalcoholic exctracts of medicinal plants namely, Achyranthes aspera (A. aspera) L. (Family Asparagaceae), Ficus caria (F. caria) (Family Moraceae), Malvi parviflora (M. parviflora) (Family Malvaceae), Vernonia species (V. species) (local name Alakit, Family Asteraceae), Solanum hastifolium (S. hastifolium) (Family Solanaceae), Calpurinia aurea (C. aurea) (Ait) Benth (Family Fabaceae), Nicotiana tabacum (N. tabacum) L. (Family Solanaceae), Ziziphus spina-christi (Z. spina-christi) (Family Rhamnaceae), Croton macrostachys (C. macrostachys) (Family Euphorbiaceae), were screened against clinical bacterial isolates of veterinary importance from October 2007 to April 2009. The antibacterial activity was tested using disc diffusion at two concentrations (200 mg/mL and 100 mg/mL) and broth dilution methods using 70%methanol macerated leaf extracts. Results:With the exception of S. hastifolium all plant extracts exhibited antibacterial activity. Among the medicinal plants tested C. aurea, C. macrostachyus, A. aspera, N. tabacum and vernonia species (Alakit) showed the most promising antimicrobial properties. Conclusions:It can be concluded that many of the tested plants have antibacterial activity and supports the traditional usage of the plants for mastitis, wound and gastrointestinal complications treatment. Further studies into their toxicity and phytochemistry is advocated.

  17. Missed bleeding events after ticagrelor in PEGASUS trial: Massive non-compliance, information censoring, or both?

    Science.gov (United States)

    Serebruany, Victor; Tomek, Ales

    2016-07-15

    PEGASUS trial reported reduction of composite primary endpoint after conventional 180mg/daily ticagrelor (CT), and lower 120mg/daily dose ticagrelor (LT) at expense of extra bleeding. Following approval of CT and LT for long-term secondary prevention indication, recent FDA review verified some bleeding outcomes in PEGASUS. To compare the risks after CT and LT against placebo by seven TIMI scale variables, and 9 bleeding categories considered as serious adverse events (SAE) in light of PEGASUS drug discontinuation rates (DDR). The DDR in all PEGASUS arms was high reaching astronomical 32% for CT. The distribution of some outcomes (TIMI major, trauma, epistaxis, iron deficiency, hemoptysis, and anemia) was reasonable. However, the TIMI minor events were heavily underreported when compared to similar trials. Other bleedings (intracranial, spontaneous, hematuria, and gastrointestinal) appear sporadic, lacking expected dose-dependent impact of CT and LT. Few SAE outcomes (fatal, ecchymosis, hematoma, bruises, bleeding) paradoxically reported more bleeding after LT than after CT. Many bleeding outcomes were probably missed in PEGASUS potentially due to massive non-compliance, information censoring, or both. The FDA must improve reporting of trial outcomes especially in the sponsor-controlled environment when DDR and incomplete follow-up rates are high. PMID:27128533

  18. Enzyme activity of β-galactosidase from Kluyveromyces lactis and Aspergillus oryzae on simulated conditions of human gastrointestinal system

    Directory of Open Access Journals (Sweden)

    Alessandra Bosso

    2015-09-01

    Full Text Available An alternative to relieve the symptoms of lactose intolerance is the intake of the enzyme β-galactosidase in pharmaceutical dosage forms. The ability of β-galactosidase produced by Kluyveromyces lactis and Aspergillus oryzae to hydrolyze lactose in simulated conditions of the human gastrointestinal tract was investigated. The experiment was carried out in the optimum temperature for each enzyme activity, 40 and 55°C, respectively, and at the normal human body temperature (37°C at concentrations of 1.5, 3.0, and 5.0 g/L (enzyme from A. oryzae or mL/L (enzyme from K. lactis. Both enzymes were completely inactivated under simulated gastric conditions (pH 2. When the enzymes were subjected to simulated small intestine conditions (pH 7.4, lactose hydrolysis has occurred, but at 37°C the percentage was lower than that under the optimal temperatures. At concentrations of 1.5, 3.0, and 5.0 mL/L the enzyme from K. lactis hydrolyzed 76.63%, 88.91% and 94.80% of lactose at 40°C, and 55.99%, 80.91% and 81.53% at 37°C, respectively. In contrast, the enzyme from A. oryzae hydrolyzed 7.11%, 16.18% and 21.29% at 55°C, and 8.4%, 11.85% and 16.43% at 37°C. It was observed that under simulated intestinal conditions, the enzyme from K. lactis was more effective on lactose hydrolysis as compared to the enzyme from A. oryzae. Considering the findings of this study, it is extremely necessary to use an enteric coating on β-galactosidase capsules so that this enzyme is released only in the small intestine, which is its site of action, thus not suffering the action of the stomach pH.Keywords: Lactase. Hydrolysis. Lactose intolerance. Gastrointestinal tract. RESUMOAtividade de β-galactosidase de Kluyveromyces lactis e Aspergillus oryzae, em condições simuladas do sistema gastrintestinal humanoUma das alternativas para amenizar os sintomas da intolerância à lactose é a ingestão de β-galactosidase em formas farmacêuticas. Neste trabalho avaliou-se a

  19. Exsanguinating upper GI bleeds due to Unusual Arteriovenous Malformation (AVM) of stomach and spleen: a case report

    OpenAIRE

    Baqai Mohammad; Baqai Muhammad; Khan Mohammad; Mufti Naveed

    2009-01-01

    Abstract Background In this paper we are reporting one case of exsanguinating upper gastrointestinal tract (GIT) bleed requiring massive blood transfusion and immediate life saving surgery. Case presentation A 30 years old female, 12 weeks pregnant was referred to our hospital from the earth-quake affected area of Kashmir with history of upper abdominal pain, haematemesis and melaena for one week. After stabilizing the patient, upper gastro-intestinal endoscopy was performed. It revealed gast...

  20. Post traumatic intra thoracic spleen presenting with upper GI bleed! – a case report

    Directory of Open Access Journa