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1.
PLoS One ; 17(5): e0267053, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35594317

RESUMO

BACKGROUND AND AIM: Gastroesophageal reflux disease (GERD) typically presents with symptoms of heartburn and acid regurgitation but occasionally manifests as atypical chest pain. Coronary artery disease (CAD) and GERD share some risk factors, such as smoking and obesity. The aims of this study were to evaluate the association between GERD and coronary atherosclerosis and to assess the risk factors for coronary atherosclerosis in GERD patients. METHODS: A total of 16616 subjects who underwent upper gastrointestinal endoscopy from 2003 to 2017 and a cardiac computed tomography (CT) scan within one year were included in this study. Coronary atherosclerosis was evaluated by the coronary artery calcium score (CACS). The severity of GERD was evaluated based on endoscopic findings using the Los Angeles classification. RESULTS: The proportion of high CACSs (≥100) increased significantly in subjects with severe GERD (p = 0.008). However, the presence of a high CACS did not increase the risk of GERD (OR = 1.007, 95% CI 0.857-1.182), nor did that of GERD increase the risk of a high CACS (OR = 1.018, 95% CI 0.865-1.198). The risk factors for a high CACS in GERD patients included age (OR = 1.087, 95% CI 1.066-1.109), male sex (OR = 5.645, 95% CI 2.561-12.446), hypertension (OR = 1.800, 95% CI 1.325-2.446), and hypercholesterolemia (OR = 1.684, 95% CI 1.213-2.338). CONCLUSIONS: Although the presence of a high CACS did not increase the risk of GERD or vice versa, the proportion of high CACSs was significantly higher in subjects with severe GERD. Therefore, it might be helpful to assess the CACS in GERD patients with multiple risk factors.


Assuntos
Doença da Artéria Coronariana , Refluxo Gastroesofágico , Dor no Peito/etiologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Endoscopia Gastrointestinal/efeitos adversos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Azia/diagnóstico , Humanos , Masculino , Fatores de Risco
3.
Sci Rep ; 12(1): 8538, 2022 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-35595856

RESUMO

Physical stress is common in GI endoscopists, leading to musculoskeletal disorders. Considering the increasing complexity of interventional GI endoscopy with prolonged examination time, work-related musculoskeletal disorders have come into focus. However, data on work-related health stress in German endoscopists are elusive. The aim of this study was therefore to investigate the prevalence and consequences of work-related musculoskeletal disorders in German endoscopists. A 24-item questionnaire on endoscopy-associated musculoskeletal disorders and standardized pain assessment was developed by an interdisciplinary team of endoscopists and sports medics. The survey was distributed online by the leading German societies for gastroenterology and endoscopy. Overall, 151 German practicing endoscopists took part in the study. Regarding the average number of endoscopic procedures per week, the study collective consisted mainly of high-volume endoscopists. The survey showed that most participants suffered from general musculoskeletal disorders (82.8%) and from work-related musculoskeletal disorders (76.8%). The most affected body parts were the neck, low back, thumb, and shoulder. Temporary absence from work due to symptoms was reported by 9.9% of the respondents. Over 30% of participating endoscopists stated the need for analgesics or physiotherapy due to musculoskeletal disorders. Age, professional experience and work time were identified as relevant risk factors for musculoskeletal health issues. A high number of German endoscopists are affected by musculoskeletal disorders due to specific working postures and repetitive movements with a large impact on personal health. Further interventional studies are mandatory to improve the risk prevention of endoscopic activity.


Assuntos
Doenças Musculoesqueléticas , Doenças Profissionais , Endoscopia Gastrointestinal/efeitos adversos , Alemanha/epidemiologia , Humanos , Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/etiologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Prevalência , Fatores de Risco , Inquéritos e Questionários
4.
FP Essent ; 516: 11-16, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35507308

RESUMO

Occult gastrointestinal (GI) bleeding is bleeding from the GI tract that is not noticeable to patients or physicians. Patients with unexplained anemia (ie, not attributable to another cause such as menstrual bleeding), particularly iron deficiency anemia, should be evaluated for occult GI bleeding. Similarly, if fecal blood is detected during routine colorectal cancer screening, an evaluation for occult bleeding is indicated. Direct visualization with colonoscopy or esophagogastroduodenoscopy are the initial tests of choice; which one is conducted first depends on a patient's risk factors for upper versus lower GI bleeding. If initial endoscopy is negative, repeat endoscopy may identify the bleeding source. If still negative, other tests, typically capsule endoscopy, can be used to evaluate for small bowel bleeding. Management of identified lesions varies, but they often are amenable to endoscopic intervention or medical management. The need for transfusion is uncommon in occult GI bleeding. Rarely, a surgical approach to visualization and resection may be undertaken. If no bleeding source is identified, or even if it is identified and successfully treated, patients should be evaluated for conditions or treatments that might increase the risk of rebleeding (eg, nonsteroidal anti-inflammatory drug use, antiplatelet/anticoagulant therapy). Need for these treatments should be reevaluated.


Assuntos
Hemorragia Gastrointestinal , Sangue Oculto , Colonoscopia/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos
5.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(4): 350-353, 2022 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-35527406

RESUMO

After nearly 40 years of development, digestive endoscopy in children has been widely applied, and it has helped to expand the spectrum of pediatric digestive system diseases and greatly improve the diagnosis and treatment of pediatric digestive system diseases. Pediatric digestive endoscopy has become a subject. However, there are some problems such as the unbalanced development of pediatric digestive endoscopy across China, the lack of homogeneity in diagnosis and treatment system, the tendency of adult-oriented diagnosis and treatment techniques, and the localization of training quality, which affect the standardized and healthy development of pediatric digestive endoscopy. The diagnosis and treatment with digestive endoscopy in children should adhere to both pediatric characteristics and technological innovation to propose the concept of comfort, emphasize the importance of standardization (including the space and process for endoscopic diagnosis and treatment, perioperative evaluation, training mode, and access qualification), standardize the minimally invasive techniques, and develop artificial intelligence. It is of great importance to formulate related consensus statements and guidelines on the basis of medical safety and the features of the growth and development of children, so as to achieve the high-quality development of pediatric digestive endoscopy, effectively improve the diagnosis and treatment levels of pediatric digestive endoscopy, and bring benefits to more pediatric patients.


Assuntos
Inteligência Artificial , Doenças do Sistema Digestório , Criança , China , Consenso , Doenças do Sistema Digestório/diagnóstico , Endoscopia Gastrointestinal , Humanos
6.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(4): 372-376, 2022 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-35527410

RESUMO

OBJECTIVES: To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children. METHODS: A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital, China Medical University, from January 2011 to May 2021. According to the cause of the disease, they were divided into primary ulcer group (primary group; n=148) and secondary ulcer group (secondary group; n=25). The clinical data were compared between the two groups. RESULTS: A total of 173 children with upper gastrointestinal ulcer were enrolled, with a male/female ratio of 3.9:1. Compared with girls, boys had significantly higher proportions of duodenal ulcer and primary ulcer (P<0.05). Compared with the children aged below 6 years, the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers. Of the 148 children in the primary group, 95 (64.2%) had Helicobacter pylori infection. Abdominal pain was the most common clinical symptom and was observed in 101 children (68.2%). Duodenal ulcer was common and was observed in 115 children (77.7%), followed by gastric ulcer in 25 children (16.9%) and esophageal ulcer in 7 children (4.7%). Multiple ulcers were observed in 32 children (21.6%). Seventy children (47.3%) experienced complications, among which bleeding was the most common complication and was observed in 63 children (43.6%). Of the 25 children in the secondary group, abdominal pain was the most common clinical symptom and was observed in 9 children (36.0%), with a significantly lower incidence rate than the primary group (P<0.05); foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children (68%), followed by abdominal Henoch-Schönlein purpura in 5 children (20.0%) and Crohn's disease in 3 children (12.0%). The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group (P<0.05). CONCLUSIONS: Upper gastrointestinal ulcer is more common in boys than girls, and duodenal ulcer and primary ulcer are more common in boys. Children aged 6-14 years often have duodenal ulcer and primary ulcer, and giant ulcer and multiple ulcers are relatively uncommon. Primary ulcer in children has a variety of clinical manifestations, mainly abdominal pain, and duodenal ulcer is relatively common, with bleeding as the main complication. The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes, and it is more likely to induce huge ulcers and multiple ulcers.


Assuntos
Úlcera Duodenal , Infecções por Helicobacter , Helicobacter pylori , Dor Abdominal , Criança , Úlcera Duodenal/complicações , Úlcera Duodenal/diagnóstico , Úlcera Duodenal/epidemiologia , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Humanos , Masculino , Estudos Retrospectivos , Úlcera
7.
BMC Gastroenterol ; 22(1): 216, 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35505286

RESUMO

BACKGROUND AND AIMS: Cholecystectomy is performed for most gallbladder polyps (GPs). However, cholecystectomy results concerning complications in some patients. For benign GPs, adoption of gallbladder-preserving surgery is worth to recommend. We describe our experiences performing gallbladder-preserving polypectomy for GPs by embryonic-natural orifice transumbilical endoscopic surgery (E-NOTES) with a gastric endoscopy. METHODS: This is a retrospective study of patients with GPs who underwent gallbladder-preserving polypectomy by E-NOTES with a gastric endoscopy from April 2018 to September 2019 in our hospital. The operative time, intraoperative hemorrhage, intraoperative and postoperative complications, gallbladder emptying function were obtained and analyzed. RESULTS: The procedure was performed successfully in all 12 patients with 5 cases of single polyp and 7 cases of multiple polyps. The range of GPs size was 2 mm to 15 mm. The mean operation time was (95.33 ± 23.08) minutes (55-135 min). There were no adverse events including heavy bleeding, mortality and conversion to open surgery during operation. All patients were discharged in 4-5 days after surgery without postoperative complications such as delayed bleeding, fever, peritonitis, intra-abdominal abscess and abdominal wall incisional hernia. All patients were followed up at 1, 3, 6, and 12 months postoperation who had almost no visible incision on the umbilical region, no recurrent GPs. The gallbladder emptying function decreased one month after surgery, and gradually improved 3, 6 and 12 months after surgery. CONCLUSION: E-NOTES gallbladder-preserving polypectomy is a safe and effective option for patients with GPs and is close to scar-free surgery which can be performed in routine clinical practice.


Assuntos
Colecistectomia Laparoscópica , Doenças da Vesícula Biliar , Pólipos , Colecistectomia Laparoscópica/métodos , Endoscopia Gastrointestinal , Doenças da Vesícula Biliar/cirurgia , Humanos , Pólipos/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Umbigo/cirurgia
8.
BMC Gastroenterol ; 22(1): 218, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35508963

RESUMO

BACKGROUND: Small intestinal stricture is a major cause for surgery in Crohn's disease (CD). Endoscopic balloon dilation (EBD) is performed for small intestinal strictures to avoid surgery, often repeatedly. However, factors that are associated with prognosis after EBD of small intestinal strictures remain poorly investigated. Mucosal healing is the therapeutic target in CD. We aimed to investigate the impact of mucosal healing defined by the presence of ulcers at the small intestinal stricture site on the prognosis of EBD in CD patients. METHODS: We retrospectively included patients with CD who underwent initial EBD for endoscopically impassable small intestinal strictures from January 2012 to March 2020 at a single center. The association between presence of ulcer at the stricture site and surgery after EBD was examined by Cox proportional hazards model. RESULTS: Of the 98 patients included, 63 (64.3%) had ulcer at the stricture site. 20 (31.7%) of these patients underwent surgery for the stricture in due course, whereas 4 (11.4%) of the patients without ulcer of the stricture underwent surgery. In multivariate analysis, patients with ulcer of the stricture had a significantly higher risk for surgery than those without ulcer (hazard ratio 4.84; 95% confidence interval 1.58-14.79). CONCLUSION: Mucosal healing at the stricture site indicated a favorable prognosis after EBD for small intestinal strictures in CD.


Assuntos
Doença de Crohn , Obstrução Intestinal , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Doença de Crohn/cirurgia , Dilatação/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Úlcera/complicações , Úlcera/cirurgia
10.
Indian J Pathol Microbiol ; 65(2): 316-320, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35435365

RESUMO

Introduction: Helicobacter pylori infection is a chronic bacterial infection associated with some extragastric diseases as well as gastric involvements that occur most commonly worldwide. In our study, we aimed to investigate the usability of immature granulocytes as a basic indicator that can reflect the severity of helicobacter pylori inflammation, to the best of our knowledge, for the first time. Materials and Methods: Patients who underwent upper gastrointestinal endoscopy between April 2019 and April 2020 and were diagnosed with antral gastritis were included in this study. The relationship between helicobacter infection and its severity detected in gastric biopsies of patients and immature granulocyte count (IGC), immature granulocyte percentage (IG%), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) were investigated. Results: Of the 868 patients, 210 were HP negative, 658 were HP positive (218 mild HP positive, 293 moderate HP positive, and 147 severe HP positive). There were statistically significant differences between the HP negative and HP positive groups in terms of IGC, IG%, NLR, and PLR. However, IG% and IGC were not clinically useful because the median IG% (0.3 vs 0.3) and IGC (0.02 vs 0.02) were the same in the HP negative and total HP positive groups. Conclusion: In our study, IGC and IG% were not found useful to detect H. pylori intensity and severity of inflammation.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Endoscopia Gastrointestinal , Granulócitos/patologia , Infecções por Helicobacter/microbiologia , Humanos , Inflamação
11.
Arq Gastroenterol ; 59(1): 117-122, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35442321

RESUMO

BACKGROUND: Behçet's disease is a rare immune-mediated disorder that can affect the gastrointestinal tract. The prevalence and extension of small bowel involvement is largely unknown. OBJECTIVE: The aim of this study was to describe the small bowel lesions diagnosed by double-balloon enteroscopy (DBE) and to verify if these findings were associated to the presence of gastrointestinal symptoms and disease activity after long-term follow-up. METHODS: This study included 19 Behçet's disease patients who underwent DBE. After a mean follow-up of 15 years the endoscopic findings were associated to the presence of gastrointestinal symptoms, disease activity and current therapy through collection of electronic medical records. RESULTS: A total of 63.2% patients were female and the mean age was 37 years at the time of DBE. Mean disease duration at baseline was 24 years. 11 patients had no gastrointestinal symptoms and eight patients presented either abdominal pain, gastrointestinal bleeding or diarrhea. The average procedure time was 1 hour and 30 minutes and the ileum was achieved in all patients but one. Small bowel ulcers were diagnosed in 78.9%, with 63.1% of jejunal involvement. Two patients presented only small bowel edema and two were normal by DBE. Eight patients had concomitant gastric ulcers. Gastrointestinal symptoms prior to DBE were present in 36.8% of the patients and, after follow-up, all of them persisted with some of the symptoms. Bleeding was reported by three patients at baseline and persisted in only one patient. The frequency of treatment with steroids and immunomodulators was 31.6% and 57.9% at baseline, respectively, and 21% in both at the end of the follow-up. No patient was treated with biologics at the time of the DBE procedure and the current rate of biologic use is 21%. CONCLUSION: Small bowel involvement in Behçet's disease was frequently demonstrated by DBE even in asymptomatic patients. Understanding clinical evolution of the disease over the years and the impact of such diagnosis still represents a challenge, possibly with the need for novel treatment.


Assuntos
Síndrome de Behçet , Adulto , Síndrome de Behçet/complicações , Síndrome de Behçet/tratamento farmacológico , Síndrome de Behçet/patologia , Enteroscopia de Duplo Balão , Endoscopia Gastrointestinal/métodos , Feminino , Seguimentos , Hemorragia Gastrointestinal/diagnóstico , Humanos , Intestino Delgado , Masculino , Estudos Retrospectivos
12.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35443490

RESUMO

Acute upper gastrointestinal bleeding (UGIB) is a common emergency and can be a serious condition that requires hospitalization, rapid evaluation and management. The usual presentation is hematemesis (vomiting of blood or coffee ground-like material) and/or melena (black, tarry stools) 1. UGIB occurs more commonly in men and older subjects. PUD is the most common cause of UGIB in the US accounting for about 50% of the cases, whereas in tropical country like India, esophageal varices attribute to half the cases. Esophago-Gastro-Duodenoscopy [EGD] is a primary diagnostic and therapeutic modality in the setting of UGIB. MATERIAL: Prospective study. Forty patients who have presented with frank blood or coffee ground color vomitus and/or melena were considered for this study. All patients greater than 18 years of age were included. Their clinical presentation, hemogram and endoscopic findings were analyzed. Descriptive statistical analysis has been applied. OBSERVATION: In our study, the age distribution was between 23 and 87 years. There is a male preponderance with 65 % males and 35%females. Among 40 patients,42.5%had varices, 17.5% had Peptic Ulcer Disease and12.5% had Erosive Gastritis. The other causes of UGIB include Pangastritis(10%), Mallory Weiss Tear(7.5%), Polyp(5%), Esophagitis(2.5%), Coagulopathy induced bleed(2.5%) and Carcinoma stomach(2.5%). Of the 40 cases admitted, only 3 patients (7.5%) had massive Upper GI Bleed.10 patients (25%) had moderate bleed and 27 patients (67.5%) had mild bleed. Amongst the patients with massive bleed, an important cause is esophageal varices(66.7%). A total of 21 (52.5%) patients have recovered. There was one death(2.5%) amongst the cases which was not attributed to UGIB. 14 patients(45%) has residual disease of which 42.5% were of variceal bleed. Patients with variceal bleed have undergone banding and have been asked to regularly follow up for check endoscopy and banding till their eradication. There was 1 patient of residual disease with Carcinoma stomach(2.5%) who has been initiated on chemotherapy. CONCLUSION: Hematemesis is much commoner than melena in the presentation of upper GI bleed. EGD has a diagnostic as well as therapeutic role in UGIB .In this study endoscopy provided diagnosis in 97.5% of patients. In this cross sectional study, the most common cause of upper GI bleed was esophageal varices, with alcoholic cirrhosis being the main cause of portal hypertension. Varices remain to be the most common cause of UGIB in both males and females, however, the percentage is more in males as compared to females. Varices are an important cause of massive variceal bleed.


Assuntos
Carcinoma , Varizes Esofágicas e Gástricas , Gastrite , Varizes , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Café , Estudos Transversais , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico , Feminino , Gastrite/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hematemese/etiologia , Humanos , Masculino , Melena/etiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Varizes/complicações , Adulto Jovem
13.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35443496

RESUMO

Esophageal variceal bleeding remains the leading cause of acute mortality in patients with cirrhosis. As per guidelines, upper gastrointestinal screening endoscopy is recommended for all patients with cirrhosis to rule out esophageal varices. However, only 50% of newly diagnosed patients with cirrhosis have Esophageal varices. Hence there is a need for non-invasive parameters to predict the presence of esophageal varices to restrict the endoscopic studies to those with a high probability of having varices. In this study, we aimed to identify the effectiveness of Platelet Count/Spleen Length Ratio as a non-invasive predictor of esophageal varices. MATERIAL: An observational cross-sectional study was conducted including 52 patients with liver cirrhosis without a previous history of upper GI bleeding. Relevant clinical parameters were assessed including complete hemogram, upper GI endoscopy, and ultrasonographic measurement of spleen length. Patients were divided into two groups, one with esophageal varices and the other without esophageal varices. Platelet Count/Spleen Length Ratio was compared between these two groups. OBSERVATION: Out of the study population 65.38% of the patients had Oesophageal varices. The following observations were made in oesophageal variceal group and non-variceal group respectively; Mean spleen length was 156.26 ± 13.64 mm and 126.06 ± 6.40 mm(p<0.001), mean platelet count was 102882 ± 20188/mm3 and 156000 ± 36378 mm3 (p<0.001), Platelet Count/Spleen Length Ratio was 672.82 ± 188.06 and 1243.55 ± 307.53 (p<0.001). Platelet Count/Spleen Length Ratio of <926 was found to have a sensitivity of 91% in predicting varices and the specificity was 78%. CONCLUSION: Platelet Count/Spleen Length RATIO can be used as a predictor of esophageal varices and also to identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, to reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies.


Assuntos
Varizes Esofágicas e Gástricas , Varizes , Estudos Transversais , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Cirrose Hepática/complicações , Contagem de Plaquetas , Valor Preditivo dos Testes , Baço/diagnóstico por imagem
14.
Sci Rep ; 12(1): 6833, 2022 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-35477727

RESUMO

The optimal timing of endoscopy in patients with acute upper gastrointestinal bleeding (UGIB) remains controversial. In this study, we investigated the clinical outcomes of urgent endoscopy in patients with UGIB compared with elective endoscopy. From January 2016 to December 2018, consecutive patients who visited the emergency department and underwent endoscopy for clinical manifestations of acute UGIB, including variceal bleeding, were eligible. Urgent endoscopy (within 6 h) and elective endoscopy (after 6 h) were defined as the time taken to perform endoscopy after presentation to the emergency department. The primary outcome was mortality rate within 30 days. A total of 572 patients were included in the analysis. Urgent endoscopy was performed in 490 patients (85.7%). The 30-day mortality rate did not differ between the urgent and elective endoscopy groups (5.3% and 6.1%, p = 0.791). There was no difference regarding the recurrent bleeding rate, total amount of transfusion, or length of hospital between the groups. In multivariate analysis, age and the amount of transfusion were associated with mortality. Urgent endoscopy was not associated with a lower 30-day mortality rate compared with elective endoscopy in patients with acute UGIB.


Assuntos
Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Doença Aguda , Serviço Hospitalar de Emergência , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico , Humanos
16.
Dig Endosc ; 34 Suppl 2: 148-150, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35483024
17.
Sci Rep ; 12(1): 6554, 2022 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-35449190

RESUMO

In this study the diagnostic capability and additional value of sequential CT arterioportography-arteriosplenography (CT AP-AS) in comparison to standard cross-sectional imaging and upper gastrointestinal endoscopy (UGE) in pediatric portal hypertension (PH) was analyzed. Patients with clinical signs of PH who underwent CT AP-AS in combination with additional contrast-enhanced magnetic resonance imaging (CE-MR) and/or contrast-enhanced computed tomography (CE-CT) were included. Two radiologists reviewed independently imaging regarding the capability to prove patency of (1) extrahepatic and intrahepatic main stem portal vein (PV), (2) intrahepatic PV system and (3) splenomesenteric venous axis. Imaging was reviewed for detection of abdominal varices and results were compared to UGE. Main venous supply of varices (PV and/or splenic vein system) and splenorenal shunting were evaluated. 47 imaging studies (20 CT AP-AS, 16 CE-MR, 11 CE-CT) and 12 UGE records of 20 patients were analyzed. CT AP-AS detected significantly more splenorenal shunts (p = 0.008) and allowed more confident characterization of the extra-/intrahepatic PV-system and splenomesenteric veins in comparison to CE-MR (p < 0.001). Extra- and intrahepatic PV-system were significantly more confidently assessed in CT AP-AS than in CE-CT (p = 0.008 and < 0.001 respectively). CT AP-AS was the only modality that detected supply of varices and additional gastric/duodenal varices. In this retrospective study CT AP-AS was superior to standard cross-sectional imaging concerning confident assessment of the venous portosplenomesenteric axis in pediatric patients. CT AP-AS detected additional varices, splenorenal shunting and supply of varices.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Varizes , Criança , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/patologia , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/patologia , Veia Porta/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Varizes/patologia
18.
BMC Gastroenterol ; 22(1): 164, 2022 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-35382748

RESUMO

BACKGROUND: Dyspepsia is a common complaint in upper gastrointestinal disorders. It is described as predominant epigastric pain lasting for at least one month. Globally, peptic ulcer disease occurs in 3.5-32% of patients with dyspepsia. Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drugs/aspirin use are the widely known risk factors for peptic ulcer disease. There was no recent document on H. pylori infection rate among patients with peptic ulcer disease in Ethiopia. This study aimed to determine magnitude and associated factors of peptic ulcer disease among dyspeptic patients in Northwest Ethiopia. METHODS: An institutional-based cross sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit 218 study subjects. A pre-designed semi-structured questionnaire was used to extract clinical information. Olympus flexible fiber-optic endoscope (Olympus, GIF-E 600, Olympus Corp., Hamburg, Germany) was used to confirm the presence of peptic ulcer disease. Diagnosis of active H. pylori infection was made using the fecal H. pylori Antigen 25 T Card Test (Anamol Lab., Pvt. Ltd., Palghar, India). The Data were entered into EPI Info version 4.6.0.2, and then exported to SPSS version 20 for analysis. Explanatory variables associated with peptic ulcer disease were analyzed by applying logistic regression model. P value < 0.05 was used to declare significant association. RESULT: A total of 218 dyspeptic patients who underwent upper gastrointestinal endoscopic evaluations were included in the study. The mean (+ SD) age of patients was 42 ± 16.4 years. Forty nine percent (95% CI 42.4-56.2) of dyspeptic patients had active H. pylori infection. Peptic ulcer disease was diagnosed in 35% (95% CI 31.4-39.2) of patients with dyspepsia. H. pylori infection (AOR = 6.298, 95% CI 2.965-13.378, P value <  0.001) and NSAIDs/ASA use (AOR = 6.252, 95% CI 2.925-13.362, P value < 0.001) were identified as risk factors for peptic ulcer disease. CONCLUSION: Medical treatment of peptic ulcer disease should target treatment of H. pylori infection and cautious use of non-steroidal anti-inflammatory drugs/aspirin.


Assuntos
Dispepsia , Infecções por Helicobacter , Helicobacter pylori , Úlcera Péptica , Adulto , Estudos Transversais , Dispepsia/complicações , Endoscopia Gastrointestinal , Etiópia/epidemiologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Hospitais , Humanos , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Prevalência
19.
JSLS ; 26(1)2022.
Artigo em Inglês | MEDLINE | ID: mdl-35444403

RESUMO

Background: Obesity is a chronic, multifactorial disease associated with multiple cardiometabolic conditions. The successful management of this condition includes a multidisciplinary approach with interventions focused on lifestyle modification, pharmaceutical therapies, and bariatric surgery. Endoscopic bariatric therapies (EBT) have been proposed as a way to bridge the gap between medical management and bariatric surgery. The Association for Bariatric Endoscopy in conjunction with the American Society for Gastrointestinal Endoscopy published the position statement approving and integrating EBT into practice. The aim of this article is to review the most common primary EBT's, their indications, outcomes, and complications. Database: A medical literature review was conducted using the defined keywords. Databases included PubMed, Google Scholar, Embase, and EBSCO. Articles in English were considered for review from June 1, 2000 to June 30, 2021. Conclusion: Endoscopic bariatric therapies should be offered in conjunction with lifestyle modification and with nutritional guidance, as part of a multidisciplinary approach in obesity management. They require a formal training process for endoscopists and bariatric surgeons to obtain the endoscopic skills needed before performing these procedures. Longer follow-up and larger trials are needed to validate current evidence, in order to enhance the process of standardization of these techniques.


Assuntos
Cirurgia Bariátrica , Cirurgia Bariátrica/métodos , Endoscopia Gastrointestinal , Humanos , Obesidade/cirurgia
20.
Lancet ; 399(10335): 1603, 2022 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-35461550
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