Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 40.520
Filtrar
1.
Medicine (Baltimore) ; 99(18): e19836, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358354

RESUMO

INTRODUCTION: Acute hemorrhagic rectal ulcer (AHRU) is a rare entity which has most frequently been described in Japan and Taiwan literature. This study characterizes 11 AHRUs identified and managed at an urban acute care hospital in the United States of America (USA). METHODS: A total of 2253 inpatients underwent colonoscopy. In 1172 patients (52%), colonoscopy was performed for evaluation of lower gastrointestinal (LGI) bleeding. Eleven (0.9%) of the 1172 patients with LGI bleeding had AHRU. RESULTS: AHRU is characterized by a sudden onset of painless and massive lower rectal bleeding in elderly, bedridden patients (pts) with major underlying diseases. The endoscopic findings were classified into 4 types. All 11 ulcers were located in the distal rectum within 10 cm of the dentate line. All 11 patients required blood transfusion (mean = 3.7 units; range 2-9 units). Seven patients responded to blood, plasma, and platelet transfusions. The other 4 patients required endoscopic hemostasis.Three patients died within a month of colonoscopy from comorbidities. None had bleeding as a cause of death. Eight surviving patients did not have recurrent bleeding. CONCLUSION: AHRU does exist in the USA and should be considered as an important cause of acute lower GI bleeding in elderly, critically ill, and bedridden patients. AHRU should be recognized and managed correctly.


Assuntos
Colonoscopia/estatística & dados numéricos , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/métodos , Doenças Retais/cirurgia , Úlcera/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retais/diagnóstico , Reto/irrigação sanguínea , Reto/cirurgia , Úlcera/diagnóstico , Estados Unidos
2.
Nursing ; 50(5): 24-29, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32332500

RESUMO

Acute upper gastrointestinal bleeding (UGIB) is common in both acute care and primary care settings. It can range from self-limited bleeding to life-threatening hemorrhagic emergencies. This article discusses the assessment and management of adults with acute UGIB, including pharmacologic and nursing interventions.


Assuntos
Hemorragia Gastrointestinal/enfermagem , Doença Aguda , Adulto , Hemorragia Gastrointestinal/fisiopatologia , Humanos , Avaliação em Enfermagem , Educação de Pacientes como Assunto
3.
Medicine (Baltimore) ; 99(15): e19630, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282712

RESUMO

To investigate computed tomography and angiography findings and clinical outcomes after transcatheter arterial embolization for acute upper gastrointestinal bleeding from advanced gastric cancers.From January 2005 to December 2014, 58 patients with pathologically proven gastric cancer were treated at our institution with transcatheter arterial embolization due to acute upper gastrointestinal bleeding recalcitrant to endoscopic treatment. The electronic medical records for each patient were reviewed for clinical presentation, endoscopy history, computed tomography and angiographic findings, blood transfusion requirements, and follow-up results.Angiography findings were positive in 13 patients (22.4%): contrast extravasation was found in 9 patients and pseudoaneurysm in 4 patients. All patients with positive angiograms underwent selective embolization treatment. Those with negative angiography findings underwent empirical embolization. Gelfoam, n-butyl cyanoacrylate, coils, or a combination of these were used as embolic agents. The overall clinical success rate was 72.4% (42/58), and the success rate for patients with positive angiography was 53.8% (7/13). The median survival was 97.5 days (range, 7-1415 days), and the 1-month survival rate was 89.6% (52/58). The 1-month survival rate of the clinical success group was 95.2% (40/42), which was significantly higher than that of the clinical failure group (P = .04). The clinical success group also required significantly fewer transfusions (2.43 units, range 0-24 units) (P = .02).Transcatheter arterial embolization is a highly effective treatment for advanced gastric cancer with active bleeding. It should be considered as an additional treatment, especially when endoscopic or surgical treatment fails or when these approaches are difficult.


Assuntos
Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/terapia , Neoplasias Gástricas/complicações , Tomografia Computadorizada por Raios X/métodos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/epidemiologia , Angiografia/instrumentação , Embolização Terapêutica/tendências , Embucrilato/uso terapêutico , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/epidemiologia , Esponja de Gelatina Absorvível/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estômago/irrigação sanguínea , Estômago/patologia , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Resultado do Tratamento
4.
Rev. esp. enferm. dig ; 112(4): 249-257, abr. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-187502

RESUMO

INTRODUCTION: the aim of this study was to determine the risk factors for rebleeding following device-assisted enteroscopy therapy of small bowel vascular lesions. METHODS: this is a systematic review and meta-analysis. A literature search was performed from January 2003 to October 2019. All studies reporting on at least one risk factor for bleeding recurrence after endoscopic therapy of small bowel vascular lesions were included. A meta-analysis of those risk factors reported in at least three studies was performed to assess their association with rebleeding. The OR and 95 % CI were used for binary outcome data. Heterogeneity analysis was performed using the Tau and I2 index. If I2 > 20 %, potential sources of heterogeneity were identified by sensitivity analyses and a random-effect model was used. RESULTS: the search identified a total of 572 articles and 35 full-text records were assessed for eligibility after screening. Finally, eight studies that included 548 patients were selected. The overall median rebleeding rate was 38.5 % (range: 10.9-53.3 %) with a median follow-up of 24.5 months. Female sex (OR: 1.96, 95 % CI: 1.14-3.37, p = 0.01, I2 = 0 %), Osler-Weber syndrome (OR: 4.35, 95 % CI: 1.22-15.45, p = 0.02, I2 = 0 %) and cardiac disease (OR: 1.89, 95 % CI: 1.12-2.97, p = 0.005, I2: 0 %) were associated with rebleeding. According to the sensitivity analysis, overt bleeding (OR: 2.13, 95 % CI: 1.22-3.70, p = 0.007, I2 = 0 %), multiple lesions (OR: 4.57, 95 % CI: 2.04-10.22, p < 0.001, I2 = 0 %) and liver cirrhosis (OR: 2.61, 95 % CI: 1.11-6.13, p = 0.03, I2 = 0 %) were also predictors for rebleeding. CONCLUSIONS: patient characteristics and comorbidities should be considered for follow-up patient management after effective device-assisted endoscopic therapy, as they can predict rebleeding


No disponible


Assuntos
Humanos , Enteroscopia de Balão/métodos , Hemorragia Gastrointestinal/cirurgia , Enteropatias/cirurgia , Intestino Delgado/cirurgia , Intestino Delgado/irrigação sanguínea , Enteroscopia de Balão/efeitos adversos , Fatores de Risco , Recidiva
5.
Rev. esp. enferm. dig ; 112(4): 258-261, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187503

RESUMO

INTRODUCCIÓN: la insuflación de dióxido de carbono (CO2) durante la enteroscopia reduce el tiempo del procedimiento y los síntomas posteriores al mismo e incrementa la profundidad de inserción comparado con aire ambiente. En colonoscopia, la técnica de intercambio de agua (IA) se asocia a menor dolor en comparación con la insuflación de CO2. La técnica IA no está bien estudiada en enteroscopia. El objetivo de este estudio es comparar la seguridad y eficacia de la enteroscopia con IA y la enteroscopia con CO2. MÉTODOS: estudio prospectivo, comparativo y observacional, que incluyó enteroscopias de doble balón (EDB) que fueron aleatorizadas en dos grupos: el primero con IA y el segundo con insuflación de CO2. Los datos recopilados se evaluaron mediante análisis univariado y una regresión logística múltiple (variables con p ≤ 0.10 en análisis univariado). RESULTADOS: se incluyeron 46 EDB (23 por brazo; mediana de edad 63,5 años, 37% mujeres). No hubo diferencias estadísticas en la vía de acceso, los hallazgos, la terapéutica y las complicaciones entre grupos. Cuatro pacientes (20%) en el grupo de CO2 tuvieron eventos adversos (distensión abdominal y dolor) y uno en el grupo IA (náuseas) sin diferencia estadística. La mediana de profundidad de inserción fue mayor en el grupo de CO2 (260 cm vs. 160 cm; p = 0,048). La regresión logística múltiple mostró una diferencia estadística en la profundidad de inserción utilizando insuflación de CO2 (OR 1,009, 1,001-1,017; p = 0,034). CONCLUSIONES: las EDB con técnica de insuflación de CO2 y con IA son seguras con una mayor profundidad de inserción con CO2


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Ciências da Saúde , Enteroscopia de Balão/métodos , Dióxido de Carbono/administração & dosagem , Hemorragia Gastrointestinal/cirurgia , Água/administração & dosagem , Enteroscopia de Balão/efeitos adversos , Resultado do Tratamento , Estudos Prospectivos , Insuflação/métodos
6.
Rev. esp. enferm. dig ; 112(4): 262-268, abr. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-187504

RESUMO

BACKGROUND: data on the long-term outcome of patients with obscure gastrointestinal bleeding (OGIB) with positive small bowel findings in capsule endoscopy but negative small bowel findings in device-assisted enteroscopy are scarce. OBJECTIVE: this study aimed to evaluate the rebleeding rate and time to rebleed in patients with no small bowel findings in enteroscopy, after a positive capsule endoscopy in the setting of OGIB. Baseline predictors for rebleeding were assessed. METHODS: a retrospective double-center study was performed, including patients with OGIB with positive findings by capsule endoscopy and negative small bowel findings by enteroscopy. RESULTS: thirty-five patients were included. Rebleeding occurred in 40 % of patients during a median follow-up of 27 months. Further evaluation in patients with a rebleed was performed in 85.7 %, leading to a final diagnosis in 78.6 %. The rebleeding rate increased progressively over time, from 17.2 % at one month to 54.4 % at four years. Overt bleeding at the time of the first episode was a predictor of rebleeding (p = 0.03) according to the multivariate analysis. This was 50 % at one year compared with 21.8 % in patients with occult bleeding on admission. CONCLUSIONS: in obscure gastrointestinal bleeding, long-term follow-up and further evaluation may be considered after a positive capsule endoscopy. Even if there are no small bowel findings by device-assisted enteroscopy. The rebleeding rate in our study was 40 %, mainly in the presence of an overt bleeding on admission


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/cirurgia , Enteroscopia de Balão , Recidiva , Endoscopia por Cápsula , Estudos Retrospectivos , Fatores de Risco
7.
Rev. esp. enferm. dig ; 112(4): 269-272, abr. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-187505

RESUMO

INTRODUCCIÓN: la lesión de Dieulafoy en intestino delgado es una causa infrecuente de hemorragia digestiva que recidiva frecuentemente tras su tratamiento endoscópico. MATERIAL Y MÉTODOS: se presenta un estudio observacional, descriptivo, retrospectivo y unicéntrico de 15 pacientes con hemorragia de intestino delgado, diagnosticados de lesión de Dieulafoy con cápsula endoscópica o enteroscopia doble balón, en los que se realizó tratamiento endoscópico combinado. Resultados y conclusiones: durante una mediana de seguimiento de 33,5 meses (rango 2-145), recidivaron tres de los 12 casos que se pudieron seguir (25 %) y todos ocurrieron precozmente en las primeras 48 horas tras la terapéutica. Se retrataron con éxito dos de ellos con una nueva enteroscopia


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Intestino Delgado/irrigação sanguínea , Intestino Delgado/cirurgia , Hemorragia Gastrointestinal/cirurgia , Recidiva , Estudos Retrospectivos , Enteroscopia de Duplo Balão , Endoscopia por Cápsula , Seguimentos
8.
Rev. esp. enferm. dig ; 112(4): 290-293, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187508

RESUMO

INTRODUCCIÓN Y OBJETIVO: estudios han evaluado la concordancia entre la cápsula endoscópica y la enteroscopia doble-balón con resultados diversos. El objetivo de este estudio es identificar factores que predicen la visualización de las lesiones en el intestino delgado por enteroscopia doble-balón después de una cápsula endoscópica positiva. MÉTODOS: estudio retrospectivo, observacional y comparativo que evaluó a pacientes con enteroscopia doble balón después de un cápsula endoscópica positiva entre enero de 2017 y agosto de 2019. Los datos estudiados fueron demográficos, indicaciones, comorbilidades y resultados de cápsula endoscópica y enteroscopia doble-balón. Se evaluaron mediante una regresión logística múltiple. RESULTADOS: se incluyeron 91 pacientes (edad 58 ± 16,5 años, 53 mujeres). Sesenta y dos enteroscopia doble-balón (68,1 %) encontraron las mismas lesiones que la cápsula endoscópica. Los factores predictivos para enteroscopia doble-balón positiva fueron lesiones múltiples (OR 8,10, 1,50-43,78; p = 0,015) y < 15 días ambos estudios (OR 5,31, 1,19-23,66; p = 0,029). En el subgrupo de pacientes con hemorragia de intestino delgado (70 pacientes), 46 enteroscopia doble-balón (65,7 %) coincidieron con la cápsula endoscópica. Los factores predictivos en este grupo fueron lesiones múltiples (OR 10,42, 1,37-79,30; p = 0,024), < 15 días entre ambos estudios (OR 13,51, 1,78-102,22; p = 0,012), > 60 años (OR 7,45, 1,51-36,75; p = 0,014) y úlceras (OR 4,67, 1,08-20,22; p = 0,039). CONCLUSIONES: los factores predictivos para enteroscopia doble-balón positiva después de cápsula endoscópica positiva son lesiones múltiples y < 15 días entre ambos procedimientos. En pacientes con hemorragia de intestino delgado, edad mayor a 60 años y presencia de úlceras también son


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/lesões , Hemorragia Gastrointestinal/diagnóstico por imagem , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Endoscopia por Cápsula , Enteroscopia de Duplo Balão , Estudos Retrospectivos
9.
Rev. esp. enferm. dig ; 112(4): 273-277, abr. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-187509

RESUMO

Standard therapy using device-assisted enteroscopy includes different hemostatic therapies, polypectomy, dilation and other possibilities. The most frequent indication is small bowel bleeding. However, other specific settings could require dedicated therapies such as desinvagination, percutaneous enteroscopic jejunostomy, stent placement, endoscopic mucosal resection in polypoid vascular lesions and foreign body extraction. The present review aimed to investigate and describe device-assisted advanced therapies in the small bowel, excluding conventional hemostatic therapies of vascular lesions


No disponible


Assuntos
Humanos , Intestino Delgado/lesões , Intestino Delgado/cirurgia , Obstrução Intestinal/cirurgia , Corpos Estranhos/cirurgia , Hemorragia Gastrointestinal/cirurgia , Enteroscopia de Duplo Balão , Endoscopia Gastrointestinal
10.
Rev. esp. enferm. dig ; 112(4): 309-318, abr. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-187512

RESUMO

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly


No disponible


Assuntos
Humanos , Enteroscopia de Balão/métodos , Intestino Delgado/cirurgia , Hemorragia Gastrointestinal/cirurgia , Endoscopia por Cápsula/métodos , Deficiência de Ferro/etiologia , Doença de Crohn/cirurgia , Polipose Intestinal/cirurgia , Doença Celíaca/cirurgia , Guias de Prática Clínica como Assunto , Sangue Oculto , Portugal , Espanha
13.
Orv Hetil ; 161(15): 583-587, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32323522

RESUMO

Introduction: Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Aim: To analyse whether the changes introduced in the treatment of variceal gastrointestinal haemorrhage in our department affected the mortality rate of these patients. Method: A retrospective method was used to compare the data of patients treated with variceal bleeding in 2014 and 2015. In 2015, two changes were made in the treatment of patients with variceal bleeding: all patients were treated in the subintensive care unit and terlipressin was administered to all patients susceptible to variceal haemorrhage. Bleeding was mitigated by means of sclerotherapy and/or ligation. Significance was calculated using Student's t-test, then we performed logistic regression to find out what treatment factors affect mortality rate. Patients: 2014 vs. 2015 figures ­ number of patients: 24 vs. 30, average age: 59.8 vs. 57.6 years, male (%): 70.8 vs. 66.7. There were no significant differences between the Child­Pugh stages of the two years, p = 0.53. For the analysis we also grouped patients based on whether irrespective of the year of treatment they were administered terlipressin or not. Number of patients: 22 vs. 32, average age: 60.4 vs. 57.4, male (%): 63.6 vs. 70.6. Results: Mortality in 2015 and 2014: 23% and 33%, respectively. Mortality of patients treated with terlipressin: 18.2 vs. 34.4, p = 0.09. Child­Pugh stages had the strongest influence on mortality (stage A vs. B p = 0.05, stage A vs. C p = 0.02). Terlipressin administered in Child­Pugh stage C reduced mortality at a rate bordering on significance (p = 0.055). Conclusion: Despite the comparatively small number of cases, the changes introduced in our department in 2015 in the treatment of variceal gastrointestinal haemorrhages resulted in a significant reduction of hospital mortality rates. Orv Hetil. 2020; 161(15): 583­587.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Terlipressina/uso terapêutico , Vasoconstritores/uso terapêutico , Idoso , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Terlipressina/efeitos adversos , Resultado do Tratamento , Varizes/fisiopatologia , Vasoconstritores/efeitos adversos
14.
Khirurgiia (Mosk) ; (3): 67-73, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271740

RESUMO

OBJECTIVE: To analyze acute complications of stromal gastrointestinal tumors and determine diagnosis and optimal treatment of these patients. MATERIAL AND METHODS: There were 33 patients with acute complications of GIST aged 40-74 years. RESULTS: Acute complications were presented by gastrointestinal and (or) intratumoral (interstitial) bleeding (n=31). Hemorrhage was combined with stomach perforation in 1 case, intussusception and obstruction of the duodenum in 1 patient, small bowel obstruction in 2 patients. All findings were confirmed by the marker CD 117 (+). One patient died in long-term period after R0-resection and chemotherapy. Targeted therapy was used in 2 patients. CONCLUSION: Clinical examples indicate the progress in diagnosis and treatment of GIST due to development of instrumental imaging techniques, histological and histochemical verification of the process.


Assuntos
Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/terapia , Adulto , Idoso , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Intestino Delgado , Intussuscepção/etiologia , Intussuscepção/terapia , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-kit/análise
15.
BMC Infect Dis ; 20(1): 281, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295538

RESUMO

BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that commonly has a lethal course caused by the tick-borne Huaiyangshan banyang virus [former SFTS virus (SFTSV)]. The viral load in various body fluids in SFTS patients and the best infection control measure for SFTS patients have not been fully established. CASE PRESENTATION: A 79-year-old man was bitten by a tick while working in the bamboo grove in Nagasaki Prefecture in the southwest part of Japan. Due to the occurrence of impaired consciousness, he was referred to Nagasaki University Hospital for treatment. The serum sample tested positive for SFTSV-RNA in the genome amplification assay, and he was diagnosed with SFTS. Furthermore, SFTSV-RNA was detected from the tick that had bitten the patient. He was treated with multimodal therapy, including platelet transfusion, antimicrobials, antifungals, steroids, and continuous hemodiafiltration. His respiration was assisted with mechanical ventilation. On day 5, taking the day on which he was hospitalized as day 0, serum SFTSV-RNA levels reached a peak and then decreased. However, the cerebrospinal fluid collected on day 13 was positive for SFTSV-RNA. In addition, although serum SFTSV-RNA levels decreased below the detectable level on day 16, he was diagnosed with pneumonia with computed tomography. SFTSV-RNA was detected in the bronchoalveolar lavage fluid on day 21. By day 31, he recovered consciousness completely. The pneumonia improved by day 51, but SFTSV-RNA in the sputum remained positive for approximately 4 months after disease onset. Strict countermeasures against droplet/contact infection were continuously conducted. CONCLUSIONS: Even when SFTSV genome levels become undetectable in the serum of SFTS patients in the convalescent phase, the virus genome remains in body fluids and tissues. It may be possible that body fluids such as respiratory excretions become a source of infection to others; thus, careful infection control management is needed.


Assuntos
Líquidos Corporais/virologia , Encefalopatias/virologia , Infecções por Bunyaviridae/epidemiologia , Hemorragia Gastrointestinal/virologia , Phlebovirus/genética , Pneumonia/virologia , RNA Viral/sangue , Idoso , Animais , Encefalopatias/tratamento farmacológico , Líquido da Lavagem Broncoalveolar/virologia , Infecções por Bunyaviridae/tratamento farmacológico , Infecções por Bunyaviridae/virologia , Terapia Combinada , Hemorragia Gastrointestinal/tratamento farmacológico , Hospitais Universitários , Humanos , Japão/epidemiologia , Masculino , Técnicas de Amplificação de Ácido Nucleico , Phlebovirus/isolamento & purificação , Pneumonia/tratamento farmacológico , Escarro/virologia , Carrapatos/virologia , Resultado do Tratamento , Carga Viral
17.
N Engl J Med ; 382(14): 1299-1308, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32242355

RESUMO

BACKGROUND: It is recommended that patients with acute upper gastrointestinal bleeding undergo endoscopy within 24 hours after gastroenterologic consultation. The role of endoscopy performed within time frames shorter than 24 hours has not been adequately defined. METHODS: To evaluate whether urgent endoscopy improves outcomes in patients predicted to be at high risk for further bleeding or death, we randomly assigned patients with overt signs of acute upper gastrointestinal bleeding and a Glasgow-Blatchford score of 12 or higher (scores range from 0 to 23, with higher scores indicating a higher risk of further bleeding or death) to undergo endoscopy within 6 hours (urgent-endoscopy group) or between 6 and 24 hours (early-endoscopy group) after gastroenterologic consultation. The primary end point was death from any cause within 30 days after randomization. RESULTS: A total of 516 patients were enrolled. The 30-day mortality was 8.9% (23 of 258 patients) in the urgent-endoscopy group and 6.6% (17 of 258) in the early-endoscopy group (difference, 2.3 percentage points; 95% confidence interval [CI], -2.3 to 6.9). Further bleeding within 30 days occurred in 28 patients (10.9%) in the urgent-endoscopy group and in 20 (7.8%) in the early-endoscopy group (difference, 3.1 percentage points; 95% CI, -1.9 to 8.1). Ulcers with active bleeding or visible vessels were found on initial endoscopy in 105 of the 158 patients (66.4%) with peptic ulcers in the urgent-endoscopy group and in 76 of 159 (47.8%) in the early-endoscopy group. Endoscopic hemostatic treatment was administered at initial endoscopy for 155 patients (60.1%) in the urgent-endoscopy group and for 125 (48.4%) in the early-endoscopy group. CONCLUSIONS: In patients with acute upper gastrointestinal bleeding who were at high risk for further bleeding or death, endoscopy performed within 6 hours after gastroenterologic consultation was not associated with lower 30-day mortality than endoscopy performed between 6 and 24 hours after consultation. (Funded by the Health and Medical Fund of the Food and Health Bureau, Government of Hong Kong Special Administrative Region; ClinicalTrials.gov number, NCT01675856.).


Assuntos
Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Úlcera Péptica Hemorrágica/diagnóstico , Doença Aguda , Idoso , Varizes Esofágicas e Gástricas/terapia , Feminino , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/mortalidade , Úlcera Péptica Hemorrágica/terapia , Medição de Risco , Fatores de Tempo , Tempo para o Tratamento
19.
Isr Med Assoc J ; 22(3): 164-168, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32147981

RESUMO

BACKGROUND: The number of investigative esophagogastroduodenoscopies (EGD) in children has increased over several decades, despite their unclear diagnostic yields. OBJECTIVES: To evaluate the indications for performing EGD, their diagnostic yields, and consequences on pediatric patient management. METHODS: A retrospective chart review was performed of consecutive pediatric patients aged 0-18 years, who underwent EGD between January and August 2014. RESULTS: During the study period, 547 EGD were performed on 478 children. The most frequent indications were suspected celiac disease, chronic non-specific abdominal pain, persistent Helicobacter pylori infection, and gastrointestinal hemorrhage. The yield of the diagnostic EGD was 59.2%, and the most common new diagnoses were celiac disease (28%), Helicobacter pylori-positive gastritis (16.5%), and Crohn's disease (5.4%). Of the patients with documented follow-up, 74.1% reported improved symptoms. Procedures performed for chronic unexplained abdominal pain had significantly lower yields (26.2%) and only 39.3% improved at follow-up. CONCLUSIONS: Our findings suggest a general high diagnostic yield for EGD in pediatric patients, stemming mainly from patients in whom a specific condition was suspected a priori. However, the role of the procedure in the diagnosis and management of non-specific gastrointestinal complaints was minor suggesting that EGD may be superfluous for some of these patients.


Assuntos
Endoscopia do Sistema Digestório/métodos , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Adolescente , Criança , Pré-Escolar , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Endoscopia do Sistema Digestório/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Humanos , Lactente , Israel/epidemiologia , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária
20.
N Engl J Med ; 382(11): 1018-1028, 2020 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-32160663

RESUMO

BACKGROUND: More information is needed about the long-term effects of low-dose aspirin (≤160 mg) on incident hepatocellular carcinoma, liver-related mortality, and gastrointestinal bleeding in persons with chronic hepatitis B or hepatitis C virus infection. METHODS: Using nationwide Swedish registries, we identified all adults who received a diagnosis of chronic hepatitis B or hepatitis C from 2005 through 2015 and who did not have a history of aspirin use (50,275 patients). Patients who were starting to take low-dose aspirin (14,205 patients) were identified by their first filled prescriptions for 90 or more consecutive doses of aspirin. We constructed a propensity score and applied inverse probability of treatment weighting to balance baseline characteristics between groups. Using Cox proportional-hazards regression modeling, we estimated the risk of hepatocellular carcinoma and liver-related mortality, accounting for competing events. RESULTS: With a median of 7.9 years of follow-up, the estimated cumulative incidence of hepatocellular carcinoma was 4.0% among aspirin users and 8.3% among nonusers of aspirin (difference, -4.3 percentage points; 95% confidence interval [CI], -5.0 to -3.6; adjusted hazard ratio, 0.69; 95% CI, 0.62 to 0.76). This inverse association appeared to be duration-dependent; as compared with short-term use (3 months to <1 year), the adjusted hazard ratios were 0.90 (95% CI, 0.76 to 1.06) for 1 to less than 3 years of use, 0.66 (95% CI, 0.56 to 0.78) for 3 to less than 5 years of use, and 0.57 (95% CI, 0.42 to 0.70) for 5 or more years of use. Ten-year liver-related mortality was 11.0% among aspirin users and 17.9% among nonusers (difference, -6.9 percentage points [95% CI, -8.1 to -5.7]; adjusted hazard ratio, 0.73 [95% CI, 0.67 to 0.81]). However, the 10-year risk of gastrointestinal bleeding did not differ significantly between users and nonusers of aspirin (7.8% and 6.9%, respectively; difference, 0.9 percentage points; 95% CI, -0.6 to 2.4). CONCLUSIONS: In a nationwide study of patients with chronic viral hepatitis in Sweden, use of low-dose aspirin was associated with a significantly lower risk of hepatocellular carcinoma and lower liver-related mortality than no use of aspirin, without a significantly higher risk of gastrointestinal bleeding. (Funded by the National Institutes of Health and others.).


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Carcinoma Hepatocelular/mortalidade , Hemorragia Gastrointestinal/induzido quimicamente , Hepatite B Crônica/complicações , Hepatite C Crônica/complicações , Neoplasias Hepáticas/mortalidade , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Risco , Suécia/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA