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1.
Cochrane Database Syst Rev ; 1: CD011561, 2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33522602

RESUMO

BACKGROUND: Portal hypertension commonly accompanies advanced liver disease and often gives rise to life-threatening complications, including bleeding (haemorrhage) from oesophageal and gastrointestinal varices. Variceal bleeding commonly occurs in children and adolescents with chronic liver disease or portal vein thrombosis. Prevention is, therefore, important. Randomised clinical trials have shown that non-selective beta-blockers and endoscopic variceal band ligation decrease the incidence of variceal bleeding in adults. In children and adolescents, band ligation, beta-blockers, and sclerotherapy have been proposed as primary prophylaxis alternatives for oesophageal variceal bleeding. However, it is unknown whether these interventions are of benefit or harm when used for primary prophylaxis in children and adolescents. OBJECTIVES: To assess the benefits and harms of band ligation compared with sham or no intervention for primary prophylaxis of oesophageal variceal bleeding in children and adolescents with chronic liver disease or portal vein thrombosis. SEARCH METHODS: We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, PubMed, Embase, and two other databases (April 2020). We scrutinised the reference lists of the retrieved publications, and we also handsearched abstract books of the two main paediatric gastroenterology and hepatology conferences from January 2008 to December 2019. We also searched clinicaltrials.gov, the United States Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the World Health Organization (WHO) for ongoing clinical trials. We imposed no language or document type restrictions on our search. SELECTION CRITERIA: We aimed to include randomised clinical trials irrespective of blinding, language, or publication status, to assess the benefits and harms of band ligation versus sham or no intervention for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. If the search for randomised clinical trials retrieved quasi-randomised and other observational studies, then we read them through to extract information on harm. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology to perform this systematic review. We used GRADE to assess the certainty of evidence for each outcome. Our primary outcomes were all-cause mortality, serious adverse events and liver-related morbidity, and quality of life. Our secondary outcomes were oesophageal variceal bleeding and adverse events not considered serious. We used the intention-to-treat principle. We analysed data using Review Manager 5. MAIN RESULTS: One conference abstract, describing a feasibility multi-centre randomised clinical trial, fulfilled our review inclusion criteria. We judged the trial at overall high risk of bias. This trial was conducted in three hospital centres in the United Kingdom. The aim of the trial was to determine the feasibility and safety of further larger randomised clinical trials of prophylactic band ligation versus no active treatment in children with portal hypertension and large oesophageal varices. Twelve children received prophylactic band ligation and 10 children received no active treatment. There was no information on the age of the children included, or about the diagnosis of any child included. All children were followed up for at least six months. Mortality was 8% (1/12) in the band ligation group versus 0% (0/10) in the no active intervention group (risk ratio (RR) 2.54, 95% confidence interval (CI) 0.11 to 56.25; very low certainty of evidence). The abstract did not report when the death occurred, but we assume it happened between the six-month follow-up and one year. No child (0%) in the band ligation group developed adverse events (RR 0.28, 95% CI 0.01 to 6.25; very low certainty of evidence) but one child out of 10 (10%) in the no active intervention group developed idiopathic thrombocytopaenic purpura. One child out of 12 (8%) in the band ligation group underwent liver transplantation versus none in the no active intervention group (0%) (RR 2.54, 95% CI 0.11 to 56.25; very low certainty of evidence). The trial reported no other serious adverse events or liver-related morbidity. Quality of life was not reported. Oesophageal variceal bleeding occurred in 8% (1/12) of the children in the band ligation group versus 30% (3/10) of the children in the no active intervention group (RR 0.28, 95% CI 0.03 to 2.27; very low certainty of evidence). No adverse events considered non-serious were reported. Two children were lost to follow-up by one-year. Ten children in total completed the trial at two-year follow-up. There was no information on funding.  We found two observational studies on endoscopic variceal ligation when searching for randomised trials. One found no harm, and the other reported E nterobacter cloacae septicaemia in one child and mild, transient, upper oesophageal sphincter stenosis in another. We did not assess these studies for risk of bias. We did not find any ongoing randomised clinical trials of interest to our review. AUTHORS' CONCLUSIONS: The evidence, obtained from only one feasibility randomised clinical trial at high risk of bias, is very scanty. It is very uncertain about whether prophylactic band ligation versus sham or no (active) intervention may affect mortality, serious adverse events and liver-related morbidity, or oesophageal variceal bleeding in children and adolescents with portal hypertension and large oesophageal varices. We have no data on quality of life. No adverse events considered non-serious were reported. The results presented in the trial need to be interpreted with caution. In addition, the highly limited data cover only part of our research question; namely, children with portal hypertension and large oesophageal varices. Data on children with portal vein thrombosis are lacking. Larger randomised clinical trials assessing the benefits and harms of band ligation compared with sham treatment for primary prophylaxis of oesophageal variceal bleeding in children and adolescents with chronic liver disease or portal vein thrombosis are needed. The trials should include important clinical outcomes such as death, quality of life, failure to control bleeding, and adverse events.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/prevenção & controle , Ligadura/métodos , Hepatopatias/complicações , Veia Porta , Trombose Venosa/complicações , Adolescente , Criança , Doença Crônica , Estudos de Viabilidade , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Ligadura/efeitos adversos , Ligadura/mortalidade , Prevenção Primária/métodos
2.
Artigo em Inglês | MEDLINE | ID: mdl-33375495

RESUMO

Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are more commonly used to prevent atrial fibrillation (AF) patients from thromboembolic events than vitamin K antagonists (VKAs). However, the gastrointestinal bleeding (GIB) risk in the Asian AF patients associated with NOACs in comparison with VKAs remained unaddressed. Materials and Methods: A systematic search of studies on NOACs and VKAs in the Asian AF patients was conducted in PubMed, Cochrane Library, and ClinicalTrials.gov. The primary outcome was the hazard ratio (HR) of any GIB associated with NOACs versus VKAs. The secondary outcome was the GIB risks in different kinds of NOACs compared with VKAs. Results: This meta-analysis included two randomized controlled trials (RCTs) and four retrospective studies, comprising at least 200,000 patients in total. A significantly lower HR of GIB risks was found in all kinds of NOACs than VKAs in the Asian AF patients (HR: 0.633; 95% confidence interval: 0.535-0.748; p < 0.001). Additionally, the GIB risks of different NOACs were apixaban (HR: 0.392), edoxaban (HR: 0.603), dabigatran (HR: 0.685), and rivaroxaban (HR: 0.794), respectively. Conclusions: NOACs significantly reduced the risk of GIB in the Asian AF patients compared with VKAs. In the four NOACs compared with VKAs, apixaban probably had a trend of the least GIB risk. We need further head-to-head studies of different NOACs to confirm which NOAC is the most suitable for Asian AF patients and to know the optimal dosage regimen of different NOACs.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial , Hemorragia Gastrointestinal/induzido quimicamente , Vitamina K/antagonistas & inibidores , Administração Oral , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Hemorragia Gastrointestinal/epidemiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
3.
Niger J Clin Pract ; 23(12): 1656-1659, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33355817

RESUMO

Background: Lower gastrointestinal bleeding (LGIB) (hematochezia) is an important indication for colonoscopy, and may be caused by hemorrhoids, diverticulosis, and tumors. Aims: The aim of this study was to compare the endoscopic findings in the young (<50 years) versus older subjects (≥50 years) with LGIB in Nigeria. Subjects and Methods: This was a retrospective study of the endoscopic findings of all adults with LGIB from January 2017 to December 2019 in Lagos, Nigeria. The records of two centers that deliver outpatient gastrointestinal endoscopic services were ploughed for biodata, presenting complaints and findings in these individuals. These data were then analyzed and are thus presented. Results: A total of 1,774 colonoscopies performed during this period, 793 were for LGIB. Of those with LGIB, 548 (69.1%) were males, 245 (30.9%) were female, mean age was 50.7 (±14) years, and 403 (50.8%) were younger than 50 years old. The most frequent findings in patients younger than 50 years were hemorrhoids (316, 78.4%), tumors (35, 8.7%), and polyps (27, 6.7%), while in the older patients, they were hemorrhoids (259, 66.4%), tumors (74, 19%) and diverticulosis (55, 14.1%). Younger age was significantly associated with the presence of hemorrhoids (P < 0.005), while older age was significantly associated with the presence of tumors (P < 0.005) and diverticulosis (P < 0.005). Conclusion: Our study showed that hemorrhoids, tumors, and diverticulosis were the most common causes of LGIB in Nigerian patients - with younger age being significantly associated with hemorrhoids, and older age with tumors and diverticulosis. A third of the tumors in this study were found in younger patients. Unfortunately, this finding of such a high proportion of colorectal tumors being found in young Africans has been shown in previous reports - this work should help heighten concern and provoke further scientific probing into the phenomenon with a view to encouraging policy to help truncate its existence.


Assuntos
Colonoscopia , Hemorroidas , Adulto , Idoso , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hemorroidas/complicações , Hemorroidas/diagnóstico , Hemorroidas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Retrospectivos
4.
Ter Arkh ; 92(9): 30-38, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33346428

RESUMO

INTRODUCTION: Upper gastrointestinal (UGI) bleeding is a common complication of antiplatelet therapy. Data from real clinical practice that characterize the range of risk factors for UGI bleeding, prophylactic proton pump inhibitors (PPIs) therapy, bleeding frequency and their long-term effects in patients with stable coronary artery disease (CAD) are limited. AIM: To identify predictors of UGI bleeding in patients with stable CAD, to assess the role of PPI in the prevention of bleeding and the long-term prognosis of patients after bleeding. MATERIALS AND METHODS: 934 patients with stable CAD (median age 61 [5368] years, 78.6% men) were included in the single institution prospective REGistry of Long-term AnTithrombotic TherApy (REGATTA). Atherosclerosis of peripheral arteries (APA) and abdominal aortic aneurysm (AAA) screening was performed by doctor decision, as well as esophagogastroduodenoscopy. 76% of patients received dual antiplatelet therapy for 612 months after elective PCI. PPIs were prescribed in 28.3% of cases. RESULTS: The median follow-up was 2.5 [1.15.1] years. The frequency of overt UGI bleeding was 1.9 per 100 patients per year. Anamnesis of peptic ulcer disease (OR 4.7; 95% CI 1.911.8;p=0.001), erosion of the upper gastrointestinal tract (OR 6.7; 2.716.6;p=0.00004 ), as well as concomitant diseases associated with a decrease in blood supply to the mucosa, such as heart failure HF (OR 6.1; 2.316.0;p=0.0002), AAA (OR 9.3; 2.534.2;p=0.0008) and APA (OR 2.3; 0.985.5;p=0.05) turned out to be independent predictors of UGI bleeding. The frequency of AAA among those who underwent UGI bleeding was 19.6% (in patients without bleeding 1.4%;p0.001). 90.2% of patients with UGI bleeding received PPI; the frequency of UGI bleeding in patients receiving pantoprazole and omeprazole did not differ significantly. After UGI bleeding, rebleeding rate was 7.8%, thrombotic events (TE) rate 31.4%, mortality rate 17.7% for 30 days, 19.4% for 1 year and 35.3% for the entire observation period. The predictors of deaths were AAA (OR 92.5; 7.7107.9;p0.0001), APA (OR 4.2; 1.0317.2;p=0.045) and HF (OR 34.5; 8.5140.6;p0.0001). The worst prognosis was expected for patients who underwent UGI bleeding and thrombotic events: 2/3 of these patients died. CONCLUSION: In a prospective analysis of patients with stable CAD, we identified UGI bleeding was a significant risk factor for late thromboembolism and death, compared with patients without bleeding. Predictors of UGI bleeding and poor prognosis are factors that indicate atherothrombotic burden abdominal aortic aneurysm, peripheral atherosclerosis and HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04347200.


Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Feminino , Fibrinolíticos/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiologia , Humanos , Masculino , Inibidores da Bomba de Prótons/efeitos adversos , Sistema de Registros , Fatores de Risco
5.
Cochrane Database Syst Rev ; 10: CD000553, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33089892

RESUMO

BACKGROUND: People with liver cirrhosis who have had one episode of variceal bleeding are at risk for repeated episodes of bleeding. Endoscopic intervention and portosystemic shunts are used to prevent further bleeding, but there is no consensus as to which approach is preferable. OBJECTIVES: To compare the benefits and harms of shunts (surgical shunts (total shunt (TS), distal splenorenal shunt (DSRS), or transjugular intrahepatic portosystemic shunt (TIPS)) versus endoscopic intervention (endoscopic sclerotherapy or banding, or both) with or without medical treatment (non-selective beta blockers or nitrates, or both) for prevention of variceal rebleeding in people with liver cirrhosis. SEARCH METHODS: We searched the CHBG Controlled Trials Register; CENTRAL, in the Cochrane Library; MEDLINE Ovid; Embase Ovid; LILACS (Bireme); Science Citation Index - Expanded (Web of Science); and Conference Proceedings Citation Index - Science (Web of Science); as well as conference proceedings and the references of trials identified until 22 June 2020. We contacted study investigators and industry researchers. SELECTION CRITERIA: Randomised clinical trials comparing shunts versus endoscopic interventions with or without medical treatment in people with cirrhosis who had recovered from a variceal haemorrhage. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. When possible, we collected data to allow intention-to-treat analysis. For each outcome, we estimated a meta-analysed estimate of treatment effect across trials (risk ratio for binary outcomes). We used random-effects model meta-analysis as our main analysis and as a means of presenting results. We reported differences in means for continuous outcomes without a meta-analytic estimate due to high variability in their assessment among all trials. We assessed the certainty of evidence using GRADE. MAIN RESULTS: We identified 27 randomised trials with 1828 participants. Three trials assessed TSs, five assessed DSRSs, and 19 trials assessed TIPSs. The endoscopic intervention was sclerotherapy in 16 trials, band ligation in eight trials, and a combination of band ligation and either sclerotherapy or glue injection in three trials. In eight trials, endoscopy was combined with beta blockers (in one trial plus isosorbide mononitrate). We judged all trials to be at high risk of bias. We assessed the certainty of evidence for all the outcome review results as very low (i.e. the true effects of the results are likely to be substantially different from the results of estimated effects). The very low evidence grading is due to the overall high risk of bias for all trials, and to imprecision and publication bias for some outcomes. Therefore, we are very uncertain whether portosystemic shunts versus endoscopy interventions with or without medical treatment have effects on all-cause mortality (RR 0.99, 95% CI 0.86 to 1.13; 1828 participants; 27 trials), on rebleeding (RR 0.40, 95% CI 0.33 to 0.50; 1769 participants; 26 trials), on mortality due to rebleeding (RR 0.51, 95% CI 0.34 to 0.76; 1779 participants; 26 trials), and on occurrence of hepatic encephalopathy, both acute (RR 1.60, 95% CI 1.33 to 1.92; 1649 participants; 24 trials) and chronic (RR 2.51, 95% CI 1.38 to 4.55; 956 participants; 13 trials). No data were available regarding health-related quality of life. Analysing each modality of portosystemic shunts individually (i.e. TS, DSRS, and TIPS) versus endoscopic interventions with or without medical treatment, we are very uncertain if each type of shunt has effect on all-cause mortality: TS, RR 0.46, 95% CI 0.19 to 1.13; 164 participants; 3 trials; DSRS, RR 0.93, 95% CI 0.65 to 1.33; 352 participants; 4 trials; and TIPS, RR 1.10, 95% CI 0.92 to 1.31; 1312 participants; 19 trial; on rebleeding: TS, RR 0.28, 95% CI 0.14 to 0.56; 127 participants; 2 trials; DSRS, RR 0.26, 95% CI 0.11 to 0.65; 330 participants; 5 trials; and TIPS, RR 0.44, 95% CI 0.36 to 0.55; 1312 participants; 19 trials; on mortality due to rebleeding: TS, RR 0.25, 95% CI 0.06 to 0.96; 164 participants; 3 trials; DSRS, RR 0.31, 95% CI 0.13 to 0.74; 352 participants; 5 trials; and TIPS, RR 0.65, 95% CI 0.40 to 1.04; 1263 participants; 18 trials; on acute hepatic encephalopathy: TS, RR 1.66, 95% CI 0.70 to 3.92; 115 participants; 2 trials; DSRS, RR 1.70, 95% CI 0.94 to 3.08; 287 participants; 4 trials, TIPS, RR 1.61, 95% CI 1.29 to 1.99; 1247 participants; 18 trials; and chronic hepatic encephalopathy: TS, Fisher's exact test P = 0.11; 69 participants; 1 trial; DSRS, RR 4.87, 95% CI 1.46 to 16.23; 170 participants; 2 trials; and TIPS, RR 1.88, 95% CI 0.93 to 3.80; 717 participants; 10 trials. The proportion of participants with shunt occlusion or dysfunction was overall 37% (95% CI 33% to 40%). It was 3% (95% CI 0.8% to 10%) following TS, 7% (95% CI 3% to 13%) following DSRS, and 47.1% (95% CI 43% to 51%) following TIPS. Shunt dysfunction in trials utilising polytetrafluoroethylene-covered stents was 17% (95% CI 11% to 24%). Length of inpatient hospital stay and cost were not comparable across trials. Funding was unclear in 16 trials; 11 trials were funded by government, local hospitals, or universities. AUTHORS' CONCLUSIONS: Evidence on whether portosystemic shunts versus endoscopy interventions with or without medical treatment in people with cirrhosis and previous hypertensive portal bleeding have little or no effect on all-cause mortality is very uncertain. Evidence on whether portosystemic shunts may reduce bleeding and mortality due to bleeding while increasing hepatic encephalopathy is also very uncertain. We need properly conducted trials to assess effects of these interventions not only on assessed outcomes, but also on quality of life, costs, and length of hospital stay.


Assuntos
Endoscopia/métodos , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Derivação Portossistêmica Cirúrgica/métodos , Viés , Causas de Morte , Varizes Esofágicas e Gástricas/prevenção & controle , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/prevenção & controle , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Humanos , Análise de Intenção de Tratamento , Derivação Portossistêmica Cirúrgica/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Prevenção Secundária , Derivação Esplenorrenal Cirúrgica/efeitos adversos
6.
S Afr Med J ; 110(9): 910-915, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32880277

RESUMO

BACKGROUND: With COVID-19 having spread across the globe, it has become standard to implement infection control strategies (colloquially known as lockdown) with the intention of reducing the magnitude and delaying the peak of the epidemiological curve. Personal infection mitigation strategies coupled with lockdown have caused a change in healthcare-seeking behaviour, with individuals not attending to their ill health as they previously did. OBJECTIVES: To determine whether admissions for urgent and emergency surgical pathologies have declined during the COVID-19 lockdown period, and the magnitude of the decline. METHODS: A retrospective analysis was conducted, comparing pre-lockdown (3 February - 26 March 2020) and lockdown (27 March - 30 April 2020) admission incidences for surgical pathologies at a tertiary healthcare complex in North West Province, South Africa. Poisson regression models were created to determine admission incidence rate ratios (IRRs). RESULTS: Of 769 surgical admissions included in the analysis, 49.7% were male and 67.2% were unemployed. There was a 44% reduction in the incidence of non-trauma admissions during lockdown (IRR 0.56; 95% confidence interval (CI) 0.47 - 0.68; p<0.001) and a 53% reduction in the incidence of trauma-related admissions (IRR 0.47; 95% CI 0.34 - 0.66; p<0.001). CONCLUSIONS: Even when the prevalence of SARS-CoV-2 infection was minimal, COVID-19 lockdown in North West was associated with a significant reduction in surgical admissions. In order to ensure an overall benefit to public health, a balance between maintaining the integrity of COVID-19 control mechanisms and access to healthcare services is essential.


Assuntos
Apendicite/epidemiologia , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Neoplasias/epidemiologia , Pneumonia Viral/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Centro Cirúrgico Hospitalar , Ferimentos e Lesões/epidemiologia , Adulto , Idoso , Betacoronavirus , Emergências , Emprego/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Obstrução Intestinal/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , África do Sul/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
7.
Yonsei Med J ; 61(10): 851-859, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32975059

RESUMO

PURPOSE: Thrombocytopenia (platelet count <150×10³/µL) is associated with poor outcomes in various critical illness settings. However, the prognostic value of platelet count in patients with cardiogenic shock (CS) remains unclear. MATERIALS AND METHODS: We enrolled 1202 patients between January 2014 and December 2018 from a multicenter retrospective-prospective cohort registry of CS. Clinical characteristics and treatment outcomes were compared between the patients with and without thrombocytopenia. RESULTS: At presentation with CS, 244 (20.3%) patients had thrombocytopenia. The patients with thrombocytopenia had lower blood pressure, hemoglobin level, and worse liver and renal functions compared to the patients without. During hospitalization, the patients with thrombocytopenia had more frequent gastrointestinal bleeding (10.5% vs. 3.8%, p=0.009), sepsis (8.3% vs. 2.6%, p=0.013), requirement of renal replacement therapy (36.5% vs. 18.9%, p<0.001), requirement of mechanical ventilation (65.2% vs. 54.4%, p=0.003), longer intensive care unit stay (8 days vs. 4 days, p<0.001), and thirty-day mortality (40.2% vs. 28.5%, p<0.001) compared to those without. In addition, the platelet count was an independent predictor of 30-day mortality (per 103/µL decrease; adjusted hazard ratio: 1.002, 95% confidence interval: 1.000-1.003, p=0.021). CONCLUSION: Thrombocytopenia at CS presentation was associated with worse clinical findings, higher frequencies of complications, and longer stay at the intensive care unit. Also, thrombocytopenia was independently associated with increased 30-day mortality. (Clinical trial registration No. NCT02985008).


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Choque Cardiogênico , Trombocitopenia , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Estado Terminal , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Contagem de Plaquetas , Prevalência , Prognóstico , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Sepse/sangue , Sepse/epidemiologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/terapia , Trombocitopenia/diagnóstico , Trombocitopenia/mortalidade , Trombocitopenia/terapia , Resultado do Tratamento
8.
Am J Gastroenterol ; 115(10): 1609-1616, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32796176

RESUMO

INTRODUCTION: Although current literature has addressed gastrointestinal presentations including nausea, vomiting, diarrhea, abnormal liver chemistries, and hyperlipasemia as possible coronavirus disease 2019 (COVID-19) manifestations, the risk and type of gastrointestinal bleeding (GIB) in this population is not well characterized. METHODS: This is a matched case-control (1:2) study with 41 cases of GIB (31 upper and 10 lower) in patients with COVID-19 and 82 matched controls of patients with COVID-19 without GIB. The primary objective was to characterize bleeding etiologies, and our secondary aim was to discuss outcomes and therapeutic approaches. RESULTS: There was no difference in the presenting symptoms of the cases and controls, and no difference in severity of COVID-19 manifestations (P > 0.05) was observed. Ten (32%) patients with upper GIB underwent esophagogastroduodenoscopy and 5 (50%) patients with lower GIBs underwent flexible sigmoidoscopy or colonoscopy. The most common upper and lower GIB etiologies were gastric or duodenal ulcers (80%) and rectal ulcers related to rectal tubes (60%), respectively. Four of the esophagogastroduodenoscopies resulted in therapeutic interventions, and the 3 patients with rectal ulcers were referred to colorectal surgery for rectal packing. Successful hemostasis was achieved in all 7 cases that required interventions. Transfusion requirements between patients who underwent endoscopic therapy and those who were conservatively managed were not significantly different. Anticoagulation and rectal tube usage trended toward being a risk factor for GIB, although it did not reach statistical significance. DISCUSSION: In COVID-19 patients with GIB, compared with matched controls of COVID-19 patients without GIB, there seemed to be no difference in initial presenting symptoms. Of those with upper and lower GIB, the most common etiology was peptic ulcer disease and rectal ulcers from rectal tubes, respectively. Conservative management seems to be a reasonable initial approach in managing these complex cases, but larger studies are needed to guide management.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Hemorragia Gastrointestinal/epidemiologia , Úlcera Péptica/epidemiologia , Pneumonia Viral/complicações , Doenças Retais/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Endoscopia/estatística & dados numéricos , Enema/efeitos adversos , Enema/instrumentação , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Úlcera Péptica/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Doenças Retais/etiologia , Doenças Retais/terapia , Fatores de Risco
9.
PLoS One ; 15(8): e0237022, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764775

RESUMO

BACKGROUND: Major bleedings other than gastrointestinal (GI) and intracranial (ICH) and mortality rates associated with antiplatelet drugs in real-world clinical practice are unknown. The objective was to estimate major bleeding risk and mortality among new users of antiplatelet drugs in real-world clinical practice. METHODS AND FINDINGS: A population-based prospective cohort using the French national health data system (SNIIRAM), identified 69,911 adults living within five well-defined geographical areas, who were new users of antiplatelet drugs in 2013-2015 and who had not received any antithrombotics in 2012. Among them, 63,600 started a monotherapy and 6,311 a dual regimen. Clinical data for all adults referred for bleeding was collected from all emergency departments within these areas, and medically validated. Databases were linked using common key variables. The main outcome measure was time to major bleeding (GI, ICH and other bleedings). Secondary outcomes were death, and event-free survival (EFS). Hazard ratios (HR) were derived from adjusted Cox proportional hazard models. We used Inverse Propensity of Treatment Weighting as a stratified sensitivity analysis according to the antiplatelet monotherapy indication: primary prevention without cardiovascular (CV) risk factors, with CV risk factors, and secondary prevention. We observed 250 (0.36%) major haemorrhages, 81 ICH, 106 GI and 63 other types of bleeding. Incidences were twice as high in dual therapy as in monotherapy. Compared to low-dose aspirin (≤ 100 mg daily), high-dose (> 100 up to 325 mg daily) was associated with an increased risk of ICH (HR = 1.80, 95%CI 1.10 to 2.95). EFS was improved by high-dose compared to low-dose aspirin (1.41, 1.04 to 1.90 and 1.32, 1.03 to 1.68) and clopidogrel (1.30, 0.73 to 2.3 and 1.7, 1.24 to 2.34) respectively in primary prevention with and without CV risk factors. CONCLUSION: The incidence of major bleeding and mortality was low. In monotherapy, low-dose aspirin was the safest therapeutic option whatever the indication. TRIAL REGISTRATION: NCT02886533.


Assuntos
Hemorragia/induzido quimicamente , Hemorragia/mortalidade , Inibidores da Agregação de Plaquetas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Estudos de Coortes , Bases de Dados Factuais , Quimioterapia Combinada , Feminino , França/epidemiologia , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia/epidemiologia , Humanos , Incidência , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Inibidores da Agregação de Plaquetas/administração & dosagem , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
10.
Niger J Clin Pract ; 23(8): 1163-1166, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788496

RESUMO

Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency that can result in significant morbidity and mortality. Aim: The aim of this study was to determine the demographic profile and etiology of UGIB in patients seen at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, North-Western Nigeria. Subjects and Methods: This descriptive retrospective study was carried out at the Gastroenterology Unit of ABUTH Zaria. Data of patients referred for upper gastrointestinal endoscopy with UGIB from June 2017 to December 2019 were extracted from the endoscopy register and analyzed. Results: One hundred and forty-four patients had upper gastrointestinal (UGI) endoscopy done for UGIB during the period under review. Of these, 105 (72.9%) were males while 39 (27.1%) were females with male-to-female ratio of 2.7:1. The mean age of the patients was 43.5 ± 17.3 and their age ranges from 11 to 89 years. The modal age group was 40-49 years. The most common cause of UGIB was esophageal varices (67 [46.5%]) followed by erosive mucosal diseases: gastritis/duodenitis 43 (29.9%), esophagitis 12 (8.3%). Less common causes were peptic ulcer disease (PUD) in five (3.5%) patients, gastric tumor in two (1.4%), hiatus hernia in one (0.7%), and portal hypertensive gastropathy in one (0.7%). Thirteen patients (9.0%) had normal findings. Conclusion: Esophageal varices are the most common cause of UGIB among our patients and middle-aged male patients were the most commonly affected group.


Assuntos
Endoscopia Gastrointestinal/métodos , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/diagnóstico por imagem , Úlcera Péptica/complicações , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Serviço Hospitalar de Emergência , Endoscopia Gastrointestinal/efeitos adversos , Varizes Esofágicas e Gástricas/epidemiologia , Feminino , Gastrite/complicações , Gastrite/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Úlcera Péptica/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
11.
Aliment Pharmacol Ther ; 52(4): 646-654, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32657466

RESUMO

BACKGROUND: Gastrointestinal bleeding (GIB) frequently occurs following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) with the prescription of P2Y12 inhibiting antiplatelet agents. Compared with clopidogrel, the newer P2Y12 inhibitors lower major adverse cardiac events with similar or possibly higher major bleeding events. The comparative GIB rates of these medications remain poorly understood. AIM: To compare GIB rates associated with clopidogrel, prasugrel and ticagrelor using national medical and pharmacy claims data from privately insured and Medicare Advantage enrollees . METHODS: Propensity score and inverse probability treatment weighting were used to balance baseline characteristics among treatment groups. The 1-year GIB risk was calculated using weighted Cox proportional hazard models and expressed as hazard ratios (HR) with 95% confidence intervals (CI) and number needed to harm (NNH). RESULTS: We identified 37 019 patients with ACS (non-ST elevation ACS [NSTE-ACS] and ST-elevation myocardial infarction [STEMI]) within 14 days of a PCI (mean age 63 years and 70% male). Clopidogrel prescription was most common (69%) with prasugrel (16%) and ticagrelor (14%) prescribed less frequently. When compared with clopidogrel, ticagrelor was associated with a 34% risk reduction (HR 0.66; 95% CI: 0.54-0.81) in GIB overall and with NSTE-ACS, and a 37% GIB risk reduction (HR 0.63; 95% CI: 0.42-0.93) in STEMI patients. When compared with clopidogrel, prasugrel was associated with a 21% risk reduction (HR 0.79; 95% CI: 0.64-0.97) overall, a 36% GIB risk reduction (HR 0.64; 95% CI: 0.49-0.85) in STEMI patients but no reduction of GIB risk in NSTE-ACS patients. CONCLUSIONS: In the first year following PCI, ticagrelor or prasugrel are associated with fewer GIB events than clopidogrel.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/cirurgia , Clopidogrel/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Intervenção Coronária Percutânea , Cloridrato de Prasugrel/efeitos adversos , Ticagrelor/efeitos adversos , Síndrome Coronariana Aguda/epidemiologia , Idoso , Clopidogrel/uso terapêutico , Estudos de Coortes , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Cloridrato de Prasugrel/uso terapêutico , Estudos Retrospectivos , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Ticagrelor/uso terapêutico , Resultado do Tratamento , Estados Unidos/epidemiologia
12.
Stroke Vasc Neurol ; 5(2): 116-120, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32606083

RESUMO

OBJECTIVE: Gastrointestinal (GI) bleeding in patients who had a stroke is strongly associated with a higher risk of death and loss of independence. However, it is unknown whether GI bleeding increases risk for recurrence of stroke. In this study, we assess the potential relationship between GI bleeding and stroke recurrence in patients within 12 months of an acute ischaemic stroke (AIS), using the China National Stroke Registry (CNSR). METHODS: This study included 22 216 patients who had an ischaemic stroke included in the CNSR from 2007 to 2008. We analysed baseline patient characteristics, GI bleeding and outcomes of patients who had an AIS, specifically stroke recurrence at 3, 6 and 12 months. We used multivariable logistic regression to evaluate a possible association between GI bleeding and stroke recurrence. RESULTS: Of the 12 415 patients included in our study, 12.3%, 15.5% and 17.7% had a stroke recurrence at 3, 6 and 12 months, respectively. GI bleeding was an independent stroke recurrence risk factor in patients after ischaemic stroke at 3 months (adjusted OR 1.481, 95% CI 1.118 to 1.962), 6 months (adjusted OR 1.448, 95% CI 1.106 to 1.896) and 12 months (adjusted OR 1.350; 95% CI 1.034 to 1.763). CONCLUSION: GI bleeding was associated with the increased risk of stroke recurrence after an AIS.


Assuntos
Isquemia Encefálica/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Admissão do Paciente , Acidente Vascular Cerebral/epidemiologia , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , China/epidemiologia , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Fatores de Tempo
13.
Surgery ; 168(3): 434-439, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32600882

RESUMO

BACKGROUND: Pancreatoduodenectomy with synchronous resection of the portal vein/superior mesenteric vein confluence may result in the development of left-sided portal hypertension. Left-sided portal hypertension presents with splenomegaly and varices and may cause severe gastrointestinal bleeding. The aim of the study is to review the incidence, treatment, and preventive strategies of left-sided portal hypertension. METHODS: A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to identify all studies published up to September 30, 2019 reporting data on patients with left-sided portal hypertension after pancreatoduodenectomy with venous resection. RESULTS: Eight articles including 829 patients were retrieved. Left-sided portal hypertension occurred in 7.7% of patients who had splenic vein preservation and 29.4% of those having splenic vein ligation. Fourteen cases of gastrointestinal bleeding owing to left-sided portal hypertension were reported at a mean interval of 28 months from pancreatoduodenectomy. Related mortality at 1 month was 7.1%. Treatment of left-sided portal hypertension consisted of splenectomy in 3 cases (21%) and colectomy in 1 (7%) case, whereas radiologic, endoscopic procedures or conservative treatments were effective in the other cases (71%). CONCLUSION: Left-sided portal hypertension represents a potentially severe complication of pancreatoduodenectomy with venous resection occurring at greater incidence when the splenic vein is ligated and not reimplanted. Left-sided portal hypertension-related gastrointestinal bleeding although rare can be managed depending on the situation by endoscopic, radiologic procedures or operative intervention with low related mortality.


Assuntos
Hipertensão Portal/epidemiologia , Veias Mesentéricas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Veia Porta/cirurgia , Complicações Pós-Operatórias/epidemiologia , Carcinoma Ductal Pancreático/cirurgia , Colectomia/estatística & dados numéricos , Tratamento Conservador/estatística & dados numéricos , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/terapia , Incidência , Ligadura/efeitos adversos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Esplenectomia/estatística & dados numéricos , Esplenomegalia/epidemiologia , Esplenomegalia/etiologia , Esplenomegalia/terapia , Resultado do Tratamento
14.
Med Clin North Am ; 104(4): 647-662, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505258

RESUMO

Hospitalists often care for patients with liver disease, including those with acute liver injury and failure and patients with complications of decompensated cirrhosis. Acute liver failure is a true emergency, requiring intensive care and oftentimes transfer of the patient to a liver transplant center. Patients with decompensated cirrhosis have complications of portal hypertension, including variceal hemorrhage, ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy. These complications increase the risk of mortality among patients with decompensated cirrhosis. Comanagement by the hospitalist with gastroenterology/hepatology can optimize care, especially for patients being considered for liver transplant evaluation.


Assuntos
Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Cirrose Hepática/terapia , Falência Hepática Aguda/etiologia , Ascite/epidemiologia , Ascite/etiologia , Varizes Esofágicas e Gástricas/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Humanos , Hipertensão Portal/epidemiologia , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Falência Hepática Aguda/epidemiologia , Transplante de Fígado , Peritonite/epidemiologia , Peritonite/etiologia
15.
Infez Med ; 28(suppl 1): 37-41, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532936

RESUMO

In December 2019, a new Coronavirus (SARS-CoV-2) emerged in China, causing the pandemic disease COVID-19. The clinical presentation is variable, but the predominant symptoms are those of the upper respiratory tract. AIM: The aim of the current study is to describe the incidence and type of the gastrointestinal injury (GI) in COVID-19, as well as their prognostic value. MATERIALS AND METHODS: We conducted a coincidental search on this topic in PubMed, Web of Science and EMBASE. We also followed a group of 31 Bulgarian COVID-19 patients throughout the course of their disease and analyzed their symptoms (catarrhal and other) and outcome. RESULTS: The publications concerning our survey followed a total of 1509 COVID-19 patients. In the Bulgarian cohort, only 14 from the 31 patients were laboratory-confirmed COVID-19 cases. Approximately 1/3 of the infected individuals presented with GI. In some patients this was the first, or only, symptom of the disease. It was also indicative of a more severe disease course. CONCLUSION: GI may be an important symptom and prognostic factor in COVID-19. Therefore, patients with acute gastrointestinal symptoms must be actively tested for SARS-CoV-2.


Assuntos
Infecções por Coronavirus/complicações , Diarreia/etiologia , Náusea/etiologia , Pneumonia Viral/complicações , Vômito/etiologia , Adolescente , Adulto , Idoso , Bulgária/epidemiologia , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Resfriado Comum/etiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Diarreia/epidemiologia , Feminino , Febre/etiologia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hepatite Viral Humana/epidemiologia , Hepatite Viral Humana/etiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Náusea/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Avaliação de Sintomas , Vômito/epidemiologia , Adulto Jovem
16.
Rev. cuba. cir ; 59(2): e956, abr.-jun. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126415

RESUMO

RESUMEN Introducción: La hemorragia digestiva alta es una entidad de elevada incidencia, de etiología múltiple y de difícil manejo. Objetivo: Evaluar la efectividad del tratamiento con ácido tranexámico en sangramiento digestivo alto. Métodos: Se realizó un estudio experimental, partiéndose de un ensayo clínico realizado en Cuba en el año 2012, que incluyó el universo de pacientes con hemorragia digestiva alta que ingresaron en el servicio de cirugía general del Hospital General Docente "Comandante Pinares" en el período comprendido entre junio del 2016 y mayo del 2018. Fueron divididos en dos grupos de estudio: a un primer grupo se les realizó el tratamiento convencional según el algoritmo establecido, y a un segundo, a los que además de los tratamientos propuestos en el algoritmo se les administró el ácido tranexámico, según protocolo para dar salida a los objetivos proyectados. Se analizaron e interpretaron las variables utilizándose números, por cientos y la técnica estadística chi cuadrado, con un 95 por ciento de confiabilidad. Resultados: Los pacientes tratados con el ácido tranexámico adicionado al protocolo de tratamiento evolucionaron satisfactoriamente; con menor estadía hospitalaria, mejor evolución de los parámetros clínicos, menor número de transfusiones e intervenciones quirúrgicas, aclaramiento de los enemas evacuantes y controles de sangramiento en 48 horas. Conclusiones: El uso del ácido tranexámico reportó mayores beneficios que el tratamiento convencional en pacientes con hemorragia digestiva alta(AU)


ABSTRACT Introduction: Upper gastrointestinal bleeding is an entity with a high incidence, multiple etiology and difficult to manage. Objective: To evaluate the effectiveness of treatment with tranexamic acid in upper digestive bleeding. Methods: An experimental study was carried out, starting from a clinical trial carried out in Cuba in 2012, which included the universe of patients with upper gastrointestinal bleeding who were admitted to the general surgery service of the General Teaching Hospital "Comandante Pinares" in the period between June 2016 and May 2018. They were divided into two study groups: a first group underwent conventional treatment according to the established algorithm, and a second, which, in addition to the treatments proposed in the algorithm, were given administered tranexamic acid, according to the protocol to achieve the projected objectives. The variables were analyzed and interpreted using numbers, per hundred and the chi square statistical technique, with 95 percent reliability. Results: The patients treated with tranexamic acid added to the treatment protocol evolved satisfactorily; with shorter hospital stay, better evolution of clinical parameters, fewer transfusions and surgical interventions, clearance of evacuating enemas and bleeding controls in 48 hours. Conclusions: The use of tranexamic acid reported greater benefits than conventional treatment in patients with upper gastrointestinal bleeding(AU)


Assuntos
Humanos , Ácido Tranexâmico/uso terapêutico , Hemorragia Gastrointestinal/epidemiologia , Resultado do Tratamento , Hemorragia Gastrointestinal/etiologia
17.
Pediatr. aten. prim ; 22(86): 189-194, abr.-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187743

RESUMO

Desde la aparición de los primeros casos en diciembre de 2019 hasta el momento actual, más de tres millones de personas se han infectado por SARS-CoV-2 en el mundo. Los síntomas más frecuentes son fiebre, tos, mialgias y dificultad respiratoria. No obstante, al progresar la pandemia, se ha prestado una atención creciente a los síntomas gastrointestinales. Entre ellos, destacan hiporexia, náuseas, vómitos y diarrea. También puede haber hipertransaminasemia. Desde el punto de vista digestivo, cabe tener en cuenta que ciertas patologías crónicas, como la enfermedad inflamatoria intestinal, pueden beneficiarse de ciertas modificaciones en cuanto a tratamiento se refiere. Por último, cabe reflejar que ha de extremarse la precaución durante la realización de endoscopias. En esta revisión se ahonda en todos estos aspectos


From the beginning of the pandemic to the current moment, more than three million people have been infected with SARS-CoV-2 in the world. The most frequent symptoms are fever, cough, myalgia and respiratory distress. However, as the pandemic progresses, more gastrointestinal symptoms have been notified. Among them, hiporexia, nausea, vomiting and diarrhea. There may also be hipertransaminasemia. Patients with inflammatory bowel disease may be benefited by certain treatment modifications. Caution should be exercised during endoscopies. All of these topics are discussed in this review


Assuntos
Humanos , Infecções por Coronavirus/diagnóstico , Vírus da SARS/patogenicidade , Doenças Inflamatórias Intestinais/complicações , Intestinos/virologia , Infecções por Coronavirus/fisiopatologia , Vômito/epidemiologia , Diarreia/epidemiologia , Anorexia/epidemiologia , Endoscopia Gastrointestinal/normas , Hemorragia Gastrointestinal/epidemiologia , Dor Abdominal/epidemiologia
19.
Endoscopy ; 52(11): 1036-1038, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32408356

RESUMO

BACKGROUND: COVID-19 has spread rapidly around the world. The Austrian government implemented a lockdown on 16 March to contain further spread of the disease. We investigated the effects of lockdown on acute upper gastrointestinal (GI) bleeding in Austria. METHODS: We contacted 98 Austrian hospitals performing emergency endoscopies. The hospitals were asked to report upper GI endoscopies performed for recent hematemesis, melena, or both, and exhibiting endoscopically visible signs of bleeding. The study period was from 3 weeks before (calendar Week 9) to 3 weeks after (Week 14) initiation of the lockdown. RESULTS: 61 % of Austrian hospitals, and importantly all major state hospitals, responded. A total of 575 upper GI bleedings occurred during the 3 weeks before and 341 during the 3 weeks after initiation of lockdown (40.7 % reduction). There was a 54.6 % decline in nonvariceal bleeding events at Week 14 compared with Week 9 (89 vs. 196), whereas rates of variceal hemorrhage did not change (15 vs. 17). CONCLUSIONS: National lockdown resulted in a dramatic decrease in upper GI bleeding events in Austrian hospitals.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis , Infecções por Coronavirus/prevenção & controle , Varizes Esofágicas e Gástricas/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social , Áustria , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Endoscopia , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
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