Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.411
Filtrar
1.
Medicine (Baltimore) ; 99(11): e19485, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176084

RESUMO

Urgent endoscopy (UE) is important to the diagnosis and treatment of liver cirrhosis patients with esophageal variceal bleeding (EVB). It was reported that a second-look endoscopy may benefit acute upper gastrointestinal bleeding (UGIB) caused by peptic ulcer, while whether it could improve UGIB caused by liver cirrhosis associated EVB remains unclear. This study aimed to investigate the characteristics of second UE for liver cirrhosis with EVB and further examined the potential prognostic factors.Patients aged ≥18 years who underwent UE for EVB within 2 hours after the admission were included and divided into scheduled second-look group (n = 245) and uncontrolled bleeding group (n = 352) based on the indications for second UE within 48 hours after initial endoscopy. Demographic and clinical data were collected and analyzed. Univariate and multivariate analysis were used to identify the risk factors for prognosis. The value of different scoring system was compared.Statistical differences were found on history of bleeding and hepatocellular carcinoma, ascites, endoscopic type of bleeding, between scheduled second-look group and uncontrolled bleeding group. Univariate and multivariate logistic regression analysis confirmed that ascites, hemoglobin <60 g/L, AIMS65 score and failure to identify in initial UE were independent risk factors for bleeding uncontrolled after initial UE, and age, bilirubin level, initial unsatisfactory UE hemostasis, failure to identify bleeding on initial UE and tube/urgent TIPS suggested in initial UE were independent risk factors for 42-day mortality.A second-look UE could bring benefit for liver cirrhosis patients with EVB without increasing the complication rate.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/estatística & dados numéricos , Cirrose Hepática/complicações , Cirurgia de Second-Look/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Árvores de Decisões , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/mortalidade , Humanos , Modelos Logísticos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
2.
Medicine (Baltimore) ; 99(5): e18913, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000397

RESUMO

The use of beta-blockers in decompensated cirrhosis accompanying ascites is still under debate. The aim of this study was to compare overall survival (OS) and incidence of cirrhotic complications between endoscopic variceal ligation (EVL) only and EVL + non-selective beta-blocker (NSBB) combination therapy in cirrhotic patients with significant ascites (≥grade 2).This retrospective study included 271 consecutive cirrhotic patients with ascites who were treated with EVL only or EVL + NSBB combination therapy as a primary prophylaxis of esophageal varices. The primary outcome was all-cause mortality. Propensity score matching was performed between the 2 groups to minimize baseline difference.Median observation period was 42.1 months (interquartile range, 18.4-75.1 months). All patients had deteriorated liver function: 81.1% Child-Pugh class B and 18.9% Child-Pugh class C. All-cause mortality was significantly higher in the EVL + NSBB group than in the EVL only group not only in non-matched cohort, but also in matched cohort (48.9% vs 31.2%; P = .039). More people died from hepatic failure in the EVL + NSBB group than that in the EVL only group (40.5% vs 20.0%; P = .020). However, the incidence of variceal bleeding, hepatorenal syndrome (HRS), or spontaneous bacterial peritonitis (SBP) was not significantly different between the 2 groups.The use of NSBB might worsen the prognosis of cirrhotic patients with significant ascites. These results suggest that EVL alone is a more appropriate treatment option for prophylaxis of esophageal varices than propranolol combination therapy when patients have significant ascites.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Ascite/terapia , Endoscopia/métodos , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Propranolol/uso terapêutico , Ascite/mortalidade , Terapia Combinada , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Hemorragia Gastrointestinal/mortalidade , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão
3.
Gastroenterology ; 158(1): 160-167, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31562847

RESUMO

BACKGROUND & AIMS: Scoring systems are suboptimal for determining risk in patients with upper gastrointestinal bleeding (UGIB); these might be improved by a machine learning model. We used machine learning to develop a model to calculate the risk of hospital-based intervention or death in patients with UGIB and compared its performance with other scoring systems. METHODS: We analyzed data collected from consecutive unselected patients with UGIB from medical centers in 4 countries (the United States, Scotland, England, and Denmark; n = 1958) from March 2014 through March 2015. We used the data to derive and internally validate a gradient-boosting machine learning model to identify patients who met a composite endpoint of hospital-based intervention (transfusion or hemostatic intervention) or death within 30 days. We compared the performance of the machine learning prediction model with validated pre-endoscopic clinical risk scoring systems (the Glasgow-Blatchford score [GBS], admission Rockall score, and AIMS65). We externally validated the machine learning model using data from 2 Asia-Pacific sites (Singapore and New Zealand; n = 399). Performance was measured by area under receiver operating characteristic curve (AUC) analysis. RESULTS: The machine learning model identified patients who met the composite endpoint with an AUC of 0.91 in the internal validation set; the clinical scoring systems identified patients who met the composite endpoint with AUC values of 0.88 for the GBS (P = .001), 0.73 for Rockall score (P < .001), and 0.78 for AIMS65 score (P < .001). In the external validation cohort, the machine learning model identified patients who met the composite endpoint with an AUC of 0.90, the GBS with an AUC of 0.87 (P = .004), the Rockall score with an AUC of 0.66 (P < .001), and the AIMS65 with an AUC of 0.64 (P < .001). At cutoff scores at which the machine learning model and GBS identified patients who met the composite endpoint with 100% sensitivity, the specificity values were 26% with the machine learning model versus 12% with GBS (P < .001). CONCLUSIONS: We developed a machine learning model that identifies patients with UGIB who met a composite endpoint of hospital-based intervention or death within 30 days with a greater AUC and higher levels of specificity, at 100% sensitivity, than validated clinical risk scoring systems. This model could increase identification of low-risk patients who can be safely discharged from the emergency department for outpatient management.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Aprendizado de Máquina , Modelos Biológicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Medição de Risco/métodos
4.
Artigo em Inglês | MEDLINE | ID: mdl-31785729

RESUMO

Colonoscopy is an integral diagnostic and therapeutic tool in the management of patients with lower gastrointestinal bleeding (LGIB). After resuscitation, reversal of coagulopathy, and exclusion of a proximal source of bleeding, colonoscopy should be performed in most patients with LGIB. Bowel preparation, typically with polyethylene glycol based solutions, is needed to closely inspect the colonic mucosa for bleeding sources. Colonoscopy within 24 h is recommended for high-risk patients with ongoing bleeding, although there is limited evidence that this strategy improves clinical outcomes. When active or stigmata of bleeding is detected, endoscopic intervention is indicated and can reduce future rebleeding. The most common options for endoscopic intervention include clipping, endoscopic band ligation, and coagulation, however rigorous head-to-head comparisons of different endoscopic tools are unavailable. Future research is needed to determine the optimal timing of colonoscopy, appropriate reversal strategies for patients on antithrombotics, and the most effective endoscopic hemostatic therapy.


Assuntos
Colonoscopia/métodos , Endoscopia/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/patologia , Humanos , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-31785731

RESUMO

Endoscopy is the gold standard for evaluating and treating acute upper gastrointestinal bleeding (UGIB). The optimal timing of endoscopy is a very important consideration in the overall management of UGIB, but there is on going uncertainty regarding timing of the procedure, particularly in those with more severe bleeding. This is reflected by inconsistencies between current guidelines. Although evidence suggests endoscopy should be undertaken within 24 h for all admitted patients with UGIB, a small group of patients with severe bleeding or high-risk features may require more urgent endoscopy. The exact timing of the procedure in this high-risk group remains unclear, with recent data suggesting that performing endoscopy too early may be associated with worse outcome. In this article we examine the evidence for optimal timing of endoscopy in patients presenting with UGIB and suggest a clinical approach to this important aspect of patient management.


Assuntos
Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Humanos
6.
Artigo em Inglês | MEDLINE | ID: mdl-31785733

RESUMO

Endoscopic therapy is the mainstay of treatment for nonvariceal upper gastrointestinal bleeding (NVUGIB). Injection plus mechanical or thermal therapy continues to be the most widely used option. New endoscopic devices such as the use of an inert powder or a new class of over-the-scope clip system have demonstrated encouraging results as a rescue therapy for difficult hemostasis. Emerging data suggest that Doppler ultrasound-guided endoscopic therapy may improve the outcome of peptic ulcer bleeding. This review sumarizes the recent advances in the management of NVUGIB. With increasing use of anti-platelet agents and anti-coagulants, the management of NVUGIB in patients on anti-thrombotic therapy is also discussed.


Assuntos
Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/terapia , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-31785736

RESUMO

Acute gastrointestinal bleeding accounts for 5,000 deaths per annum in the UK and is the second-most common indication for transfusion of blood components. Transfusion of blood components is integral to management of these patients. Recent years have seen an expansion in the evidence base for their use in this population and this review aims to provide up-to-date guidance on the use of red cells, plasma, platelets, sources of concentrated fibrinogen and adjuncts such as antifibrinolytic agents in patients with acute gastrointestinal haemorrhage. Key considerations include whether or not it is appropriate to extrapolate from studies in trauma patients to the GI bleeding population, whether restrictive red cell transfusion is appropriate for all patients and whether the presence or absence of liver disease has implications for our transfusion practice. Clinical evidence now favours restrictive transfusion of red blood cells in the haemodynamically stable bleeding patient, but there remain significant evidence gaps concerning the use of plasma, platelets and adjunctive measures.


Assuntos
Transfusão de Sangue/métodos , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/patologia , Humanos
8.
Artigo em Inglês | MEDLINE | ID: mdl-31785739

RESUMO

The management of small bowel bleeding, also known as obscure gastrointestinal bleeding, has changed substantially over the past two decades due to revolutionary technological advances in small intestinal endoscopy. This clinical review will summarize the evolving definition of small bowel bleeding, how to perform a detailed initial assessment of patients with the condition, the strengths and limitations of small bowel endoscopy, and the treatment of small bowel bleeding.


Assuntos
Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/terapia , Humanos
9.
Am Surg ; 85(11): 1246-1252, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775966

RESUMO

When endoscopy is performed for acute GI bleeding, therapeutic endoscopic procedures are infrequently required (only 6% of cases). We sought to determine the natural history of GI hemorrhage in patients who have undergone therapeutic endoscopy. We queried our hospital database for inpatients with acute GI bleeding who underwent therapeutic endoscopy between 2015 and 2017. The primary endpoints were recurrence of bleeding and the subsequent need for repeated endoscopic interventions, angioembolization, or surgery. Demographic information was collected. We reviewed 205 hospitalized patients: mean age was 70 years, 58 per cent were male, and mean hemoglobin was 9 g/dL. Patients had medical conditions predisposing them to bleeding in 59 per cent and history of previous GI bleeding in 37 per cent of cases. Sixty per cent were on antiplatelet/anticoagulation medications, and 10 per cent were receiving nonsteroidal anti-inflammatory medications. Blood transfusions were given to 78 per cent of patients, with an average of 2.3 units of packed red blood cells transfused per patient before intervention. Recurrence of hemorrhage after therapeutic endoscopy was seen in 9 per cent of patients. Only 2 per cent underwent a second therapeutic endoscopic procedure, and 5 per cent had surgery or angioembolization (half of these patients then had a further recurrence of bleeding). In total, seven patients died (3%). Recurrence of GI bleeding after therapeutic endoscopies is uncommon (9%). Surgery and angioembolization are not commonly necessary, but when used are only successful in 50 per cent of cases.


Assuntos
Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Anticoagulantes/uso terapêutico , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/sangue , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemoglobina A/análise , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Recidiva , Retratamento , Estudos Retrospectivos , Adulto Jovem
10.
Zhonghua Gan Zang Bing Za Zhi ; 27(8): 582-593, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594075

RESUMO

Portal hypertension(PH) is one of the main complications of cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS) is the percutaneous creation of a conduit from the hepatic vein to the portal vein that is used to manage consequences of PH (i.e., variceal bleeding and refractory ascites) and used as a bridging therapy to liver transplant for decompensated cirrhosis. The following Clinical Practice Guidelines (CPGs) presents profession associational recommendations of the Chinese College of Interventionalists(CCI) on TIPS for PH. The CPGs was written by more than 30 experts in the field of TIPS in China (including interventional radiologists, liver surgeons, hepatologists and gastroenterologist, et al.). The panel of experts, produced these CPGs using evidence from PubMed and Cochrane database searches and combined with relevant expert consensuses and high quality clinical researches in China providing up to date guidance on TIPS for PH with the only purpose of improving clinical practice.


Assuntos
Hipertensão Portal/terapia , Derivação Portossistêmica Transjugular Intra-Hepática , China , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Humanos , Cirrose Hepática/terapia , Resultado do Tratamento
11.
Eur J Radiol ; 120: 108691, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31589996

RESUMO

PURPOSE: To determine radiological or clinical criteria guiding treatment decisions in active lower gastrointestinal bleeding (LGIB). MATERIALS AND METHODS: We consecutively and retrospectively included all patients admitted to our emergency department for acute LGIB proven by CT angiography (CTA) from 2004 to 2017. Patients were divided into two groups depending on whether they first underwent interventional radiological (IR) or surgical treatment. Two radiologists reviewed CTA and angiographic images. Patients' hemodynamic and clinical parameters, delay between imaging and treatment, procedure characteristics, and outcomes were investigated to detect differences between the two groups. RESULTS: Initial management consisted of IR in 62 cases (70.5%) and surgery in 26 (29.5%). IR cases were older than surgical cases (74.3 vs 64.3y, p = 0.014). Baseline hemodynamic parameters were similar between the two groups. For colonic bleeding sources, the delay between CTA and IR was shorter than between CTA and surgery (p = 0.027), while there was a trend towards a shorter delay for all LGIB taken together (p = 0.061). In cases with hematochezia or melena, IR was more frequently performed than surgery (p = 0.001). Surgical cases showed higher base excesses (p = 0.039) and lactate levels (p = 0.042) after treatment compared with IR cases. Length of hospital stay was similar between the two groups (p = 0.728). During angiography, 41 (66%) cases were embolized. Complications occurred in three cases after IR (7%) and in five after surgery (19%). CONCLUSION: Initial management of active LGIB revealed by CTA (i.e. IR versus surgery), may depend on age and clinical signs, rather than hemodynamic parameters.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Doença Aguda , Idoso , Feminino , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiologia Intervencionista/métodos , Estudos Retrospectivos , Resultado do Tratamento
12.
J Coll Physicians Surg Pak ; 29(10): 977-985, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564274

RESUMO

Non-variceal upper gastrointestinal bleeding (NUGIB) is a common disease in clinical practice; and many related guidelines/consensuses have been published. The authors assessed the methodological quality of the NUGIB guidelines/ consensuses published in English, in order to uncover which guidelines/consensuses are of better quality in methodology and the deficiency in the area. Appraisal of guidelines for research and evaluation instrument tools were adopted to assess the quality of the guidelines/consensuses. Each guideline/consensus was assessed independently by three researchers. Intra-class correlation (ICC) among researchers was retrieved to reflect reliability. Eight guidelines/consensuses regarding the management of NUGIB published in English were obtained. The ICCs among the evaluators were all above 0.75, indicating satisfactory reliability. Quality evaluation of the obtained guidelines via the AGREE II tools showed that the overall quality of the included guidelines/consensuses was moderate in all domains. A few guidelines/consensuses were better developed in scientific and methodological aspects than the others. The grades of recommendations with the guidelines/consensuses, according to a brief and preliminary scheme, were of practical value. Moreover, the recommendations regarding the pharmacological treatments in the guidelines/consensuses above, are various according to the study. Overall, the quality of some NUGIB guidelines/consensuses were generally acceptable and applicable, those yet are with minor deficiencies. The others may be improved according to the AGREE II items, likely by evaluating the quality of the guidelines/consensuses when the guidelines/consensuses are updated.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Guias de Prática Clínica como Assunto , Consenso , Medicina Baseada em Evidências , Humanos
13.
Vox Sang ; 114(8): 853-860, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31489645

RESUMO

BACKGROUND: Management of major gastrointestinal bleeding (GIB) may require massive transfusion (MT), but limited data are available. Upper and lower GIB have different aetiologies, prognosis, bleeding patterns and outcomes. Better understanding of current transfusion management and outcomes in these patients is important. We sought to define and validate an algorithm based on clinical coding data to distinguish critical upper and lower GIB using data from the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR). STUDY DESIGN AND METHODS: Australian and New Zealand Massive Transfusion Registry hospital-source data on adult patients receiving a MT (defined as ≥5 red cell units within 4 h) for any bleeding context were used. An algorithm allocating ICD-10-AM codes into 'probable' or 'possible' causes of GIB was developed and applied to the ANZ-MTR. Source medical records of 69 randomly selected cases were independently reviewed to validate the algorithm. RESULTS: Of 5482 MT cases available from 25 hospitals, 716 (13%) were identified as GIB with 538/716 (75%) categorized 'probable' and 178/716 'possible' GIB. Upper and lower GIB causes of MT were identified for 455/538 (85%) and 76/538 (14%) 'probable' cases, respectively; 7/538 (1·3%) cases had both upper and lower GIB. Allocation by the algorithm into a 'probable' GIB category had a 95·7% (CI: 90-100%) positive predictive value when validated against source medical records. CONCLUSION: An algorithm based on ICD-10-AM codes can be used to accurately categorize patients with luminal GIB as the primary reason for MT, enabling further study of this critically unwell and resource-intensive cohort of patients.


Assuntos
Transfusão de Sangue/normas , Codificação Clínica/métodos , Hemorragia Gastrointestinal/classificação , Sistema de Registros , Adulto , Idoso , Algoritmos , Austrália , Codificação Clínica/normas , Estudos de Coortes , Feminino , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Retrospectivos
14.
Expert Rev Gastroenterol Hepatol ; 13(9): 893-897, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31389265

RESUMO

Introduction: The most recent guidelines vary in their approach to the management of variceal bleeding especially with the use of endoscopic sclerotherapy (ES) and endoscopic tissue adhesive (ETA). This review highlights their clinical use for variceal bleeding from different guidelines perspectives. Areas covered: A comprehensive literature review of three major guidelines including the American Association for the Study of Liver Diseases (AASLD) 2017, United Kingdom (UK) guidelines 2015 and Baveno VI Consensus workshop guidelines in 2015 on the use of ES and ETA in variceal bleeding. Expert opinion: While endoscopic band ligation (EBL) completely replaced endoscopic sclerotherapy (ES) for esophageal varices. There is a valuable use of endoscopic sclerotherapy (ES) and endoscopic tissue adhesive (ETA) especially for patients with gastroesophageal varices (GOV2) and isolated gastric varices (IGV2). The current standard of care heading toward portosystemic shunting with Trans-jugular-Intrahepatic Portosystemic Shunt (TIPS) and balloon retrograde transvenous obliteration (BRTO). However, recent advancement in endoscopic ultrasound (EUS) allowing direct injection of sclerosant and tissue adhesive into the varix bringing promising results in achieving hemostasis and lowering the risk of complications. Also, ES and ETA have great clinical value in achieving hemostasis for isolated (ectopic) varices and stomal varices.


Assuntos
Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Escleroterapia/métodos , Adesivos Teciduais/administração & dosagem , Endoscopia do Sistema Digestório , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Cirrose Hepática/complicações
15.
Niger J Clin Pract ; 22(8): 1099-1108, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417053

RESUMO

Background: Upper gastrointestinal system (GIS) bleeding is one of the most common causes of mortality and morbidity. The predictive values of pre-endoscopic Rockall score (PERS), full Rockall score (FRS), Glasgow-Blatchford score (GBS), pre-endoscopic Baylor score (PEBS), and full Baylor score (FBS) to predict bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death are investigated in our study. Methods: This study was retrospectively conducted in patients admitted to emergency department with upper GIS bleeding. Demographic and clinical characteristics of the patients were recorded. The relationships of the aforementioned scores with in-hospital termination, bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death were explored. Results: The study included a total of 420 subjects, of which 269 (64%) were men. All scoring systems were able to predict transfusion need and GBS was superior to other scores (P < 0.0001). In terms of endoscopic treatment, it was determined that only PERS, FRS, and FBS were statistically significant in predicting ability and PERS >3, FRS >5 and FBS >10 patients needed endoscopic treatment. All scoring systems were able to predict rebleeding. In comparison of two groups for rebleeding, it was found that PEBS was better able to predict bleeding during follow-up than both FRS and FBS, and PERS was better able to predict bleeding during follow-up than both FRS and FBS. All scoring systems were able to predict mortality. FRS and PERS scores had a greater discriminatory power for predicting death than the rest of the scores (P < 0.001). Conclusion: All scoring systems were effective for predicting need for blood transfusion, rebleeding, and death. GBS had more predictive power for transfusion need, PERS and PEBS for rebleeding, and FRS for mortality. PERS, FRS, and FBS were found to be effective in predicting endoscopic treatment.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Hospitalização/estatística & dados numéricos , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Serviço Hospitalar de Emergência , Endoscopia do Sistema Digestório , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Turquia/epidemiologia
16.
J Assoc Physicians India ; 67(4): 79-81, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31299848

RESUMO

Acute fulminant necrotizing amebic colitis rarely presents with massive lifethreatening lower gastrointestinal bleeding without diarrhea. Diagnosis is difficult as colonoscopy is suboptimal due to active bleeding, stool testing is often negative and a positive serology cannot confirm the diagnosis. We herein report a case of a 39-year-old male who presented with profuse bleeding per rectum, without associated significant antecedent history of fever or diarrhea. Colonoscopy was inconclusive as active bleeding obscured the vision. Computed tomography of abdomen revealed non-specific thickening of the caecum. Emergency laparotomy with right hemicolectomy and temporary ileostomy was performed. Microscopic examination of colonic mucosa revealed Entamoeba histolytica trophozoites with erythrophagocytosis suggestive of fulminant amebic colitis. Intravenous metronidazole was given subsequently and patient recovered completely. Ileocolonic anastomosis was done after closing the ileostomy three months later. This case highlights this exceedingly rare presentation of fulminant amebic colitis which poses a diagnostic challenge and can be life threatening without early surgical intervention.


Assuntos
Disenteria Amebiana/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Adulto , Colo , Colonoscopia , Diarreia , Disenteria Amebiana/terapia , Hemorragia Gastrointestinal/microbiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino
17.
Emerg Med Clin North Am ; 37(3): 511-527, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262418

RESUMO

Patients with end-stage liver disease (ESLD) who require intensive care unit admission have high rates of mortality. This article reviews the pathophysiology and emergency department assessment and management of the most frequent conditions and complications encountered in critically ill ESLD patients including hepatic encephalopathy, gastrointestinal bleeding, sepsis and bacterial peritonitis, hepatorenal syndrome, severe coagulopathy, and hepatic hydrothorax.


Assuntos
Estado Terminal , Doença Hepática Terminal/complicações , Doença Hepática Terminal/terapia , Manuseio das Vias Aéreas/métodos , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/terapia , Medicina de Emergência , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/terapia , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/terapia , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiologia , Hidrotórax/terapia , Hiperamonemia/etiologia , Hiperamonemia/terapia , Unidades de Terapia Intensiva , Transplante de Fígado , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/terapia , Medição de Risco , Índice de Gravidade de Doença
18.
Blood Coagul Fibrinolysis ; 30(5): 243-245, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31261161

RESUMO

: Angiodysplastic (AD) lesion is the most common cause of recurrent gastrointestinal (GI) bleeding in inherited Von Willebrand disease (VWD) patients lacking high-molecular-weight multimers. Defect or dysfunction of von Willebrand factor (VWF) may lead to enhanced endothelial cell proliferation followed by the development of neoangiogenesis and vascular malformation, which result in severe bleeding. Recurrent bleeding causing by GI AD is a challenging complication of VWD. The management of VWD could be difficult due to frequent recurrence and severity of bleeding episodes. The primary aim of management is not only to stop but also to prevent bleeding. We present two patients of type 3 VWD associated with AD and severe GI bleeding, which were successfully treated by endoscopic coagulation and prophylactic therapy with different regimens of plasma-derived VWF/factor VIII (pdVWF/FVIII) concentrate to maintain a trough level in the patient unresponsive to standard treatment.


Assuntos
Angiodisplasia/complicações , Hemorragia Gastrointestinal/complicações , Doença de von Willebrand Tipo 3/complicações , Adulto , Angiodisplasia/terapia , Combinação de Medicamentos , Endoscopia Gastrointestinal , Fator VIII/uso terapêutico , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de von Willebrand Tipo 3/terapia , Fator de von Willebrand/uso terapêutico
19.
Intern Med ; 58(22): 3239-3242, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31327831

RESUMO

Mid-esophageal diverticulum is a rare disease, formed by the traction caused by inflamed bronchial lymph nodes or by pulsion induced by motility disorder. We herein report a case of mid-esophageal diverticular bleeding in a patient with kyphosis who was taking an anti-platelet drug. She was successfully treated with endoscopic hemostasis. An 80-year-old woman presented to our emergency department with hematemesis. She had kyphosis and was taking dipyridamole for her chest pain. Emergent upper endoscopy revealed bleeding from a mid-esophageal diverticulum; hemostasis was achieved via clipping. Mid-esophageal diverticula can cause upper gastrointestinal bleeding. An endoscopic examination and hemostasis are effective treatments.


Assuntos
Diverticulite/complicações , Divertículo Esofágico/complicações , Hemorragia Gastrointestinal/complicações , Cifose/complicações , Idoso de 80 Anos ou mais , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hematemese/etiologia , Hemostase Endoscópica/métodos , Humanos , Inibidores da Agregação de Plaquetas/administração & dosagem
20.
Rev Gastroenterol Peru ; 39(2): 105-110, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31333224

RESUMO

INTRODUCTION: The Glasgow-Blatchford (GBS) scale allows us to classify the patient as a high or low risk of presenting complications.In the patients identified as "low risk", the performance of an early endoscopy could reduce the intrahospital days and the overall cost. In our environment, we do not know the usefulness of the GBS scale. OBJECTIVE: To describe the utility of the Glasgow-Blatchford scale (GBS) in the stratification of risk in patients with non-variceal upper gastrointestinal bleeding (HDA) seen in the emergency department of a tertiary hospital. MATERIALS AND METHODS: 218 patients were prospectively included, and they were performed in the first 24-48 hr an urgent endoscopy. These were stratified, according to the GBS scale, at low risk (GBS ≤ 2), and high risk (GBS ≥ 3). We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the GBS scale in our setting based on the requirement of endoscopic, radiological treatment (arterial embolization), transfusion of blood products and / or surgery, as our gold standar to classify patients as "high risk". RESULTS: A total of 218 patients were included, with a mean age of 56 ± 18 years, of which 121/218 (55%) were male. 156/218 required intervention for what were classified as "high risk" while 62/218 did not specify and classified as "low risk". A cut-off value of GBS ≤ 2 showed a sensitivity of 98% with a NPV of 100%. The utility of the GBS scale showed an area under the ROC curve 0.83 (95% CI 0.75-0.90). CONCLUSION: The GBS scale used in patients with non-variceal UGB attended in the emergency department has adequate diagnostic validity to predict the need for intervention.


Assuntos
Tratamento de Emergência , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/terapia , Medição de Risco , Trato Gastrointestinal Superior , Adulto , Idoso , Serviço Hospitalar de Emergência , Feminino , Hemorragia Gastrointestinal/complicações , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Panamá , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Centros de Atenção Terciária , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA