Assuntos
Doença de Crohn/diagnóstico por imagem , Endoscopia Gastrointestinal/métodos , Doenças do Esôfago/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Adulto , Doença de Crohn/complicações , Doença de Crohn/terapia , Doenças do Esôfago/etiologia , Doenças do Esôfago/terapia , Feminino , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/terapiaRESUMO
BACKGROUND: Nasogastric lavage (NGL) is often performed early in the management of GI bleeding. This practice assumes that NGL results can assist with timely risk stratification and management. OBJECTIVE: We performed a retrospective analysis to test whether NGL is associated with improved process measures and outcomes in GI bleeding. DESIGN: Propensity-matched retrospective analysis. SETTING: University-based Veterans Affairs medical center. PATIENTS: A total of 632 patients admitted with GI bleeding. MAIN OUTCOME MEASUREMENTS: Thirty-day mortality rate, length of hospital stay, transfusion requirements, surgery, and time to endoscopy. RESULTS: Patients receiving NGL were more likely to take nonsteroidal anti-inflammatory drugs and be admitted to intensive care, but less likely to have metastatic disease or tachycardia, be taking warfarin, or present on weekdays. After propensity matching, NGL did not affect mortality (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.37-1.92), length of hospital stay (7.3 vs 8.1 days, P = .57), surgery (OR 1.51; 95% CI, 0.42-5.43), or transfusions (3.2 vs 3.0 units, P = .94). However, NGL was associated with earlier time to endoscopy (hazard ratio 1.49; 95% CI, 1.09-2.04), and bloody aspirates were associated high-risk lesions (OR 2.69; 95% CI, 1.08-6.73). LIMITATIONS: Retrospective design. CONCLUSIONS: Performing NGL is associated with the earlier performance of endoscopy, but does not affect clinical outcomes. Performing NGL at initial triage may promote more timely process of care, but further studies will be needed to confirm these findings.
Assuntos
Transfusão de Sangue , Lavagem Gástrica , Hemorragia Gastrointestinal/mortalidade , Tempo de Internação , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , Endoscopia Gastrointestinal , Feminino , Conteúdo Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
We report the first known case of both Noonan syndrome and Whipple's disease occurring in the same patient. A 36-year-old female with history of Noonan syndrome developed fatigue, anorexia, arthritis of the knees and hands with a diffuse hyperpigmented rash, night sweats, and an unintentional fifteen pound weight loss over 4 mo. Small bowel enteroscopy demonstrated mild edematous yellowish mucosa without friability. Random small bowel biopsies revealed extensive periodic acid-Schiff positive material within the foamy macrophages. She was treated with a 12 mo course of trimethoprim-sulfamethoxazole DS with clinical improvement to baseline status.