Challenges to Risk Determination for Patients with Upper Gastrointestinal Bleeding

Since the initial description of the Rockall Score (RS) in 1996,1 clinical prediction tools have been used to risk-stratify patients hospitalized with upper gastrointestinal bleeding (UGIB). Because of the demand for a simple, pre-endoscopic, risk-assessment tool to help providers optimize resource allocation, the Glasgow Blatchford Score (GBS) then was derived to assess which patients with UGIB were likely to require hospital-based treatment before performance of an esophagogastroduodenoscopy.2 The GBS subsequently has been validated in numerous studies to accurately predict the need for endoscopic intervention and mortality.
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Editorial Source Type: research

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Authors: Park N, Jang JS, Cha JH Abstract Peptic ulcer disease is the most common cause of acute gastrointestinal bleeding, followed by variceal bleeding, Mallory-Weiss syndrome, and malignancy. On the contrary, acquired hemophilia A is a very rare hemorrhagic disease, which usually manifests with musculocutaneous bleeding, caused by autoantibodies against coagulation factor VIII. A 78-year-old man presented to the Emergency Department with melena. Dieulafoy's lesions were observed on esophagogastroduodenoscopy, and endoscopic cauterization was performed. However, the patient complained of back pain and symptoms in...
Source: Clinical Endoscopy - Category: Gastroenterology Tags: Clin Endosc Source Type: research
Conclusion: Guidelines recommendH. pylori testing under non-suppressive conditions. However, this does not always meet the clinical practice. Our data show that de facto, many patients undergoing elective EGD are tested forH. pylori under suppressive conditions coming along with a higher risk of potentially false negative results. Particularly, concerning this issue, further research is needed to improve and clarify everyday clinical practice.Digestion
Source: Digestion - Category: Gastroenterology Source Type: research
Obscure GI bleeding is persistent bleeding from the GI tract without an identifiable source on both upper and lower endoscopy. In most cases of obscure GI bleeding, the source is eventually found in the small intestine, the majority of which cannot be examined using routine esophagogastroduodenoscopy or colonoscopy. Double balloon enteroscopy (DBE) is an endoscopic technique which allows for visual examination of the entire GI tract. It also provides the ability to intervene on any active GI bleed using techniques such as argon plasma coagulation, hemoclipping, or epinephrine injection.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Sunday abstract Source Type: research
Acute upper GI bleeding is common and requires investigation with esophagogastroduodenoscopy (EGD) but endotherapy is not always necessary. Magnetically assisted capsule endoscopy (MACE) uses a capsule steerable by an external magnet and allows examination of the upper GI tract and small bowel but its role in acute upper GI bleeding has not been assessed.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Source Type: research
Acute upper GI bleeding is common and requires investigation with EGD, but endotherapy is not always necessary. Magnetically assisted capsule endoscopy (MACE) uses a capsule steerable by an external magnet and allows examination of the upper GI tract and small bowel, but its role in acute upper GI bleeding has not been assessed.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Original article Source Type: research
Endosc Int Open 2019; 07: E337-E346 DOI: 10.1055/a-0824-6647 Background and study aims We evaluated the utility of esophagogastroduodenoscopy (EGD) or capsule endoscopy (CE) as the next diagnostic approach after negative colonoscopy (CS) results in acute-onset hematochezia. Patients and methods We retrospectively analyzed 401 patients emergently hospitalized for acute hematochezia who underwent CS within 48 hours of arriving at two large emergency hospitals and in whom a definitive bleeding source was not identified. The positive endoscopic findings, requirement for additional therapeutic procedures, and 30...
Source: Endoscopy International Open - Category: Gastroenterology Authors: Tags: Original article Source Type: research
Since the initial description of the Rockall Score (RS) in 1996,1 clinical prediction tools have been used to risk-stratify patients hospitalized with upper gastrointestinal bleeding (UGIB). Because of the demand for a simple, pre-endoscopic, risk-assessment tool to help providers optimize resource allocation, the Glasgow Blatchford Score (GBS) then was derived to assess which patients with UGIB were likely to require hospital-based treatment before performance of an esophagogastroduodenoscopy.2 The GBS subsequently has been validated in numerous studies to accurately predict the need for endoscopic intervention and mortality.
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Editorial Source Type: research
​BY GREGORY TAYLOR, DO, &SHERIF EL-ALAYLI, DOA 60-year-old man with a significant history of alcohol abuse, metastatic hepatocellular carcinoma, and cirrhosis presented to the emergency department complaining of vomiting up bright red blood. The patient was reportedly supposed to have an esophagogastroduodenoscopy (EGD) six months earlier but failed to follow up.He had two episodes of melena the night before and two episodes of hematemesis that morning. He was also experiencing fatigue, weakness, and abdominal pain, which he described as achy and localized to the epigastric region. He had refused treatment for his he...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Conclusions: The IOG is a complementary method in the diagnosis and treatment of UGI pathology. It enables minimally invasive finalization of the procedures and individualization of the therapy. PMID: 30002748 [PubMed]
Source: Videosurgery and Other Miniinvasive Techniques - Category: Surgery Tags: Wideochir Inne Tech Maloinwazyjne Source Type: research
Authors: Bunchorntavakul C, Yodket Y, Singhasena N Abstract Background: Acute upper gastrointestinal bleeding (UGIB) is common and carries significant morbidity worldwide. Effective risk assessment for UGIB is required in order to deliver the optimal therapeutic plans. Objectives: To describe clinical characteristics and treatment outcomes of acute UGIB in Thailand and to evaluate predictors for rebleeding and complications. Material and Method: Consecutive patients with acute UGIB who underwent esophagogastroduodenoscopy at Rajavithi Hospital, Bangkok, between 2012 and 2015 were retrospectively analyzed. I...
Source: Journal of the Medical Association of Thailand = Chotmaihet thangphaet - Category: General Medicine Tags: J Med Assoc Thai Source Type: research
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