Upper gastrointestinal bleeding in mechanically ventilated patients in medical ICU: A single-center study

Aims Upper Gastrointestinal bleeding (UGIB) in critically ill patients under mechanical ventilation (MV) is a significant cause of morbidity and mortality. Therefore, it aimed to study the incidence, predictors, and etiology of UGIB in critically ill patients under MV. Patients and Methods Three hundred and sixty critically ill patients were managed by mechanical ventilation. The patients were evaluated by complete clinical examination, APACHE II score, liver and kidney function tests, and abdominal ultrasound. In addition, upper gastrointestinal endoscopy was done for survived patients with UGIB during MV after weaning with a stable clinical condition for at least 48 hours. Results 41 patients (11.4 %) had UGIB; 15 patients (36.6%) survived and death occurred in 26 (63.4%). Upper endoscopy revealed large ulcers > 2 cm in the gastric antrum (n=1), multiple antral ulcers (n=2), large >2cm corporeal gastric ulcers (n=2) [all were Forrest Ib with oozing surface], bleeding small duodenal bulb ulcers < 2cm (n=1) [Forrest Ia with spurting], small ulcers in the lower esophagus with lower end esophagitis (n=2), black esophagus (n=1), ulcer on top of grade III oesophageal varices (n=2), severe portal hypertensive gastropathy (n=3), candida esophagitis and gastritis (n=1). Logistic regression analysis revealed that the independent variables of UGIB were elevated serum creatinine, APACHE II score >14, peak inspiratory pressure ≥ 30cmH2O, and prolonged aPTT. Conclusions : Mechanically ventilated patients had a high risk of upper gastrointestinal bleeding, which the postulated parameters can predict for adequate prophylaxis.

Management of upper gastrointestinal bleeding

This paper will describe the common symptoms, signs and causes of upper gastrointestinal bleeding. We will then provide advice on the management of upper gastrointestinal bleeding at primary care level

Incidence and Clinical Features of Bleeding Peptic Ulcers in Acute Upper Gastrointestinal Bleeding: -Experience of Moroccan University Hospital Unit

Introduction: Peptic ulcer disease (PUD) has been recognized as the leading cause of acute upper gastrointestinal bleeding (AUGIB). This study aims to report general features of bleeding peptic ulcers in patients who benefit of urgent endoscopy in our department after an acute upper gastrointestinal hemorrhage. Results: A total of 1809 patients were explored for acute upper gastrointestinal bleeding in our unit since 2003 to 2008. Gastroduodenal peptic ulcers were the most frequent diagnosed etiology. They present 38% of all reported causes of bleeding (n=527) (table I). 25% were located at duodenal mucosa (n= 347) and 13% were gastric ulcers (n=180). No esophageal ulcers were reported. Incidence of both duodenal and gastric ulcers decreases during the last years. Conclusion: In our department; incidence of bleeding peptic ulcer disease is decreasing but they continue to be the first cause of AUGIB

Functional Dyspepsia - An Updated Review

Functional dyspepsia (FD) refers to upper abdominal symptoms like upper abdominal or retrosternal pain or discomfort; heart burn; nausea; etc. The symptoms are common; but often poorly understood and mistaken for conditions like chronic gastritis and peptic ulcer disease. Worldwide; the prevalence of dyspepsia is about 20-30 [1]. In the department of internal medicine at the Ruhengeri hospital; there have been 16.4 outpatient cases and 16.1 cases of admissions (Jan-June-2014). A high number of cases would be in other hospitals as well. The causes postulated are the increased production of acid; visceral hypersensitivity; H. pylori infection; emotional stress; reduced immunity; etc. The diagnosis is based on exclusion of organic causes for similar symptoms. The treatment is mainly with lifestyle modifications; and the pharmacological therapy consists of antacids; antiflatulents; prokinetic drugs; cytoprotective drugs; and proton pump inhibitors. It can be recommended that greater awareness needs to be generated among physicians regarding FD. They in turn can counsel patients and lay stress on lifestyle and preventive factors to improve this described condition

Upper Gastrointestinal Endoscopy Findings in Patients Referred with Upper Gastrointestinal Symptoms in Eldoret; Kenya: a Retrospective Review

Background: Dyspepsia is one of the major indications for upper gastrointestinal endoscopy. Other indications include dysphagia; odynophagia and gastrointestinal bleeding. Endoscopy is an expensive procedure that is out of reach of many patients in resource constrained region such as western Kenya. We reviewed endoscopy records from both public and private health institutions spanning ten years. Objective: To determine the pattern of referral and endoscopy diagnoses in patients referred for upper gastrointestinal endoscopy in Eldoret; Kenya. Design: Retrospective chart review. Setting: Moi Teaching and Referral Hospital; private hospitals and private clinics in Eldoret; Kenya Subjects: One thousand six hundred and ninety (1690) Patients who underwent upper GI endoscopy from 1993 to 2003 were reviewed after obtaining clearances from the respective institutions. Information on age; sex; symptoms; and endoscopy diagnosis were extracted and subjected to statistical analysis. Results: The most common symptom was dyspepsia in 1059 (62.7) followed by dysphagia in 224 (13.3). Others were referred with diagnosis of cancer of the stomach or oesophagus. Common endoscopy diagnoses were cancer of the oesophagus in 199 (11.8) and duodenal ulcer in 186 (11.0). The majority of the patients (30.4) had normal endoscopy findings. Of the 1059 patients with dyspepsia; only 154 (14.5) had duodenal ulcer and 34 (3.2) had gastric ulcers; the majority; 37.2 had normal endoscopy findings. Conclusion: Dyspepsia was main reason for referral; but the majority of such patients had normal findings. Cancer of the oesophagus was the main diagnosis in patients with dysphagia. In view of the cost of endoscopy; only those with dyspepsia and alarm symptoms be referred for the procedure

Upper gastrointestinal endoscopy at the Korle Bu Teaching Hospital, Accra, Ghana

Objectives: To study the indications for endo-scopy, the endoscopic diagnosis and other lessons learnt.. Methods: A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. Results: A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 + 0.5 and females 43.7 + 0.6 years. Epi-gastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duo-denal ulcer (19.6%), acute gastritis (12.7%), duo-denitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. Conclusion: The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ul-cer is usually associated with H. pylori infection and is the commonest cause of upper gastrointesti-nal bleeding

Spinal (Intrathecal) Ketamine Anaesthesia for Upper Abdominal Surgery : Case Report

Intravenous ketamine is usually administered for the induction of general anaesthesia. Spinal ketamine for lower abdominal and lower limb surgery is sporadically reported in the literature. However; the use of spinal ketamine for upper body surgery is rare. We describe the case of a 35-year old man; with a retroperitoneal tumour and severe intercurrent cardiovascular morbidity; that had exploratory laparotomy and tumour biopsy with Intrathecal ketamine administered through the L4/L5 interspace. The patient had good surgical analgesia; with stable vital signs throughout the surgery. After surgery; the spinal catheter was left in place; and withdrawn 48 hours later. The patient did well in the immediate postoperative period; although he gradually succumbed to the primary illness (malignant retroperitoneal cancer) on the 15th postoperative day

Upper gastrointestinal endoscopic findings in adolescents at Lacor hospital; Uganda

Background and Objectives: Fiberoptic endoscopy is a highly efficient diagnostic tool; which is now being increasingly used; in the pediatric age group.This study has been carried out to demonstrate indications for and common findings of endoscopy in children. Materials and Methods:We retrospectively reviewed the medical records for endoscopy indication and result of children who had endoscopy between Jan 2000 to June 2005. Results:We analyzed 135 children who were referred for upper gastrointestinal endoscopy.There were 38 boys and 97 girls.The mean age was 16 years (SD+/-1.4293).The main indications comprised epigastric pain (67.4); dyspepsia (11.9); hematemesis (8.9); recurrent abdominal pain (3) recurrent vomiting (3); and miscellaneous (5.8). Endoscopic diagnose included duodenal ulcer (14.8) and gastritis (12.6); duodenal scarring (5.2); bile reflux (5.2) duodenitis (4.4) and miscellaneous 6.4. Conclusion:In Upper gastrointestinal endoscopy is a diagnostic procedure in children with gastrointestinal disorder. Gastritis and duodenal disease are commonly seen in children; hence must be included in differential diagnosis of children with digestive complaints and its management