Hemorragia digestiva alta no varicosa: comportamiento e índice de Rockall / Behavior and Rockall risk scoring in the non-variceal upper gastrointestinal bleeding

Introducción: la hemorragia digestiva alta no varicosa es actualmente una emergencia quirúrgica de difícil manejo, hecho que motivó el conocer su comportamiento y, usando el índice de Rockall, el riesgo de los afectados de sufrir resultados adversos durante su evolución, aquellos de posible alta precoz y las causas que la impiden. Métodos: estudio descriptivo de corte transversal realizado en el Hospital General Docente Ernesto Guevara de la Serna con 182 pacientes atendidos entre 2009 y 2010. Resultados: los hombres fueron los más afectados (54,4 por ciento) y el grupo de 60-80 años tuvo el mayor número de casos. La úlcera gastroduodenal fue la primera causa (52,7 por ciento). La melena se presentó como manifestación inicial en el 60,4 por ciento de los pacientes. La hipertensión arterial fue la comorbilidad más frecuente (60,7 por ciento). El 44,5 por ciento de los pacientes necesitó transfusión sanguínea. La mortalidad fue del 8,2 por ciento. La mayor parte de la muestra se ubicó en el grupo de riesgo intermedio de Rockall (40,1 por ciento). Recibió alta precoz solo el 11,5 por cientode los pacientes, y la inestabilidad hemodinámica (38 por ciento) fue la mayor responsable de este bajo número. El Rockall tuvo sensibilidad del 98,3 por ciento, especificidad del 56,9 por ciento, valor predictivo positivo del 52,3 por ciento, valor predictivo negativo del 98,6 por ciento y una exactitud del 70,9 por ciento. En los pacientes clasificados de bajo riesgo la única complicación fue la recidiva (1,4 por ciento). Conclusiones: el alta precoz puede ser dada a pacientes con Rockall bajo, siempre que se preste especial atención a la estabilidad hemodinámica.

Introduction: Non-variceal upper gastrointestinal bleeding is a current surgical emergency of difficult management. This fact prompted the authors to find out its behavior and to use Rockall risk scoring system to determine the risk of suffering adverse effects during the recovery period, those patients that may be early discharged and the causes that prevent it. Methods: Cross-sectional descriptive study conducted in 182 patients from Ernesto Guevara de la Serna general teaching hospital, who were seen in the period of 2009 through 2010. Results: Males were the most affected (54.4 per cent) and the 60-80 years age group registered the highest number of cases. Gastroduodenal ulcer was the first cause (52.7 por ciento). The initial manifestation was tarry stools in 64 per cent of cases. Blood hypertension was the most frequent comorbidity (60.7per cent). In the study group, 44.5per cent of patients needed blood transfusion. The mortality rate was 8.2 per cent. Most of patients were classified as intermediate risk cases according to Rockall system (40.1 per cent). Just 11.5 per cent of patients were early discharged since the hemodynamic instability (38 per cent) was the main responsible for this low number. Rockall risk scoring system showed 98.3per cent sensitivity, 56.9per cent specificity, 52.3 per cent positive predictive value, 98.6per cent negative predictive value and 70.9 per cent accuracy. The only complication in low risk patients were relapse (1.4 per cent). Conclusions: Early discharge from hospital occurs in low Rockall risk score patients provided that special attention is paid to hemodynamic stability.

A Case of Argon Plasma Coagulation Therapy for Hemorrhagic Radiation-induced Gastritis / 대한소화기내시경학회지

Hemorrhagic radiation-induced gastritis is a rare but serious complication of upper gastrointestinal radiation treatment, and no simple and effective treatment method has yet been developed. Studies on effective treatment methods for achieving hemostasis in patients with hemorrhagic radiation-induced gastritis are necessary, because the new indications for upper gastrointestinal radiotherapy in the field digestive oncology can potentially lead to an increased incidence of radiation-induced gastric vasculopathy. For the first time in Korea and to the best of our knowledge, we report here on a 59-years-old male patient with hemorrhagic gastritis that was induced by external radiotherapy for ampullary adenocarcinoma. This was all well-treated using Argon plasma coagulation (APC).

A case of henoch-Sch?nlein purpura complicated by hemorrhagic gastroenteritis and IgA nephropathy in a patient suffering with juvenile rheumatoid arthritis / 대한내과학회지

Henoch-Sch?nlein purpura (HSP) is a systemic vasculitis with IgA dominant immune complex deposits that affect the small vessels in the skin, joints, gastrointestinal tract and kidneys. Gastrointestinal symptoms are common and the manifestations include abdominal pain, bleeding, bowel infarction, intussusceptions or even perforation. Polyarticular onset juvenile rheumatoid arthritis (JRA) is a rare form of arthritis that affects children and young adults. The relationship between HSP and JRA is uncertain. We report on a 24-year-old man with a history of polyarticular onset JRA and HSP that was complicated by hemorrhagic gastroenteritis. The gastroscopy and colonoscopic findings showed extensive hemorrhagic inflammatory changes of the gastric and intestinal mucosa. The patient had severe bloody diarrheal symptoms, abdominal pain and gross hematuria. The 24 hours urine chemistry profile showed the proteinuria was greater than 4.5 g/day, and immunofluorescent staining of the renal biopsy specimen showed diffuse granular mesangial deposits of IgA and C3. The abdominal manifestations and proteinuria were improved after methylprednisolone therapy.

A Case of Hemorrhagic Gastritis due to Cow's Milk Allergy / 대한소아소화기영양학회지

Hematemesis is a rare condition in infants and can be a symptom of cow's milk-induced hemorrhagic gastritis. Other clinical manifestations of cow's milk allergy are vomiting, malnutrition and anemia. The criteria for the diagnosis of cow's milk allergy includes elimination of cow milk formula resulting in improvement of symptoms, specific endoscopic and histologic findings as well as exclusion of other causes. Cow's milk allergy should be considered in the etiologic differential diagnosis of hematemesis and gastritis in infancy. We have experienced a 1-month-old female infant with hematemesis due to cow's milk-induced hemorrhagic gastritis, and report the case with a review of previously published cases.

A Case of Stongyloidiasis Associated with Acute Hemorrhagic Gastritis / 대한소화기내시경학회지

A 69-year-old male was admitted to the neurosurgery department for traumatic intracra-nial hemorrhage in both frontal lobes. After 2 months, he complained of epigastric dis-comfort, nausea, vomiting, and loose stools. The gastric endoscopic examination found acute hemorrhagic gastritis and there were rhabditoid nematode larvae in the gastric fluid and biopsy sections. The filariform larvae of Strongyloides sp. were discovered from a fecal culture. The patient was treated with albendazole (200 mg, po bid, for 4 weeks). The epigastric discomfort disappeared and endoscopic findings improved after treatment.