The prognostic value of blood urea nitrogen/albumin ratio in patients with acute non-variceal upper gastrointestinal bleeding / 中华急诊医学杂志

Objective:To determine whether the blood urea nitrogen to serum albumin (B/A) ratio was a useful prognostic factor of mortality in the patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB).Methods:Totally 1 120 patients with acute upper gastrointestinal bleeding (VUGIB) admitted to the Emergency Department from January 2019 to December 2021 were prospectively and continuously collected and 449 eligible patients with acute non-varicose upper gastrointestinal tract were finally enrolled. The clinical data, laboratory tests and endoscopic results of the patients were recorded, and the data from the 30-day survival group and the non-survival group were compared and analyzed.Results:Significant differences were observed in age, mean arterial pressure, pulse rate, albumin levels, total protein levels, blood urea nitrogen levels, glucose, Glasgow-Blatchford score (GBS), Rockall, and AIMS65 scores between the survival and non-survival groups (all P <0.05). The B/A ratio in the non-survival group was significantly higher than that in the survival group [(24.9 ± 16.4) vs. (9.0 ± 8.6) mg/g, P<0.001]. Receiver operating characteristic (ROC) curve showed that the best cutoff value of B/A ratio for predicting 30-day death was 32.08 mg/g, with a sensitivity of 0.776 and specificity of 0.823. There was a significant difference in the 30-day Kaplan-Meier survival curve between patients with B/A ratio ≥32.08 mg/g and those with B/A ratio <32.08 mg/g (Log Rank 32.229, P<0.001). Multivariate logistic regression analysis revealed that the B/A ratio (≥32.08 mg/g) was associated with 30-day mortality ( OR=4.87, 95% CI: 1.94-6.85, P<0.001). Area under the ROC curve (AUC) for B/A ratio, GBS, Rockall and AIMS65 scores for predicting 30-day mortality were 0.855 (95% CI: 0.807-0.902), 0.849 (95% CI: 0.796-0.901), 0.657 (95% CI: 0.576-0.737), and 0.828 (95% CI: 0.774-0.883), respectively. Conclusions:The B/A ratio is a simple but potentially useful prognostic factor of mortality in the ANVUGIB patients.

Vascular embolization for acute non-variceal upper gastrointestinal rebleeding after conventional endoscopic hemostasis / 中华消化内镜杂志

From April 2017 to June 2020, 46 patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB) underwent endoscopic vascular embolization (EVE) in the Department of Gastroenterology of the First Affiliated Hospital of University of Science and Technology of China for rebleeding after endoscopic hemostasis therapy (including local drug injection, electrocoagulation, hemostatic clamp and ligation, etc.). All 46 patients immediately stopped bleeding after EVE, and the effective rate of immediate hemostasis was 100.0%. Postoperative abdominal pain occurred in 13 cases (28.3%), abdominal distension in 3 cases (6.5%) and fever in 2 cases (4.3%). The mucosa healed gradually under gastroscopy 3 and 12 months after the operation. No gastrointestinal rebleeding occurred during the follow-up. Therefore, EVE is a safe and effective method for ANVUGIB patients with failure of initial endoscopic hemostasis, which is worthy of further clinical study and application.

Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding (2018, Hangzhou) / 中华内科杂志

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common medical emergencies worldwide.In 2009,the first edition of "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding"was published in China.These guidelines were updated in 2015,which aimed to provide the standard diagnosis and management for patients with ANVUGIB.Based on the rapid development of multiple disciplines and latest understanding of ANVUGIB,this new edition of guidelines was therefore released for standardizing the diagnosis and management process of ANVUGIB.

A Review of the 2018 Asia-Pacific Working Group Consensus on Non-variceal Upper Gastrointestinal Bleeding / 대한소화기학회지

Despite recent advances in endoscopic techniques and acid-suppressive therapies, non-variceal upper gastrointestinal bleeding (NVUGIB) is still associated with significant morbidity and mortality. The increased use of dual antiplatelet agents and oral anticoagulants has complicated the management of NVUGIB. Physicians often have to decide on when to discontinue and resume these medications in patients with NVUGIB. However, clinical data regarding the resumption of antiplatelets and anticoagulants are still minimal. Here, we report and summarize the key recommendations made in the recent Asia-Pacific guidelines regarding management of antithrombotics in patients with NVUGIB.

Clinical observation of Qingre-Jiangni-Zhixue decoction combined with omeprazole sodium in the treatment of acute nonvariceal upper gastrointestinal hemorrhage / 国际中医中药杂志

Objective To observe the clinical effect of Qingre-Jiangni-Zhixue decoction combined with omeprazole sodium on acute non-variceal upper gastrointestinal bleeding. Methods A total of 64 patients with acute non-variceal upper gastrointestinal bleeding were divided into the observation group and control group according to random number table method, with 32 cases in each group. The control group was given the routine clinical treatment combined with omeprazole sodium, and the observation group was given Qingre-Jiangni-Zhixue decoction on the basis of the control group. After 7 days of continuous treatment, the basic clinical indexes (hemostasis time, blood transfusion volume, hospitalization time, 72 hours hemostasis rate, rebleeding rate), oxidative stress indexes (cortisol, malondialdehyde, antidiuretic hormone, blood glucose) and serum inflammatory factors (hs-CRP, TNF-α, IL-1β) were observed before and after treatment, and the clinical efficacy were evaluated. Results The total effective rate of the observation group was 90.6% (29/32), which was significantly higher than that of the control group 71.9% (23/32), with statistically significant (χ2=4.730, P=0.029). After treatment, the hemostasis time (18.86 ± 2.97 h vs. 29.12 ± 4.07 h, t=7.354),blood transfusion volume (559.32 ± 67.17 ml vs. 612.73 ± 75.81 ml, t=11.032),hospitalization time (5.43 ± 0.67 d vs. 9.26 ± 1.15 d, t=5.871) of the observation group were significantly lower than those of the control group (P<0.05). The 72 h hemostasis rate of the observation group was 3.1%, which was significantly lower than that of the control group 21.9%, with statistically significant (χ2=5.143, P<0.05). The rebleeding rate of the observation group was 96.9%, which was significantly higher than that of the control group 81.3% (χ2=4.010, P=0.045). After treatment, the cortisol level, the malondialdehyde level, blood glucose, antidiuretic hormone of the observation group were lower than those of the control group (t were 8.106, 4.976, 4.842, 5.093, all Ps<0.01). After treatment, the hs-CRP, serum TNF-α, serum IL-1β of the observation group were lower than those of the control group (t were 5.506, 4.983, 7.962, all Ps<0.01). Conclusions The application of Qingre-Jiangni-Zhixue decoction combined with omeprazole sodium can inhibit the expression of serum inflammatory cytokines in patients with acute non-variceal upper gastrointestinal bleeding, reduce the oxidative stress injury caused by bleeding, and improve the hemostatic efficiency.

Clinical evaluation of efficacy of OTSC for closure of acute non-variceal upper gastrointestinal bleeding / 中国内镜杂志

Objective To evaluate the clinical efficacy of the over-the-scope-clip (OTSC) for endoscopic closure of acute refractory non-variceal upper gastrointestinal bleeding. Methods This retrospective study selected 16 refractory patients, including 2 cases with Mallory-Weiss syndrome, 7 cases with gastric ulcer, 1 case with gastric carcinoma and 6 cases with duodenal ulcer, underwent OTSC treatment of acute non-variceal upper gastrointestinal bleeding from January 2015 to June 2016 as study subjects. Results All of the 16 patients with bleeding lesions were successfully controlled. The successful rate is 100.0%. The mean procedure of OTSC for endoscopic bleeding closure was between 5.0 and 6.0 min. Conclusion The Over-the-Scope-Clip system is safe and effective for closure of acute non-variceal upper gastrointestinal bleeding in refractory patients, and deserves further clinical applications.

Comportamiento de los costos hospitalarios en el sangrado digestivo alto no variceal / Behavior of hospital costs in the non-variceal upper gastrointestinal bleeding

Introducción: el mantenimiento de la salud cubana en los niveles deseados es una tarea que requiere del esfuerzo de muchos factores y de cuantiosos recursos monetarios, por lo que se hace necesario garantizar la utilización eficiente de los recursos, el ahorro y la eliminación de gastos innecesarios. Objetivo: analizar el comportamiento de los costos hospitalarios en los pacientes con sangrado digestivo alto no variceal ingresados en el Hospital Universitario General Calixto García en el periodo comprendido entre junio de 2012 a diciembre de 2013. Métodos: se realizó un estudio cuasi-experimental, explicativo de tipo observacional, de corte longitudinal con dos grupos de pacientes con el diagnóstico de sangrado digestivo alto no variceal a través de la aplicación del método clínico. Resultados: los costos hospitalarios de importantes indicadores disminuyeron considerablemente en el grupo de pacientes a los que se les aplicó el ácido tranexámico cómo variante terapéutica con respecto a los que no se le administró este medicamento. Conclusiones: en el grupo de pacientes que se usó el ácido tranexámico, disminuyó el número de complicaciones y fallecidos, lo que se traduce en una rápida reincorporación social del paciente y mejor calidad de vida para este y sus familiares(AU)

Introduction: keeping the Cuban population´s health at desirable levels is one task requiring the efforts of many people and a lot of financial resources, so it is necessary to assure the effective use of resources, saving and reduction of unwanted costs. Objective: to analyze the behavior of hospital costs in the treatment of patients with non-variceal upper gastrointestinal bleeding and admitted to General Calixto Garcia university hospital in the period of June 2012 through December 2013. Methods: quasiexperimental, observational-type explanatory and longitudinal study performed in two groups of patients diagnosed as non-variceal upper gastrointestinal bleeding cases through the clinical method. Results: the hospital costs of essential indicators significantly lowered in the group of patients treated with traexamic acid as therapeutic option when compared with those who were not administered this drug. Conclusions: the number of complications and of deaths decreased in the group of patients using tranexamic acid, which means rapid social reincorporation and better quality of life for them and their relatives(AU)

Escalas de predicción en el pronóstico del paciente con hemorragia digestiva alta no varicosa / Predicting scales for prognosis of patients with non-variceal upper gastrointestinal bleeding

La hemorragia digestiva alta no varicosa constituye una importante causa de morbilidad y mortalidad en el mundo. Para su manejo se ha impuesto la necesidad de usar escalas pronósticas para definir la conducta a seguir con un empleo óptimo de los recursos médicos, de manera tal que se garantice una asistencia de calidad al paciente. El objetivo del trabajo es realizar un resumen de los aspectos positivos y negativos de las escalas, relacionar los parámetros que contemplan y las posibilidades de su aplicación en Cuba. Se efectuó una búsqueda en los registros bibliográficos existentes de las bases de datos de PUBMED y EBSCO. Se utilizaron las palabras claves, en idiomas español e inglés: hemorragia digestiva alta no varicosa y escalas pronósticas. Se realizó una revisión de los diferentes modelos; se relacionaron a los autores principales de las escalas; se dividieron en preendoscópicas y endoscópicas y se caracterizaron las más utilizadas. La información recogida permitió obtener una visión general, al mostrar las diferentes variantes existentes y clasificar al paciente según el riesgo que presenta, de acuerdo con los índices pronósticos obtenidos después de la aplicación de la escala. Se concluye que las escalas pronósticas permiten evaluar la necesidad de intervención urgente, la probabilidad de sangrado, la necesidad de cirugía o la mortalidad aguda en la toma de decisiones médicas y su uso está en correspondencia con las particularidades de cada contexto.

The non-variceal upper gastrointestinal bleeding is a major cause of morbidity and mortality worldwide. The need for prognostic scales to define the course of action regarding the optimal use of medical resources has imposed, so that patient care quality is guaranteed. The aim of this paper is to go over the positive and negative aspects of the scales, to relate the parameters included and the possibilities of its application in Cuba. A search was conducted on existing bibliographic records in PubMed and EBSCO databases. Keywords in Spanish and English were used, such as non-variceal upper gastrointestinal bleeding, and prognostic scales. A review of different models was performed; the principal authors of the scales were related; scales were divided into pre-endoscopic and endoscopic and the most used were characterized. The information collected allowed for an overview, showing the various existing variants and classify patients according to risks, according to forecasts indices obtained after the scale application. It is concluded that the prognostic scales to assess the need for urgent intervention, the bleeding likelihood, surgery or acute mortality in medical decision making and their use is in line with each context particularities.

Utilidad de la escala clínica de Rockall en la hemorragia digestiva alta no varicosa / Usefulness of Rockall clinical score in upper non variceal gastrointestinal bleeding

Introducción: la escala clínica de Rockall se utliza para clasificar la hemorragia digestiva alta en individuos atendiendo al riesgo de presentar sangrado activo, que necesiten de la realización urgente de la endoscopia digestiva. Objetivo: evaluar, la eficacia de la escala clínica de Rockall para identificar a los pacientes que requieren terapéutica endoscópica. Métodos: se realizó un estudio prospectivo. Se calculó el índice clínico de Rockall según escala homónima. Se realizó endoscopia de urgencia y terapéutica hemostática a pacientes con sangrado activo o reciente. La eficacia de este proceder se determinó mediante el análisis por curva de escala clínica de Rockall, índice de Youden y cálculo de sensibilidad y especificidad del mejor punto de corte. Resultados: incluidos 118 pacientes, 22 de los cuales (18,6 por ciento) recibieron terapéutica endoscópica por presentar sangrado activo o reciente. Índice clínico de Rockall con una media de 1,79 puntos. Riesgo alto 83 pacientes (70,3 por ciento) y bajo 35 casos (29,7 por ciento). La capacidad predictiva excelente, con valor del área bajo la curva = 0,960 (IC 95 por ciento: 0,904-1,017); punto de corte igual a 1 ( índice de Youden = 0,971) con una sensibilidad de 97 por ciento y de especificidad de 71 por ciento. Conclusiones: la escala clínica de Rockall puede ser utilizada con seguridad para la toma de decisiones en relación con la realización urgente de la endoscopia en el paciente con hemorragia digestiva alta no varicosa(AU)

Introduction: the clinical Rockall score serves to stratify the individuals with non variceal upper gastrointestinal hemorrhage depending on the risk of presenting active bleeding and therefore, they urgently need digestive endoscopy. Objective: to evaluate the effectiveness of the Rockwall clinical score in identifying patients who need therapeutic endoscopy. Methods: a prospective study with calculation of the Rockall clinical score according to a homonymous scale. Performance of urgent endoscopy and of therapeutic hemostatic endoscopy in patients with active or recent bleeding. Determination of efficacy through the analysis of ROC curves, Youden´s index and calculation of sensibility and specificity of the best cutoff point. Results: one hundred and eighteen patients were included, 22 of whom (18.6 percent) received therapeutic endoscopy to manage active or recent bleeding. Rocwall clinical score reached a mean of 1.79 points. It was found that 83 (70.3 percent) were high and 35 (29.7 percent) low risk patients. The predictive capacity was excellent, being the ABC= 0.960 (95 percent CI: 0,904-1,017). The cutoff point was 1 (J= 0.971) with 97 percent sensibility and 71 percent specificity. Conclusions: the Rockall clinical score can be safely used to make a decision on the urgent performance of endoscopy in patients with non-variceal upper gastrointestinal bleeding(AU)

Predictores de recurrencia de sangrado en pacientes con hemorragia digestiva alta no variceal / Predictors of bleending recurrence in patients with non-varicose upper gastrointestinal bleeding

Introducción: La tasa de resangrado en hemorragia digestiva alta no variceal continúa siendo elevada. Objetivo: identificar los predictores de falla terapéutica endoscópica en adultos con hemorragia digestiva alta recurrente no variceal atendidos en el Hospital Universitario de Maracaibo entre enero, 2006 y diciembre, 2010 que ameritaron una segunda endoscopia. Materiales y Métodos: estudio retrospectivo y transversal. La muestra fue dividida en grupo A (resangró) y B (no resangró). Resultados: del total de 380 casos que recibieron terapia inicial, 271 úlceras (71,3% p<0,0001) representaron el tipo de lesión más frecuente, correspondiendo con los 24 casos que resangraron (6,31%). Las lesiones que resangraron se ubicaron en segunda porción de duodeno (20,8%), fundus gástrico (16,6%) y cara posterior de bulbo duodenal (12,5%). De éstas, 11 fueron úlceras (54,5% duodenales vs 45,4% gástricas), tipo Forrest IA, IB y IIA (p<0,03), con vaso expuesto >2mm (media 5mm, DE±3mm). Conclusión: los predictores de falla terapéutica endoscópica (úlcera ≥2cms, ubicación en cara posterior de bulbo duodenal, Forrest IA, IB y IIA, y terapia endoscópica aplicada durante el primer episodio de sangrado) contribuyen de manera independiente al aumento del riesgo del resangrado.

Introduction: Rebleeding’s rate in non-variceal upper gastrointestinal bleeding remains high. Aim: Identify predictors of endoscopic therapy failure in adult patients with recurrent non-variceal upper gastrointestinal bleeding treated at the Hospital Universitario de Maracaibo between January, 2006 and December, 2010 that required a second endoscopy. Methods: a retrospective and cross sectional study. The sample was divided into Group A (with rebleeding) and Group B (without rebleeding). Results: of the 380 cases who received therapy during the first endoscopy, 271 ulcers (71,3% p <0,0001) represented the most frequent type of injury, being consistent with the 24 cases that rebleed (6,31%). Rebleeding lesions were located in second portion of duodenum (20,8%), gastric fundus (16,6%) and posterior duodenal bulb (12,5%). Meanwhile, the rebleeding ulcers (n=11), were duodenal 54,5% vs gastric 45,4%, classified as Forrest IA, IB and IIA (p <0,03), with exposed vessel >2mm. Conclusions: the predictors of endoscopic therapy failure in our location are similar to those established (ulcer size ≥2cms, placed on posterior duodenal bulb, Forrest IA, IB and IIA, and endoscopic therapy applied during the first episode) and contribute independently to increased risk of rebleeding despite applying the recommended therapeutic.