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1.
Medicina UPB ; 41(1): 67-74, mar. 2022. tab, Ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1362702

ABSTRACT

La hemorragia del tracto digestivo superior (HTDS) es el sangrado originado por encima del ángulo de Treitz. A pesar del aumento en las estrategias de prevención, del incremento en los tratamientos con Inhibidor de bomba de protones (IBP) y de la intervención endoscópica temprana, esta patología sigue siendo una causa frecuente de consulta a urgencias, con una morbimortalidad no despreciable y alta carga para el sistema de salud. Esta revisión se enfoca en la HTDS de causa diferente a las varices. La principal causante de esta entidad es la enfermedad ácido-péptica, que es consecuencia del gran consumo de antiinflamatorios no esteroideos (AINES) y de la infección por Helicobacter Pylori. Otras causas son el síndrome de Mallory Weiss, la esofagitis erosiva, las malformaciones arteriovenosas y la malignidad.


Upper gastrointestinal bleeding (UGIB) refers to any bleeding originating above the angle of Treitz. Despite an increase in prevention strategies, proton pump inhibitor (PPI) therapy and early endoscopic intervention, this pathology continues to be an important cause of admission to the emergency department for gastrointestinal causes, having a pretty high morbidity and mortality in addition to a high burden on the health system. This review focuses on non-variceal UGIB. The main cause of this entity being peptic acid disease, due to great consumption of NSAIDs and Helicobacter Pylori infection. Other causes are Mallory Weiss syndrome, erosive esophagitis, arteriovenous malformations, and malignancy.


A hemorragia do trato digestivo superior (HTDS) é o sangrado originado acima do ângulo de Treitz. Apesar do aumento nas estratégias de prevenção, do incremento nos tratamentos com Inibidor da bomba de prótons (IBP) e da intervenção endoscópica precoce, esta patologia segue sendo uma causa frequente de consulta a urgências, com uma morbimortalidade não depreciável e alta carga para o sistema de saúde. Esta revisão se enfoca na HTDS de causa diferente às varizes. A principal causante desta entidade é a doença ácido-péptica, que é consequência do grande consumo de anti-inflamatórios não esteróideos (AINES) e da infecção por HelicobacterPylori. Outras causas são a síndrome de Mallory Weiss, a esofagites erosiva, as malformações arteriovenosas e a malignidade. Palavras-chave: hemorragia gastrointestinal; úlcera péptica; endoscopia gastrointestinal; inibidores da bomba de prótons; medicina geral.


Subject(s)
Humans , Gastrointestinal Hemorrhage , Peptic Ulcer , Anti-Inflammatory Agents, Non-Steroidal , Endoscopy, Gastrointestinal , Helicobacter pylori , Gastrointestinal Tract , Emergency Service, Hospital , Esophagitis , Proton Pump Inhibitors , Mallory-Weiss Syndrome , Neoplasms
3.
Arch. argent. pediatr ; 120(1): S19-S61, feb 2022. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1353860

ABSTRACT

La historia natural de la enfermedad hepática crónica (EHC) se caracteriza por una fase de cirrosis compensada asintomática seguida de una fase descompensada, que se acompaña de signos clínicos evidentes, de los cuales los más frecuentes son la ascitis, las hemorragias, la encefalopatía y la ictericia. Esta guía actualizada sobre el manejo de pacientes con EHC en la edad pediátrica fue confeccionada con el propósito de mejorar la práctica clínica de estos pacientes complejos y darle herramientas al pediatra de cabecera para un seguimiento adecuado. Para ello, un grupo de expertos subrayó la importancia del inicio temprano del tratamiento etiológico en cualquier grado de enfermedad hepática y ampliaron su labor jerarquizando las complicaciones de la cirrosis: ascitis, hemorragia digestiva, infecciones, malnutrición; aspectos endocrinológicos, neurológicos, oftalmológicos y gastrointestinales; y complicaciones vasculares pulmonares y renales. Se incluyeron, además, aspectos psicosociales, así como el cuidado del adolescente en su transición a la vida adulta.


The natural history of chronic liver disease (CLD) is characterized by a phase of asymptomatic compensated cirrhosis followed by a decompensated phase, accompanied by the development of evident clinical signs, the most frequent being ascites, hemorrhages, encephalopathy and jaundice. This updated guideline on the management of pediatric patients with CLD was developed with the purpose of improving the clinical practice of these complex patients and to provide the pediatrician with tools for an adequate follow-up. To this end, a group of experts, after stressing the importance of early initiation of etiologic treatment in any degree of liver disease, expanded their work to include a hierarchy of complications of cirrhosis: ascites, gastrointestinal bleeding, infections, malnutrition, endocrinological, neurological, ophthalmological, gastrointestinal, pulmonary vascular and renal complications. Psychosocial aspects including the care of the adolescent in their transition to adult life were also included.


Subject(s)
Humans , Child , Adolescent , Adult , Ascites/etiology , Jaundice , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Liver Cirrhosis/therapy
4.
Rev. Hosp. Ital. B. Aires (2004) ; 41(4): 171-175, dic. 2021. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1366760

ABSTRACT

Introducción: la amiloidosis AA puede ser una complicación de ciertos trastornos inflamatorios crónicos, aunque entre el 21% y 50% puede ser idiopática. No existe un tratamiento específico. El tocilizumab, dirigido contra el receptor de IL-6 y orientado a disminuir la producción de SAA, podría ser eficaz. Métodos: en este estudio informamos datos de 6 pacientes con amiloidosis AA tratados con tocilizumab monoterapia subcutáneo en el período 2011-2018. Los criterios de valoración principales fueron la mejora clínica y bioquímica de los órganos afectados y los parámetros bioquímicos marcadores de inflamación. Resultados: el riñón estaba afectado en todos los pacientes, manifestándose con caída del filtrado glomerular y síndrome nefrótico. La hemorragia digestiva se presentó en un paciente y otro tenía afectación pulmonar en la biopsia. Luego del posterior al tratamiento, todos mejoraron el hematocrito, la albúmina sérica y el índice de masa corporal. El SAA disminuyó en 5 pacientes. Un paciente mejoró su función renal, mientras 4 se mantuvieron estables. Tres pacientes disminuyeron los valores de proteinuria. Conclusión: el tratamiento con tocilizumab podría ser eficaz en el tratamiento de los pacientes con amiloidosis AA. (AU)


Introduction: AA amyloidosis can be a complication of certain chronic inflammatory disorders, although between 21% and 50% can be idiopathic. There is no specific treatment. Tocilizumab, directed against the IL-6 receptor and aimed at decreasing SAA production, could be effective. Methods: in this study, we report data from 6 patients with AA amyloidosis treated with subcutaneous tocilizumab monotherapy between the period 2011-2018. The main endpoints were the clinical and biochemical improvement of the affected organs and the biochemical parameters markers of inflammation. Results: the kidney was affected in all patients, manifesting with a fall in glomerular filtration rate and nephrotic syndrome. Gastrointestinal bleeding occurred in one patient and another had lung involvement on biopsy. After treatment, all improved hematocrit, serum albumin, and body mass index. SAA decreased in 5 patients. One patient improved his kidney function, while 4 remained stable. Three patients decreased proteinuria values. Conclusion: treatment with tocilizumab could be effective in the treatment of patients with AA amyloidosis. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Serum Amyloid A Protein/drug effects , Antibodies, Monoclonal, Humanized/therapeutic use , Amyloidosis/drug therapy , Body Mass Index , Receptors, Interleukin-6/drug effects , Antibodies, Monoclonal, Humanized/administration & dosage , Glomerular Filtration Rate/drug effects , Gastrointestinal Hemorrhage/complications , Amyloidosis/blood , Inflammation/complications , Lung Diseases/complications , Nephrotic Syndrome/complications
5.
Arq. bras. cardiol ; 117(3): 512-517, Sept. 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1339177

ABSTRACT

Resumo Fundamentos A síndrome de Heyde é a associação de estenose aórtica importante com episódio de sangramento gastrointestinal por lesões angiodisplásicas. Pouco é conhecido sobre os fatores associados a novos sangramentos e desfechos em longo prazo. Além disso, a maioria dos dados é restrita a relatos de casos e pequenas séries. Objetivo Avaliar o perfil clínico, laboratorial e ecocardiográfico de pacientes com síndrome de Heyde submetidos a intervenção valvar ou tratamento medicamentoso. Métodos Coorte prospectiva de 24 pacientes consecutivos entre 2005 e 2018. Foram avaliados dados clínicos, laboratoriais, ecocardiográficos e relacionados à intervenção valvar e a desfechos após o diagnóstico. Valor de p<0,05 foi considerado estatisticamente significante. Resultados Metade dos 24 pacientes apresentou sangramento com necessidade de transfusão sanguínea na admissão. Angiodisplasias foram encontradas mais frequentemente no cólon ascendente (62%). Intervenção valvar (cirúrgica ou transcateter) foi realizada em 70,8% dos pacientes, e 29,2% foram mantidos em tratamento clínico. Novos episódios de sangramento ocorreram em 25% dos casos, e não houve diferença entre os grupos clínico e intervenção (28,6 vs. 23,5%, p=1,00; respectivamente). A mortalidade no seguimento de 2 e 5 anos foi de 16% e 25%, sem diferença entre os grupos (log-rank p = 0,185 e 0,737, respectivamente). Conclusões Pacientes com síndrome de Heyde tiveram alta taxa de sangramento com necessidade de transfusão sanguínea na admissão, sugerindo ser uma doença grave e com risco elevado de mortalidade. Não encontramos diferenças entre os grupos submetidos ao tratamento clínico e à intervenção valvar em relação a taxas de ressangramento e mortalidade tardia.


Abstract Background Heyde's syndrome is the association of severe aortic stenosis with episodes of gastrointestinal bleeding due to angiodysplastic lesion. Little is known about the factors associated with new episodes of bleeding and long-term outcomes. Furthermore, most data are restricted to case reports and small case series. Objective To assess the clinical, laboratory and echocardiography profile of patients with Heyde's syndrome who underwent valve intervention or drug therapy. Methods Prospective cohort of 24 consecutive patients from 2005 to 2018. Clinical, laboratory and echocardiography data were assessed, as well as those related to valve intervention and outcomes after diagnosis. A P <0.05 was used to indicate statistical significance. Results Half of the 24 patients presented with bleeding requiring blood transfusion on admission. Angiodysplasias were more frequently found in the ascending colon (62%). Valve intervention (surgical or transcatheter) was performed in 70.8% of the patients, and 29.2% remained on drug therapy. News episodes of bleeding occurred in 25% of the cases, and there was no difference between clinical and intervention groups (28.6 vs 23.5%, p = 1.00; respectively). Mortality at 2-year and 5-year was 16% and 25%, with no difference between the groups (log-rank p = 0.185 and 0.737, respectively). Conclusions Patients with Heyde's syndrome had a high rate of bleeding requiring blood transfusion on admission, suggesting that it is a severe disease with high mortality risk. No difference was found between clinical and intervention group regarding the rate of rebleeding and late mortality.


Subject(s)
Humans , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/diagnostic imaging , Angiodysplasia/complications , Angiodysplasia/therapy , Prospective Studies , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy
6.
Arq. gastroenterol ; 58(3): 337-343, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1345291

ABSTRACT

ABSTRACT BACKGROUND: The COVID-19 pandemic has changed digestive endoscopy services around the world. OBJECTIVE: This study aimed to measure the number of urgent/emergency endoscopic procedures performed in a Brazilian hospital, comparing it to the same period in the previous year, and to identify risk factors in COVID-19 patients undergoing endoscopic procedures for upper gastrointestinal bleeding (UGIB). METHODS: This was a retrospective, cross-sectional, observational, single-center study. The study evaluated urgent/emergency endoscopic procedures performed on adult patients from March to August in 2019 and 2020. The COVID-19 patients included were diagnosed using RT-PCR, aged over 18 years with complete medical record information. The variables evaluated were age, sex, comorbidities, length of stay, D-dimer, need for intensive care unit (ICU) and mechanical ventilation. Student's t-test for independent samples or the non-parametric Mann-Whitney test was used to compare quantitative variables. Categorical variables were analyzed using Fisher's exact test. A P-value <0.05 indicated statistical significance. RESULTS: A total of 130 urgent/emergency endoscopic procedures were performed in 2020 and 97 in 2019. During the study period, 631 patients were hospitalized due to COVID-19, of whom 16 underwent urgent/emergency endoscopic procedures, 10 (1.6%) due to UGIB. Of the variables analyzed, the need for ICU and/or mechanical ventilation during hospitalization was statistically significant as a risk factor for UGIB. CONCLUSION: This study showed increased urgent/emergency endoscopic procedures during the pandemic at the study site. Among the patients hospitalized with the novel coronavirus, there is a higher risk for UGIB in those needing ICU and/or mechanical ventilation.


RESUMO CONTEXTO: A pandemia da COVID-19 tem alterado o funcionamento de serviços de endoscopia digestiva pelo mundo. OBJETIVO: O presente estudo tem por objetivo medir o número de exames endoscópicos de urgência/emergência realizados em um hospital público brasileiro, comparando-o ao mesmo período do ano anterior, além de avaliar os fatores de risco dos pacientes com COVID-19 que realizaram exame endoscópico por hemorragia digestiva alta (HDA). MÉTODOS: Estudo retrospectivo, transversal, observacional e unicêntrico. Foram avaliados todos os exames endoscópicos de urgência/emergência realizados em pacientes acima de 18 anos, nos períodos de março a agosto dos anos de 2019 e 2020. Os pacientes com COVID-19 incluídos foram diagnosticados por RT-PCR, acima de 18 anos, com informações completas em prontuário. As variáveis avaliadas foram: tipo de exame endoscópico, idade, sexo, comorbidades, tempo de internação, d-dímero, necessidade de UTI e ventilação mecânica durante a internação. A comparação dos grupos em relação a variáveis quantitativas foi feita através do teste t de Student para amostras independentes ou o teste não-paramétrico de Mann-Whitney. As variáveis categóricas foram avaliadas pelo teste exato de Fisher. Valores de P<0,05 indicaram significância estatística. RESULTADOS: Observaram-se 130 exames endoscópicos de urgência/emergência no período avaliado em 2020, e 97 em 2019. No período do estudo foram internados 631 pacientes por COVID-19, dos quais 16 realizaram exame endoscópico de urgência/emergência, sendo 1,6% por HDA. Dentre as variáveis analisadas, necessidade de UTI e/ou ventilação mecânica durante o internamento foram estatisticamente significativos como risco para desenvolvimento de HDA. CONCLUSÃO: O presente estudo mostra que para a realidade local houve incremento de exames endoscópicos de urgência/emergência durante a pandemia. Dentre os pacientes internados com o novo coronavírus, há maior risco de HDA naqueles que necessitam de UTI e/ou ventilação mecânica.


Subject(s)
Humans , Adult , Pandemics , COVID-19 , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Endoscopy, Gastrointestinal , SARS-CoV-2 , Gastrointestinal Hemorrhage/etiology , Middle Aged
8.
Rev. ecuat. pediatr ; 22(2): 1-6, 31 de agosto del 2021.
Article in Spanish | LILACS | ID: biblio-1284490

ABSTRACT

Propósito de la revisión: el objetivo de la revisión es delinear la fisiopatología de la Entero Colitis Necrotizante (ECN) clásica del recién nacido, proponer un listado de antecedentes perinatales que definan un grupo de riesgo y establecer parámetros simples y objetivos, que ayuden a establecer un diagnóstico clínico precoz. Recientes hallazgos: La mortalidad de la Entero Colitis Necrotizante clásica del recién nacido sigue siendo elevada. Aunque la enfermedad tiene varias presentaciones, es única con una única vía de instalación, la hipoperfusión intestinal como agente agresor inicial. Extracto: La falta de estrategias de prevención y el diagnóstico clínico muy tardío explican la mortalidad elevada de la ECN. Existe una gran confusión sobre el origen de la enferme-dad, dando a entender que existen diferentes tipos de ECN, aunque la enfermedad es única, tiene diferentes manifestaciones según las condiciones del recién nacido con una vía común de instalación, la hipoperfusión intestinal como agente agresor inicial. En este artículo se postula que reconocer a la hipoperfusión intestinal como agente agresor inicial, es "encontrar el hilo perdido", que permitirá desarrollar estrategias de prevención y tratamiento, al identificar los pacientes en riesgo de ECN y lograr el diagnóstico de manera precoz.


Purpose of the review: The objective of the review is to delineate the pathophysiology of the classic Entero Necrotizing Colitis (NEC) of the newborn, propose a list of perinatal ante-cedents that define a risk group and establish simple and objective parameters that help to establish an early clinical diagnosis. Recent findings: The mortality of the classic Necrotizing Entero Colitis of the newborn is still high. Although the disease has several presentations, it is unique with a single installation route, intestinal hypoperfusion as the initial offending agent. Excerpt: The lack of prevention strategies and very late clinical diagnosis explain the high mortality of NEC. There is great confusion about the origin of the disease, giving to under-stand that there are different types of NEC, although the disease is unique, it has different manifestations according to the conditions of the newborn with a common route of installation, intestinal hypoperfusion as an initial assailant agent. This article postulates that recog-nizing intestinal hypoperfusion as the initial offending agent is "finding the lost thread", that developing prevention and treatment strategies, by identifying patients at risk of NEC and achieving a diagnosis in a way early.


Objetivo da revisão: O objetivo da revisão é delinear a fisiopatologia da Entero Colite Necrosante (NEC) clássica do recém-nascido, propor uma lista de antecedentes perinatais que definem um grupo de risco e estabelecer parâmetros simples e objetivos que auxiliem no diagnóstico clínico precoce. Descobertas recentes: A mortalidade da Entero Colite Necrosante clássica do recém-nascido ainda é alta. Embora a doença tenha várias apresentações, é única com uma única via de instalação, a hipoperfusão intestinal como agente agressor inicial. Resumo: A falta de estratégias de prevenção e o diagnóstico clínico muito tardio explicam a alta mortalidade da NEC. Há grande confusão sobre a origem da doença, sugerindo que existem diferentes tipos de NEC, embora a doença seja única, ela tem diferentes manifestações dependendo das condições do recém-nascido com uma via comum de instalação, a hipoperfusão intestinal como agente. assaltante inicial. Este artigo postula que reconhecer a hipoperfusão intestinal como agente agressor inicial é "encontrar o fio condutor", o que permitirá o desenvolvimento de estratégias de prevenção e tratamento, por meio da identificação de pacientes em risco de NEC e do diagnóstico precoce.


Subject(s)
Humans , Infant, Newborn , Enterocolitis, Necrotizing , Diving Reflex , Gastrointestinal Hemorrhage , Infant, Newborn , Infant, Premature , Endotoxemia , Enterocolitis
9.
Arq. gastroenterol ; 58(2): 202-209, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285321

ABSTRACT

ABSTRACT BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) secondary to peptic ulcer disease is a medical digestive emergency and could be one of the most serious adverse drug reactions. OBJECTIVE: To identify the frequency of diagnosis of NVUGIB secondary to peptic ulcer disease. METHODS: Prospective and epidemiological study conducted in a tertiary referral Brazilian hospital, from July 2016 to December 2019. Upper gastrointestinal endoscopies (UGE) reports were evaluated daily. The diagnosis of NVUGIB secondary to peptic ulcer disease was defined through endoscopic findings of peptic ulcer and erosive gastric lesions, and clinical symptoms. The frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was estimated through the ratio between the number of patients diagnosed and the number of patients underwent UGE in the same period. RESULTS: A total of 2,779 endoscopic reports (2,503 patients) were evaluated, and 178 patients were eligible. The total frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was 7.1%. The annual frequency of diagnosis between 2017 and 2019 ranged from 9.3% to 5.7%. Most patients were men (72.8%); self-declared white (71.8%); older people (56.7%); and, had no familiar or personal history of gastrointestinal diseases (60.1%). 90% of the patients had a peptic ulcer and melena (62.8%). Patients made chronic use of low-dose aspirin (29.3%), other antiplatelet agents (21.9%) and, oral anticoagulants (11.2%); and non-steroidal anti-inflammatories use in the week a prior to the onset of clinical symptoms (25.8%). CONCLUSION: Seven in every 100 patients admitted and underwent UGE in a tertiary hospital were diagnosed with NVUGIB secondary to peptic ulcer disease.


RESUMO CONTEXTO: A hemorragia digestiva alta não varicosa (HDANV) secundária à úlcera péptica é uma emergência médica digestiva e pode ser uma reação adversa a medicamento severa. OBJETIVO: Estimar a frequência de HDANV secundária à doença péptica. MÉTODOS: Estudo prospectivo e epidemiológico realizado em um hospital brasileiro terciário de referência, no período de julho de 2016 a dezembro de 2019. Os laudos de endoscopia gastrointestinal alta foram avaliados diariamente. O diagnóstico de HDANV secundária para úlcera péptica foi definido por achados endoscópicos de úlcera péptica e lesões gástricas erosivas e sintomas clínicos. A frequência de diagnóstico de HDANV secundária à úlcera péptica foi estimada por meio da razão entre o número de pacientes diagnosticados e o número de pacientes submetidos à endoscopia gastrointestinal alta no mesmo período. RESULTADOS: Um total de 2.779 laudos endoscópicos (2.503 pacientes) foram avaliados e 178 pacientes foram elegíveis. A frequência total de diagnóstico de HDANV secundária à úlcera péptica foi de 7,1%. A frequência anual de diagnósticos entre 2017 e 2019 variou de 9,3% a 5,7%. A maioria dos pacientes era do sexo masculino (72,8%); auto-declarado branco (71,8%); idoso (56,7%); e não possuía histórico familiar ou pessoal de doenças gastrointestinais (60,1%). 90% dos pacientes apresentaram úlcera péptica e melena (62,8%). Os pacientes faziam uso crônico de ácido acetilsalicílico como antiagregante plaquetário (29,3%), outros antiplaquetários (21,9%) e anticoagulantes orais (11,2%); e fizeram uso e uso de anti-inflamatórios não esteroidais na semana anterior ao início dos sintomas clínicos de HDANV (25,8%). CONCLUSÃO: Cerca de sete em cada 100 pacientes admitidos em um hospital terciário e submetidos à endoscopia gastrointestinal alta foram diagnosticados com HDANV secundária à úlcera péptica.


Subject(s)
Humans , Male , Peptic Ulcer/complications , Peptic Ulcer/epidemiology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/epidemiology , Referral and Consultation , Prospective Studies , Tertiary Care Centers
10.
Medicentro (Villa Clara) ; 25(2): 178-196, tab, graf
Article in Spanish | LILACS | ID: biblio-1279415

ABSTRACT

RESUMEN Introducción: el sangrado digestivo alto constituye un problema clínico-quirúrgico frecuente, que causa morbilidad y mortalidad en todos los grupos de edad. Objetivo: determinar los factores pronósticos de mortalidad intrahospitalaria en pacientes con sangrado digestivo alto. Métodos: se realizó un estudio observacional analítico de casos y controles en pacientes con sangrado digestivo alto que fueron atendidos en el servicio de Cirugía General del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro¼, durante el año 2018. La población de estudio quedó conformada por 424 pacientes. Resultados: se identificaron como factores de riesgo en la ocurrencia de mortalidad: el sexo masculino (OR=2,011), el sangrado secundario a hipertensión portal (OR=7,174), la presencia de enfermedad mayor (OR=13,892), la melena y hematemesis como forma de presentación (OR=4,008), y Forrest ≤ IIa (OR=40,385). El área bajo la curva para el hematócrito, frecuencia cardíaca y respiratoria fue de: 0,897, 0,877, y 0,873, respectivamente, para una excelente fiabilidad. La media de supervivencia fue considerablemente menor para las categorías de las variables identificadas como factores de riesgo asociados a la mortalidad. Conclusiones: dentro de los factores pronósticos asociados a la mortalidad, se identificaron los siguientes: el sangrado secundario a hipertensión portal, la presencia de enfermedad mayor, la hematemesis con melena como forma de presentación, un Forrest ≤ IIa, el hematócrito, la frecuencia cardíaca, frecuencia respiratoria, tensión arterial sistólica y la creatinina.


ABSTRACT Introduction: upper gastrointestinal bleeding constitutes a frequent clinical and surgical problem, which causes morbidity and mortality in all age groups. Objective: to determine prognostic factors for in-hospital mortality in patients with upper gastrointestinal bleeding. Methods: an analytical, observational study of cases and controls was carried out in patients with upper digestive bleeding who were treated in the General Surgery service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital during 2018. The study population consisted of 424 patients. Results: male gender (OR = 2.011), bleeding secondary to portal hypertension (OR = 7.174), presence of major disease (OR = 13.892), melena and hematemesis as a form of presentation (OR = 4.008), and Forrest ≤ IIa (OR = 40.385) were identified as the risk factors in the occurrence of mortality. The area under the curve for hematocrit, heart and respiratory rates was 0.897, 0.877 and 0.873, respectively, for excellent reliability. The mean survival was considerably lower for the categories of variables identified as risk factors associated with mortality. Conclusions: bleeding secondary to portal hypertension, presence of major disease, hematemesis with melena as a form of presentation, Forrest ≤ IIa, hematocrit, heart rate, respiratory rate, systolic blood pressure and creatinine were identified among the prognostic factors associated with mortality.


Subject(s)
Risk Factors , Hospital Mortality , Gastrointestinal Hemorrhage
11.
Arch. argent. pediatr ; 119(5): e513-e517, oct. 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292683

ABSTRACT

La enfermedad de injerto contra huésped es una complicación grave que se presenta después del trasplante de médula ósea, con morbilidad y mortalidad elevadas. El patrón de oro para evaluar su compromiso gastrointestinal es la endoscopia digestiva alta y baja con toma de biopsia. El desarrollo de hematoma duodenal intramural es una complicación poco frecuente asociada con este procedimiento .Se presentan dos casos de hematoma duodenal intramural posendoscopia en pacientes con trasplante y sospecha de enfermedad injerto contra huésped que presentaron un cuadro agudo de dolor abdominal y sangrado intestinal. El diagnóstico se realizó por tomografía y recibieron tratamiento conservador, con un resultado favorable. En ambos casos, el diagnóstico de enfermedad injerto contra huésped gastrointestinal se hizo a través de las biopsias colónicas con histología duodenal normal, lo que sugiere evitar la toma de muestras duodenales para prevenir esta grave complicación en pacientes de alto riesgo y, de este modo, disminuir la morbilidad.


Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes.Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.


Subject(s)
Humans , Male , Infant , Child , Duodenal Diseases/diagnosis , Duodenal Diseases/etiology , Graft vs Host Disease/diagnosis , Graft vs Host Disease/etiology , Endoscopy, Gastrointestinal , Hematoma/diagnosis , Hematoma/etiology , Gastrointestinal Hemorrhage
12.
Article in English | WPRIM | ID: wpr-921880

ABSTRACT

Objective To explore the characteristics and clinical outcomes of patients with Heyde syndrome (HS) who undergo aortic valve replacement (AVR). Methods Electronic databases including PubMed, Embase, Ovid, WANFANG, VIP and CNKI were searched to identify all case reports of HS patients undergoing AVR surgery, using different combinations of search terms "Heyde syndrome", "gastrointestinal bleeding", "aortic stenosis", and "surgery". Three authors independently extracted the clinical data including the patients' characteristics, aortic stenosis severity, gastrointestinal bleeding sites, surgical treatments and prognosis. Results Finally, 46 case reports with 55 patients aging from 46 to 87 years, were determined eligible and included. Of them, 1 patient had mild aortic stenosis, 1 had moderate aortic stenosis, 42 had severe aortic stenosis, and 11 were not mentioned. Gastrointestinal bleeding was detected in colon (


Subject(s)
Angiodysplasia/surgery , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Gastrointestinal Hemorrhage/etiology , Humans , Transcatheter Aortic Valve Replacement , Treatment Outcome
13.
Article in Chinese | WPRIM | ID: wpr-878724

ABSTRACT

Objective To analyze clinical characteristics and short-term efficacy of endoscopic hemostasis in acute duodenal hemorrhage. Methods A retrospective study was conducted for the patients who received endoscopy in the PUMC Hospital due to upper gastrointestinal bleeding and were confirmed to be on account of duodenal lesions for bleeding from January 2011 to December 2018.Clinical information of patients was collected,including demographics,comorbidities,and medication use.Endoscopic information included the origin of bleeding,the number and location of lesions,Forrest classes and size of ulcers,and endoscopic therapeutic methods.Factors that could be relative to the failure of endoscopic hemostasis or short-term recurrence of hemorrhage in these patients were analyzed. Results Among all the patients with duodenal hemorrhage,79.7%(102/128)were due to ulcers,14.1%(18/128)to tumors,3.9%(5/128)to vascular malformation,and 2.3%(3/128)to diverticulum.Fifty-three(41.4%)patients received endoscopic hemostasis,and six patients(4.7%)received surgery or interventional embolization after the endoscopic test.Among the patients receiving endoscopic hemostasis,5.7%(3/53),66.0%(35/53),and 28.3%(15/53)received injection therapy,mechanical therapy,and dual endoscopic therapy,respectively,and 94.3% of them were cured.However,10(18.9%)of them experienced recurrence of hemorrhage and 3 patients died during hospitalization.Only one patient suffered from perforation after the second endoscopic treatment.Lesions located on the posterior wall of bulb appeared to be a risk factor for the failure of endoscopic hemostasis(OR=31.333,95% CI=2.172-452.072,P=0.021).The lesion diameter≥1 cm was a risk factor of rebleeding after endoscopic therapy(OR=7.000,95% CI=1.381-35.478,P=0.023).Conclusions Peptic ulcers were always blamed and diverticulum could also be a common reason for duodenal hemorrhage,which was different from the etiological constitution of acute upper gastrointestinal hemorrhage.Lesions locating on the posterior wall of the duodenum had a higher potential to fail the endoscopic hemostasis.The lesion diameter≥1 cm was a predictive factor for short-term recurrence.Forrest classes of ulcers at duodenum did not significantly affect the endoscopic therapeutic efficacy or prognosis.


Subject(s)
Duodenal Ulcer/therapy , Embolization, Therapeutic , Endoscopy , Gastrointestinal Hemorrhage/etiology , Hemostasis, Endoscopic , Humans , Recurrence , Retrospective Studies
14.
Repert. med. cir ; 30(2): 173-179, 2021. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1362765

ABSTRACT

Objetivo: describir el caso de un paciente del Hospital de San José de Bogotá con hemorragia del tracto digestivo superior secundaria a lesión de Dieulafoy, que presentó cuadro compatible con neuropatía óptica anterior isquémica no arterítica (NOIANA). Metodología: se hace una revisión narrativa y búsqueda sistemática de la literatura para determinar las características clínicas, demográficas, tratamiento y pronóstico visual de los pacientes con NOIANA. Materiales y métodos: reporte de caso, revisión narrativa y búsqueda sistemática de la literatura en las bases de datos Medline (vía Ovid) y Embase de NOIANA secundaria a hipovolemia. Se analizaron las variables sociodemográficas, clínicas, diagnóstico, condiciones asociadas, tratamiento y pronóstico visual. El análisis estadístico se realizó mediante frecuencias absolutas y relativas. Resultados: la mejoría de agudeza visual final en los pacientes que presentaron un episodio de NOIANA es incierta. En 42% hubo algún tipo de mejoría de la agudeza visual, independiente del tratamiento recibido. Menos del 50% de los casos clínicos reportados incluidos en este estudio que recibieron tratamiento con corticoides intravenosos mejoraron la visión. Discusión: la NOIANA por choque hipovolémico es una entidad infrecuente y poco reportada que puede generar cambios irreversibles en la agudeza visual, por lo que es importante sospecharla y detectarla para dar un manejo oportuno. Conclusión: este caso de NOIANA es uno de los pocos descritos como secundarios a hemorragia digestiva y el primero asociado con lesión de Dieulafoy.


Objetive: to describe the case of a patient from Hospital de San José in Bogotá with upper gastrointestinal tract bleeding secondary to a Dieulafoy ́s lesion, who presented symptoms compatible with a non-arteritic anterior ischemic optic neuropathy (NA-AION). Methodology: a narrative review and systemic search of the literature was conducted to determine the clinical and demographic characteristics, treatment and visual prognosis in patients with NA-AION. Materials and methods: case report, narrative review and systematic search of the literature in Medline via Ovid and Embase databases on NA-AION secondary to hypovolemia. Sociodemographic and clinical variables, diagnosis, associated conditions, treatment and visual prognosis were analyzed. A statistical analysis was performed using absolute and relative frequencies. Results: improvement of final visual acuity in patients who presented a NA-AION episode was uncertain. In 42% there was some kind of visual acuity improvement regardless of treatment received. Vision improved in less than 50% of the reported clinical cases included in this study that received treatment with intravenous steroids. Discussion: hypovolemic NA-AION is a rare and underreported entity that may generate irreversible changes in visual acuity, so it is important to suspect and detect it to provide timely management. Conclusion: this case of NA-AION is one of the few described as secondary to gastrointestinal bleeding and the first associated with a Dieulafoy ́s lesion.


Subject(s)
Optic Nerve Diseases , Hypovolemia , Gastrointestinal Hemorrhage , Vision, Ocular , Visual Acuity
15.
Rev. méd. hondur ; 89(1, supl): 23-27, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1280947

ABSTRACT

Antecedentes: La hemorragia gastrointestinal oculta representa aproximadamente del 5%-10% del total de las hemorragias digestivas. Descripción del caso clínico: Paciente femenina de 62 años, procedente de Santa Cruz de Yojoa, Cortés, sin comorbilidades, con episodios intermitentes de melena de un año de evolución; evaluada y manejada con hierro parenteral y transfusiones sanguíneas. Se le realizó protocolo diagnóstico, sin encontrar origen del sangrado. Fue sometida a laparoscopía diagnóstica en junio del 2019, realizándole apendicectomía, resección yeyunal, colecistectomía y ooforectomía; cursando asintomática luego de la cirugía. En diciembre, reinicia con melena, 3-4 episodios diarios, abundante cantidad (aproximadamente 300 ml). Evaluada nuevamente sin lograr identificar el origen del sangrado, por lo cual se realizó vídeo capsula endoscópica que reportó, restos hemáticos sin observar sitio de sangrado. Se llevó a cabo enteroscopía de empuje y duodenoscopía observando sitio de sangrado cercano a la papila duodenal. Se decide realizar angiotomografía, la cual fue compatible con sangrado digestivo a nivel de la II y III porción del duodeno. Luego se efectúa arteriografía selectiva de vasos abdominales, evidenciando fuga de medio de contraste originada en la rama de la arteria hepática derecha de origen en la mesentérica superior. Finalmente se procedió a la aplicación de 2 hemoclip vía endoscópica obteniendo un resultado satisfactorio.Conclusiones: El tipo de lesión responsable de la hemorragia del intestino delgado depende de la edad del paciente. Los factores de riesgo de hemorragia recurrente por angioectasia incluyen el número de lesiones, la edad avanzada, comorbilidades y la terapia anticoagulante...(AU)


Subject(s)
Humans , Female , Middle Aged , Endoscopy, Gastrointestinal/methods , Angiodysplasia , Gastrointestinal Hemorrhage/diagnosis , Intestine, Small
16.
Autops. Case Rep ; 11: e2021301, 2021. graf
Article in English | LILACS | ID: biblio-1285398

ABSTRACT

Aortoduodenal fistula (ADF) is the most common type of aortoenteric fistula (AEF). This is a rare entity, which produces communication between an abdominal aortic aneurysm (AAA) and the gastrointestinal tract (GIT), resulting in massive gastrointestinal bleeding. AEF/ADF is difficult to recognize clinically, with the classical triad of symptoms including a pulsating, palpable mass, abdominal pain, and GIT bleeding. AEF/ADF can be classified into primary when a communication between an AAA and the GIT develops with no history of prior aortic reconstructive surgery, and secondary, where the communication is on the background of previous aortic reconstructive surgery. Herein we present a case report of a 75-year-old Caucasian male patient with a clinical history of AAA, who presented with massive GIT bleeding and expired shortly after. An autopsy revealed communication between an atherosclerotic AAA and the lower third of the duodenum.


Subject(s)
Humans , Male , Aged , Digestive System Fistula , Aortic Aneurysm, Abdominal , Gastrointestinal Hemorrhage/complications , Autopsy
17.
Autops. Case Rep ; 11: e2021284, 2021. graf
Article in English | LILACS | ID: biblio-1285396

ABSTRACT

Acute esophageal necrosis (AEN), also known as "black esophagus," is an entity characterized by the circumferential black appearance of esophageal mucosa, usually associated with hypoperfusion and gastric outlet obstruction. This entity has a reported prevalence of up to 0.2%, affecting predominantly elderly men with multiple comorbidities. Most cases resolve with conservative treatment with no need of surgical intervention. However, the overall prognosis is poor, with mortality reaching one-third of cases due to the patient's underlying illness. In this article we present three cases of patients with AEN.


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Esophageal Diseases , Necrosis , Gastrointestinal Hemorrhage , Ischemia
18.
ABCD arq. bras. cir. dig ; 34(2): e1581, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1345002

ABSTRACT

ABSTRACT Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up. Aim: To assess the impact on behavior of esophageal varices and bleeding recurrence after post-operative endoscopic treatment of patients submitted to EGDS. Methods: Thirty-six patients submitted to EGDS were followed for more than five years. They were divided into two groups, according to the portal pressure drop, more or less than 30%, and compared with the behavior of esophageal varices and the rate of bleeding recurrence. Results: A significant reduction on the early and late post-operative varices caliber when compared the pre-operative data was observed despite an increase in diameter during follow-up that was controlled by endoscopic therapy. Conclusion: The drop in portal pressure did not significantly influence the variation of variceal calibers when comparing pre-operative and early or late post-operative diameters. The comparison between the portal pressure drop and the rebleeding rates was also not significant.


RESUMO Racional: O tratamento de escolha para pacientes com hipertensão portal esquistossomótica com sangramento de varizes é a desconexão ázigo-portal mais esplenectomia (DAPE) associada à terapia endoscópica. Porém, estudos mostram aumento do calibre das varizes em alguns pacientes durante o seguimento em longo prazo. Objetivo: Avaliar o impacto da DAPE e tratamento endoscópico pós-operatório no comportamento das varizes esofágicas e recidiva hemorrágica, de pacientes esquistossomóticos. Métodos: Foram estudados 36 pacientes com seguimento superior a cinco anos, distribuídos em dois grupos: queda da pressão portal abaixo de 30% e acima de 30% comparados com o calibre das varizes esofágicas no pós-operatório precoce e tardio além do índice de recidiva hemorrágica. Resultados: Após a DAPE houve diminuição significativa no calibre das varizes esofágicas que, durante o seguimento aumentaram de calibre e foram controladas com tratamento endoscópico. A queda da pressão portal não influenciou significativamente o comportamento do calibre das varizes no pós-operatório precoce nem tardio nem os índices de recidiva hemorrágica. Conclusão: A queda na pressão portal não influenciou significativamente a variação dos calibres das varizes ao comparar os diâmetros pré e pós-operatórios precoces ou tardios. A comparação entre a queda de pressão do portal e as taxas de ressangramento também não foi significativa.


Subject(s)
Humans , Schistosomiasis , Esophageal and Gastric Varices/surgery , Hypertension, Portal/surgery , Recurrence , Splenectomy , Follow-Up Studies , Portal Pressure , Gastrointestinal Hemorrhage/surgery , Gastrointestinal Hemorrhage/etiology
19.
Clinics ; 76: e2921, 2021. tab, graf
Article in English | LILACS | ID: biblio-1278928

ABSTRACT

OBJECTIVES: Acute variceal bleeding (AVB) results from rupture of esophageal or gastric varices. It is a life-threatening complication of portal hypertension. Nevertheless, it remains unclear how to predict adverse outcomes and identify high-risk patients. In variceal hemorrhage, high Child-Turcotte-Pugh (Child) and Model for End-stage Liver Disease (MELD) scores are associated with a worse prognosis. The Rockall system (Rockall), Glasgow-Blatchford (Blatchford), and AIMS65 scores have been validated for risk stratification for nonvariceal upper gastrointestinal bleeding; however, their use is controversial in AVB. The aim of this study was to compare the performance of Child, MELD, Rockall, Blatchford, and AIMS65 scores in risk stratification for rebleeding and/or mortality associated with AVB. METHODS: This retrospective study was conducted at a tertiary care hospital over 42 months. The outcomes were 6-week rebleeding and mortality. The AUROC was calculated for each score (1-0.9, 0.9-0.8, and 0.8-0.7, indicating excellent, good, and acceptable predictive power, respectively). RESULTS: In total, 222 patients were included. Six-week rebleeding and mortality rates were 14% and 18.5%, respectively. No score was useful for discriminating patients at a higher risk of rebleeding. The AUROCs were 0.59, 0.57, 0.61, 0.63, and 0.56 for Rockall, Blatchford, AIMS65, Child, and MELD scores, respectively. Prediction of 6-week mortality based on Rockall (AUROC 0.65), Blatchford (AUROC=0.60), and AIMS65 (AUROC=0.67) scores were also not considered acceptable. The AUROCs for predicting mortality were acceptable for Child and MELD scores (0.72 and 0.74, respectively). CONCLUSION: Rockall, Blatchford, and AIMS65 scores are not useful for predicting 6-week rebleeding or mortality in patients with AVB. Child and MELD scores can identify patients at higher risk for 6-week mortality but not for 6-week rebleeding.


Subject(s)
Humans , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/etiology , End Stage Liver Disease , Prognosis , Severity of Illness Index , Retrospective Studies , ROC Curve , Hospital Mortality , Risk Assessment , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy
20.
Autops. Case Rep ; 11: e2021284, 2021. graf
Article in English | LILACS | ID: biblio-1249014

ABSTRACT

Acute esophageal necrosis (AEN), also known as "black esophagus," is an entity characterized by the circumferential black appearance of esophageal mucosa, usually associated with hypoperfusion and gastric outlet obstruction. This entity has a reported prevalence of up to 0.2%, affecting predominantly elderly men with multiple comorbidities. Most cases resolve with conservative treatment with no need of surgical intervention. However, the overall prognosis is poor, with mortality reaching one-third of cases due to the patient's underlying illness. In this article we present three cases of patients with AEN.


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Esophageal Diseases/pathology , Necrosis , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage
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