A study on clinical profile and risk factors in drug induced UGI bleeding

Back ground: It is highly unfortunate that many patients are admitted daily with hematemesis and or malena due to the adverse effects of drugs either prescribed or self-medicated. Incidence of such cases can be greatly reduced if medical practitioners are not only aware of the adverse effects of drugs on gastrointestinal tract but also assess the patients for the risk factors of drug-induced UGI bleeding before prescribing these drugs and also by properly educating the patients. Aim: To study the clinical profile and risk factors in fifty cases of drug induced UGI bleeding. Materials and methods: Fifty patients (32 males and 18 females) admitted with drug-induced hematemesis and or malena were studied with respect to age group, number of bouts of hematemesis, approximate quantity of total blood loss, causative drug responsible for UGI bleeding, risk factors of GI bleeding, number of individual risk factors in each patients. The prevalence of individual risk factors in those fifty patients and the prevalence of number of risk factors in those fifty patients were studied. Thorough clinical and laboratory investigations were done. Results: Hematemesis was the common symptom. Ibuprofen was responsible for the majority of cases (38%) followed by diclofenac (22%). Prevalence of risk factors among the patients are as follows: Age > 50 years of age - 66%, ‘O’ Blood group – 50%, Alcoholism – 42%, Not using Gastro protective agents – 40%, Self-medication / OTC drugs – 36%, Smoking – 30%, Stress and Serious systemic illnesses – 12%, Helicobacter pylori – 12%, Known Peptic ulcer disease – 10% , High doses/ Chronic drug intake – 10%, Concomitant use of Steroids – 8% and Concomitant use of anticoagulants – 4%. Conclusion: NSAIDs were the commonest cause for UGI bleeding. Age > 50 years (66%) was the commonest risk factor for UGI bleeding. All those fifty cases had at least one known risk factor and majority (80%) had more than one risk factors of drug-induced UGI bleeding

A study on endoscopic abnormality in drug induced UGI bleeding

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin are among the most frequently prescribed drugs worldwide and are available ‘Over-The-Counter’ (OTC) also. Though reasonably safe in most cases in prescribed dosages and for short durations, these drugs cause serious gastrointestinal toxicity in a large number of cases. They can affect all segments of the gastrointestinal tract causing ulcers, severe bleeding, perforation, and obstruction. Aim: To study the endoscopic abnormalities in fifty cases of drug induced UGI bleeding. Materials and methods: Fifty patients (32 males and 18 females) admitted with drug-induced hematemesis and or malena were studied with respect to age group, number of bouts of hematemesis, approximate quantity of total blood loss, causative drug responsible for UGI bleeding, risk factors of GI bleeding, number of individual risk factors in each patients. Thorough clinical and laboratory investigations were done. UGI scopy was done for all patients. Results: NSAIDs were the commonest cause for UGI bleeding. Age > 50 years (66%) was the commonest risk factor for UGI bleeding. It was observed that ten patients were having normal endoscopic study, twenty five patients were having lesions in stomach only, ten patients were having lesions in duodenum only and five were having lesions in both stomach and duodenum. None of the patients studied, had lesions in the esophagus. It was found that ulcers were more common than erosions. Conclusion: Stomach is the commonest site affected (50%) and ulcers (64%) were common than erosion.

How Can We Maximize Skills for Non-Variceal Upper Gastrointestinal Bleeding: Injection, Clipping, Burning, or Others?

Endoscopy has its role in the primary diagnosis and management of acute non-variceal upper gastrointestinal bleeding. Main roles of endoscopy are identifying high risk stigmata lesion, and performing endoscopic hemostasis to lower the rebleeding and mortality risks. Early endoscopy within the first 24 hours enables risk classification according to clinical and endoscopic criteria, which guide safe and prompt discharge of low risk patients, and improve outcomes of high risk patients. Techniques including injection therapy, ablative therapy and mechanical therapy have been studied over the recent decades. Combined treatment is more effective than injection treatment, and single treatment with mechanical or thermal method is safe and effective in peptic ulcer bleeding. Specific treatment and correct decisions are needed in various situations depending on the site, location, specific characteristics of lesion and patient's clinical conditions.

Upper Gastrointestinal Bleeding in Full-Term Infants / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to evaluate the clinical characteristics, endoscopic findings and risk factors related to the upper gastrointestinal bleeding (UGIB) seen in full-term infants. METHODS: A clinical analysis for 9 cases with UGIB confirmed by endoscopy was carried out retrospectively. Patients were admitted to the Department of Pediatrics, Eulji Hospital, from January to December 2003. RESULTS: UGIB from gastric or duodenal mucosal lesions has been seen in 0.13% in newborns infants. All patients were full-term AGA neonates without asphyxic findings at birth. Hematemesis, melena or recurrent vomiting developed within 4.4+/-3.8 days after birth. Vital sign and laboratory test was normal on admission. Endoscopic findings showed hemorrhagic gastritis in 6 cases and peptic ulcers in 3 cases. All patients were successfully managed by medical treatment for 18.6+/-5.0 days. On treatment, clinical symptoms improved within 0.9+/-0.3 days. Follow-up endoscopy was not performed because there was no recurrence of symptoms in all patients. Case mothers had no history of gastritis, ulcer or anti-ulcer medications before and during pregnancy. CONCLUSION: If the healthy full-term infants express UGIB within a few days after birth, it is necessary to take careful history of family, mother and delivery process and to practice endoscopy for mucosal lesions of the patients. A follow-up endoscopy dose not seem to be necessary if the infant is clinically well.

Observation of 35 Cases of Mallory: Weiss Syndrome Diagnosed by Endoscopy / 대한소화기내시경학회지

35 cases of Mallory-Weiss syndrome among 277 cases of upper gastrointestinal bleeding were ascertained by endoscopy at department of internal medicine St. Columban's hospital. The mean age was 41.6 years. All of 35 cases were found in male. Combined disease were gastritis(15 cases), peptic ulcer(7 cases) and esophageal varix(3 cases). The most common precipitating factor was vomiting, 22 cases among the 28 cases of vomiting(80%) developed after drinking. Endoscopic finding revealed active bleeding in 5 cases, blood clot without active bleeding in 22 cases, and scar change without bleeding evidence in 8 cases. Most cases had had hematemesis after active bleeding but 5 cases had had only melena without hematemesis. The Mallory-Weiss lacerations were located at stomach in 16 cases(46%), at esophagogastric junction in 11 cases(31%) and at esophagus in 8 cases. On the view of gastric direction, 14 cases were on anterior wall side, 9 cases were on posterior wall side, 11 cases were on lesser curvature side and one case was on great curvature side. Single lacerations were more common than multiple lacerations.

A Case of Duodenal Metastasis of Hepatocellular Carcinoma Presenting Gastrointestinal Bleeding / 대한소화기내시경학회지

Extrahepatic metastasis of Hepatocellular carcinoma(HCC) to the gastrointestinal tract is uncommon. Because most of metastases to the gastrointestinal tract have no clinical manifestations, they are usually found incidentally at the time of an autopsy or a laparotomy, We experienced a case of duodenal metastasis of HCC, which presented UGI bleeding. A 59 years old male was admitted to our hospital due to generalized jaundice, which lasted for about a week. From the third day of admission, he had episodes of hematemesis and melena. An abdoinal CT scan demonstrated multiple, variable sized low-density masses in the entire liver with portal vein thrombosis and conglomerated lymph nodes. An esophagogastroduodenoscopy showed a protruded submucosal mass-like lesion with multiple ulceration in the duodenal bulb. We confirmed the duodenal mass-like lesion to be hepatocellular carcinoma by a biopsy and a histoimmunochemical study.

Endoscopic Observation of Gastric Varices / 대한소화기내시경학회지

We observed the gastric varices in l89 variceal patients with liver cirrhosis and in 129 patients with UGI bleeding by endoscopy. Gastric varices was found in 27 cases(14.2%) amoag 189 variceal cases. There was variceal bleeding in 74 cases(57.4%) beieg the toy cause of UGI: bleeding among l29 cases with UGI bleeding and 6(4.7%) had endoscopically proved gastric Variceal bleeding. Cardiac and fundic varices were observed in l8 and 12 cases, respectively end 12 cases of cardiac varices were mainly observed on the lesser curvature side. The incidence of isolated gastric varices being 30 % amoag gastric varices was far less than that of esophagogastric varices. There was no significant relations between the severity of liver cirrhosis and the kinds of varices These results suggest that gastric varices are not infrequent cause of UGI bleeding cases. Therefore all must have attention in gastric intestinal fiberscopic examination in portal hypertensive patients.