Hemorragia digestiva alta no varicosa en portugal: un estudio multicéntrico retrospectivo en doce hospitales portugueses / Nonvariceal upper gastrointestinal bleeding in Portugal: A multicentric retrospective study in twelve Portuguese hospitals

Antecedentes La hemorragia digestiva alta no varicosa (HDANV) se asocia con un grado importante de mortalidad. Para mejorar el manejo de la HDANV es necesario recopilar más información. Los objetivos de este estudio fueron: a) caracterizar los pacientes portugueses y los enfoques clínicos utilizados para la HDANV, b) comparar el enfoque utilizado en Portugal con los enfoques generales utilizados en los otros países europeos, c) identificar los factores asociados con las opciones de tratamiento, d) identificar los factores asociados con los desenlaces adversos. Métodos ENERGiB es un estudio de cohorte, observacional y retrospectivo sobre la HDANV en el que se utilizó evaluación endoscópica y realizado en toda Europa. Este estudio se centra en los pacientes portugueses del estudio ENERGiB. Los pacientes fueron tratados mediante la pautas de atención habituales. Más tarde, se obtuvieron datos a partir de los historiales. Se realizaron análisis de multivarianza y univarianza con los factores predictivos de evolución y decisiones clínicas deficientes. Resultados Los pacientes (n=404) eran en su mayoría hombres (66,8%), con una edad media de 68 años, presencia de comorbilidades (72%), y, con frecuencia, uso de AINEs o aspirina. La mayoría fueron atendidos por médicos de familia (57,8%) o equipos quirúrgicos (20,6%), sólo el 19,4% fue tratado por equipos de gastroenterología /sangrado del IG. Los (..) (AU)

Background Nonvariceal upper gastrointestinal bleeding (NVUGIB) is associated with important mortality. More information is needed in order to improve NVUGIB management. The aims of this study were: (a) characterizing Portuguese patients and clinical approaches used in NVUGIB, (b) comparing management used in Portugal with management globally used in European countries, (c) identify factors associated with management options, and (d) identify factors associated with adverse outcome. Methods ENERGiB was an observational, retrospective cohort study, on NVUGIB with endoscopic evaluation, carried across Europe. This study focuses on Portuguese patients of the ENERGiB study. Patients were managed according to routine care. Later, data were collected from files. Multivariate/univariate analyses were conducted on predictive factors of poor outcome and clinical decisions. Results Patients (n=404) were mostly men (66.8%), mean age 68, with co-morbidities (72%), frequently on NSAIDs/aspirin. Most were assisted by general medical (57.8%) or surgical team (20.6%), only 19.4% by gastroenterology/GI-bleeding team. PPI was largely used. Gastric/duodenal ulcers, erosive gastritis and esophagitis were the main bleeding causes. 10% had bleeding persistence/recurrence. Death occurred in 24 patients, 20 from a non-bleeding related cause. Poor outcomes were related with age >65, co-morbidities, fresh blood haematemesis, shock/syncope, bleeding through previous nasogastric tube, massive fluid replacement or transfusions besides erythrocytes. Conclusions This study contributed to characterization of Portuguese patients and NVUGIB episodes in real clinical setting and identified factors associated with a poor outcome. It also identified differences, especially in the organization of GI bleeding teams, which might help us to improve the management of these patients (AU)

Nonvariceal upper gastrointestinal bleeding in Portugal: a multicentric retrospective study in twelve Portuguese hospitals.

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is associated with important mortality. More information is needed in order to improve NVUGIB management. The aims of this study were: (a) characterizing Portuguese patients and clinical approaches used in NVUGIB, (b) comparing management used in Portugal with management globally used in European countries, (c) identify factors associated with management options, and (d) identify factors associated with adverse outcome. METHODS: ENERGiB was an observational, retrospective cohort study, on NVUGIB with endoscopic evaluation, carried across Europe. This study focuses on Portuguese patients of the ENERGiB study. Patients were managed according to routine care. Later, data were collected from files. Multivariate/univariate analyses were conducted on predictive factors of poor outcome and clinical decisions. RESULTS: Patients (n=404) were mostly men (66.8%), mean age 68, with co-morbidities (72%), frequently on NSAIDs/aspirin. Most were assisted by general medical (57.8%) or surgical team (20.6%), only 19.4% by gastroenterology/GI-bleeding team. PPI was largely used. Gastric/duodenal ulcers, erosive gastritis and esophagitis were the main bleeding causes. 10% had bleeding persistence/recurrence. Death occurred in 24 patients, 20 from a non-bleeding related cause. Poor outcomes were related with age >65, co-morbidities, fresh blood haematemesis, shock/syncope, bleeding through previous nasogastric tube, massive fluid replacement or transfusions besides erythrocytes. CONCLUSIONS: This study contributed to characterization of Portuguese patients and NVUGIB episodes in real clinical setting and identified factors associated with a poor outcome. It also identified differences, especially in the organization of GI bleeding teams, which might help us to improve the management of these patients.