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Shahrebabak MG, Nezhad NZ, Azadmanesh MA, Shahpar A, Shahrebabak AG. Descriptive analysis of common causes of upper gastrointestinal bleeding in pediatric patients in Kerman: a study from 2022 to 2023. BMC Gastroenterol 2025; 25:152. [PMID: 40065200 PMCID: PMC11895127 DOI: 10.1186/s12876-025-03750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 03/03/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) in pediatric patients is a significant clinical concern requiring prompt diagnosis and management. This study aims to provide a descriptive analysis of the common causes of UGIB in pediatric patients in Kerman, Iran. METHODS A cross-sectional study was conducted at Afzalipour Hospital, Kerman, from January 2022 to December 2023. All pediatric patients under 18 years with UGIB were included. Data on demographics, clinical presentation, and endoscopic findings were collected and analyzed. RESULTS A total of 120 patients were included, with a mean age of 8.8 ± 4.7 years. Hematemesis was the predominant presenting feature (57.5%). All patients underwent endoscopy, with a diagnostic yield of 88.4%. Gastric erosion was the most common cause of UGIB (33.3%), followed by esophageal varices (13.3%). The etiology varied across age groups, with Mallory-Weiss syndrome being the second most common cause in infants. Blood transfusion was required in 31.67% of patients. CONCLUSION This study highlights the common causes and clinical features of pediatric UGIB in Kerman, Iran. Gastric erosion (33.3%) was the most frequent cause, and endoscopy achieved a high diagnostic yield (88.4%). Blood transfusion was necessary in 31.67% of patients. These findings emphasize the need for age-specific diagnostic strategies and reflect regional differences in UGIB etiology.
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Affiliation(s)
- Maryam Gholami Shahrebabak
- Department of Pediatrics, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Nazanin Zeinali Nezhad
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
| | | | - Amirhossein Shahpar
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman, Iran
| | - Azam Gholami Shahrebabak
- Department of Pediatrics Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Li C, Zhang N, Zhang Y, Guo N, Sun X, Li S, Xu Y, Wang T, Chen C. Comparison of risk scores for predicting adverse outcomes in acute lower gastrointestinal bleeding. Heliyon 2024; 10:e38877. [PMID: 39640794 PMCID: PMC11620128 DOI: 10.1016/j.heliyon.2024.e38877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/21/2024] [Accepted: 10/01/2024] [Indexed: 12/07/2024] Open
Abstract
Objective Acute lower gastrointestinal bleeding is a common emergency in gastroenterology. Currently, there is insufficient information to predict adverse outcomes in patients with acute lower gastrointestinal bleeding. Our study aimed to compare the effectiveness of the clinical risk scores currently utilized and their ability to predict significant outcomes in lower gastrointestinal bleeding. Methods We conducted a prognostic study of patients hospitalized for acute lower gastrointestinal bleeding who underwent colonoscopy or angiography at a single-center hospital between January 2015 and October 2023. Adverse outcomes associated with ALGIB included rebleeding, blood transfusion, hemostatic interventions, and in-hospital death. We calculated three risk scores at admission (Oakland, Birmingham, SALGIB). We measured the accuracy of these scores using the area under the receiver operating characteristic curve (AUC) and compared them with DeLong's test. Results 222 patients with confirmed lower gastrointestinal bleeding (aged 64 years, 53-75) were finally included. The most common diagnoses were colorectal cancer (28 %) and hemorrhoids (14 %). The Oakland score, Birmingham score, and SALGIB score displayed comparable performance in predicting any adverse outcome (AUC = 0.54, 0.53, 0.55). However, none of the scores were able to sufficiently discriminate rebleeding, blood transfusion, or hemostatic intervention. Using the Youden index, cutoff points for predicting undesired results were identified for the Oakland score at 13, Birmingham score at 3, and SALGIB score at 2. Conclusions None of the three scores demonstrated satisfactory discrimination for adverse outcomes. Therefore, it is necessary to develop novel risk stratification scores with higher performance to improve risk stratification in acute lower gastrointestinal bleeding.
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Affiliation(s)
- Chenyang Li
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ningning Zhang
- Department of Gastroenterology, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yuying Zhang
- Department of Gastroenterology, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Nan Guo
- Department of Gastroenterology, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaomeng Sun
- Department of Gastroenterology, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Shuling Li
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yan Xu
- Department of Gastroenterology, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Tao Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chao Chen
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Li C, Linghu E, Chen C. Comparison of Risk Scores for Predicting Adverse Outcomes in Acute Lower Gastrointestinal Bleeding. Gastroenterol Res Pract 2024; 2024:3111414. [PMID: 38550954 PMCID: PMC10978071 DOI: 10.1155/2024/3111414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/13/2024] [Accepted: 02/29/2024] [Indexed: 01/11/2025] Open
Abstract
PURPOSE Acute lower gastrointestinal bleeding (ALGIB) is a common emergency in gastroenterology. Currently, there is insufficient information to predict adverse outcomes in patients with acute lower gastrointestinal bleeding. Our study is aimed at comparing the effectiveness of the clinical risk scores currently utilized and their ability to predict significant outcomes in lower gastrointestinal bleeding. METHODS We conducted a retrospective observational study of patients who were admitted to ALGIB and underwent colonoscopy or angiography at a single center between January 2018 and December 2022. Adverse outcomes associated with ALGIB included rebleeding, blood transfusion, hemostatic interventions, and in-hospital death. We calculated six risk scores at admission (Oakland, Birmingham, SHA2PE, Ramaekers, SALGIB, and CNUH-5). We measured the accuracy of these scores using the area under the receiver operating characteristic curve (AUC) and compared them with DeLong's test. RESULTS 123 patients with confirmed LGIB (aged 65 years, 55-75) were finally included. The most common diagnoses were colorectal cancer (25%) and hemorrhoids (14%). All scores demonstrated sufficient and comparable effectiveness for hemostatic intervention but no discrimination for rebleeding. The Oakland and SALGIB scores were superior to the other scores in predicting blood transfusion (AUC: 0.97 and 0.95, respectively; p = 0.208) and any adverse outcomes (AUC: 0.78 and 0.78, respectively; p = 0.854). CONCLUSIONS The Oakland and SALGIB scores outperform the other scores in predicting the requirement for blood transfusion in ALGIB patients, but no single prediction tool had the best ability across all outcomes. Novel risk stratification scores with higher performance are needed for better risk stratification in ALGIB.
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Affiliation(s)
- Chenyang Li
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Enqiang Linghu
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chao Chen
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Adeniyi OF, Lesi OA, Odeghe EA, Oyeleke G, Croft N. Gastrointestinal Bleeding in Children: The Role of Endoscopy and the Sheffield Scoring System in a Resource-Limited Setting. JPGN REPORTS 2023; 4:e369. [PMID: 38034436 PMCID: PMC10684120 DOI: 10.1097/pg9.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/15/2023] [Indexed: 12/02/2023]
Abstract
Objective To document the clinical presentation, endoscopic diagnosis, and Sheffield scores of children with gastrointestinal (GI) bleeding who were referred for endoscopy at the Lagos University Teaching Hospital. The participants who needed endoscopy based on clinical criteria and according to the Sheffield scores were also documented. Methods This study analyzed the records of 111 children with GI bleeding retrospectively from January 2013 to January 2021, while 9 children were recruited prospectively from February 2021 to March 2022. Receiver operating curves and area under the curve were generated to test the ability of the Sheffield scores to predict rebleeds, mortality, and the need for endoscopic intervention for upper GI bleeds. Results One hundred and twenty participants were recruited. Ninety-one (75.8%) presented with upper GI bleeding (UGIB), while 29 (24.2%) had lower GI bleeding (LGIB). Only 70 (58.3%) (53 UGIB and 17 LGIB) had endoscopy performed. For UGIB, 5 (9.4%) had no source of the bleeding identified at endoscopy, 12 (22.6%) had variceal bleeding, and 36 (67.9%) had nonvariceal bleeding. Colonoscopy revealed juvenile polyps in 5 (29.4%), indeterminate colitis in 5 (29.4%), ulcerative colitis in 4 (23.5%), Crohn's disease in 1 (5.9%), and hemorrhoids in 2 (11.8%) participants, respectively. The Sheffield score was ≥8 in 42 (46.1%) of the participants who presented only with UGIB (hematemesis and melena). The scores were significantly related to the type of bleeds, rebleeds, and deaths (P = 0.00). Conclusion The clinical and endoscopic findings in this study are similar to those reported previously. The Sheffield scoring was useful in assessing Nigerian children. However, due to limited access and other restraints, endoscopy was not performed on all the study participants even when the scoring system was suggestive. The availability, and therefore, utility of GI endoscopy in this setting are still suboptimal. The need for the provision of adequate equipment and resources and the training of personnel is thus recommended.
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Affiliation(s)
- Oluwafunmilayo Funke Adeniyi
- From the Department of Paediatrics, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufunmilayo Adenike Lesi
- Department of Medicine, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Emuobor Aghoghor Odeghe
- Department of Medicine, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ganiyat Oyeleke
- Department of Medicine, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nicholas Croft
- Barts and the London School of Medicine and Dentistry/Queen Mary University of London, United Kingdom
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Singh M, Chiang J, Seah A, Liu N, Mathew R, Mathur S. A clinical predictive model for risk stratification of patients with severe acute lower gastrointestinal bleeding. World J Emerg Surg 2021; 16:58. [PMID: 34809648 PMCID: PMC8607718 DOI: 10.1186/s13017-021-00402-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lower gastrointestinal bleeding (LGIB) is a common presentation of surgical admissions, imposing a significant burden on healthcare costs and resources. There is a paucity of standardised clinical predictive tools available for the initial assessment and risk stratification of patients with LGIB. We propose a simple clinical scoring model to prognosticate patients at risk of severe LGIB and an algorithm to guide management of such patients. METHODS A retrospective cohort study was conducted, identifying consecutive patients admitted to our institution for LGIB over a 1-year period. Baseline demographics, clinical parameters at initial presentation and treatment interventions were recorded. Multivariate logistic regression was performed to identify factors predictive of severe LGIB. A clinical management algorithm was developed to discriminate between patients requiring admission, and to guide endoscopic, angiographic and/or surgical intervention. RESULTS 226/649 (34.8%) patients had severe LGIB. Six variables were entered into a clinical predictive model for risk stratification of LGIB: Tachycardia (HR ≥ 100), hypotension (SBP < 90 mmHg), anaemia (Hb < 9 g/dL), metabolic acidosis, use of antiplatelet/anticoagulants, and active per-rectal bleeding. The optimum cut-off score of ≥ 1 had a sensitivity of 91.9%, specificity of 39.8%, and positive and negative predictive Values of 45% and 90.2%, respectively, for predicting severe LGIB. The area under curve (AUC) was 0.77. CONCLUSION Early diagnosis and management of severe LGIB remains a challenge for the acute care surgeon. The predictive model described comprises objective clinical parameters routinely obtained at initial triage to guide risk stratification, disposition and inpatient management of patients.
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Affiliation(s)
- Manraj Singh
- Department of General Surgery, Singapore General Hospital, 20 College Rd, Singapore, 169856 Singapore
| | - Jayne Chiang
- Department of General Surgery, Singapore General Hospital, 20 College Rd, Singapore, 169856 Singapore
| | - Andre Seah
- Department of General Surgery, Singapore General Hospital, 20 College Rd, Singapore, 169856 Singapore
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
- Department of Trauma and Acute Care Surgery, Singapore General Hospital, Singapore, Singapore
| | - Nan Liu
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
| | - Ronnie Mathew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Sachin Mathur
- Department of General Surgery, Singapore General Hospital, 20 College Rd, Singapore, 169856 Singapore
- Department of Trauma and Acute Care Surgery, Singapore General Hospital, Singapore, Singapore
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Quach DT, Nguyen NTM, Vo UPP, Le LTK, Vo CHM, Ho PT, Nguyen TN, Bo PK, Nguyen NH, Vu KT, Van Dang M, Dinh MC, Nguyen TQ, Van Nguyen X, Le STN, Tran CP. Development and Validation of a Scoring System to Predict Severe Acute Lower Gastrointestinal Bleeding in Vietnamese. Dig Dis Sci 2021; 66:823-831. [PMID: 32285322 DOI: 10.1007/s10620-020-06253-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS The prevalence of acute lower gastrointestinal bleeding (ALGIB) has progressively increased worldwide but there are few studies in Asian populations. This study aimed to develop and validate a scoring system to predict severe ALGIB in Vietnamese. METHODS Risk factors for severe ALGIB were identified by multiple logistic regression analysis using data from a retrospective cohort of 357 patients admitted to a tertiary hospital. These factors were weighted to develop the severe acute lower gastrointestinal bleeding (SALGIB) score to predict severe ALGIB. The performance of SALGIB was validated in a prospective cohort of 324 patients admitted to 6 other hospitals using area under the receiver operating characteristics curve (AUC) analysis. RESULTS There were four factors at admission independently associated with severe ALGIB in the derivation cohort: heart rate ≥ 100/min, systolic blood pressure < 100 mmHg, hematocrit < 35%, and platelets ≤ 150 × 103/µL. The SALGIB score determined severe ALGIB with AUC values of 0.91 and 0.86 in the derivation and validation cohorts, respectively. A SALGIB score < 2 associated with low risk of severe ALGIB in both cohorts (3.7% and 1.2%; respectively). CONCLUSIONS The SALGIB score has good performance in discriminating risk of severe ALGIB in Vietnamese.
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Affiliation(s)
- Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh, Vietnam.
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh, Vietnam.
| | | | - Uyen Pham-Phuong Vo
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh, Vietnam
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh, Vietnam
| | - Ly Thi-Kim Le
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh, Vietnam
| | - Cong Hong-Minh Vo
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh, Vietnam
| | - Phat Tan Ho
- Department of Gastroenterology, Cho-Ray Hospital, Ho Chi Minh, Vietnam
| | - Tran Ngoc Nguyen
- Department of Gastroenterology, Can-Tho Central Hospital, Can Tho, Vietnam
| | - Phuong Kim Bo
- Department of Gastroenterology, Can-Tho Central Hospital, Can Tho, Vietnam
| | - Nam Hoai Nguyen
- Department of Gastroenterology, Bach-Mai Hospital, Ha Noi, Vietnam
| | - Khanh Truong Vu
- Department of Gastroenterology, Bach-Mai Hospital, Ha Noi, Vietnam
| | - Manh Van Dang
- Department of Gastroenterology, Dong-Nai General Hospital, Bien Hoa, Vietnam
| | - Minh Cao Dinh
- Department of Gastroenterology, Dong-Nai General Hospital, Bien Hoa, Vietnam
| | - Thai Quang Nguyen
- Department of Gastroenterology, Da-Nang General Hospital, Da Nang, Vietnam
| | - Xung Van Nguyen
- Department of Gastroenterology, Da-Nang General Hospital, Da Nang, Vietnam
| | | | - Chi Pham Tran
- Department of Gastroenterology, Hue Central Hospital, Hue, Vietnam
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Talib MA, Aziz MT, Suleman H, Khosa GK, Joya SJ, Hussain I. Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children's Hospital. Pak J Med Sci 2021; 37:556-560. [PMID: 33679949 PMCID: PMC7931281 DOI: 10.12669/pjms.37.2.2676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To determine etiology and outcome of children with lower gastrointestinal bleeding (LGIB). Methods: This was a prospective study conducted at the Department of Pediatric Gastroenterology and Hepatology, Children’s Hospital and The Institute of Child’s Heath, Multan, Pakistan, from July 2019 to March 2020. A total of 148 cases presented with bleeding per rectum and underwent colonoscopy, were included. Children of both genders and aged three month to 15 years were included. Detailed history, clinical examination, laboratory studies, colonoscopy and histopathology were done in all cases. Study information like demographics, complaints, general clinical examination, colonoscopy and histopathological findings were recorded. Results: Overall, mean age was noted to be 7.20±1.83 years. Abdominal pain was reported in 41 (27.7%), diarrhea 36 (24.3%), fever 12 (8.1%) and constipation in 4 (2.7%). Pallor was noted among 68 (45.9%), weight loss 39 (26.3%) and tachycardia 31 (20.9%). Colonoscopy revealed juvenile colonic / rectal polyps, infectious colitis and solitary rectal ulcer (SRU) as the most common etiologies found among 58 (39.2%), 20 (13.5%) and 19 (12.8%) cases respectively. Juvenile polyps and non-specific colitis were the commonest histopathological findings seen in 55 (37.2%) and 20 (13.5%) cases respectively. Colonoscopic polypectomy was used to remove all juvenile polyps. Conclusion: LGIB is presentation of various underlying causes. Children with LGIB commonly present with abdominal pain. Juvenile polyps were the most frequent cause of LGIB among children flowed by non-specific colitis. Most of the children having LGIB were diagnosed and treated successfully, few are in remission and very few were found resistant to treatment.
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Affiliation(s)
- Muhammad Abu Talib
- Muhammad Abu Talib, Department of Pediatric Gastroenterology and Hepatology, Children's Hospital and The Institute of Child's Heath, Multan, Pakistan
| | - Muhammad Tariq Aziz
- Muhammad Tariq Aziz, Department of Pediatric Gastroenterology and Hepatology, Children's Hospital and The Institute of Child's Heath, Multan, Pakistan
| | - Hassan Suleman
- Hassan Suleman, Department of Pediatric Gastroenterology and Hepatology, Children's Hospital and The Institute of Child's Heath, Multan, Pakistan
| | - Ghazi Khan Khosa
- Ghazi Khan Khosa, Department of Pediatric Gastroenterology and Hepatology, Children's Hospital and The Institute of Child's Heath, Multan, Pakistan
| | - Saima Jabeen Joya
- Saima Jabeen Joya, Department of Pediatric Gastroenterology and Hepatology, Children's Hospital and The Institute of Child's Heath, Multan, Pakistan
| | - Ibrar Hussain
- Ibrar Hussain, Department of Pediatric Gastroenterology and Hepatology, Children's Hospital and The Institute of Child's Heath, Multan, Pakistan
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Woodhull S, Goon H, Rajadurai P, Tan S, Tan Z. Adhesive subacute small bowel obstruction presenting with gross rectal bleeding. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Adegboyega T, Rivadeneira D. Lower GI Bleeding: An Update on Incidences and Causes. Clin Colon Rectal Surg 2019; 33:28-34. [PMID: 31915423 DOI: 10.1055/s-0039-1695035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bleeding from the lower gastrointestinal tract represents a significant source of morbidity and mortality. The colon represents the vast majority of the location of bleeding with only a much smaller incidence occurring in the small intestine. The major causes of lower gastrointestinal bleeding (LGIB) are from diverticulosis, vascular malformations, and cancer. We discuss the incidence and causes of LGIB.
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Affiliation(s)
- Titilayo Adegboyega
- Department of Surgery, Donald and Barbara Zucker School of Medicine Hofstra University, Northwell Health System, New York
| | - David Rivadeneira
- Department of Surgery, Donald and Barbara Zucker School of Medicine Hofstra University, Northwell Health System, New York
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Zhang Y, Wu SY, Du YQ, Li BH, Li CF, Li Y, Li ZS, Bai Y. Epidemiology of obscure gastrointestinal bleeding in China: A single-center series and comprehensive analysis of literature. J Dig Dis 2018; 19:33-39. [PMID: 29251428 DOI: 10.1111/1751-2980.12568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 12/10/2017] [Accepted: 12/12/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the etiologies of obscure gastrointestinal bleeding (OGIB) in a Chinese population using a retrospective case series and a systematic analysis of the literatures on OGIB in Chinese patients. METHODS A large enteroscopy database in a tertiary endoscopic center was searched to identify patients with OGIB from 2010 to 2016. The patients' characteristics and diagnostic findings were collected and analyzed. A comprehensive search of the literature was carried out to harvest all relevant studies published from 2004 to 2016. RESULTS In total, 708 patients were included in the case series. The most common causes of OGIB were inflammatory diseases (36.3%), non-small bowel lesions (10.2%) and neoplasms (10.0%). A systematic analysis of the literatures included 39 studies providing relevant data for 3145 patients with a pooled detection rate of 84.2%. Inflammatory lesions (27.4%), neoplasms (18.5%), vascular lesions (16.1%) and diverticula or intestinal duplication (11.9%) were the most common causes of OGIB. CONCLUSIONS Inflammatory lesions, neoplasms, vascular lesions and diverticula or intestinal duplication are the most common in Chinese OGIB patients, while in pediatric patients diverticula or intestinal duplication, vascular lesions and Crohn's disease are prevalent. Furthermore, the etiologies of OGIB distribute differently across different areas in China.
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Affiliation(s)
- Yao Zhang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.,Department of Basic Medicine, Second Military Medical University, Shanghai, China
| | - Sui Yi Wu
- Department of Basic Medicine, Second Military Medical University, Shanghai, China
| | - Yi Qi Du
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bing Han Li
- Department of Basic Medicine, Second Military Medical University, Shanghai, China
| | - Chen Fei Li
- Department of Basic Medicine, Second Military Medical University, Shanghai, China
| | - Ying Li
- Department of Basic Medicine, Second Military Medical University, Shanghai, China
| | - Zhao Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Diamantopoulou G, Konstantakis C, Kottorοu A, Skroubis G, Theocharis G, Theopistos V, Triantos C, Nikolopoulou V, Thomopoulos K. Acute Lower Gastrointestinal Bleeding: Characteristics and Clinical Outcome of Patients Treated With an Intensive Protocol. Gastroenterology Res 2017; 10:352-358. [PMID: 29317943 PMCID: PMC5755637 DOI: 10.14740/gr914w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/11/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years major advances have been made in the management of patients with acute lower gastrointestinal bleeding. The aim of this study was to investigate the characteristics and clinical outcome of patients with acute lower gastrointestinal bleeding (ALGIB) treated with an intensive protocol. METHODS We analyzed the medical records of 528 patients with ALGIB. All patients after hemodynamic stabilization underwent colonoscopy during the first 24 h of hospitalization and capsule enteroscopy when needed. Patients with massive ongoing bleeding underwent computed tomography angiography (CTA), and when active bleeding was detected embolization was immediately performed. RESULTS The mean age of the patients was 70.2 ± 14.6 years and 271 (51.3%) of them were men. At least one comorbidity was present in 464 patients (87.9%), cardiovascular disease in 266 (50.4%), while 158 (30%) patients were on antiplatelet drugs and 96 (18.2%) on anticoagulants. The most common causes of bleeding were diverticulosis (19.7%) and ischemic colitis (19.3%). Thirty-six patients (6.9%) had small intestinal bleeding. In 117 patients (22.2%) active bleeding or recent bleeding stigmata were found and in 82 of them (92.1%) endoscopic hemostasis was applied. Embolization was performed in 10 (1.9%) and was successful in seven (70%) cases, while surgical hemostasis was required in only six (1.1%) cases. Forty-four (8.3%) patients had a rebleeding episode, and 13 patients died with an overall mortality of 2.5%. CONCLUSIONS Management of ALGIB based on an intensive protocol is safe and effective. The bleeding source can be identified in most cases with a favorable outcome.
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Affiliation(s)
| | | | - Anastasia Kottorοu
- Laboratory of Molecular Oncology, University Hospital of Patras, 26504 Rio, Greece
| | - Georgios Skroubis
- Department of Surgery, University Hospital of Patras, 26504 Rio, Greece
| | - Georgios Theocharis
- Department of Gastroenterology, University Hospital of Patras, 26504 Rio, Greece
| | - Vasileios Theopistos
- Department of Gastroenterology, University Hospital of Patras, 26504 Rio, Greece
| | - Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, 26504 Rio, Greece
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Romano C, Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG, Cardile S, Gaiani F, de’Angelis GL, Torroni F. Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology. World J Gastroenterol 2017; 23:1328-1337. [PMID: 28293079 PMCID: PMC5330817 DOI: 10.3748/wjg.v23.i8.1328] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 01/01/2017] [Accepted: 01/17/2017] [Indexed: 02/06/2023] Open
Abstract
There are many causes of gastrointestinal bleeding (GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) carried out a systematic search on MEDLINE via PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, case-control studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.
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Moravej H, Dehghani SM, Nikzadeh H, Malekpour A. Lower Gastrointestinal Bleeding in Children: Experiences From Referral Center in Southern Iran. JOURNAL OF COMPREHENSIVE PEDIATRICS 2013; 4. [DOI: 10.17795/compreped-8423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Pfeifer J. Surgical management of lower gastrointestinal bleeding. Eur J Trauma Emerg Surg 2011; 37:365-72. [PMID: 26815273 DOI: 10.1007/s00068-011-0122-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 05/22/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE Lower gastrointestinal bleeding (LGIB) is any form of bleeding distal to the Ligament of Treitz. In most cases, acute LGIB is self-limited and resolves spontaneously with conservative management. METHODS Only a minority of approximately 10% is admitted to hospital with signs of massive bleeding and shock requiring resuscitation, urgent evaluation and treatment. RESULTS Over the past decade, there has been a progressive decrease in upper GI events and a significant increase in lower GI events. Overall, mortality has also decreased, but in-hospital fatality due to upper or lower GI complications have remained constant. The problem is that LGIB can arise from a number of sources and may be a significant cause of hospitalisation and mortality in elderly patients. CONCLUSIONS After initial resuscitation, the diagnosis and treatment of LGIB remains a challenge for acute care surgeons, whereby the identification of the source of bleeding is of utmost importance.
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Affiliation(s)
- J Pfeifer
- Division of General Surgery, Department of Surgery and Section for Surgical Research, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
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