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Miilunpohja S, Jyrkkä J, Kärkkäinen JM, Kastarinen H, Heikkinen M, Paajanen H, Rantanen T, Hartikainen J. Discontinuing low-dose acetylsalicylic acid after gastrointestinal bleeding is associated with increased mortality. Scand J Gastroenterol 2022; 57:618-624. [PMID: 35041575 DOI: 10.1080/00365521.2022.2026461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrointestinal bleeding is a common clinical problem in patients using low-dose acetylsalicylic acid (ASA). It is uncertain whether aspirin should continue to be used in patients who develop acute gastrointestinal bleeding during low-dose ASA therapy. AIMS To assess whether ASA should be continued in patients who develop GI bleeding during low-dose ASA. METHODS All patients admitted to an academic hospital for acute gastrointestinal bleeding between 2009 and 2011 were reviewed retrospectively. Clinical characteristics, comorbidities, medications and treatments were recorded from the patient records. Patients were divided into two groups based on continuing or discontinuing ASA after discharge. RESULTS A total of 548 patients were included. ASA was continued in 282 (51.5%) (ASAc group) and discontinued in 266 (48.5%) patients (ASAd group). ASAc patients had more often coronary artery disease (57.8% vs. 42.5%, p < .001) and peripheral artery disease (17.4% vs. 9.0%, p = .004) than ASAd patients, whereas no differences were found in other comorbidities. There was no difference in 30-day all-cause mortality between ASAd and ASAc groups. However, after adjustment for age, gender and comorbidities, one-year all-cause mortality was double in the ASAd group (hazard ratio 2.16, 95% confidence interval 1.39-3.35). ASAd and ASAc groups did not differ with respect to cardiovascular mortality (4.9% vs. 5.3%, p = .811, respectively) or re-bleeding (10.2% vs. 9.2%, p = .713, respectively). CONCLUSION Continuing low-dose ASA after gastrointestinal bleeding was associated with lower all-cause mortality during the first year without increasing the risk of re-bleeding.
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Affiliation(s)
- Sami Miilunpohja
- Heart Centre, Kuopio University Hospital, Kuopio, Finland.,Emergency Department, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Jyrkkä
- Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland
| | - Jussi M Kärkkäinen
- Heart Centre, Kuopio University Hospital, Kuopio, Finland.,Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Helena Kastarinen
- Insurance Medicine Unit, The Social Insurance Institution of Finland, Kuopio, Finland
| | - Markku Heikkinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Paajanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Rantanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha Hartikainen
- Heart Centre, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Fang B, Li D, Liu H, Yang S, Xu R, Chen G, Hu J. Impact of Subjective and Objective Sleep Quality on Peptic Ulcer Rebleeding in Older Adults. Psychosom Med 2021; 83:995-1003. [PMID: 34420000 DOI: 10.1097/psy.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to examine the association of subjective and objective sleep quality with subsequent peptic ulcer rebleeding among older patients. METHODS Of 1196 older patients with peptic ulcer bleeding (PUB) recruited from 12 grade A hospitals in the People's Republic of China, 1106 achieved full recovery from PUB, and they were followed up for up to 30 days. Using multiple measures at 1-week intervals, patients who presented PUB symptoms were invited to have an esophagogastroduodenoscopy examination. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Objective sleep quality domains were measured using an accelerometer, including sleep onset latency, sleep efficiency, total sleep time, and the number of awakenings. RESULTS This study documented a 30-day cumulative ulcer rebleeding rate of 15.3%. Multivariate analyses showed that longer sleep onset latency (hazard ratio [HR] = 2.136 [1.336-2.558]) and more nighttime awakenings (HR = 1.698 [1.169-2.666]) increased the risk of ulcer rebleeding. However, a longer total sleep time (HR = 0.768 [0.698-0.887]) and better sleep efficiency (HR = 0.795 [0.682-0.975]) protected against ulcer rebleeding. Older patients who perceived poorer sleep quality were also more likely to experience ulcer rebleeding (HR = 2.295 [1.352-3.925]). CONCLUSIONS The present results highlight the importance of proper treatment and prevention of sleep problems in older adults after successful PUB treatment. Our results, if replicable in future studies with more rigorous design and representative samples, might shed light on the etiology of ulcer rebleeding and suggest new pathways for preventing this disease.
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Affiliation(s)
- Boye Fang
- From the School of Sociology and Anthropology (Fang, Li), Sun Yat-sen University, Guangdong Province; Department of Sociology (Liu), Central South University, Changsha, China; Department of Social Work (Yang), Hong Kong Baptist University, Kowloon, Hong Kong; Department of Gastrointestinal Surgery (Xu, Chen), Shantou University Medical College, Shantou; and Department of Hematology (Hu), Xiangya Hospital, Central South University, Changsha, China
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Safety and Efficacy of the Noncessation Method of Antithrombotic Agents after Emergency Endoscopic Hemostasis in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study. Can J Gastroenterol Hepatol 2021; 2021:6672440. [PMID: 34095017 PMCID: PMC8164533 DOI: 10.1155/2021/6672440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/01/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS The present study aimed to clarify the safety and efficacy of the noncessation method of antithrombotic agents after emergency endoscopic hemostasis in patients with nonvariceal upper gastrointestinal bleeding (UGIB). METHODS In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for nonvariceal UGIB in patients taking antithrombotic agents and resumed the medications without a cessation period (group A). The clinical characteristics, types of antithrombotic agents, UGIB etiology, treatment outcome, and adverse events were evaluated. We used propensity score matching to compare treatment outcomes and adverse events with our previous cohort (group B) in whom antithrombotic agents were transiently discontinued after emergency endoscopic hemostasis. RESULTS Forty-three consecutive patients were prospectively enrolled. The main antithrombotic agents were low-dose aspirin and direct oral anticoagulants; 11 patients (25.6%) were taking multiple antithrombotics. Peptic ulcers were the main cause of bleeding (95.4%). Endoscopic hemostasis was successful in all patients and the incidence of rebleeding within a month was 7.0%. Propensity score matching created 40 matched pairs. Endoscopic hemostasis was performed by soft coagulation significantly more frequently in group A than in group B (97.5% versus 60.0%, P < 0.001). Neither the rebleeding rate within a month nor thromboembolic event rate was different between the two groups. However, the mean duration of hospitalization was significantly shorter in group A than in group B (8.6 ± 5.2 d versus 14.4 ± 7.1 d, P < 0.001). CONCLUSIONS Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for nonvariceal UGIB.
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Fukuda M, Fukuda S, Ando J, Yamamoto K, Yonemoto N, Suzuki T, Niwa Y, Inoue T, Satoh-Asahara N, Hasegawa K, Shimatsu A, Tsukahara T. Disruption of P2X4 purinoceptor and suppression of the inflammation associated with cerebral aneurysm formation. J Neurosurg 2019; 134:102-114. [PMID: 31860812 DOI: 10.3171/2019.9.jns19270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are no effective therapeutic drugs for cerebral aneurysms, partly because the pathogenesis remains unresolved. Chronic inflammation of the cerebral arterial wall plays an important role in aneurysm formation, but it is not clear what triggers the inflammation. The authors have observed that vascular endothelial P2X4 purinoceptor is involved in flow-sensitive mechanisms that regulate vascular remodeling. They have thus hypothesized that shear stress-associated hemodynamic stress on the endothelium causes the inflammatory process in the cerebral aneurysm development. METHODS To test their hypothesis, the authors examined the role of P2X4 in cerebral aneurysm development by using P2X4-/- mice and rats that were treated with a P2X4 inhibitor, paroxetine, and subjected to aneurysm-inducing surgery. Cerebral aneurysms were induced by unilateral carotid artery ligation and renovascular hypertension. RESULTS The frequency of aneurysm induction evaluated by light microscopy was significantly lower in the P2X4-/- mice (p = 0.0488) and in the paroxetine-treated male (p = 0.0253) and female (p = 0.0204) rats compared to control mice and rats, respectively. In addition, application of paroxetine from 2 weeks after surgery led to a significant reduction in aneurysm size in the rats euthanized 3 weeks after aneurysm-inducing surgery (p = 0.0145), indicating that paroxetine suppressed enlargement of formed aneurysms. The mRNA and protein expression levels of known inflammatory contributors to aneurysm formation (monocyte chemoattractant protein-1 [MCP-1], interleukin-1β [IL-1β], tumor necrosis factor-α [TNFα], inducible nitric oxide synthase [iNOS], and cyclooxygenase-2 [COX-2]) were all significantly elevated in the rats that underwent the aneurysm-inducing surgery compared to the nonsurgical group, and the values in the surgical group were all significantly decreased by paroxetine administration according to quantitative polymerase chain reaction techniques and Western blotting. Although immunolabeling densities for COX-2, iNOS, and MCP-1 were not readily observed in the nonsurgical mouse groups, such densities were clearly seen in the arterial wall of P2X4+/+ mice after aneurysm-inducing surgery. In contrast, in the P2X4-/- mice after the surgery, immunolabeling of COX-2 and iNOS was not observed in the arterial wall, whereas that of MCP-1 was readily observed in the adventitia, but not the intima. CONCLUSIONS These data suggest that P2X4 is required for the inflammation that contributes to both cerebral aneurysm formation and growth. Enhanced shear stress-associated hemodynamic stress on the vascular endothelium may trigger cerebral aneurysm development. Paroxetine may have potential for the clinical treatment of cerebral aneurysms, given that this agent exhibits efficacy as a clinical antidepressant.
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Affiliation(s)
- Miyuki Fukuda
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
- 2Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shunichi Fukuda
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
| | - Joji Ando
- 3Laboratory of Biomedical Engineering, School of Medicine, Dokkyo Medical University, Mibu City, Tochigi
| | - Kimiko Yamamoto
- 4Department of Biomedical Engineering, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo
| | | | - Takashi Suzuki
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
- 6Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto; and
| | - Youko Niwa
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
| | - Takayuki Inoue
- 7Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute
| | - Noriko Satoh-Asahara
- 7Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute
| | | | - Akira Shimatsu
- 9Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tetsuya Tsukahara
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
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Matsuura S, Sakata Y, Tsuruoka N, Miyahara K, Hara M, Ito Y, Nakayama K, Shimamura T, Noda T, Yukimoto T, Shimoda R, Iwakiri R, Fujimoto K. Outcomes of Patients Undergoing Endoscopic Hemostasis for the Upper Gastrointestinal Bleeding Were Not Influenced by the Timing of Hospital Emergency Visits: A Situation Prevailing in Japan. Digestion 2018; 97:260-266. [PMID: 29428942 DOI: 10.1159/000485653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/23/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the present study was to determine differences in the prognosis of patients in Japan who underwent emergency endoscopic hemostasis (i) during regular hours versus off hours and (ii) as outpatients versus hospitalized patients. METHODS The present retrospective study included 443 patients who underwent emergency endoscopic hemostasis for non-variceal upper gastrointestinal bleeding from January 2008 to December 2014. These patients were classified into 2 groups: hospitalized patients and outpatients. The outpatients were further subclassified into those who visited the hospital during regular hours and those who visited during off hours. RESULTS The outcomes of outpatients who underwent emergency hemostasis during off hours did not differ from patients treated during regular hours. Multivariate analysis revealed that outcomes of hospitalized patients, including mortality, need for blood transfusion and length of hospitalization, were worse than those of outpatients; it also revealed that patient age, malnutrition rate and prevalence of diabetes and neoplasms were higher among hospitalized patients than those in outpatients. CONCLUSIONS The clinical outcomes of patients who underwent emergency endoscopic hemostasis for upper gastrointestinal bleeding during off hours did not differ from those of patients treated during regular hours. Outcomes were worse among hospitalized patients, mainly because of their bad general condition.
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Affiliation(s)
- Satoko Matsuura
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Yasuhisa Sakata
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Nanae Tsuruoka
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Koichi Miyahara
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Saga Medical School, Karatsu Red Cross Hospital, Saga, Japan
| | - Yoichiro Ito
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Kenichiro Nakayama
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Takuya Shimamura
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Takahiro Noda
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | | | - Ryo Shimoda
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Ryuichi Iwakiri
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Kazuma Fujimoto
- Department of Internal Medicine, Saga Medical School, Saga, Japan
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Yamaguchi D, Sakata Y, Yoshida H, Furukawa NE, Tsuruoka N, Higuchi T, Watanabe A, Shimoda R, Tsunada S, Iwakiri R, Fujimoto K. Effectiveness of Endoscopic Hemostasis with Soft Coagulation for Non-Variceal Upper Gastrointestinal Bleeding over a 12-Year Period. Digestion 2018; 95:319-326. [PMID: 28564642 DOI: 10.1159/000477439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/08/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS In this study, investigations were carried out to ascertain whether soft coagulation hemostasis for non-variceal upper gastrointestinal bleeding (UGIB) has ever been performed in a time-dependent manner. METHODS Medical records of 502 patients who had undergone emergency endoscopic hemostasis for non-variceal UGIB from 2003 to 2014 were checked and the modalities were used to achieve hemostasis compared between the first period from 2003 to 2008 (197 patients) and the second period from 2009 to 2014 (305 patients). RESULTS Endoscopic hemostasis was successfully achieved in 96.0% of study patients. Peptic ulcers were the main cause of bleeding (89.4%). Endoscopic hemostasis was performed by soft coagulation significantly more frequently during the second (71.1%) than the first period (11.7%; p < 0.001). Endoscopic hemostasis was mainly achieved by trainees during the second period (76.1%); these trainees comprised a significantly greater proportion of endoscopists than during the first period (56.3%; p < 0.001). Endoscopic-related complications did not differ between the 2 periods. The only risk factor for rebleeding after hemostasis was Helicobacter pylori infection; the use of soft coagulation and the fact that endoscopists were just trainees were not risk factors. CONCLUSION Our findings suggest that using soft coagulation to achieve endoscopic hemostasis for non-variceal UGIB is safe and effective, even when it is performed by trainees.
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Affiliation(s)
- Daisuke Yamaguchi
- Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan
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7
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Fujita M, Manabe N, Murao T, Osawa M, Hirai S, Fukushima S, Shogen Y, Nakato R, Ishii M, Matsumoto H, Hata J, Shiotani A. Differences in the clinical course of 516 Japanese patients with upper gastrointestinal bleeding between weekday and weekend admissions. Scand J Gastroenterol 2017; 52:1365-1370. [PMID: 28925290 DOI: 10.1080/00365521.2017.1377762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Patients suspected of having upper gastrointestinal bleeding (UGIB) admitted during the weekend tend to have a poor outcome in western countries. However, no Japanese studies have been reported on this matter. We aimed to evaluate differences in the clinical course of patients with UGIB between weekday and weekend admissions in Japan. METHODS Medical records of patients who had undergone emergency endoscopy for UGIB were retrospectively reviewed. The severity of UGIB was evaluated using the Glasgow-Blatchford (GB) and AIMS65 score. Patients in whom UGIB was stopped and showed improved iron deficiency anemia after admission were considered as having a good clinical course. RESULTS We reviewed 516 consecutive patients and divided them into two groups: Group A (daytime admission on a weekday: 234 patients) and Group B (nighttime or weekend admission: 282 patients). There was no significant difference in GB and AIM65 scores between the Groups. The proportions of patients with good clinical course were not significantly different between groups (A, 67.5% and B, 67.0%; p = .90). However, patients in Group B underwent hemostatic treatments more frequently compared with those in Group A (58.5% vs 47.4%, p = .012). Multivariate analysis showed that taking acid suppressants, no need for blood transfusions, use of hemostatic treatments, and GB score <12 were associated with a good clinical course. CONCLUSIONS There were no significant differences in the clinical outcomes of patients with UGIB admitted during daytime on weekdays and those admitted at nighttime or weekends partly owing to the sufficient performance of endoscopic hemostatic treatments.
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Affiliation(s)
- Minoru Fujita
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
| | - Noriaki Manabe
- b Department of Clinical Pathology and Laboratory Medicine, Division of Endoscopy and Ultrasonography , Kawasaki Medical School , Kurashiki , Japan
| | - Takahisa Murao
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
| | - Motoyasu Osawa
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
| | - Shinsuke Hirai
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
| | - Shinya Fukushima
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
| | - Yo Shogen
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
| | - Rui Nakato
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
| | - Manabu Ishii
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
| | - Hiroshi Matsumoto
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
| | - Jiro Hata
- b Department of Clinical Pathology and Laboratory Medicine, Division of Endoscopy and Ultrasonography , Kawasaki Medical School , Kurashiki , Japan
| | - Akiko Shiotani
- a Department of Internal Medicine, Division of Gastroenterology , Kawasaki Medical School , Kurashiki , Japan
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Clinical Risk Factors for Gastroduodenal Ulcer in Romanian Low-Dose Aspirin Consumers. Gastroenterol Res Pract 2016; 2016:7230626. [PMID: 27579036 PMCID: PMC4992789 DOI: 10.1155/2016/7230626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/01/2016] [Accepted: 07/11/2016] [Indexed: 12/14/2022] Open
Abstract
Background. Aspirin use for cardiovascular or cancer prevention is limited due to its gastrointestinal side effects. Objective. Our prospective, observational case-control study aims to identify the predictive factors for ulcers in low-dose aspirin consumers (75-325 mg/day). Methods. The study included patients who underwent an upper digestive endoscopy and took low-dose aspirin treatment. Results. We recruited 51 patients with ulcer (ulcer group) and 108 patients with no mucosal lesions (control group). In univariate analysis, factors significantly associated with ulcers were male gender (p = 0.001), anticoagulants (p = 0.029), nonsteroidal anti-inflammatory drugs (p = 0.013), heart failure (p = 0.007), liver (p = 0.011) or cerebrovascular disease (p = 0.004), diabetes mellitus (p = 0.043), ulcer history (p = 0.044), and alcohol consumption (p = 0.018), but not Helicobacter pylori infection (p = 0.2). According to our multivariate regression analysis results, history of peptic ulcer (OR 3.07, 95% CI 1.06-8.86), cotreatment with NSAIDs (OR 8, 95% CI 2.09-30.58) or anticoagulants (OR 4.85, 95% CI 1.33-17.68), male gender (OR 5.2, 95% CI 1.77-15.34), and stroke (OR 7.27, 95% CI 1.40-37.74) remained predictors for ulcer on endoscopy. Conclusions. Concomitant use of NSAIDs or anticoagulants, comorbidities (cerebrovascular disease), and male gender are the most important independent risk factors for ulcer on endoscopy in low-dose aspirin consumers, in a population with a high prevalence of H. pylori infection.
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Fujii S, Hara M, Nonaka S, Ishikawa S, Aoki Y, Anzai K, Morita S, Fujimoto K, Mawatari M. Infectious disease during hospitalization is the major causative factor for prolonged hospitalization: multivariate analysis of diagnosis procedure combination (DPC) data of 20,876 cases in Japan. J Clin Biochem Nutr 2016; 59:49-52. [PMID: 27499579 PMCID: PMC4933693 DOI: 10.3164/jcbn.16-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/16/2016] [Indexed: 12/17/2022] Open
Abstract
This study aimed to evaluate causative factors for prolonged hospitalization based on hospitalization status, type of hospital ward, and comorbidities, specifically diabetes mellitus and infectious diseases, in 20,876 patients hospitalized in Saga University Hospital from April 1, 2012, to February 28, 2015. Prolonged hospitalization was defined as hospital days exceeding period 3 in the diagnosis procedure combination system. Among all factors, causative (risk) factors for prolonged hospitalization were evaluated by multiple logistic regression analysis. Multivariate analysis indicated causative factors for prolonged hospitalization were aging, comorbid diabetes mellitus, time spent in the intensive care unit, and infectious diseases contracted during hospitalization. The risk factors for contracting infectious diseases during hospitalization were aging, male sex, comorbid diabetes mellitus, and increased number of days spent in period 3 in the diagnosis procedure combination code. These data indicated that critical factors for discharge from hospital within an appropriate time frame were prevention of infectious diseases during hospitalization, and a fast and effective therapeutic approach to patients in the intensive care unit.
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Affiliation(s)
- Susumu Fujii
- Saga University Hospital, 5-1-1 Nabeshima Saga, Saga 849-8501, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Sayuri Nonaka
- Saga University Hospital, 5-1-1 Nabeshima Saga, Saga 849-8501, Japan
| | | | - Yosuke Aoki
- Saga University Hospital, 5-1-1 Nabeshima Saga, Saga 849-8501, Japan
| | - Keizo Anzai
- Saga University Hospital, 5-1-1 Nabeshima Saga, Saga 849-8501, Japan
| | - Shigeki Morita
- Saga University Hospital, 5-1-1 Nabeshima Saga, Saga 849-8501, Japan
| | - Kazuma Fujimoto
- Saga University Hospital, 5-1-1 Nabeshima Saga, Saga 849-8501, Japan
| | - Masaaki Mawatari
- Saga University Hospital, 5-1-1 Nabeshima Saga, Saga 849-8501, Japan
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Iwatsuka K, Gotoda T, Kono S, Suzuki S, Yagi Kuwata N, Kusano C, Sugimoto K, Itoi T, Moriyasu F. Clinical Backgrounds and Outcomes of Elderly Japanese Patients with Gastrointestinal Bleeding. Intern Med 2016; 55:325-32. [PMID: 26875955 DOI: 10.2169/internalmedicine.55.5396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Elderly gastrointestinal bleeding (GIB) patients sometimes cannot be discharged home. In some cases, they die after hemostasis, even following appropriate treatment. This study investigates the clinical backgrounds and outcomes of elderly Japanese GIB patients. METHODS The medical records of 185 patients (123 men, 62 women; mean age 68.2 years; range 10-99 years) with GIB symptoms who underwent esophagogastroduodenoscopy or colonoscopy to detect or treat the source of GIB were retrospectively reviewed. We compared the outcomes between patients ≤70 (n=85) and >70 (n=100) years. The clinical backgrounds of the patients who died or changed hospitals to undergo rehabilitation or receive palliative care were evaluated, as were the association of four factors with these poor outcomes: GIB (re-bleeding or uncontrolled bleeding), endoscopic procedure-related complications, exacerbation of the pre-existing comorbidity, and any complications that were not directly related to GIB. RESULTS Of the patients ≤70 and >70 years of age, three (3.5%) and 17 (17.0%), respectively, were transferred to another hospital (p=0.003). One (1.2%) and five (5.0%), respectively, died (p=0.144). All three patients ≤70 years old that changed hospitals did so because their comorbidities became worse. The reasons for changing hospitals in the 17 patients >70 years of age included exacerbation of a pre-existing comorbidity (41.1%, 7/17), other complications (35.4%, 6/17), GIB itself (17.6%, 3/17), and endoscopic procedure-related complications (5.9%, 1/17). CONCLUSION Although non-elderly and elderly GIB patients had similar mortality rates, many more elderly patients could not be discharged home for various reasons.
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Affiliation(s)
- Kunio Iwatsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
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