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Zhang Y, Liu H, Liu X. Salvage treatment for severe upper gastrointestinal bleeding caused by Mallory-Weiss syndrome and myocardial depression after acute myocardial infarction. Heliyon 2022; 8:e11638. [DOI: 10.1016/j.heliyon.2022.e11638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/28/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
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Phan T, Peterson A, Le S. Digital Health Interventions for Colorectal Polyp Detection: Are We Ready for Prime Time? Clin Gastroenterol Hepatol 2022; 20:2413-2414. [PMID: 33524591 DOI: 10.1016/j.cgh.2021.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Timothy Phan
- Department of Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia
| | - Adam Peterson
- Department of Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia
| | - Suong Le
- Department of Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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Su X, Wei Y, Pang S, Zhang Z, Zhang Y, Zheng P, Li H, Sang H, Dong J. Clinical Characteristics and Risk Factors of In-Hospital Mortality in Patients With Acute Myocardial Infarction With Subsequent Gastrointestinal Bleeding: A Single-Center Experience. Front Cardiovasc Med 2022; 9:942467. [PMID: 35911533 PMCID: PMC9326005 DOI: 10.3389/fcvm.2022.942467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/06/2022] [Indexed: 12/16/2022] Open
Abstract
Objective Gastrointestinal bleeding (GIB) post acute myocardial infarction (AMI) is a severe clinical condition with a poor prognosis. The purpose of the study was to evaluate the rate of in-hospital mortality in patients with GIB post-AMI and to identify the potential risk factors of this situation. Methods In this single-center retrospective study, a total of 154 patients diagnosed with AMI who subsequently suffered GIB were enrolled from October 2013 to December 2021. Demographic, laboratory, and clinical data were collected. The in-hospital mortality was the outcome of interest. Logistic regression analysis was used to investigate the potential risk factors of in-hospital mortality. Results Among the 154 subjects included in the final analysis, the mean age was 65.58 ± 11.20 years, and 104 (67.53%) were males. GIB occurred in 11 patients after thrombolytic therapy, 50 patients after percutaneous coronary intervention (PCI), and 93 patients during drug conservative treatment. A total of 41 patients died in the hospital. The in-hospital mortality rate of the thrombolysis group, PCI group, and drug conservative treatment group was 27.27% (3/11), 28.00% (14/50), and 25.81% (24/93), respectively. There was no difference in the in-hospital mortality among the three groups. The multivariate logistic regression analysis showed that the peak levels of TnI (OR 1.07, 95% CI 1.02–1.12, P = 0.011), condition of cardiogenic shock after admission (OR 14.52, 95% CI 3.36–62.62, P < 0.001), and the use of the mechanical ventilator (OR 8.14, 95% CI 2.03–32.59, P = 0.003) were significantly associated with in-hospital mortality. Conclusion Regardless of the treatment strategy for AMI, once GIB occurred, the prognosis was poor. High in-hospital mortality in patients with GIB post-AMI was independently associated with the peak levels of TnI, condition of cardiogenic shock, and the use of a mechanical ventilator.
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Affiliation(s)
- Xin Su
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuzhen Wei
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuo Pang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zeqing Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yunxiao Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peipei Zheng
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haiyu Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haiqiang Sang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzeng Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Jiang GJ, Gao RK, Wang M, Xie TX, Zhan LY, Wei J, Sun SN, Ji PY, Tan DY, Lyu JJ. A Nomogram Model for Predicting Type-2 Myocardial Infarction Induced by Acute Upper Gastrointestinal Bleeding. Curr Med Sci 2022; 42:317-326. [PMID: 35290603 DOI: 10.1007/s11596-022-2543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the independent risk factors of type-2 myocardial infarction (T2MI) elicited by acute upper gastrointestinal bleeding (AUGIB), and to establish a nomogram model for the prediction of AUGIB-induced T2MI. METHODS A nomogram model was established on the basis of a retrospective study that involved 533 patients who suffered from AUGIB in the Department of Critical Care Medicine (CCM) or Emergency Intensive Care Unit (EICU) of Renmin Hospital of Wuhan University, Wuhan, China, from January 2017 to December 2020. The predictive accuracy and discriminative power of the nomogram were initially evaluated by internal validation, which involved drawing the receiver operating characteristic (ROC) curve, calculating the area under the curve (AUC), plotting the calibration curve derived from 1000 resampled bootstrap data sets, and computing the root mean square error (RMSE). The predictive ability of the nomogram was further validated through the prospective and multicenter study conducted by the investigators, which enrolled 240 AUGIB patients [including 88 cases from Renmin Hospital of Wuhan University, 73 cases from Qilu Hospital of Shandong University (Qingdao), and 79 cases from Northern Jiangsu People's Hospital)], who were admitted to the Department of CCM or EICU, from February 2021 to July 2021. RESULTS Among the 533 patients in the training cohort, 78 (14.6%) patients were assigned to the T2MI group and 455 (85.4%) patients were assigned to the non-T2MI group. The multivariate analysis revealed that age >65, hemorrhagic shock, cerebral stroke, heart failure, chronic kidney disease, increased blood urea nitrogen, decreased hematocrit, and elevated D-Dimer were independent risk factors for AUGIB-induced T2MI. All these factors were incorporated into the nomogram model. The AUC for the nomogram for predicting T2MI was 0.829 (95% CI, 0.783-0.875) in the internal validation cohort and 0.848 (95% CI, 0.794-0.902) in the external validation cohort. The calibration curve for the risk of T2MI exhibited good consistency between the prediction by the nomogram and the actual clinical observation in both the internal validation (RMSE=0.016) and external validation (RMSE=0.020). CONCLUSION The nomogram was proven to be a useful tool for the risk stratification of T2MI in AUGIB patients, and is helpful for the early identification of AUGIB patients who are prone to T2MI for early intervention, especially in emergency departments and intensive care units.
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Affiliation(s)
- Gui-Jun Jiang
- Emergency Department, Renmin Hospital of Wuhan University, Wuhan, 430060, China.,Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Ru-Kai Gao
- Wuhan Britain-China School, Wuhan, 430022, China
| | - Min Wang
- Medical College of Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Tu-Xiu Xie
- Department of General Practice, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Li-Ying Zhan
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jie Wei
- Emergency Department, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Sheng-Nan Sun
- Emergency Department, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266000, China
| | - Pei-Yu Ji
- Emergency Department, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Ding-Yu Tan
- Emergency Department, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jing-Jun Lyu
- Emergency Department, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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龙 艺, 肖 雪, 严 海, 杨 锦. [Mortality Risk Factors for Inpatients with Ischemic Heart Disease Complicated with Gastrointestinal Bleeding]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2021; 52:1034-1040. [PMID: 34841774 PMCID: PMC10408827 DOI: 10.12182/20211160108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the risk factors of in-hospital mortality in patients with combined ischemic heart disease (IHD) and gastrointestinal bleeding (GIB). METHODS Patients who were hospitalized and received treatment for IHD combined with GIB at West China Hospital, Sichuan University between Jan. 2015 and Jan. 2018 were included in the study. Information concerning their baseline data, comorbidities, history of anticoagulant and antiplatelet medication, laboratory data on admission, and in-hospital treatments was collected. In-hospital death of all causes was taken as the primary endpoint event of the study, and multivariate logistic regression analysis was conducted to identify the independent risk factors of mortality during their hospital stay for this specific type of patients. Then, receiver operating characteristic ( ROC) curve was drawn and the area under curve ( AUC) was calculated accordingly. RESULTS A total of 395 patients met the enrollment criteria and were included in the study. Among them, 342 patients were discharged after their condition improved, and 53 patients died during hospitalization. Analysis of the cause of death revealed that cardiogenic death was the leading cause of death (54.7%), which was followed by infection-caused death (24.5%). Logistic regression analysis revealed that patients with ST-segment elevation myocardial infarction (STEMI) had a 2.527-fold risk of mortality compared with patients with non-acute coronary syndrome (odds ratio [ OR]=2.527, 95% confidence interval [ CI]: 1.152-8.277, P=0.043), and patients with comorbidity of chronic renal disease (CKD) had a 2.89-fold risk of mortality ( OR=2.89, 95% CI:1.187-7.037, P=0.019). It was also shown the higher level of WBC count ( OR=1.123, 95% CI: 1.057-1.193, P<0.001) and lower hemoglobin ( OR=1.014, 95% CI: 1.003-1.025, P=0.013) on admission were related to in-hospital mortality. On the other hand, endoscopy ( OR=0.305, 95% CI: 0.103-0.881, P=0.029) was identified as a protective factor in hospital treatment that decreased the risk of in-hospital mortality. ROC curve was drawn by combining the aforementioned variables to predict in-hospital mortality, which had an AUC of 0.79. CONCLUSION The actual type of IHD being STEMI, the patient's condition being complicated with chronic kidney disease, and having high white blood cells and low hemoglobin levels upon admission were considered independent risk factors for in-hospital death outcome of IHD patients complicated with GIB, while undergoing endoscopy during hospitalization was considered as a protective factor.
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Affiliation(s)
- 艺 龙
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 雪 肖
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 海琳 严
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 锦林 杨
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
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Alruzug IM, Aldarsouny TA, Semaan T, Aldaher MK, AlMustafa A, Azzam N, Aljebreen A, Almadi MA. Time trends of causes of upper gastrointestinal bleeding and endoscopic findings. Saudi J Gastroenterol 2020; 27:28-34. [PMID: 33078720 PMCID: PMC8083243 DOI: 10.4103/sjg.sjg_378_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a frequent cause for emergency endoscopy and, in a proportion, requires the application of endotherapy. We aim to evaluate the proportion of variceal and nonvariceal upper gastrointestinal bleeding (NVUGIB), the endoscopic findings that were detected, as well as the temporal trends of endoscopic findings over a period of 13 years. METHODS This is a retrospective study of patients who underwent an esophagogastroduodenoscopy with an indication of UGIB or presented with hematemesis, melena, or both, as well as those who had hematochezia, from January 2004 to December 2016 (13 years). RESULTS A total of 2075 patients were included with a mean age of 56.8 years (range 18-113) and males constituted 67.9%, while 65.9% had at least one comorbidity. Symptoms on presentation included hematemesis (52.5%), melena (31.2%), both hematemesis & melena (15.1%), and hematochezia (1.2%). The majority of UGIB were from a NVUGIB source (80.5%) and a variceal source was found in 13.1%, while no endoscopic findings were found in 6.4% of cases. The most common endoscopic diagnosis was gastroduodenal erosions (23.8%), duodenal ulcers (23.5%), reflux esophagitis (16.0%), esophageal varices (12.1%), and gastric ulcers (10.8%). There was no change in the endoscopic findings over the time period of the study. A third of duodenal ulcers (33.3%) as well as 21.9% of gastric ulcers were actively bleeding at the time of endoscopy, while 3.3% of duodenal ulcers had an adherent clot. CONCLUSIONS NVUGIB composed the majority of cases presenting with UGIB and variceal bleeding was lower than that described in prior studies, but there were no clear trends in the proportion of causes of UGIB during the study duration.
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Affiliation(s)
| | | | - Toufic Semaan
- Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Manhal K. Aldaher
- Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adnan AlMustafa
- Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nahla Azzam
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Aljebreen
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Majid A. Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada,Address for correspondence: Prof. Majid A. Almadi, Professor of Medicine and Consultant, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh 11451, Saudi Arabia. E-mail:
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Almadi MA, Almutairdi A, Alruzug IM, Aldarsouny TA, Semaan T, Aldaher MK, AlMustafa A, Azzam N, Batwa F, Albawardy B, Aljebreen A. Upper gastrointestinal bleeding: Causes and patient outcomes. Saudi J Gastroenterol 2020; 27:20-27. [PMID: 33047678 PMCID: PMC8083248 DOI: 10.4103/sjg.sjg_297_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) remains a healthcare burden and is associated with considerable morbidity and mortality. We aim to describe the presentation, clinical, and laboratory characteristics of patients presenting with UGIB as well as important patient outcomes. METHODS This is a retrospective study performed at a tertiary care university hospital in Riyadh. Electronic endoscopic reports of patients undergoing gastroscopies for the indication of UGIB from January 2006 to January 2015 were included. Demographic data, past medical conditions, medications used, symptoms on presentation, as well as the patients' hemodynamic status, laboratory investigations on presentations, the need for blood products, the need for admission to an intensive care unit, rebleeding, and in-hospital mortality rates were retrieved from medical records. RESULTS Two hundred fifty-nine patients were included with a mean age of 57.1 years and males constituted 66.8% of the study cohort. At least one comorbidity was present in 88.2%, while 20.7% had a history of prior UGIB, 12.6% had a history of peptic ulcer disease, and 9.2% had known esophageal varices. A nonvariceal source represented 80.1% of the causes (95% CI: 75.4 to 85.3%), 15.5% required admission to the intensive care unit (ICU), the rebleeding rate was 8.9% (95% CI; 5.7% to 12.2%) while the in-hospital mortality was 4.4% (95% CI; 2.4% to 6.9%). The mean pre-endoscopic Rockall score was 2.6 (range: 0 to 5), while the total Rockall score was 4.4 (range: 1 to 9). There was no association between the pre-endoscopic Rockall score and rebleeding (3.0 vs. 2.5, P = 0.27) or need for ICU admission (3.2 vs. 2.4, P = 0.08), the total Rockall score and rebleeding (5.0 vs. 4.4, P = 0.58) or need for ICU admission (5.0 vs. 4.3, P = 0.36). CONCLUSION Causes of UGIB in this patient population were predominantly nonvariceal and the rebleeding and mortality rates resembled those of other studies.
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Affiliation(s)
- Majid A. Almadi
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Jeddah, Saudi Arabia,Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada
| | - Abdulelah Almutairdi
- Gastroenterology Section, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim M. Alruzug
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Thamer A. Aldarsouny
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Toufic Semaan
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Manhal K. Aldaher
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adnan AlMustafa
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nahla Azzam
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Jeddah, Saudi Arabia
| | - Faisal Batwa
- Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Badr Albawardy
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, USA
| | - Abdulrahman Aljebreen
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Jeddah, Saudi Arabia,Address for correspondence: Prof. Abdulrahman Aljebreen, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. E-mail:
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Gastrointestinal bleeding in patients admitted to cardiology: risk factors and a new risk score. Hellenic J Cardiol 2020; 62:291-296. [PMID: 32687882 DOI: 10.1016/j.hjc.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Although the early use of a risk stratification score in gastrointestinal bleeding (GIB) is recommended, so far there has been no risk score for GIB in patients admitted to the cardiology department. To describe the risk factors of GIB and develop a new risk score model in patients admitted to the cardiology department. METHODS A total of 633 inpatients with GIB from January 2014 to December 2018 were recruited, 4,231 inpatients with non-GIB were recruited as the control group. Multivariate logistic regression was used to describe the risk factors of GIB. A new risk score model was developed in the derivation cohort. Accuracy to predict GIB was assessed by the area under the receiver operating characteristic (AUROC) curve in the validation cohort. RESULTS Male, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin, and alanine aminotransferase (ALT) were associated with GIB. The model had a high predictive accuracy (AUROC 0.816 and 95% CI, 0.792-0.839), which was supported by the validation cohort (AUROC 0.841 and 95% CI, 0.807~0.874). Besides, the prediction of the model was better than HAS-BLED score (AUROC 0.557; 95% CI, 0.513~0.602) and CRUSADE score (AUROC 0.791; 95%CI, 0.757~0.825), respectively. Among the inpatients with a score of 0-3, 4-7, and ≥8 points, the incidence of GIB, the proportion of inpatients requiring suspended red blood cells transfusion, length of stay, and in-hospital mortality all increased gradually (P< 0.001). CONCLUSIONS Male, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin, and ALT are associated with GIB. The new risk score model is an accurate risk score that predicts GIB in patients admitted to the cardiology department.
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Du BB, Wang XT, Li XD, Li PP, Chen WW, Li SM, Yang P. Treatment of severe upper gastrointestinal bleeding caused by Mallory-Weiss syndrome after primary coronary intervention for acute inferior wall myocardial infarction: A case report. World J Clin Cases 2019; 7:4407-4413. [PMID: 31911925 PMCID: PMC6940352 DOI: 10.12998/wjcc.v7.i24.4407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/03/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) after an acute myocardial infarction (AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome (MWS) is usually a dire situation with massive bleeding and hemodynamic instability. Acute UGIB caused by MWS after an AMI has not been previously reported.
CASE SUMMARY A 57-year-old man with acute inferior wall ST elevation myocardial infarction underwent a primary coronary intervention of the acutely occluded right coronary artery. Six hours after the intervention, the patient had a severe UGIB, followed by vomiting. His hemoglobin level dropped from 15.3 g/dL to 9.7 g/dL. In addition to blood transfusion and a gastric acid inhibition treatment, early endoscopy was employed and MWS was diagnosed. Bleeding was stopped by endoscopic placement of titanium clips.
CONCLUSION Bleeding complications after stent implantation can pose a dilemma. MWS is a rare but severe cause of acute UGIB after an AMI that requires an early endoscopic diagnosis and a hemoclip intervention to stop bleeding.
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Affiliation(s)
- Bei-Bei Du
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Xing-Tong Wang
- Department of Hematology and Oncology, Cancer Center, The First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Xiang-Dong Li
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Pei-Pei Li
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Wei-Wei Chen
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Si-Ming Li
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Ping Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
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Albeiruti R, Chaudhary F, Alqahtani F, Kupec J, Balla S, Alkhouli M. Incidence, Predictors, and Outcomes of Gastrointestinal Bleeding in Patients Admitted With ST-Elevation Myocardial Infarction. Am J Cardiol 2019; 124:343-348. [PMID: 31182211 DOI: 10.1016/j.amjcard.2019.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
Gastrointestinal bleeding (GIB) complicating ST-elevation myocardial infarction (STEMI) poses significant management challenges and may be associated with poor outcomes. We sought to evaluate the incidence and outcomes of GIB in STEMI patients using a nationwide database. We identified adults admitted with STEMI between in the National Inpatient Sample (2003 to 2016), and compared the morbidity, mortality, resource utilization, and cost in patients with and without GIB. We assessed rates of endoscopy referral and its associated with mortality. Among 1,450,696 weighted STEMI hospitalizations, 32,624 (2.2%) were complicated with GIB. Patients with GIB were older, and had distinctive characteristics compared to those without GIB. Older age, cardiogenic shock; history of peptic ulcer disease, cirrhosis, anemia, or alcohol use disorder were the strongest predictors of GIB during STEMI hospitalizations. In-hospital mortality was higher in the GIB group (28.2% vs 11.1%, p <0.001). The excess mortality associated with GIB persisted after propensity-score matching, and in sensitivity analyses excluding patients who underwent coronary intervention >24-hours after admission, and those transferred to another hospital. Post-STEMI GIB was associated with more strokes and acute kidney injury, longer hospitalizations, and higher cost. In a logistic regression analysis, GIB was independently associated with mortality (odds ratios [OR] 1.91, 95% confidence interval [CI] 1.85 to 1.97, p <0.001). There was a correlation between undergoing endoscopy and lower in-hospital mortality (unadjusted OR 0.27; 95% CI, 0.24 to 0.29; adjusted-OR 0.30; 95% CI, 0.27 to 0.33; p <0.001). In conclusion, GIB complicating STEMI is uncommon but is associated with excess morbidity, mortality, resource utilization and cost. Referral to endoscopy in this cohort may be associated with reduced in-hospital mortality.
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Manuel V, Steffen SP, Gaiotto FA, Puig LB. Acute myocardial infarction in a patient with active actinic rectitis bleeding: Between the sword and the wall. J Card Surg 2019; 34:638-640. [PMID: 31212360 DOI: 10.1111/jocs.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022]
Abstract
A The coronary artery bypass graft (CABG) is common. Sometimes can be challenging. Here we present a 79-year-old man presented with unstable angina and simultaneous activelower gastrointestinal bleeding (hemoglobin level, 5.1 g/L) due to actinic rectitis after radiation therapy for prostate carcinoma performed 1 year previously. Coronary angiography showed marked stenosis of the left anterior descending artery. Antiplatelet aggregation therapy, such as percutaneous coronary intervention or systemic heparin therapy for coronary artery bypass, was not feasible owing to the active rectal bleeding. Therefore, off-pump CABG has performed without systemic heparin therapy and the patient recovered well. For specific cases, CABG without systemic heparin therapy can be safely performed.
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Affiliation(s)
- Valdano Manuel
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Pinheiros, São Paulo, Brazil
| | - Samuel P Steffen
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Pinheiros, São Paulo, Brazil.,Hospital SEPACO, Pinheiros, São Paulo, Brazil
| | - Fábio A Gaiotto
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Pinheiros, São Paulo, Brazil
| | - Luiz B Puig
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Pinheiros, São Paulo, Brazil.,Hospital SEPACO, Pinheiros, São Paulo, Brazil
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Martel M, Ménard C, Restellini S, Kherad O, Almadi M, Bouchard M, Barkun AN. Which Patient-Related Factors Determine Optimal Bowel Preparation? ACTA ACUST UNITED AC 2018; 16:406-416. [PMID: 30390208 DOI: 10.1007/s11938-018-0208-9] [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: 02/07/2023]
Abstract
PURPOSE OF REVIEW Adequate bowel cleansing before colonoscopy is a simple concept but the high rate of inadequate or incomplete bowel cleanliness and its consequences have been the subject of many studies, guidelines, and meta-analysis. The complexity resides in all the factors surrounding preparation intake such as type and regimen of bowel preparation, diets, compliance, and also patient-related factors that all influence quality of the bowel preparation. The purpose of this review is to focus specifically on patient-related factors and their challenges. Patients with lower GI bleeding are excluded from this review. RECENT FINDINGS Patient factors that may be associated with a poor bowel preparation were searched for in the literature. With regard to patient's characteristics, higher age, male gender, and socio-economic status (lower income, Medicaid, and lower education) were all associated with higher rates of inadequate bowel preparation. Comorbidities such as inflammatory bowel disease (IBD), in-patients, body mass index (BMI), cirrhosis, constipation, and neurological condition as well as some pharmacotherapy were also associated with inadequate bowel preparation. Studies identifying predictive patient factors as well as those studying these patients in particular showed variability in the strength of the patient factor associations. Patients taking tricyclic antidepressant, narcotics, and those with neurological conditions were identified to have a stronger association with worse bowel cleanliness. Those can be implemented with the current recommendations of split-dosing. Identifying individual factors that can impact the quality of bowel cleanliness can be challenging. Some have been well-studied in the literature such as age, in-patient status, or constipation and others such as male gender or higher BMI have required more studies to clearly conclude on any possible association. In many studies, simple recommendations like walking 30 min during the preparation, and additional instructions or support have also been added to instructions to improve motility and compliance.
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Affiliation(s)
- Myriam Martel
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
| | | | - Sophie Restellini
- Department of Specialties of Internal Medicine, Division of Gastroenterology, Geneva University Hospital, Geneva, Switzerland
| | - Omar Kherad
- Internal Medicine, La Tour Hospital, University of Geneva, Geneva, Switzerland
| | - Majid Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Maïté Bouchard
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada.
- Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, McGill University, 1650 Cedar Avenue, D7.346, Montréal, Québec, H3G1A4, Canada.
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