Causes and clinical outcome of acute upper gastrointestinal bleeding: a prospective analysis of 1534 cases

Despite considerable improvement in the diagnostic and therapeutic approach to patients with acute upper gastrointestinal (GI) bleeding, several studies suggest there has been no overall change in mortality. The aim of this study was to evaluate prospectively the effect of early emergency diagnostic and therapeutic endoscopy and medico-surgical collaboration in the clinical outcome of 1534 patients with acute upper GI bleeding treated in our hospital over the past five years. Emergency endoscopy and injection haemostasis were performed within 24 hours of admission, or immediately after resuscitation, in patients with massive bleeding; patients were then treated with close co-operation between surgeons and gastroenterologists. We observed an increase in the incidence of peptic ulcer (67%) with a simultaneous decrease in the incidence of gastroduodenitis (13.5%) as a cause of bleeding compared with the previous decade. In peptic ulcer bleeding, emergency surgical haemostasis was required in 92 patients (8.9%), while none of the patients with erosive gastroduodenitis required surgical intervention. Overall mortality was 2.9%, and in peptic ulcer bleeding patients 2.1% with a postsurgical mortality of 8.7%. Peptic ulcer remains the main cause of upper GI bleeding. Improved clinical outcome and low mortality can be achieved with early diagnostic and therapeutic endoscopy and medico-surgical collaboration.

Does haemostatic therapy improve the prognosis in upper gastrointestinal bleeding?

A study was conducted of 816 patients with peptic ulcer haemorrhage, comparing outcome before and after the introduction of endoscopic therapy. The control group comprised 505 patients admitted with bleeding due to benign peptic ulcer over a 5-year period before endoscopic therapy, and 311 patients after introduction of endoscopic therapy were studied prospectively. The two groups were well matched for age, sex, shock, endoscopic findings and use of ulcerogenic drugs. The introduction of endoscopic therapy was associated with a reduction in surgical intervention and mortality rates for gastric and duodenal ulcer. The beneficial effects of endoscopic therapy appear to be due to a reduction in the need for surgical intervention in patients with an ulcer base visible vessel. The authors suggest that endoscopic injection therapy may result in an improved outcome from peptic ulcer haemorrhage. Adrenaline injection treatment seems to be the treatment of choice in view of its simplicity, low cost and availability.

Production of interleukin-1b and tumor necrosis factor--a by peripheral blood human mononuclear cells in active and inactive stages of ulcerative colitis

The production of Interleukin-1b (IL-1b) and Tumor necrosis factor a (TNF-a) by peripheral blood human mononuclear cells has been measured by an enzyme linked immunosorbent assay in 49 patients with ulcerative colitis (UC), 16 patients with first onset of the disease, 15 with untreated active disease, 18 patients with active UC under treatment and 14 healthy control subjects. IL-1b and TNF-a values were significantly higher (p < 0.001) in all groups of patients with active disease comparing to values after the achievement of remission or healthy controls. This increase was more profound in patients with pancolitis, in all groups with UC in active stage, when a comparison was made with rectosigmoiditis patients (p < 0.05). These results point towards a correlation between IL-1b and TNF-a production in UC patients and activity and extent of the disease.

Six-month maintenance treatment of duodenal ulcer with sucralfate: influence on antral gastritis and Helicobacter pylori antral colonization--a prospective uncontrolled study

Fifty-four patients (41 men, 13 women), aged 17 to 78 years (mean +/- SD, 48.13 +/- 13.5 years), with endoscopically confirmed healing of their duodenal ulcer after treatment with sucralfate (2 gm BID for 4 to 8 weeks) were recruited for this study. They were started on a 6-month maintenance treatment with sucralfate 1 gm BID. Endoscopy was done at the end of the 6-month period or whenever there was any evidence of ulcer relapse. Helicobacter pylori antral colonization (CLO test) and antral gastritis were estimated from biopsy samples taken before, and at the end of, the healing treatment, as well as at the end of the maintenance treatment. Cumulative relapse rate after 6 months was 15% (8 of 54). No patient discontinued treatment because of side effects. No influence of sucralfate on H pylori antral colonization or antral gastritis was observed after the healing or maintenance treatment. It is concluded that sucralfate 1 gm BID for 6 months is an effective maintenance treatment for duodenal ulcer, but has no beneficial effect on either H pylori antral colonization or antral gastritis.