The incidence of gastrointestinal bleeding is a significant concern among adult patients with gastrointestinal tract (GIT) disorders, as it is a leading cause of mortality. However, there is growing ...evidence of changes in the pattern of gastrointestinal pathologies among children, primarily attributed to an increasing number of cases related to peptic ulcer disease (PUD) and erosive processes of the GIT. Purpose - to investigate the prevalence and analyze changes in the structure of GIT diseases in children complicated by upper gastrointestinal bleeding (GIB), based on esophagogastroduodenoscopy (EGD) data. Materials and methods. Based on the clinic’s records, a total of 4,457 children underwent EGD at the Regional Medical Center of Family Health in Dnipro. Among them, 1,393 (31.25%) patients were admitted to the surgical department with suspected GIB. In 201 (14.4%) cases, EGD was performed during active bleeding to determine its origin. The utilization of EGD during the acute phase in patients with suspected GIB is considered highly effective for both diagnosing the bleeding source and initiating early-stage treatment. The data were processed using the methods of variation statistics using the Statistica v 6.1 software package. To compare the relative indicators, the Pearson Hi-quadrat test (χ2) and the two-sided Fisher’s exact test (TCF) were used. The critical level of statistical significance (p) was accepted as <0.05. Results. To conduct a comparative analysis of diagnosed cases of GIB, two groups of children with endoscopically confirmed GIB were formed: the Group I (n=125) representing the period of 2012-2013, and the Group II (n=201) - the period of 2020-2021. The results revealed an increase of 1.6 times in the number of patients with upper GIT diseases accompanied by bleeding in the Group II. Additionally, a significant rise in the frequency of GIT diseases, specifically erosive esophagitis, was observed. The number of patients with erosive esophagitis tripled in the Group II compared to the Group I. Conclusions. In recent years, there has been a notable rise in GIT diseases accompanied by upper GIB. The number of such cases increased by 1.6 times, from 125 to 201 patients. Notably, there is a pronounced increase in the incidence of erosive esophagitis, particularly among children in the early and younger age groups. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
Unified decentralized models have led to many significant advances, including XML and Boolean logic. After years of unproven research into DHTs, we show the simulation of DHCP. Gib, our new heuristic ...for context-free grammar, is the solution to all of these challenges.
Introduction: Gastrointestinal bleeding (GIB) is one of the most important diseases in internal medicine, which can occur due to bleeding in any of the gastrointestinal organs. The best diagnostic ...method for identifying the source of bleeding in patients is endoscopy and colonoscopy. Therefore, this study was conducted to determine the causes and the most common risk factors for GIB in patients referring to Shahid Mustafa Khomeini Hospital in Ilam. Material & Methods: In this retrospective analytical study, all patients with clear gastrointestinal bleeding symptoms, including melena, hematemesis, hematochezia, and passing clots, who referred to Shahid Mustafa Khomeini Hospital in Ilam from 2014 to 2019, were evaluated. The demographic information of the patients, their medical history, and the description of the medications they were taking, which were recorded in their medical records, were entered into the questionnaire form. Data analysis was performed using descriptive and inferential statistical methods. Findings: In this study, 650 patients with an average age of 57.24 years, ranging from 19 to 99 years, were included. The majority of patients were in the older age group (above 60 years) and were male. The most common complaint among patients was hematemesis (41.4%), while anemia was the least common complaint (1.8%). The most common causes of gastrointestinal bleeding in both genders were peptic ulcer, gastric mass, and esophageal varices. There was a significant correlation between age and gastrointestinal bleeding symptoms (p < 0.05). Gastrointestinal bleeding symptoms, including hematemesis, melena, and rectorrhagia, were more common in men and in smokers. Alcohol consumption also had an impact on the occurrence of gastrointestinal bleeding with hematemesis, melena, and rectorrhagia. Discussion & Conclusion: Endoscopy and colonoscopy are the best diagnostic methods for patients with gastrointestinal bleeding. Therefore, this study was conducted to determine the causes and the most common risk factors for GIB in patients referring to Shahid Mustafa Khomeini Hospital in Ilam from 2014 to 2019. The findings of this study can help improve the diagnosis and management of gastrointestinal bleeding in these patients.
Background Patients with left ventricular assist devices (LVADs) are at increased risk of GI bleeding (GIB), primarily from GI angiodysplastic lesions (GIAD). Objective To perform meta-analysis of ...the medical literature in order to determine prevalence and risk factors for GIB. Design A literature search was performed to identify studies reporting GIB in LVAD patients. We extracted rates of prevalence, rebleeding, and overall mortality from each study. Pooled event rates and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Setting Meta-analysis of 17 case-control and cohort studies. Patients A total of 1839 LVAD patients of whom 1697 (92%) had continuous-flow LVADs. Results The pooled prevalence of GIB in LVAD patients was 23% (95% CI, 20.5%-27%). Subgroup analysis demonstrated that older age (standard difference in means (SDm), 0.69; 95% CI, 0.23-1.15), and elevated creatinine (SDm, 0.65; 95% CI, 0.12-1.18, P = .02) were associated with GIB. Risk factors not associated with GIB included LVAD as destination therapy (OR 1.85; 95% CI, 0.8-4.3), prior history of GIB (OR 2.22; 95% CI, 0.83-5.96), hypertension (OR 1.6; 95% CI, 0.87-2.97), and/or the presence of a continuous-flow LVAD (OR 4.5; 95% CI, 2.1-9.5). Recurrence of GIB occurred in 9.3% (95% CI, 7%-12%), with a GIB mortality rate of 23% (95% CI, 16%-32%). The pooled event rates were 48% (95% CI, 39%-57%) for upper GIB, 22% (95% CI, 16%-31%) for lower GIB, and 15% (95% CI, 8%-25%) for small-bowel bleeding. GIAD in the proximal GI tract were the most common cause of GIB (29%). Limitations Lack of information regarding endoscopic therapy and follow-up in most studies. Conclusions The prevalence of GIB is increased in patients with continuous-flow LVADs, primarily secondary to the presence of GIAD.
Gastrointestinal bleeding (GIB) is a notable complication in patients diagnosed with aortic dissection (AD). We evaluated the outcomes and identified the risk factors associated with GIB in patients ...with AD.
A retrospective case-control study was conducted on patients diagnosed with type A aortic dissection (TAAD) who underwent total aortic arch replacement (TAAR) at our institution from July 2021 to July 2023. Comprehensive clinical data, laboratory findings, and imaging results were meticulously gathered and analyzed to identify potential risk factors linked to GIB in this patient cohort.
Of the 198 AD patients who underwent TAAR, 38 (19.2%) developed postoperative GIB (GIB group), with a median interval of 7 days between surgery and bleeding onset. The GIB group exhibited significantly higher mortality (26.3%
3.1%, P<0.001), prolonged intensive care unit (ICU) stay {15 interquartile range (IQR), 8-25
7 (IQR, 5-12) days, P<0.001}, and extended duration of ventilation 168 (IQR, 120-372)
71 (IQR, 34-148) hours, P<0.001 compared to the control group (n=160, 80.8%). Logistic regression analysis identified age >54 years odds ratio (OR): 3.529, intraoperative red blood cell (RBC) transfusion >600 mL (OR: 3.865), and concomitant celiac trunk and superior mesenteric artery (SMA) hypoperfusion (OR: 15.974) as independent risk factors for GIB in AD patients.
GIB subsequent to TAAR in AD patients is linked to adverse prognosis. Factors such as advanced age, extensive intraoperative transfusion, and gastrointestinal (GI) perfusion abnormalities may heighten the risk of GIB in this patient population.
BACKGROUND: Gastrointestinal bleeding (GIB) is a complication of many diseases of the gastrointestinal tract (GIT), including erosive and ulcerative lesions, vascular malformations, diverticula, and ...tumors. In developed countries, the GIB mortality rate ranges from 5% to 15%, reaching 30%40% in the group of patients with severe recurrent bleeding.
AIM: The study aimed to develop an automated diagnostic algorithm for patients with GIB.
METHODS: Knowledge engineering is used to extract terms and their relationships from the scientific literature related to the GIT. After agreement with the experts, information on the diagnosis and treatment of patients with GIB was arranged using a MS Excel spreadsheet editor. For building GIB localization rules, the study included data from histories of 280 patients aged 2094 years (61 44; 74); of these, 47.5% were women, while all others were men. The patients were diagnosed and treated at the Municipal Clinical Hospital No. 31 between 2008 and 2021. For testing the algorithm, data from histories of 514 patients aged 2096 years (62 46; 74) were used; of these, 57% were men, while the rest were women. The patients under study were diagnosed and treated at the Municipal Clinical Hospital No. 17 and the Municipal Clinical Hospital No. 31 between 2008 and 2022. For each study subject, data were available on 37 signs, including 19 clinical, 3 laboratory, and 15 endoscopic signs. Statistical data analysis was performed using the Statistica 13 software package, R Project programming language, and GraphPad online calculator. The software implementation of the algorithm was performed using the JavaScript programming language.
RESULTS: Using polynomial logistic regression, an algorithm for differential diagnosis of GIB according to the preliminary localization of the bleeding source was developed. Having the data from 8 clinical and laboratory parameters with probability, a preliminary localization of the bleeding source may be determined. Thus, the probability of bleeding localization in the upper, middle, and lower GIT accounts for 84% (95% CI 78%; 89%), 84% (95% CI 74%; 91%), and 75% (95% CI 69%; 80%), respectively. A final algorithm to support clinical decision-making in the management of patients with GIB (sergisa.smrtp.ru/medical/edit.html) was developed and implemented as a web-service, working with 92.2% efficiency.
The sequence of operations of the algorithm for diagnosing GIB is as follows:
Obtaining clinical and laboratory signs of a patient with suspected GIB.
Determining the nature of bleeding (overt/occult) using literature data, assessing the severity of bleeding (mild/medium/severe) based on Gorbashko classification, and detecting the preliminary localization of bleeding (upper/middle/lower GIT) by regression equation.
Providing recommendations for selecting a research method based on production rules and expert opinions.
Obtaining endoscopic signs.
Determining the localization and source of bleeding using the production rules.
Providing recommendations for stopping/preventing GIB based on literature and expert opinions.
CONCLUSIONS: An algorithm to support clinical decision-making for the management of patients with GIB, considering the nature of clinical manifestations and the severity and the cause of bleeding based on expert opinions, production rules, and polynomial logistic regression, which allows to assume a preliminary localization of the source of bleeding, was developed for the first time in the Russian Federation. The developed algorithm is implemented as a web-service and may be integrated into the medical information system at the automated workstation of a surgeon, an endoscopist, and a gastroenterologist to support clinical decision-making in the management of patients with GIB.
We aimed to establish and validate a prognostic nomogram model for improving the prediction of 30-day mortality of gastrointestinal bleeding (GIB) in critically ill patients with severe sepsis.
In ...this retrospective study, the current retrospective cohort study extracted data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, then partitioned the cohort randomly into training and validation subsets. The cohort was partitioned into training and validation subsets randomly. Our primary endpoint was 30-day all-cause mortality. To reduce data dimensionality and identify predictive variables, the least absolute shrinkage and selection operator (LASSO) regression was employed. A prediction model was constructed by multivariate logistic regression. Model performance was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curve, and decision curve analysis (DCA).
The analysis included 1435 total patients, comprising 1005 in the training cohort and 430 in the validation cohort. We found that age, smoking status, glucose, (BUN), lactate, Sequential Organ Failure Assessment (SOFA) score, mechanical ventilation≥48h (MV), parenteral nutrition (PN), and chronic obstructive pulmonary disease (COPD) independently influenced mortality in sepsis patients with concomitant GIB. The C-indices were 0.746 (0.700–0.792) and 0.716 (0.663–0.769) in the training and validation sets, respectively. Based on the area under the curve (AUC) and DCA, the nomogram exhibited good discrimination for 30-day all-cause mortality in sepsis with GIB.
For sepsis patients complicated with GIB, we created a unique nomogram model to predict the 30-day all-cause mortality. This model could be a significant therapeutic tool for clinicians in terms of personalized treatment and prognosis prediction.
•MI occurred in 3% patients hospitalized for a gastrointestinal bleed.•Type 2 MI is more frequent than type 1 MI during a gastrointestinal bleeding.•Invasive MI management rate were very low in the ...gastrointestinal bleeding setting.•In-hospital mortality was higher with type 1 MI than with type 2 MI during a GIB.•Type 1 and type 2 MI had a similar risk for 6-month MI and related mortality.
Patients with gastrointestinal bleeding (GIB) are at an increased risk of cardiovascular events and myocardial infarction (MI). Myocardial supply-demand mismatch results in type 2 MI(T2MI) and atherosclerotic plaque rupture leads to type 1 MI(T1MI). Data comparing the prognostic impact of these MI types in GIB are sparse.
Patients hospitalized for GIB were identified in the 2019 US Nationwide Readmissions Sample. In this population, we studied the differences in management of T1MI and T2MI, and the association of these MI types with in-hospital mortality and risk for 6-month MI and MI-related mortality.
Of 444,475 patients admitted for a GIB, 12,860 (2.9%) had an MI (1.7% T2MI, 1.2% T1MI). Patients with T1MI were more likely to receive coronary angiography and revascularization than patients with T2MI. In-hospital mortality occurred in 2.0% patients, at a significantly higher rate in patients with an MI (7.9% vs 1.8%; P < 0.001), and higher with T1MI (11.9%) than T2MI (5.3%; P < 0.001). Among the survivors, 2.2% patient had an MI within 6 months, at a significantly higher rate in patients with index MI (13.1% vs 2.0%, adjusted OR 4.3 95% CI 3.83–4.90; P < 0.001). Mortality during the subsequent MI occurred in 0.3% of all patients (12% with an MI), at a 6-fold higher rate in patients with index MI (1.7% vs 0.3%; adjusted OR 3.69 95% CI 2.75–4.95; P < 0.001). The elevated risks were associated with both MI types. The risks for 6-month MI and related mortality were similar between T1MI and T2MI (6-month AMI: adjusted OR for T2MI = 1.03, 95% 0.83–1.29; fatal MI: adjusted OR for T2MI = 1.5, 95% CI 0.85–2.7).
The occurrence of an MI is associated with a substantially elevated risk for subsequent AMI and related mortality in patients hospitalized for a GIB. This future prognostic impact was similar between T1MI and T2MI.
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