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PubMed1986

Effect of non-surgical treatment on gingival bleeding in smokers and non-smokers.

According to previous findings, gingival bleeding seems to be reduced under the influence of cigarette smoking. The present study deals with the effect of non-surgical therapy on gingival bleeding in smokers and non-smokers. The underlying hypothesis was that the therapeutic effect in terms of reduction of gingival bleeding might differ in smokers and non-smokers. Twenty patients with moderate to severe periodontitis, 10 smokers and 10 non-smokers, took part in the study. Gingival bleeding was assessed by probing under a standardized pressure (60 g), and measurements were performed before and 1 month after the completion of active treatment. The active treatment included debridement of supra- and sub-gingival deposits by means of hand instrumentation. The treatment caused a reduction in plaque index and gingival bleeding both in smokers and in non-smokers. The plaque reduction was significantly greater in smokers. Nevertheless, the reduction in gingival bleeding was significantly less pronounced than that attained in non-smokers. The findings suggest that the gingival bleeding response to treatment is reduced in smokers. It would seem that in response to a given amount of plaque reduction the changes in gingival bleeding will be less apparent under the influence of smoking.

Adult↗
PubMed1985

Diverticular disease and minor rectal bleeding.

The purpose of the study was to compare the history of rectal bleeding during the year before the study and the presence of faecal occult bleeding in patients with advanced diverticular disease of the large bowel and two sex- and age-matched reference groups, one consisting of patients with normal large-bowel barium enemas and the other of persons without any history of gastrointestinal disease. The number of persons with faecal occult bleeding or macroscopic anal bleeding during the year before the study was not increased in the group with diverticular disease as compared with the other two groups. The bleeding frequency and characteristics of the bleeding did not differ among the three groups. It is concluded that minor rectal bleeding is rather uncommon in persons with uncomplicated diverticular disease. Patients with a history of rectal bleeding in whom a barium study has only shown diverticular disease should be further investigated as though the diverticula were not present.

Aged↗
PubMed1993

Diagnosis and treatment of acute lower gastrointestinal bleeding.

Diagnostic sigmoidoscopy and barium enema examinations (n = 214) or colonoscopy (n = 52) were performed for acute lower gastrointestinal (GI) bleeding. The cause of bleeding was detected in 76% (203 of 266) of the primary examinations, and the cause remained unclear after subsequent examinations in 17% of the cases. Hemorrhoids were the cause of bleeding in 28% (56 of 203) of the cases, colonic diverticular disease in 19% (39 of 203), adenomatous polyps in 11% (23 of 203), and colorectal cancer in 10% (20 of 203). The sources of bleeding did not differ significantly by sex. An anorectal site of bleeding was most often detected in patients less than 50 years of age (p < 0.0001) and a left colonic site in those more than 70 years (p < 0.0001). Hemorrhoids significantly more often caused rectal bleeding among the youngest patients (p < 0.0001) and colonic diverticular disease among the oldest patients (p < 0.0001) and colonic diverticular disease among the oldest patients (p < 0.0001) than among the others. Of the 266 patients, 19% have been operated on for the bleeding lesion. The mortality related to lower GI bleeding was 4% (11 of 266). The mean age of the patients who died was higher than that of those who survived (p < 0.05).

Acute Disease↗
PubMed1997

The effect of endoscopic injection therapy on the clinical outcome of patients with benign peptic ulcer bleeding.

BACKGROUND: Our aim was to investigate the effect of endoscopic injection therapy on the clinical outcome of patients with benign peptic ulcer bleeding. METHODS: In this study 1203 patients admitted with peptic ulcer bleeding over a 5-year period (January 1987 to April 1991) before endoscopic therapy and 1028 patients admitted with peptic ulcer bleeding after introduction of endoscopic therapy (May 1991 to March 1996) were assessed. Endoscopic therapy was performed in all patients with active bleeding or non-bleeding visible vessels during emergency endoscopy with injection of adrenaline, 1:10,000 in 0.9% saline. RESULTS: The introduction of injection therapy was associated with a reduction in transfusion requirements (from 5.1 +/- 2.6 to 3.4 +/- 1.8 units), hospitalization days (from 10.8 +/- 6.5 to 7.8 +/- 5.1 days), surgical interventions (from 50.6% to 23.6%), and mortality (from 12.9% to 4.6%) in patients with active bleeding or non-bleeding visible vessels (P < 0.05) but remained unchanged in the rest. Patients with gastric ulcer had a more pronounced reduction in emergency surgical haemostasis and mortality than patients with duodenal ulcer. There were no deaths or procedure-related complications. CONCLUSION: Endoscopic injection therapy with adrenaline/saline is a simple, low-cost, and safe method that improves the clinical outcome and reduces the mortality in patients with peptic ulcer bleeding.

Blood Transfusion↗
PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗
PubMed2005

Spontaneous intracranial meningioma bleeding: clinicopathological features and outcome.

OBJECT: The aim of this study was to determine the clinicopathological features of patients with intracranial bleeding from unsuspected meningioma and to relate these data to surgery-related outcome. METHODS: The authors report on two cases in which hemorrhage of an unsuspected meningioma occurred in the tentorial ridge and in the falx, and they discuss the details of 143 cases described in the literature. A bleeding propensity index of the meningioma, related to the patient's age, sex, and the lesion's intracranial location and histological type was computed as a ratio between the frequencies of bleeding meningioma and all meningiomas. This was tested by independent samples t-test for proportions. A chi-square test was used to determine the correlations between several variables: location and type of bleeding; survival and type of bleeding; and consciousness and survival. Increased bleeding tendency was found to be associated with two age groups (< 30 years and > 70 years), convexity and intraventricular locations, and fibrous meningiomas. The overall mortality rate documented in cases of bleeding meningiomas was 21.1% (13.9% in the computerized tomography [CT] scanning era), and that in surgically treated cases was 9.5% (7.5% in the CT scanning era). The overall major morbidity rate was 36% (33.8% in the CT scanning era). Overall 96.2% of conscious patients survived after their meningiomas spontaneously hemorrhaged. In patients who were unconscious before surgery, overall mortality rate was 74.1%, and that in surgically treated cases was 46.2%. CONCLUSIONS: The mortality rate in preoperatively conscious patients (those in whom acute deterioration and irreversible brain damage were prevented by early diagnosis and definitive surgery) was similar (< 3% in the CT scanning era) to that documented in cases in which meningiomas did not bleed. In contrast, the associated morbidity rates were much higher. One-stage total removal of the hemorrhagic meningioma and hematoma is the treatment of choice in such patients.

Adolescent↗
PubMed2004

Use of D-STAT to prevent bleeding following percutaneous transhepatic intraportal islet transplantation.

An infrequent but nevertheless concerning complication associated with percutaneous transhepatic islet transplantation is bleeding. Historically in 61 procedures at this institution, we experienced four bleeding complications in three patients (6.6%), two requiring blood transfusion (3.3%) and two asymptomatic intraperitoneal bleeds detected sonographically at 24 h postprocedure (3.3%). It is suggested that the source of the majority of these bleeds is the liver parenchymal tract following removal of the infusion catheter combined with a significant dose of heparin administered to prevent portal vein thrombosis. Various techniques have been used to reduce the risk of tract bleeding, including gelfoam, intravascular coils, and cautery. In our experience gelfoam alone has been used to plug the catheter tract (n = 47); however, in the aforementioned three patients, this technique failed, either due to dislodgement of, or bleeding peripheral to, the plug. This article describes the use of D-Stat, a collagen/thrombin paste that is injected into the peripheral tract. In five consecutive cases performed using D-Stat, there has been no bleeding or thromboses detected. D-Stat combined with a single gelfoam plug offers a quick, easy, efficacious way of sealing the entire catheter tract without leaving any permanent hardware in the liver. This new method may simplify tract closure and reduce bleeding complications in islet transplantation.

Animals↗
PubMed2005

Acute upper gastrointestinal bleeding in operated stomach: outcome of 105 cases.

AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past. METHODS: The causes and clinical outcome were compared between 105 patients with AUGB and a history of gastric surgery, and 608 patients with AUGB but without a history of gastric surgery. RESULTS: Patients who underwent gastric surgery in the past were older (mean age: 68.1+/-11.7 years vs 62.8+/-17.8 years, P = 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding, compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P = 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past (9/73 (12.3%) vs 19/360 (5.3%), P = 0.025). Moreover surgically treated patients in the past required more blood transfusion (3.3+/-4.0 vs 1.5+/-1.7, P = 0.0001) and longer hospitalization time (8.6+/-4.0 vs 6.9+/-4.9 d, P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups (4/105 (3.8%) vs 19/608 (3.1%)). CONCLUSION: Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients.

Acute Disease↗
PubMed2005

Prevalence and risk factors of stress-induced gastrointestinal bleeding in critically ill children.

AIM: To assess the frequency and the risk factors of stress-induced gastrointestinal (GI) bleeding in children admitted to a pediatric intensive care unit (PICU). METHODS: The medical records of children aged between 1 month and 15 years admitted to the PICU between January 2002 and December 2002 were reviewed. Demographic data, indications for PICU admission, principle diagnosis, and basic laboratory investigations were recorded. Previously described factors for stress ulcer bleeding (mechanical ventilation, sepsis, acute respiratory distress syndrome, renal insufficiency, coagulopathy, thrombocytopenia, and intracranial pathology) were used as independent variables in a multivariate analysis. RESULTS: One hundred and seventy of two hundred and five medical records were eligible for review. The most common indication for PICU admission was respiratory failure (48.8%). Twenty-five children received stress ulcer bleeding prophylaxis with ranitidine. The incidence of stress ulcer bleeding was 43.5%, in which 5.3% were clinically significant bleeding. Only mechanical ventilation and thrombocytopenia were significantly associated with stress ulcer bleeding using the univariate analysis. The odds ratio and 95% confidence intervals were 5.13 (1.86-14.12) and 2.26 (1.07-4.74), respectively. However, the logistic regression analysis showed that mechanical ventilation was the only significant risk factor with the odds ratio of 14.1. CONCLUSION: The incidence of gastrointestinal bleeding was high in critically ill children. Mechanical ventilation was an important risk factor for gastrointestinal bleeding.

Adolescent↗
PubMed2002

Reported management of early-pregnancy bleeding and miscarriage by general practitioners in Victoria.

OBJECTIVES: To describe the management of early-pregnancy bleeding and miscarriage reported by general practitioners in Victoria. DESIGN, SETTING, AND PARTICIPANTS: Self-administered, mailed survey of a stratified random sample of GPs in Victoria. Responses weighted by strata to reflect GP population. MAIN OUTCOME MEASURES: Reported management in referral; investigation (especially ultrasound); expectant versus interventional management; and prevention of rhesus iso-immunisation RESULTS: 382 of 621 eligible GPs responded (response rate, 62%). GPs' reported referral was more likely if the patient had painful bleeding (55%) or if the pregnancy was not viable (77%). Ultrasound strongly influenced the assessment of bleeding. Two-thirds of doctors (262/369; 66%) would routinely order ultrasound for painless bleeding, and 328/369 (84%) for painful bleeding. Expectant management was recommended by 15/353 (4%) for incomplete miscarriage with light bleeding and by 6/351 (2%) when bleeding was heavy. Some GPs are uncertain of the indications for anti-D prophylaxis, including instrumentation of the uterus, for which 261/337 (77%) said they would routinely offer anti-D. There was less agreement about anti-D after threatened miscarriage, for which 213/353 (57%) said they offered the injection. CONCLUSIONS: GPs need a working knowledge of the management of early-pregnancy bleeding, and can probably encourage more rational management. There are significant areas where GPs are uncertain, often reflecting uncertainty elsewhere, and some areas where a minority of GPs are not aware of essential requirements.

Abortion, Spontaneous↗
PubMed1987

Prophylactic therapy for stress ulcer bleeding: a reappraisal.

The combined data from 16 prospective trials (2133 patients) appear to suggest that antacids prevent stress ulcer bleeding more effectively than does cimetidine. However, the use of occult blood detection methods to diagnose stress ulcer bleeding may have led to the recognition of clinically insignificant bleeding. When the data from these trials are categorized according to the criteria used for the diagnoses of bleeding (either occult blood detection or clinically overt bleeding), there was no significant difference between antacids and cimetidine in the prevention of overt bleeding (3.3% of 458 compared with 2.7% of 402 patients who bled, respectively; p = 0.69). In addition, both agents were more effective (p less than 0.001) than placebo (15% of 720 patients who bled) in the prevention of overt bleeding. Cimetidine and antacids are equal in preventing significant stress ulcer bleeding.

Antacids↗
PubMed1992

Guideline-based consultation to prevent anticoagulant-related bleeding. A randomized, controlled trial in a teaching hospital.

OBJECTIVE: To test the efficacy of consultation designed to prevent anticoagulant-related bleeding. DESIGN: Randomized, controlled trial. SETTING: A large teaching hospital. PATIENTS: A total of 101 patients at increased (greater than 15%) risk for major, in-hospital bleeding while starting long-term anticoagulant therapy who were identified using a validated prediction rule. INTERVENTIONS: Fifty-five patients received usual care under the direction of the attending physician who had initiated anticoagulant therapy. Forty-six patients received guideline-based consultation in addition to usual care. Guideline-based consultation included individualized review of the risks and benefits of anticoagulant therapy and, on the basis of current practice guidelines, recommendations for daily management. MEASUREMENTS: The main outcome was in-hospital bleeding, which was classified using a reliable, explicit index. RESULTS: Major or minor bleeding occurred in 17 of 55 patients (31%) receiving usual care alone, compared with 6 of 46 patients (13%) receiving consultation in addition to usual care (P = 0.03). The protective efficacy of consultation was 58% (95% CI, 3% to 82%). Consultation was associated with similar reductions in the frequencies of major bleeding (from 13% to 4%) and minor bleeding (from 18% to 9%). Consultative recommendations had an 84% compliance rate and directly affected anticoagulant management: In the consult group, nonsteroidal anti-inflammatory agents were stopped in six patients (13%), and therapeutic ranges were achieved more often for activated partial thromboplastin times (52% compared with 45% in the usual care group, P = 0.08) and for prothrombin times (47% compared with 27% in the usual care group, P less than 0.001). Nearly all housestaff and attending physicians (91%) for patients receiving consultation also reported that consultation improved housestaff learning. The consult group had a somewhat lower rate of thromboembolism in the 90 days after discharge (5% compared with 17%, P = 0.06). Death rates and mean lengths of stay were similar in the two groups. CONCLUSION: Guideline-based consultation was associated with reduction in the frequency of anticoagulant-related bleeding in patients at increased risk for major in-hospital bleeding.

Aged↗
PubMed1996

The risk for and severity of bleeding complications in elderly patients treated with warfarin. The National Consortium of Anticoagulation Clinics.

OBJECTIVE: To determine whether increasing age is associated with an increased risk for bleeding during warfarin treatment. DESIGN: Combined retrospective and prospective cohort studies. SETTING: 6 anticoagulation clinics. PATIENTS: 2376 patients receiving warfarin for various indications. MEASUREMENTS: Bleeding events categorized as minor (resulting in no costs or consequences), serious (requiring testing or treatment), life-threatening, or fatal. RESULTS: 812 first bleeding events (4 fatal, 33 life-threatening, 222 serious, and 553 minor) occurred during 3702 patient-years. Age was inversely related to the mean warfarin dose and dose-adjusted prothrombin time ratio. The unadjusted incidence of minor bleeding complications did not vary according to age group: 18.0 per 100 patient-years for patients younger than 50 years of age, 21.5 for patients 50 to 59 years of age, 24.0 for patients 60 to 69 years of age; 23.5 for patients 70 to 79 years of age, and 16.3 for patient 80 years of age and older. The unadjusted incidence of serious bleeding complications also did not vary according to age group: 9.3 per 100 patient-years for patients younger than 50 years of age, 7.1 for patients 50 to 59 years of age, 6.6 for patients 60 to 69 years of age, 5.1 for patients 70 to 79 years of age, and 4.4 for patients 80 years of age and older. The unadjusted incidence of life-threatening or fatal complications combined was significantly higher among the oldest patients: 0.75 per 100 patient-years for patients younger than 50 years of age, 0.97 for patients 50 to 59 years of age, 1.10 for patients 60 to 69 years of age, 0.68 for patients 70 to 79 years of age, and 3.38 for patients 80 years of age and older. Patients 80 years of age and older had a relative risk of 4.5 (95% CI, 1.3 to 15.6) compared with patients younger than 50 years of age. After adjustment for the intensity of anticoagulation therapy and the deviation in the prothrombin time ratio using Cox and Poisson regression, age was not generally associated with the occurrence of bleeding; relative risk estimates ranged from 0.99 to 1.03 per year of age (lower-bound 95% CI, 0.97 to 1.01; upper-bound 95% CI, 1.00 to 1.09). The single exception was life-threatening and fatal complications in patients 80 years of age or older (relative risk, 4.6 [CI, 1.2 to 18.1]). CONCLUSIONS: Age did not appear to be an important determinant of risk for bleeding in patients receiving warfarin, with the possible exception of age 80 years or older. The intensity of anticoagulation therapy and the deviation in the prothrombin time ratio were much stronger predictors of risk for bleeding.

Age Factors↗
PubMed1999

Right-sided colonic diverticular disease as a source of lower gastrointestinal bleeding.

Right-sided colonic diverticular disease is a distinct disease entity uncommon in the West. Occasionally, the condition may be complicated by hemorrhage and present as lower gastrointestinal bleeding. We report a series of 25 cases of bleeding right colon diverticulosis and discuss its presentation and management. Patients were selected from the colonoscopic reports of all 190 patients presented with suspected acute lower gastrointestinal bleeding in National University Hospital, Singapore, from 1988 to 1994. Fifty-seven patients (30%) had bleeding diverticulosis in which 25 patients (44%) suffered from right-sided disease. Sixty-four per cent of patients had a history of hypertension. Patients presented with either fresh blood in stools or melena. Fifteen patients (60%) required blood transfusion (median, 2 units). Colonoscopy showed blood clots in the right colon in 15 cases (60%) and active bleeding from the right colon diverticula in 3 patients (12%). The bleeding stopped spontaneously in 16 patients (64%). The other 9 patients required surgery because of continuous or recurrent bleeding. All had a right hemicolectomy performed. The hospital stay was 13 days in this group, compared with 5 days for those undergoing conservative treatment (P = 0.0004). There were no deaths. No patients had further bleeding episodes during a median 7-month follow-up.

Acute Disease↗
PubMed1999

Iron-deficiency anemia due to chronic gastrointestinal bleeding.

AIMS: chronic gastrointestinal bleeding is the most common cause of iron deficiency anemia (IDA) in the general population. The objectives of this study were to determine the most frequent gastrointestinal lesions in IDA, the frequency and localization of potentially bleeding lesions, the value of the clinical history in diagnosis, the value of fecal occult blood testing, and the most appropriate diagnostic procedure for these patients. METHODS: we prospectively studied 80 patients older than 40 years with IDA, using upper gastrointestinal tract (GI) endoscopy and colonoscopy, beginning with the former (group A) or the latter (group B) depending on the clinical findings. Barium enema was done when colonoscopy was incomplete or unsatisfactory. If all these tests were negative, conventional barium contrast study of the small intestine and arteriography were done, if necessary. RESULTS: upper GI endoscopy found at least one lesion in 50 patients (72%), 13 in association with a colonic lesion (26%). Colonoscopy detected at least one lesion in 31 patients (45%), among whom 11 had another upper GI lesion (35.5%). Barium enema was positive in 4 out of 24 patients (17%). Barium contrast study of the small intestine detected lesions in 1 out of 7 patients (14%), and arteriography in 1 out of 4 patients (25%). The most common upper GI lesions were of peptic origin (esophagitis in 10, gastroduodenal erosions in 10, and peptic ulcer in 8). Neoplasms (17 cancers and 3 polyps) were the most common colonic lesion. Thirteen out of 38 patients (34%) with a potentially bleeding benign upper GI lesion had another lesion in the colon. The fecal occult blood test was positive in 9 out of 10 patients with colonic cancer and in 5 out of 9 with gastric cancer (74% positive predictive value). Nonsteroid antiinflammatory drug use did not correlate with the presence, location or type of lesion. The reliability of the clinically suspected origin of bleeding was 96% sensitivity, 43% specificity and 74% positive predictive value in group A, and 34%, 93% and 80% respectively in group B. CONCLUSIONS: lesions that cause chronic bleeding were more frequently located in the upper digestive tract than in the colon. There was a high prevalence of neoplasms in patients with IDA. One-third of the patients with a potentially bleeding benign lesion in the upper digestive tract had another lesion in the colon. A positive fecal occult blood test correlated highly with neoplastic lesions, and the presence of blood in the stool did not indicate whether bleeding originated in the upper or lower GI tract. Clinical history was of limited value in predicting the location of a bleeding lesion, but can be suggestive of a prior upper GI tract exploration. These patients need a complete study of both the upper and lower GI tracts. In patients in whom the aforementioned explorations are negative, the small bowel should be studied.

Adult↗
PubMed1999

Helicobacter pylori increases the risk of peptic ulcer bleeding: a case-control study.

AIM: Aim of the present case-control study was to establish whether Helicobacter pylori increases the risk of ulcer bleeding. PATIENTS AND METHODS: All patients presenting with upper gastrointestinal bleeding between November 1994 and November 1995 were prospectively investigated and compared with hospital controls matched for age, sex, and race. We evaluated the frequency of Helicobacter pylori infection, intake of aspirin or non-steroidal anti-inflammatory drugs, use of alcohol, and smoking habits in patients and controls. RESULTS: Included in the study were 128 patients. In 72 patients, the source of bleeding was a peptic ulcer (duodenal ulcer: n = 33; gastric ulcer: n = 39). Ulcer patients were more frequently infected by Helicobacter pylori than controls (72% vs 42%; p < 0.001) while the incidence of infection was similar in patients with non-ulcer bleeding and controls (52% vs 46%; p = 0.59). Conditional multiple logistic regression analysis showed that Helicobacter pylori infection (odds ratio, 3.3 [Confidence interval, 1.5 to 7.0]; p = 0.002) and regular use of alcohol (odds ratio, 3.1 [Confidence interval, 1.0 to 9.0]; p = 0.041) increased the risk of peptic ulcer bleeding while previous intake of aspirin (> 100 mg) or non-steroidal anti-inflammatory drugs independently increased the risk of bleeding only in the case of gastric ulcer (odds ratio, 8.1 [Confidence interval 1.2 to 56.6]; p = 0.034). CONCLUSIONS: Helicobacter pylori infection increases the risk of peptic ulcer bleeding. Our results suggest that Helicobacter pylori and non-steroidal anti-inflammatory drugs are independent risk factors for peptic ulcer bleeding.

Adult↗
PubMedDate not supplied

Comparison of predictive value for colorectal cancer in subjects with and without rectal bleeding.

BACKGROUND/AIMS: To clarify the association between a sign of rectal bleeding and colorectal cancer, and to reveal the relationship of rectal bleeding to the results of an immunochemical fecal occult blood test. METHODOLOGY: In a population-based cross sectional study, 30,138 subjects who received immunochemical fecal occult blood screening with a 2-day method were divided into two groups, according to the results of a questionnaire on a sign of rectal bleeding, and the positivity rate of an immunochemical occult blood test as well as the predictive value for colorectal cancer were compared in the two groups. RESULTS: The fecal occult blood test was positive in 8.8% of subjects with rectal bleeding and in 6.0% of subjects without rectal bleeding, and the predictive value was 6.4% and 3.3% in subjects with and without rectal bleeding, respectively, showing a significant difference in the positivity rate (p<0.001) as well as the predictive value (p<0.05) between these two groups. CONCLUSIONS: These findings indicate that there are positive relations between the subjects with rectal bleeding presentation and colorectal cancer, and a sign of rectal bleeding and the results of an immunochemical fecal occult blood test.

Colorectal Neoplasms↗
PubMedDate not supplied

A prospective randomized trial from Turkey comparing octreotide versus injection sclerotherapy in acute variceal bleeding.

BACKGROUNDS/AIMS: Bleeding from gastroesophageal varices continues to be a life threatening complication of chronic liver diseases and portal hypertension. The purpose of this randomized prospective study is to compare the efficacy of octreotide administration and emergency injection sclerotherapy for the control of actively bleeding esophageal varices and prevention of early rebleeding in patients with cirrhosis. METHODOLOGY: A total of 66 episodes of endoscopically proven active variceal bleeding in 52 patients were included in this study. Following admission to the hospital, the patients were resuscitated with blood and plasma, and fiberoptic endoscopy was performed within 2 hours. Thirty-six bleeds in 28 patients and 30 bleeds in 24 patients were randomized to endoscopic variceal sclerotherapy (1% polidocanol) and to octreotide infusion (at 50 micrograms/h for 12 hours following the initial 50 micrograms i.v. bolus), respectively. RESULTS: Bleeding was initially controlled within 6 hours in 75% of episodes by endoscopic variceal sclerotherapy and in 73.3 by octreotide infusion (P > 0.05). There were no significant differences between the 2 groups in early rebleeding (within 72 hours of randomization) (22% vs. 22.7%), blood transfusion (4.2 +/- 1.8 units vs. 4.8 +/- 2.9 units), or hospital mortality (3.6% vs. 3.3%). Treatment failed in 9 episodes (25%) in the sclerotherapy group and in 8 episodes (26.7%) in the octreotide group. CONCLUSIONS: We consider that Octreotide would appear to be as effective as sclerotherapy in both the early control of variceal hemorrhage and in the prevention of early recurrent bleeding and should therefore be considered the treatment of choice in those centers where 24-hour endoscopy is not available. Furthermore, even in hospitals that do have a 24-hour endoscopy service there is good evidence that octreotide therapy should be commenced as soon as a patient enters hospital with a suspected variceal bleed to achieve rapid homeostasis. When initial hemostasis is achieved, elective endoscopic therapies can be undertaken with greater success.

Acute Disease↗