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Injection therapies for nonvariceal bleeding disorders of the GI tract

Division of Gastroenterology and Hepatology, Stanford University, Stanford, California 94305, USA.
Gastrointestinal Endoscopy (Impact Factor: 4.9). 09/2007; 66(2):343-54. DOI: 10.1016/j.gie.2006.11.019
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    • "A bleeding peptic ulcer is one of the most frequently encountered emergency conditions in daily practice for gastroenterologists (Park et al. 2007). This medical condition often requires complex treatments or strategies, such as proton pump inhibitor (PPI) administration, endoscopic hemostasis or salvage surgery, together with consideration of the use of antiplatelet or anticoagulation drugs (Nakayama et al. 2009; Arima et al. 2010). "
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    ABSTRACT: The clinical outcomes of treatments for several medical conditions are better in teaching hospitals than in non-teaching hospitals. However, there is only limited information for comparisons of the clinical outcomes of bleeding peptic ulcers between teaching and non-teaching hospitals. A total of 4,863 patients treated by endoscopic hemostasis on admission for bleeding peptic ulcers were evaluated in 586 hospitals of the Diagnosis Procedure Combination (DPC) system. We collected their data from the database associated with the DPC system to compare the risk-adjusted length of stay (LOS) and in-hospital mortality within 30 days with respect to the hospital characteristics. The hospitals were categorized into two groups: teaching hospitals that were certified by the Japanese Society of Gastroenterology (3,332 patients in 360 hospitals) and non-teaching hospitals (1,531 patients in 226 hospitals). There was no significant difference with regard to the mean LOS and the crude in-hospital mortality within 30 days between groups (p = 0.181 and 0.174, respectively). Multiple linear regression analyses revealed that the hospital characteristics were not associated with the risk-adjusted LOS. The standardized coefficient for non-teaching hospitals was 0.019 (p = 0.172). Multiple logistic regression analyses further showed no significant difference in the in-hospital mortality within 30 days (non-teaching hospitals, odds ratio = 1.35, 95% confidence interval = 0.786 - 2.319, p = 0.277). In conclusion, both teaching and non-teaching hospitals have equivalent qualities in management of bleeding peptic ulcers. These findings suggest that the standardization of medical treatments for bleeding peptic ulcers has become disseminated in Japan.
    The Tohoku Journal of Experimental Medicine 01/2011; 223(1):1-7. DOI:10.1620/tjem.223.1 · 1.28 Impact Factor
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    ABSTRACT: Among the gastrointestinal emergencies, acute upper gastrointestinal bleeding (UGIB) remains a challenging clinical problem owing to significant patient morbidity and costs involved with management. Peptic ulcer bleeding (PUB) contributes to the majority of causes of UGIB with a growing concern of its impact on the elderly and the increasing use of NSAIDs as precipitating bleeding episodes. Apart from initial critical assessment and care, endoscopy remains as the preferred initial management of PUB. Early use of high-dose proton pump inhibitor therapy is cost-effective and reduces the need for endotherapy as well as rebleed rates. Current endoscopic modalities offer a wide range of choices in high-risk PUB (active arterial bleeding or non-bleeding visible vessel). A combination of injection (epinephrine) along with thermal or endoclips therapy offers the best strategy for overall successful clinical outcomes. The role of endotherapy for adherent clots is controversial. A second-look endoscopy may be beneficial in high-risk patients. A multidisciplinary team approach should be part of all treatment protocols for the ideal management of UGIB.Copyright © 2010 S. Karger AG, Basel
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    ABSTRACT: Acute upper gastrointestinal bleed (UGIB) remains a challenging clinical problem owing to significant patient morbidity and costs involved with management. Peptic ulcer bleeding (PUB) contributes to the majority of causes of UGIB with a growing concern of its impact on the elderly and the increasing use of non-steroidal anti-inflammatory drugs as precipitating bleeding episodes. Apart from initial critical care, endoscopy is the preferred first-line management of PUB. Early use of empirical high-dose proton pump inhibitor therapy prior, during and after endoscopy is cost-effective and reduces the need for endotherapy. Current endoscopic modalities, both thermal and non-thermal, offer a wide range of choices in high-risk PUB (active arterial bleeding or non-bleeding visible vessel). Combinations of injection (epinephrine) along with thermal therapy or endoclips are recommended for better clinical outcomes. The role of endotherapy for adherent clots is controversial. A second-look endoscopy may be beneficial in high-risk patients. A multidisciplinary team approach should be part of all treatment protocols for the ideal management of UGIB.
    Digestive Diseases 02/2008; 26(4):291-9. DOI:10.1159/000177011 · 1.83 Impact Factor
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