The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Don C. Rockey - One of the best experts on this subject based on the ideXlab platform.
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Gastrointestinal Bleeding.
Gastroenterology clinics of North America, 2020Co-Authors: Don C. RockeyAbstract:Gastrointestinal Bleeding encompasses a broad array of clinical scenarios. The spectrum is diverse because of the multiple types of lesions that can cause Bleeding, and because Bleeding can occur from virtually anywhere in the Gastrointestinal tract. The fundamental tenets of management of patients with Gastrointestinal Bleeding include the following: (1) the patient must undergo immediate assessment and stabilization of hemodynamic status, (2) the source of Bleeding must be identified, (3) active Bleeding should be stopped, (4) the underlying abnormality should be treated, and (5) recurrent Bleeding should be "prevented.
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Diagnosis and management of lower Gastrointestinal Bleeding.
Current Opinion in Gastroenterology, 2020Co-Authors: Richard S. Bloomfeld, Don C. RockeyAbstract:: There are few randomized, prospective trials evaluating the optimal diagnostic and therapeutic strategies in the management of lower Gastrointestinal Bleeding. However, recent data suggest that urgent colonoscopy represents a safe and effective initial diagnostic approach. The role of tagged erythrocyte scintigraphy is yet to be defined, but it may be of utility as a screening test for visceral angiography. Colonoscopy and angiography both offer substantial therapeutic options but remain of unproved benefit from a treatment standpoint; surgery continues to play an important role in the management of lower Gastrointestinal Bleeding. Obscure Gastrointestinal Bleeding, which often presents as lower Gastrointestinal Bleeding, continues to be one of the most challenging diagnostic and therapeutic problems in gastroenterology. Occult Gastrointestinal Bleeding, often arising from the lower Gastrointestinal tract, usually mandates Gastrointestinal evaluation.
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Gastrointestinal Bleeding. Gastrointestinal Bleeding risk is increased by novel anticoagulants.
Nature Reviews Gastroenterology & Hepatology, 2015Co-Authors: Don C. RockeyAbstract:A report has demonstrated that in patients with atrial fibrillation the novel oral anticoagulant, dabigatran, increases the risk of Gastrointestinal Bleeding by nearly twofold compared with warfarin. Here, the risk of Gastrointestinal Bleeding associated with anticoagulants and antiplatelet agents is placed into clinical context and key management principles are emphasized.
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occult Gastrointestinal Bleeding
Gastroenterology Clinics of North America, 2005Co-Authors: Don C. RockeyAbstract:: Occult Gastrointestinal Bleeding commonly manifests as iron deficiency anemia or fecal occult blood. Iron deficiency anemia results from chronic occult Gastrointestinal Bleeding. Evaluation of asymptomatic patients who have iron deficiency anemia or fecal occult blood usually should begin with investigation of the colon. Colonoscopy is preferred, but flexible sigmoidoscopy plus air contrast barium enema, or computed tomographic colonography may be acceptable in certain circumstances. If evaluation of the colon does not reveal a Bleeding site, evaluation of the upper Gastrointestinal tract is mandatory in patients who have iron deficiency anemia, and this should be considered in those who have fecal occult blood. In patients who have Gastrointestinal symptoms, evaluation of the portion of the Gastrointestinal tract from which the symptoms is derived should be pursued initially. The role of small intestinal investigation is controversial, and this probably should be reserved for patients who have iron deficiency anemia and persistent Gastrointestinal symptoms or those who fail to respond to appropriate therapy. Celiac sprue should be considered as a potential cause of iron deficiency anemia in all patients. The treatment and prognosis of patients who have iron deficiency anemia or fecal occult blood depends on the Gastrointestinal tract abnormality(ies) identified. Those without identifiable Bleeding sites generally respond to conservative management and have a favorable prognosis. On the other hand, the outlook is poorer for patients with refractory occult blood loss or those who have vascular ectasias. Both groups of patients are clinically challenging and require a focused and experienced team approach to diagnosis and therapy.
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Acute Gastrointestinal Bleeding.
Seminars in gastrointestinal disease, 2003Co-Authors: Bryan T. Green, Don C. RockeyAbstract:Abstract Acute Gastrointestinal Bleeding is a common disorder with a wide spectrum of presentations that may encompass multiple clinical scenarios. Initial hemodynamic assessment and resuscitation are critical. Once accomplished, the source of Bleeding should be localized, active Bleeding should be stopped, the underlying abnormality should be treated, and recurrent Bleeding should be prevented. The means to accomplish these goals depends on the specific clinical situation. For most forms of upper Gastrointestinal Bleeding, early endoscopy is the cornerstone of diagnosis and management. It can predict and improve clinical outcomes. A variety of endoscopic and pharmacologic modalities are effective at achieving and maintaining hemostasis. The optimum means of evaluation and treatment of acute lower Gastrointestinal Bleeding is less clear and is now evolving. Endoscopy (usually expectant, less often early) is widely used and effective for diagnosis but has unproven therapeutic benefits. Angiography is effective (diagnostically and/or therapeutically) in certain situations. Surgery offers the opportunity for definitive therapy at the cost of higher morbidity. At this time, the approach to evaluation and management should be based on the specific clinical situation and available local expertise.
Loren Laine - One of the best experts on this subject based on the ideXlab platform.
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clinical practice upper Gastrointestinal Bleeding due to a peptic ulcer
The New England Journal of Medicine, 2016Co-Authors: Loren LaineAbstract:Key Clinical PointsUpper Gastrointestinal Bleeding Gastrointestinal Bleeding is the most common cause of hospitalization due to Gastrointestinal disease in the United States. Peptic ulcers, primarily due to Helicobacter pylori infection and the use of nonsteroidal antiinflammatory drugs (NSAIDs), are the most common cause of upper Gastrointestinal Bleeding. In patients with upper Gastrointestinal Bleeding, tachycardia (heart rate, ≥100 beats per minute), hypotension (systolic blood pressure, ≤100 mm Hg), age older than 60 years, and major coexisting conditions are associated with increased risks of further Bleeding and death. Patients with Bleeding ulcers due to H. pylori infection should receive treatment for this infection and, after eradication is confirmed, discontinue antisecretory medications. Patients with Bleeding ulcers due to NSAIDs other than low-dose aspirin should discontinue NSAIDs; if NSAIDs must be resumed, a cyclooxygenase-2 (COX-2)–selective NSAID plus a proton-pump inhibitor should be u...
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Blood transfusion for Gastrointestinal Bleeding.
The New England Journal of Medicine, 2013Co-Authors: Loren LaineAbstract:Gastrointestinal Bleeding accounts for more than 450,000 hospitalizations annually in the United States1 and is a frequent indication for red-cell transfusion. Blood transfusions are given to 43% of patients hospitalized with upper Gastrointestinal Bleeding in the United Kingdom2 and to 21% of patients hospitalized with lower Gastrointestinal Bleeding in the United States.3 Transfusion practices for patients with Gastrointestinal Bleeding have fluctuated over the past 100 years. Avoidance of transfusions early in the 20th century, owing to concern that increased blood pressure would induce reBleeding, gave way to more liberal use of transfusions,4 and a hemoglobin threshold for transfusion of 10 . . .
Cyril Goulenok - One of the best experts on this subject based on the ideXlab platform.
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Management by the intensivist of Gastrointestinal Bleeding in adults and children
Annals of Intensive Care, 2012Co-Authors: David Osman, Michel Djibré, Daniel Da Silva, Cyril GoulenokAbstract:Intensivists are regularly confronted with the question of Gastrointestinal Bleeding. To date, the latest international recommendations regarding prevention and treatment for Gastrointestinal Bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of Gastrointestinal Bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of Gastrointestinal Bleeding before endoscopic diagnosis, treatment of upper Gastrointestinal Bleeding unrelated to portal hypertension, treatment of upper Gastrointestinal Bleeding related to portal hypertension, management of presumed lower Gastrointestinal Bleeding, and prevention of upper Gastrointestinal Bleeding in intensive care.
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Management by the intensivist of Gastrointestinal Bleeding in adults and children
Annals of Intensive Care, 2012Co-Authors: David Osman, Michel Djibré, Daniel Da Silva, Cyril GoulenokAbstract:Intensivists are regularly confronted with the question of Gastrointestinal Bleeding. To date, the latest international recommendations regarding prevention and treatment for Gastrointestinal Bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of Gastrointestinal Bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Societe de Reanimation de Langue Francaise (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of Gastrointestinal Bleeding before endoscopic diagnosis, treatment of upper Gastrointestinal Bleeding unrelated to portal hypertension, treatment of upper Gastrointestinal Bleeding related to portal hypertension, management of presumed lower Gastrointestinal Bleeding, and prevention of upper Gastrointestinal Bleeding in intensive care.
Lawrence S. Friedman - One of the best experts on this subject based on the ideXlab platform.
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Gastrointestinal Bleeding in the elderly
Nature Clinical Practice Gastroenterology & Hepatology, 2008Co-Authors: Patrick S. Yachimski, Lawrence S. FriedmanAbstract:Gastrointestinal Bleeding affects a substantial number of elderly persons and is a common indication for hospitalization. The authors of this Review discuss trends in the epidemiology and outcome of Gastrointestinal Bleeding in elderly patients. Specific causes of upper and lower Gastrointestinal Bleeding are also discussed, along with recommendations for an approach to endoscopic diagnosis and therapy. Gastrointestinal Bleeding affects a substantial number of elderly people and is a frequent indication for hospitalization. Bleeding can originate from either the upper or lower Gastrointestinal tract, and patients with Gastrointestinal Bleeding present with a range of symptoms. In the elderly, the nature, severity, and outcome of Bleeding are influenced by the presence of medical comorbidities and the use of antiplatelet medication. This Review discusses trends in the epidemiology and outcome of Gastrointestinal Bleeding in elderly patients. Specific causes of upper and lower Gastrointestinal Bleeding are discussed, and recommendations for approaches to endoscopic diagnosis and therapy are given.
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Review article: the management of lower Gastrointestinal Bleeding
Alimentary Pharmacology & Therapeutics, 2005Co-Authors: James J. Farrell, Lawrence S. FriedmanAbstract:Summary Several recent advances have been made in the evaluation and management of acute lower Gastrointestinal Bleeding. This review focuses on the management of lower Gastrointestinal Bleeding, especially acute severe Bleeding. The aim of the study was to critically review the published literature on important management issues in lower Gastrointestinal Bleeding, including haemodynamic resuscitation, diagnostic evaluation, and endoscopic, radiologic, and surgical therapy, and to develop an algorithm for the management of lower Gastrointestinal Bleeding, based on this literature review. Publications pertaining to lower Gastrointestinal Bleeding were identified by searches of the MEDLINE database for the years 1966 to December 2004. Clinical trials and review articles were specifically identified, and their reference citation lists were searched for additional publications not identified in the database searches. Clinical trials and current clinical recommendations were assessed by using commonly applied criteria. Specific recommendations are made based on the evidence reviewed. Approximately, 200 original and review articles were reviewed and graded. There is a paucity of high-quality evidence to guide the management of lower Gastrointestinal Bleeding, and current endoscopic, radiologic, and surgical practices appear to reflect local expertise and availability of services. Endoscopic literature supports the role of urgent colonoscopy and therapy where possible. Radiology literature supports the role of angiography, especially after a positive Bleeding scan has been obtained. Limited surgical data support the role of segmental resection in the management of persistent lower Gastrointestinal Bleeding after localization by either colonoscopy or angiography. There is limited high-quality research in the area of lower Gastrointestinal Bleeding. Recent advances have improved the endoscopic, radiologic and surgical management of this problem. However, treatment decisions are still often based on local expertise and preference. With increased access to urgent therapeutic endoscopy for the management of acute upper Gastrointestinal Bleeding, diagnostic and therapeutic colonoscopy can be expected to play an increasing role in the management of acute lower Gastrointestinal Bleeding.
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Lower Gastrointestinal Bleeding
Gastroenterology Clinics of North America, 2003Co-Authors: Brenna C. Bounds, Lawrence S. FriedmanAbstract:: Lower Gastrointestinal Bleeding is defined as blood loss that originates from a source distal to the ligament of Treitz and results in hemodynamic instability or symptomatic anemia. Although approximately 10% to 15% of patients presenting with acute severe hematochezia have an upper Gastrointestinal source of Bleeding identified on upper endoscopy, the most common causes of lower Gastrointestinal Bleeding are diverticulosis, hemorrhoids, ischemic colitis, and angiodysplasia. As with upper Gastrointestinal Bleeding, lower Gastrointestinal Bleeding ceases spontaneously in most cases.
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Gastrointestinal Bleeding IN THE ELDERLY
Gastroenterology Clinics of North America, 2001Co-Authors: James J. Farrell, Lawrence S. FriedmanAbstract:Among patients with acute Gastrointestinal Bleeding, older age is associated with an increased rate of comorbidity, greater medication use, and atypical clinical presentations. The aging of the population makes the evaluation and management of Gastrointestinal Bleeding in the elderly a special and increasingly common clinical challenge. The unique features and common causes of upper and lower Gastrointestinal Bleeding in the elderly are reviewed. Important management issues considered include hemodynamic resuscitation; anticoagulation; and medical, surgical, and endoscopic therapy.
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Less frequent causes of lower Gastrointestinal Bleeding.
Gastroenterology Clinics of North America, 1994Co-Authors: Larry S. Miller, Barbarevech C, Lawrence S. FriedmanAbstract:Abstract In the United States, four diseases account for the vast majority of cases of lower intestinal Bleeding: arteriovenous malformation, diverticulosis, neoplasms, and internal hemorrhoids. In this article the authors discuss less frequent causes of Gastrointestinal Bleeding. "Common" less frequent causes of Gastrointestinal Bleeding include solitary rectal ulcer syndrome, colonic varices, mesenteric vascular insufficiency, small bowel diverticula, Meckel's diverticulum, aortoenteric fistula, vasculitis, small intestinal ulceration, endometriosis, radiation-induced injury, and intussusception. Less frequent causes of Gastrointestinal Bleeding that have been recently described include portal colopathy, diversion colitis, and Gastrointestinal Bleeding in runners.
David Osman - One of the best experts on this subject based on the ideXlab platform.
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Management by the intensivist of Gastrointestinal Bleeding in adults and children
Annals of Intensive Care, 2012Co-Authors: David Osman, Michel Djibré, Daniel Da Silva, Cyril GoulenokAbstract:Intensivists are regularly confronted with the question of Gastrointestinal Bleeding. To date, the latest international recommendations regarding prevention and treatment for Gastrointestinal Bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of Gastrointestinal Bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of Gastrointestinal Bleeding before endoscopic diagnosis, treatment of upper Gastrointestinal Bleeding unrelated to portal hypertension, treatment of upper Gastrointestinal Bleeding related to portal hypertension, management of presumed lower Gastrointestinal Bleeding, and prevention of upper Gastrointestinal Bleeding in intensive care.
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Management by the intensivist of Gastrointestinal Bleeding in adults and children
Annals of Intensive Care, 2012Co-Authors: David Osman, Michel Djibré, Daniel Da Silva, Cyril GoulenokAbstract:Intensivists are regularly confronted with the question of Gastrointestinal Bleeding. To date, the latest international recommendations regarding prevention and treatment for Gastrointestinal Bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of Gastrointestinal Bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Societe de Reanimation de Langue Francaise (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of Gastrointestinal Bleeding before endoscopic diagnosis, treatment of upper Gastrointestinal Bleeding unrelated to portal hypertension, treatment of upper Gastrointestinal Bleeding related to portal hypertension, management of presumed lower Gastrointestinal Bleeding, and prevention of upper Gastrointestinal Bleeding in intensive care.
