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Sapna Syngal - One of the best experts on this subject based on the ideXlab platform.
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risk factors for mortality in lower Intestinal Bleeding
Clinical Gastroenterology and Hepatology, 2008Co-Authors: Lisa L Strate, John Z Ayanian, Gregory Kotler, Sapna SyngalAbstract:Background & Aims: Previous studies of lower Intestinal Bleeding (LIB) have limited power to study mortality. We sought to identify characteristics associated with in-hospital mortality in a large cohort of patients with LIB. Methods: We used the 2002 Healthcare Cost and Utilization Project Nationwide Inpatient Sample to study a cross-sectional cohort of 227,022 hospitalized patients with discharge diagnoses indicating LIB. Predictors of mortality were identified by using multiple logistic regression. Results: In 2002, an estimated 8737 patients with LIB (3.9%) died while hospitalized. Independent predictors of in-hospital mortality were age (age >70 vs Conclusions: The all-cause in-hospital mortality rate in LIB was low (3.9%). Advanced age, Intestinal ischemia, and comorbid illness were the strongest predictors of mortality.
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validation of a clinical prediction rule for severe acute lower Intestinal Bleeding
The American Journal of Gastroenterology, 2005Co-Authors: Lisa L Strate, John R Saltzman, Rie Ookubo, Muthoka L Mutinga, Sapna SyngalAbstract:OBJECTIVES: Acute lower Intestinal Bleeding is a heterogeneous disorder and identification of high-risk patients is challenging. We previously retrospectively identified predictors of severity in patients with acute lower Intestinal Bleeding. The aim of this study was to prospectively validate a clinical prediction rule for severe acute lower Intestinal Bleeding. METHODS: This was a prospective, observational cohort study of consecutive patients admitted to an academic, tertiary care or a community-based teaching hospital for management of acute lower Intestinal Bleeding. Data were collected on seven previously identified predictors of severe Bleeding: heart rate > or = 100/min, systolic blood pressure 2 comorbid conditions. Severe Bleeding was defined as transfusion of > or =2 units of red blood cells, and/or a decrease in hematocrit of > or =20% in the first 24 h, and/or recurrent rectal Bleeding after 24 h of stability (accompanied by a further decrease in hematocrit of > or =20%, and/or additional blood transfusions, and/or readmission for acute lower Intestinal Bleeding within 1 wk of discharge). Patients were stratified into 3 risk groups according to the previously developed prediction rule: low (no risk factors), moderate (1-3 risk factors), and high (>3 risk factors). RESULTS: A total of 275 patients with acute lower Intestinal Bleeding were identified. The risk of severe Bleeding in each risk category was similar in the validation and derivation cohorts (p values >0.05): low risk 6%versus 9%, moderate risk 43%versus 43%, and high risk 79%versus 84%. The area under the receiver operating characteristic curve was 0.754 for the validation cohort and 0.761 for the derivation cohort. The magnitude of the risk score was significantly correlated with major clinical outcomes including surgery, death, blood transfusions, and length of stay. CONCLUSION: We have developed and prospectively validated a clinical prediction rule for acute severe lower Intestinal Bleeding. This prediction rule could improve the triage of patients to appropriate levels of care and interventions, and guide a more standardized approach to acute lower Intestinal Bleeding.
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predictors of utilization of early colonoscopy vs radiography for severe lower Intestinal Bleeding
Gastrointestinal Endoscopy, 2005Co-Authors: Lisa L Strate, Sapna SyngalAbstract:Background The management of acute lower Intestinal Bleeding is not standardized. This study assessed factors associated with early (within 24 hours of presentation) colonoscopy vs. radiographic evaluation of patients with severe acute lower Intestinal Bleeding in routine practice. Methods A cohort of 252 patients admitted with acute lower Intestinal Bleeding to a teaching hospital (August 1996 to June 1999) was studied retrospectively. Severe Bleeding was defined as transfusion of two units of packed red blood cells and/or a greater than 20% decrease in hematocrit within 24 hours of presentation. If both colonoscopy and radiography were performed, the initial procedure was analyzed. Multivariable regression was used to identify independent factors related to each of the two initial interventions. Results A total of 118 patients met criteria for severe Bleeding; 33 (28%) underwent an initial, early colonoscopy and 20 (17%) underwent an initial, early radiographic procedure (17 radionuclide scintigraphy, 3 angiography). Independent factors related to early colonoscopy were post-polypectomy Bleeding (OR 6.3: 95% CI[1.4, 28.0]), admission on a weekday (OR 3.0: 95% CI[1.0, 8.6]), and admission late in the day (OR 2.7: 95% CI[1.0, 7.0]). Independent factors related to early radiography were tachycardia (OR 5.1: 95% CI[1.7, 14.9]), syncope (OR 3.8: 95% CI[1.1, 13.2]) and Bleeding during the first 4 hours after admission (OR 3.1: 95% CI[1.0, 9.0]). Colonoscopy was associated with shorter hospital stay ( p =0.025), increased diagnostic yield ( p =0.005), and fewer red blood cell transfusions ( p =0.024). Rates of therapeutic intervention, surgery, and death did not differ significantly between the two strategies. Conclusions Logistical factors and the likelihood of a localized source of Bleeding influence the performance of early colonoscopy for the evaluation of acute lower Intestinal Bleeding, whereas patients with clinical indicators of severe Bleeding often undergo radiographic procedures. Because early colonoscopy may improve outcomes, further studies are needed to compare available strategies and to standardize the management of acute lower Intestinal Bleeding.
H Lochs - One of the best experts on this subject based on the ideXlab platform.
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thalidomide for treatment of severe Intestinal Bleeding
Gut, 2004Co-Authors: J Bauditz, G Schachschal, S Wedel, H LochsAbstract:Apart from its anti-inflammatory activity, which has been used for the treatment of active Crohn’s disease, thalidomide is also a potent inhibitor of angiogenesis. We therefore studied the effect of thalidomide in six patients with severe recurrent Intestinal Bleeding refractory to standard treatment (three patients with Crohn’s disease (CD), three patients with obscure Intestinal Bleeding; mean of 56 blood transfusions within the last 24 months). Bleeding stopped within two weeks after the start of thalidomide in all patients. Haemoglobin normalised without further transfusions for the whole observation period (mean follow up 33 months) while patients needed a mean of 2.2 (CD) and 3.1 (obscure Bleeding) blood units/month in the 12 months before treatment. After three months of thalidomide therapy, serum levels of vascular endothelial growth factor were strongly suppressed compared with pretreatment levels. (CD 818 (82) v 129 (86) pg/ml; obscure Bleeding 264 (68) v 50 (25) pg/ml). All six patients reported transient fatigue. Peripheral neuropathy was observed in one patient with CD after nine months and was reversible after lowering the dose to 100 mg daily. These results indicate that thalidomide might be useful for patients with otherwise refractory Intestinal Bleeding.
Lisa L Strate - One of the best experts on this subject based on the ideXlab platform.
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risk factors for mortality in lower Intestinal Bleeding
Clinical Gastroenterology and Hepatology, 2008Co-Authors: Lisa L Strate, John Z Ayanian, Gregory Kotler, Sapna SyngalAbstract:Background & Aims: Previous studies of lower Intestinal Bleeding (LIB) have limited power to study mortality. We sought to identify characteristics associated with in-hospital mortality in a large cohort of patients with LIB. Methods: We used the 2002 Healthcare Cost and Utilization Project Nationwide Inpatient Sample to study a cross-sectional cohort of 227,022 hospitalized patients with discharge diagnoses indicating LIB. Predictors of mortality were identified by using multiple logistic regression. Results: In 2002, an estimated 8737 patients with LIB (3.9%) died while hospitalized. Independent predictors of in-hospital mortality were age (age >70 vs Conclusions: The all-cause in-hospital mortality rate in LIB was low (3.9%). Advanced age, Intestinal ischemia, and comorbid illness were the strongest predictors of mortality.
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validation of a clinical prediction rule for severe acute lower Intestinal Bleeding
The American Journal of Gastroenterology, 2005Co-Authors: Lisa L Strate, John R Saltzman, Rie Ookubo, Muthoka L Mutinga, Sapna SyngalAbstract:OBJECTIVES: Acute lower Intestinal Bleeding is a heterogeneous disorder and identification of high-risk patients is challenging. We previously retrospectively identified predictors of severity in patients with acute lower Intestinal Bleeding. The aim of this study was to prospectively validate a clinical prediction rule for severe acute lower Intestinal Bleeding. METHODS: This was a prospective, observational cohort study of consecutive patients admitted to an academic, tertiary care or a community-based teaching hospital for management of acute lower Intestinal Bleeding. Data were collected on seven previously identified predictors of severe Bleeding: heart rate > or = 100/min, systolic blood pressure 2 comorbid conditions. Severe Bleeding was defined as transfusion of > or =2 units of red blood cells, and/or a decrease in hematocrit of > or =20% in the first 24 h, and/or recurrent rectal Bleeding after 24 h of stability (accompanied by a further decrease in hematocrit of > or =20%, and/or additional blood transfusions, and/or readmission for acute lower Intestinal Bleeding within 1 wk of discharge). Patients were stratified into 3 risk groups according to the previously developed prediction rule: low (no risk factors), moderate (1-3 risk factors), and high (>3 risk factors). RESULTS: A total of 275 patients with acute lower Intestinal Bleeding were identified. The risk of severe Bleeding in each risk category was similar in the validation and derivation cohorts (p values >0.05): low risk 6%versus 9%, moderate risk 43%versus 43%, and high risk 79%versus 84%. The area under the receiver operating characteristic curve was 0.754 for the validation cohort and 0.761 for the derivation cohort. The magnitude of the risk score was significantly correlated with major clinical outcomes including surgery, death, blood transfusions, and length of stay. CONCLUSION: We have developed and prospectively validated a clinical prediction rule for acute severe lower Intestinal Bleeding. This prediction rule could improve the triage of patients to appropriate levels of care and interventions, and guide a more standardized approach to acute lower Intestinal Bleeding.
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predictors of utilization of early colonoscopy vs radiography for severe lower Intestinal Bleeding
Gastrointestinal Endoscopy, 2005Co-Authors: Lisa L Strate, Sapna SyngalAbstract:Background The management of acute lower Intestinal Bleeding is not standardized. This study assessed factors associated with early (within 24 hours of presentation) colonoscopy vs. radiographic evaluation of patients with severe acute lower Intestinal Bleeding in routine practice. Methods A cohort of 252 patients admitted with acute lower Intestinal Bleeding to a teaching hospital (August 1996 to June 1999) was studied retrospectively. Severe Bleeding was defined as transfusion of two units of packed red blood cells and/or a greater than 20% decrease in hematocrit within 24 hours of presentation. If both colonoscopy and radiography were performed, the initial procedure was analyzed. Multivariable regression was used to identify independent factors related to each of the two initial interventions. Results A total of 118 patients met criteria for severe Bleeding; 33 (28%) underwent an initial, early colonoscopy and 20 (17%) underwent an initial, early radiographic procedure (17 radionuclide scintigraphy, 3 angiography). Independent factors related to early colonoscopy were post-polypectomy Bleeding (OR 6.3: 95% CI[1.4, 28.0]), admission on a weekday (OR 3.0: 95% CI[1.0, 8.6]), and admission late in the day (OR 2.7: 95% CI[1.0, 7.0]). Independent factors related to early radiography were tachycardia (OR 5.1: 95% CI[1.7, 14.9]), syncope (OR 3.8: 95% CI[1.1, 13.2]) and Bleeding during the first 4 hours after admission (OR 3.1: 95% CI[1.0, 9.0]). Colonoscopy was associated with shorter hospital stay ( p =0.025), increased diagnostic yield ( p =0.005), and fewer red blood cell transfusions ( p =0.024). Rates of therapeutic intervention, surgery, and death did not differ significantly between the two strategies. Conclusions Logistical factors and the likelihood of a localized source of Bleeding influence the performance of early colonoscopy for the evaluation of acute lower Intestinal Bleeding, whereas patients with clinical indicators of severe Bleeding often undergo radiographic procedures. Because early colonoscopy may improve outcomes, further studies are needed to compare available strategies and to standardize the management of acute lower Intestinal Bleeding.
Jiang Yu - One of the best experts on this subject based on the ideXlab platform.
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diagnosis and treatment of small Intestinal Bleeding retrospective analysis of 76 cases
World Journal of Gastroenterology, 2006Co-Authors: Mingchen Ba, Sanhua Qing, Xiangcheng Huang, Guoxin Li, Jiang YuAbstract:AIM: To investigate the causes of small Intestinal Bleeding as well as its diagnosis and therapeutic approaches. METHODS: A retrospective analysis was conducted according to the clinical records of 76 patients with small Intestinal Bleeding admitted to our hospital in the past 5 years. RESULTS: In these patients, tumor was the most frequent cause of small Intestinal Bleeding (37/76), followed by Meckel’s diverticulum (21/76), angiopathy (15/76) and ectopic pancreas (3/76). Of the 76 patients, 21 were diagnosed by digital subtraction angiography, 13 by barium and air double contrast X-ray examination of the small intestine, 11 by 99mTc-sestamibi scintigraphy of the abdominal cavity, 6 by enteroscopy of the small intestine, 21 by laparoscopic laparotomy, and 4 by exploratory laparotomy. Although all the patients received surgical treatment, most of them (68/76) received part enterectomy covering the diseased segment and enteroanastomosis. The follow-up time ranged from 1 year to 5 years. No case had recurrent alimentary tract Bleeding or other complications. CONCLUSION: Tumor is the major cause of small Intestinal Bleeding followed by Meckel’s diverticulum and angiopathy. The main approaches to definite diagnosis of small Intestinal Bleeding include digital subtraction angiography, 99mTc-sestamibi scintigraphy of the abdominal cavity, barium and air double contrast X-ray examination of the small intestine, laparoscopic laparotomy or exploratory laparotomy. Part enterectomy covering the diseased segment and enteroanastomosis are the most effective treatment modalities for small Intestinal Bleeding.
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application of laparoscopy in diagnosis and treatment of massive small Intestinal Bleeding report of 22 cases
World Journal of Gastroenterology, 2006Co-Authors: Mingchen Ba, Sanhua Qing, Xiangcheng Huang, Guoxin Li, Jiang YuAbstract:Application of laparoscopy in diagnosis and treatment of massive small Intestinal Bleeding: Report of 22 cases
J Bauditz - One of the best experts on this subject based on the ideXlab platform.
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thalidomide for treatment of severe Intestinal Bleeding
Gut, 2004Co-Authors: J Bauditz, G Schachschal, S Wedel, H LochsAbstract:Apart from its anti-inflammatory activity, which has been used for the treatment of active Crohn’s disease, thalidomide is also a potent inhibitor of angiogenesis. We therefore studied the effect of thalidomide in six patients with severe recurrent Intestinal Bleeding refractory to standard treatment (three patients with Crohn’s disease (CD), three patients with obscure Intestinal Bleeding; mean of 56 blood transfusions within the last 24 months). Bleeding stopped within two weeks after the start of thalidomide in all patients. Haemoglobin normalised without further transfusions for the whole observation period (mean follow up 33 months) while patients needed a mean of 2.2 (CD) and 3.1 (obscure Bleeding) blood units/month in the 12 months before treatment. After three months of thalidomide therapy, serum levels of vascular endothelial growth factor were strongly suppressed compared with pretreatment levels. (CD 818 (82) v 129 (86) pg/ml; obscure Bleeding 264 (68) v 50 (25) pg/ml). All six patients reported transient fatigue. Peripheral neuropathy was observed in one patient with CD after nine months and was reversible after lowering the dose to 100 mg daily. These results indicate that thalidomide might be useful for patients with otherwise refractory Intestinal Bleeding.
