The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
Lawrence S Friedman - One of the best experts on this subject based on the ideXlab platform.
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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.
Jürgen F. Riemann - One of the best experts on this subject based on the ideXlab platform.
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Idiopathic mesenteric varices causing Lower Gastrointestinal Bleeding.
European journal of gastroenterology & hepatology, 1996Co-Authors: Dieter Schilling, Mathias Maier, Kohler B, Walter WÜrmel, Peter Jakob, Jürgen F. RiemannAbstract:We report a case of Lower Gastrointestinal Bleeding caused by idiopathic mesenteric varices. A 25-year-old man presented with a history of two episodes of Lower Gastrointestinal Bleeding without transfusion. Colonoscopy revealed varices of the entire colon and terminal ileum. Intravariceal blood flow was demonstrated by dopplersonography. Vascular abnormalities were excluded by selective angiography of the upper and Lower mesenteric artery. No therapy was given without a new episode of Bleeding and there has been no further Bleeding to date (a period of 14 months). Mesenteric varices are a rare cause of Lower Gastrointestinal Bleeding, almost always associated with portal hypertension. The varices are idiopathic in only a few cases. The therapy depends on the intensity of Bleeding, but resection is the most frequent treatment.
Helmut Messmann - One of the best experts on this subject based on the ideXlab platform.
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Diagnosis and management of Lower Gastrointestinal Bleeding
Nature Reviews Gastroenterology & Hepatology, 2009Co-Authors: Jurgen Barnert, Helmut MessmannAbstract:The etiologies of Lower Gastrointestinal Bleeding (LGIB), defined as Bleeding from a colonic or anorectal source, are numerous and varied. LGIB can be acute or chronic; for both types, colonoscopy is the diagnostic and therapeutic procedure of choice. Hemostasis, if not occurring spontaneously, can usually be promoted by embolization or modern endoscopy techniques, and surgery is only undertaken as a last resort. Lower Gastrointestinal Bleeding (LGIB) can present as an acute and life-threatening event or as chronic Bleeding, which might manifest as iron-deficiency anemia, fecal occult blood or intermittent scant hematochezia. Bleeding from the small bowel has been shown to be a distinct entity, and LGIB is defined as Bleeding from a colonic source. Acute Bleeding from the colon is usually less dramatic than upper Gastrointestinal hemorrhage and is self-limiting in most cases. Several factors might contribute to increased mortality, a severe course of Bleeding and recurrent Bleeding, including advanced age, comorbidity, intestinal ischemia, Bleeding as a result of a separate process, and hemodynamic instability. Diverticula, angiodysplasias, neoplasms, colitis, ischemia, anorectal disorders and postpolypectomy Bleeding are the most common causes of LGIB. Volume resuscitation should take place concurrently upon initial patient assessment. Colonoscopy is the diagnostic and therapeutic procedure of choice, for acute and chronic Bleeding. Angiography is used if colonoscopy fails or cannot be performed. The use of radioisotope scans is reserved for cases of unexplained intermittent Bleeding, when other methods have failed to detect the source. Embolization or modern endoscopy techniques, such as injection therapy, thermocoagulation and mechanical devices, effectively promote hemostasis. Surgery is the final approach for severe Bleeding. The severity of acute Lower Gastrointestinal Bleeding (LGIB) is variable, but overall mortality is low In most cases, Bleeding will stop spontaneously Mortality is higher in older adults, and in those with intestinal ischemia and other comorbidities Colonoscopy is the diagnostic and therapeutic mainstay in the management of acute and chronic LGIB Visceral angiography is the preferred diagnostic and therapeutic method in patients with hemodynamic instability The existing scoring systems are time consuming and offer little help in clinical decision-making
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diagnosis and management of Lower Gastrointestinal Bleeding
Nature Reviews Gastroenterology & Hepatology, 2009Co-Authors: Jurgen Barnert, Helmut MessmannAbstract:The etiologies of Lower Gastrointestinal Bleeding (LGIB), defined as Bleeding from a colonic or anorectal source, are numerous and varied. LGIB can be acute or chronic; for both types, colonoscopy is the diagnostic and therapeutic procedure of choice. Hemostasis, if not occurring spontaneously, can usually be promoted by embolization or modern endoscopy techniques, and surgery is only undertaken as a last resort.
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Lower Gastrointestinal Bleeding--the role of endoscopy.
Digestive Diseases, 2003Co-Authors: Helmut MessmannAbstract:Endoscopy is the method of choice in diagnosing the cause of Lower Gastrointestinal Bleeding, and it offers the opportunity to treat patients suffering from Lower Gastrointestinal Bleeding. Endoscopic procedures must be integrated with other approaches to reach a correct diagnosis rapidly, safely, and economically. In all patients, evaluation begins with a history and physical examination. The sequence of other tests depends on many factors, especially the rate of Bleeding. New technologies such as wireless capsule endoscopy will influence the management of patients with Lower Gastrointestinal Bleeding.
Joseph D. Feuerstein - One of the best experts on this subject based on the ideXlab platform.
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Risk Factors for Adverse Outcomes in Patients Hospitalized With Lower Gastrointestinal Bleeding.
Mayo Clinic proceedings, 2015Co-Authors: Neil Sengupta, Elliot B. Tapper, Vilas Patwardhan, Gyanprakash A. Ketwaroo, Adarsh M. Thaker, Daniel A. Leffler, Joseph D. FeuersteinAbstract:Objective To determine which risk factors and subtypes of Lower Gastrointestinal Bleeding (LGIB) are associated with adverse outcomes after hospital discharge (30-day readmissions, recurrent LGIB, and death).
Jianpeng Gao - One of the best experts on this subject based on the ideXlab platform.
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successful endoscopic hemoclipping of massive Lower Gastrointestinal Bleeding from paratyphoid a fever
World Journal of Gastroenterology, 2015Co-Authors: Hui Wang, Xiaolin Dong, Kyu Sung Chung, Jianpeng GaoAbstract:Paratyphoid fever can be complicated by massive Lower Gastrointestinal Bleeding with ileocolonic ulcerations, which are commonly localized using colonoscopy. The most common manifestations include multiple, variable-sized, round or oval-shaped, punched-out ulcers. Occasionally, massive Lower Gastrointestinal Bleeding can occur from erosion of blood vessels. We present a rare case of severe Lower Gastrointestinal Bleeding due to paratyphoid A fever that was successfully controlled with hemoclippings. A 30-year-old man experienced high fever and hematochezia whose blood culture showed Salmonella paratyphi A. A complete colonoscopy was successfully performed up to the level of the terminal ileum, which showed multiple, shallow, ulcerated lesions over the entire terminal ileum. A Bleeding vessel was seen in one of the ulcers, with overlaying blood clots. Endoscopic hemostasis was successfully performed with four pieces of endoclip and without immediate complication. This report highlights the use of colonoscopy and endoscopic therapy with endoclips for Lower Gastrointestinal Bleeding, which should be considered before surgery.
