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Henrik Toft Sørensen - One of the best experts on this subject based on the ideXlab platform.

  • chronic liver disease and 90 day mortality in 21 359 patients following Peptic Ulcer bleeding a nationwide cohort study
    2015
    Co-Authors: Christian Fynbo Christiansen, Henrik Gammelager, R. N. Mortensen, L Hollandbill, L Pedersen, Henrik Toft Sørensen
    Abstract:

    Summary Background Bleeding is a serious and frequent complication of Peptic Ulcer disease. Hepatic dysfunction can cause coagulopathy and increases the risk of Peptic Ulcer bleeding. However, whether chronic liver disease increases mortality after Peptic Ulcer bleeding remains unclear. Aim To examine the prognostic impact of chronic liver disease on mortality after Peptic Ulcer bleeding. Methods We used population-based medical registries to conduct a cohort study of all Danish residents hospitalised with incident Peptic Ulcer bleeding from 2004 through 2011. We identified patients diagnosed with liver cirrhosis or non-cirrhotic chronic liver disease before their admission for Peptic Ulcer bleeding. We then computed 90-day mortality after Peptic Ulcer bleeding based on the Kaplan–Meier method (1 – survival function) and used a Cox regression model to estimate mortality rate ratios (MRRs), controlling for potential confounders. Results We identified 21 359 patients hospitalised with Peptic Ulcer bleeding. Among these, 653 (3.1%) had a previous diagnosis of liver cirrhosis and 474 (2.2%) had a history of non-cirrhotic chronic liver disease. Patients with liver cirrhosis and non-cirrhotic chronic liver disease had a cumulative 90-day mortality of 25.3% and 20.7%, respectively, compared to 18.3% among patients without chronic liver disease. Liver cirrhosis was associated with an adjusted 90-day MRR of 2.38 (95% CI: 2.02–2.80), compared to 1.49 (95% CI: 1.22–1.83) among patients with non-cirrhotic chronic liver disease. Conclusion Patients with chronic liver disease, particularly liver cirrhosis, are at increased risk of death within 90 days after hospitalisation for Peptic Ulcer bleeding compared to patients without chronic liver disease.

  • antipsychotic drugs and short term mortality after Peptic Ulcer perforation a population based cohort study
    2008
    Co-Authors: Christian Fynbo Christiansen, Steffen Christensen, Anders H. Riis, Reimar W. Thomsen, S. P. Johnsen, Else Tønnesen, Henrik Toft Sørensen
    Abstract:

    SUMMARY Background Peptic Ulcer perforation is a serious surgical emergency with a substantial short-term mortality, but the influence of antipsychotic drug use on the prognosis remains unknown. Aim To examine the association between antipsychotic drug use and 30-day mortality following Peptic Ulcer perforation. Methods This cohort study comprised 2033 patients with a first-time hospitalization with Peptic Ulcer perforation, in Northern Denmark, between 1991 and 2004. Data on preadmission use of antipsychotics and other medications, psychiatric disease, other comorbidities and mortality were obtained through population-based medical databases. We used Cox regression analyses to compute adjusted mortality rate ratios (MRRs). Results One hundred and sixteen (5.7%) patients with Peptic Ulcer perforation were current users of antipsychotic drugs at the time of hospital admission and 205 (10.1%) were former users. The overall 30-day mortality was 27%. Among current users of antipsychotics 30-day mortality was 39%. The adjusted 30-day MRR for current users of antipsychotic drugs compared with non-users was 1.7 (95% CI: 1.2‐2.3). Former use was not a predictor of mortality. The increase in mortality was equal in users of conventional and atypical antipsychotics. Conclusion Use of antipsychotic drugs is associated with substantially increased mortality following Peptic Ulcer perforation.

  • short term mortality after perforated or bleeding Peptic Ulcer among elderly patients a population based cohort study
    2007
    Co-Authors: Steffen Christensen, Anders H. Riis, Henrik Toft Sørensen, Mette Norgaard, Reimar W. Thomsen
    Abstract:

    Background Mortality after perforated and bleeding Peptic Ulcer increases with age. Limited data exist on how the higher burden of comorbidity among elderly patients affects this association. We aimed to examine the association of age with short-term mortality after perforated and bleeding Peptic Ulcer and to determine the impact of comorbidity on this association.

Reimar W. Thomsen - One of the best experts on this subject based on the ideXlab platform.

  • the Peptic Ulcer perforation pulp score a predictor of mortality following Peptic Ulcer perforation a cohort study
    2012
    Co-Authors: Morten Hylander Moller, Jorgen Bendix, Sven Adamsen, Malene Cramer Engebjerg, Reimar W. Thomsen
    Abstract:

    Background Accurate and early identification of high-risk surgical patients with perforated Peptic Ulcer (PPU) is important for triage and risk stratification. The objective of the present study was to develop a new and improved clinical rule to predict mortality in patients following surgical treatment for PPU. Methods Design: nationwide cohort study based on prospectively collected data. Setting: thirty-five hospitals in Denmark. Patients: a total of 2668 patients surgically treated for gastric or duodenal PPU between 1 February 2003 and 31 August 2009. Outcome measure: 30-day mortality. Results We derived a new clinical prediction rule for 30-day mortality and evaluated and compared its prognostic performance with the American Society of Anaesthesiologists (ASA) and Boey scores. A total of 708 patients (27%) died within 30 days of surgery. The Peptic Ulcer Perforation (PULP) score – comprised eight variables with an adjusted odds ratio of more than 1.28: 1) age > 65 years, 2) active malignant disease or AIDS, 3) liver cirrhosis, 4) steroid use, 5) time from perforation to admission > 24 h, 6) pre-operative shock, 7) serum creatinine > 130 μM, and 8) the four levels of the ASA score (from 2 to 5). The score predicted mortality well (area under receiver operating characteristics curve (AUC) 0.83). It performed considerably better than the Boey score (AUC 0.70) and better than the ASA score alone (AUC 0.78). Conclusion The PULP score accurately predicts 30-day mortality in patients operated for PPU and can assist in risk stratification and triage.

  • antipsychotic drugs and short term mortality after Peptic Ulcer perforation a population based cohort study
    2008
    Co-Authors: Christian Fynbo Christiansen, Steffen Christensen, Anders H. Riis, Reimar W. Thomsen, S. P. Johnsen, Else Tønnesen, Henrik Toft Sørensen
    Abstract:

    SUMMARY Background Peptic Ulcer perforation is a serious surgical emergency with a substantial short-term mortality, but the influence of antipsychotic drug use on the prognosis remains unknown. Aim To examine the association between antipsychotic drug use and 30-day mortality following Peptic Ulcer perforation. Methods This cohort study comprised 2033 patients with a first-time hospitalization with Peptic Ulcer perforation, in Northern Denmark, between 1991 and 2004. Data on preadmission use of antipsychotics and other medications, psychiatric disease, other comorbidities and mortality were obtained through population-based medical databases. We used Cox regression analyses to compute adjusted mortality rate ratios (MRRs). Results One hundred and sixteen (5.7%) patients with Peptic Ulcer perforation were current users of antipsychotic drugs at the time of hospital admission and 205 (10.1%) were former users. The overall 30-day mortality was 27%. Among current users of antipsychotics 30-day mortality was 39%. The adjusted 30-day MRR for current users of antipsychotic drugs compared with non-users was 1.7 (95% CI: 1.2‐2.3). Former use was not a predictor of mortality. The increase in mortality was equal in users of conventional and atypical antipsychotics. Conclusion Use of antipsychotic drugs is associated with substantially increased mortality following Peptic Ulcer perforation.

  • short term mortality after perforated or bleeding Peptic Ulcer among elderly patients a population based cohort study
    2007
    Co-Authors: Steffen Christensen, Anders H. Riis, Henrik Toft Sørensen, Mette Norgaard, Reimar W. Thomsen
    Abstract:

    Background Mortality after perforated and bleeding Peptic Ulcer increases with age. Limited data exist on how the higher burden of comorbidity among elderly patients affects this association. We aimed to examine the association of age with short-term mortality after perforated and bleeding Peptic Ulcer and to determine the impact of comorbidity on this association.

Joseph J.y. Sung - One of the best experts on this subject based on the ideXlab platform.

  • management of gi emergencies Peptic Ulcer acute bleeding
    2013
    Co-Authors: Sunny H Wong, Joseph J.y. Sung
    Abstract:

    Peptic Ulcer bleeding is a common medical emergency. Management of acute Ulcer bleeding requires prompt assessment for risk stratification, evaluation for early endoscopy, initiation of pharmacotherapy and treatment of co-morbid diseases. Tremendous advances in endoscopic technique and pharmacotherapy in the past few decades have reduced recurrent bleeding, the need for surgery and mortality of the disease. Strategies to minimize recurrence have been defined for various types of Peptic Ulcers. This article reviews the current management of acute Peptic Ulcer bleeding.

  • The risk of Peptic Ulcer bleeding mortality in relation to hospital admission on holidays: a cohort study on 8,222 cases of Peptic Ulcer bleeding.
    2012
    Co-Authors: Kelvin K.f. Tsoi, Philip Wai Yan Chiu, Francis K.l. Chan, Jessica Y.l. Ching, James Y.w. Lau, Joseph J.y. Sung
    Abstract:

    The Risk of Peptic Ulcer Bleeding Mortality in Relation to Hospital Admission on Holidays: A Cohort Study on 8,222 Cases of Peptic Ulcer Bleeding

  • systematic review of the epidemiology of complicated Peptic Ulcer disease incidence recurrence risk factors and mortality
    2011
    Co-Authors: James Y.w. Lau, Joseph J.y. Sung, C Hill, Catherine Henderson, Colin W Howden, David C Metz
    Abstract:

    Background/Aims: The incidence of uncomplicated Peptic Ulcer has decreased in recent years. It is unclear what the impact of this has been on the epidemiology of Peptic Ulcer compli

  • intravenous esomeprazole for prevention of Peptic Ulcer re bleeding rationale design of Peptic Ulcer bleed study
    2008
    Co-Authors: Joseph J.y. Sung, James Y.w. Lau, Alan N. Barkun, Joachim Mossner, E J Kuipers, Dennis M Jensen, Robert C Stuart, Ola Junghard, G Olsson
    Abstract:

    Summary Background  A limited number of trials have investigated the efficacy of proton pump inhibitors for Peptic Ulcer bleeding, and some study design issues have been identified. Aim  To present the design of a large trial evaluating the effects of intravenous esomeprazole on clinical outcomes in high-risk patients who have undergone endoscopic haemostasis for Peptic Ulcer bleeding. Methods  The Peptic Ulcer Bleed study is an international, randomized, double-blind, placebo-controlled trial comparing either esomeprazole 80 mg intravenous bolus infusion for 30 min followed by esomeprazole 8 mg/h intravenously for 71.5 h, or placebo infusion for 72 h, after successful endoscopic haemostasis in patients with Peptic Ulcer bleeding and associated high-risk stigmata. All patients will receive once daily oral esomeprazole 40 mg for 27 days after intravenous therapy. The primary end point is the rate of clinically significant re-bleeding during the first 72 h after endoscopy. Secondary end points include: rate of re-bleeding during the first 7 and 30 days after treatment; length of hospitalization; mortality; blood transfusion; endoscopic re-treatment and surgery. Results  Expected 2008. Conclusions  The carefully designed protocol and quality control measures represent a pragmatic approach to contemporary challenges in Peptic Ulcer bleeding management and, it is hoped, qualify the Peptic Ulcer Bleed study as a new standard for future interventional studies.

Ian M Gralnek - One of the best experts on this subject based on the ideXlab platform.

  • diagnosis and treatment of Peptic Ulcer disease
    2019
    Co-Authors: Robert T Kavitt, Anna M Lipowska, Adjoa Anyaneyeboa, Ian M Gralnek
    Abstract:

    Peptic Ulcer disease continues to be a source of significant morbidity and mortality worldwide. Approximately two-thirds of patients found to have Peptic Ulcer disease are asymptomatic. In symptomatic patients, the most common presenting symptom of Peptic Ulcer disease is epigastric pain, which may be associated with dyspepsia, bloating, abdominal fullness, nausea, or early satiety. Most cases of Peptic Ulcer disease are associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs), or both. In this review, we discuss the role of proton pump inhibitors in the management of Peptic Ulcer disease, highlight the latest guidelines about the diagnosis and management of H. pylori, and discuss the latest evidence in the management of complications related to Peptic Ulcer disease, including endoscopic intervention for Peptic Ulcer-related bleeding. Timely diagnosis and treatment of Peptic Ulcer disease and its sequelae are crucial in order to minimize associated morbidity and mortality, as is prevention of Peptic Ulcer disease among patients at high risk, including those infected with H. pylori and users of NSAIDs.

  • management of acute bleeding from a Peptic Ulcer
    2008
    Co-Authors: Ian M Gralnek, Alan N. Barkun, Marc Bardou
    Abstract:

    The mortality associated with acute bleeding from a Peptic Ulcer remains high (5 to 10%), and the condition accounts for more than 400,000 hospital admissions per year in the United States. This review summarizes the approach to patient triage and risk stratification, the goals of early endoscopy, the options for medical therapy, and the role of surgery and interventional radiology.

Hung Lau - One of the best experts on this subject based on the ideXlab platform.

  • laparoscopic repair of perforated Peptic Ulcer a meta analysis
    2004
    Co-Authors: Hung Lau
    Abstract:

    Laparoscopic repair of perforated Peptic Ulcer has been gaining popularity in recent years, but few data exist to support the superiority of the laparoscopic approach over open repair. The objective of the current study was to compare the safety and efficacy of open and laparoscopic repair of perforated Peptic Ulcer in an evidence-based approach using meta-analytical techniques. A search of electronic databases, including MEDLINE and EMBASE, was conducted to identify relevant articles published between January 1990 and December 2002. Only studies in the English language comparing the outcomes of laparoscopic and open repair of perforated Peptic Ulcer were recruited. All reports were critically appraised with respect to their methodology and outcome. Data from all included studies were extracted using standardized data extraction forms developed a priori. Both qualitative and quantitative statistical analyses were performed. The effect size of outcome parameters was estimated by odds ratio where feasible and appropriate. A total of 13 publications comprising 658 patients met the inclusion criteria. The overall success rate of laparoscopic repair was 84.7% (n = 249). Postoperative pain was lower after laparoscopic repair than after open repair, supported by a significant reduction in postoperative analgesic requirement after laparoscopic repair. Meta-analyses demonstrated a significant reduction in the wound infection rate after laparoscopic repair, as compared with open repair, but a significantly higher reoperation rate was observed after laparoscopic repair. Evidence suggests that laparoscopic repair of perforated Peptic Ulcer confers superior short-term benefits in terms of postoperative pain and wound morbidity. This approach is as safe and effective as open repair. Laparoscopic Graham–Steele patch repair of perforated duodenal or justapyloric Ulcer is beneficial for patients without Boey’s risk factors.