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Demographical and clinical characteristics of the patients with non-variceal upper gastrointestinal bleeding

Year 2012, Volume: 20 Issue: 2, 32 - 39, 01.08.2012
https://doi.org/10.17940/endoskopi.74828

Abstract

Background and Aims: Non-variceal upper gastrointestinal bleeding (NVUGB) is one of the most frequent emergencies. The aim of the present study was to determine the demographic and clinical features of NVUGB pa-tients. Materials and methods: Patients with NVUGB admitted between 2005-2010 years examined with endoscopy were evaluated retrospectively in terms of demographical characteristics, etiological risk factors, treatment mo-dalities and mortality.Results: Mean age of 228 (%77) male and 120 (%23) female was 59, 9 (17-99). 84 (%25.5) of the patients were smoking, 12 (%7) were drinking alcohol, 292 (%88.5) were using drug (148/292 (%44.8) non-steroidal anti-inflammatory drug (NSAIID), 113/292 (%34.2) acetyl salicylic acid. Hypertension (n=96, %29.1) was the most common comorbidty. En-doscopic procedure time: 156 (%47.3) in first 12 hours, 117 (%35.5) in first 12-24 hours, and 57 (%17.3) after 24 hours. Endoscopic therapy was perfor-med in 84 (%25.5) of the patients. Adrenalin injection was the most frequent treatment modality. Urease test was performed in 122 (%37) of the patients and 107 (%87) of this was helicobacter pylori positive. Patients were given 0.81±1.0 erythrocyte suspension at the first 12 hours, totally 1.8±2.1 eryt-hrocyte suspension were given.Conclusion: The most common causes of bleeeding were; 257 (%77.9) peptic ulcer, 119 (% 36.1) gastric ulcer, 203 (%61.5) and erosive gastritis. According to rockall score 61 (%18.5) patients had low risk, 260 (%78.8) patients had moderate risk and 9 (%2.7) patients had high risk. According to forrest score most of the patients had stage 3 ul-cer (n=153, %40.9) and stage 2B correlated with mortality positivley. Seven (%2.1) patients required surgical treatment and six (%1.8) patients died. Pep-tic ulcer was the most common cause of non-variciel upper gastrointestinal bleeding. Bleeding is seen more commonly in males and elders. Acetyl salicy-lic acid and NSAIID were found as risk factors in over half of the bleeding pa-tients. Rate of mortality, surgery and transfusion of erythrocyte suspension was very low. This might be related to the high rate of early endoscopy and endoscopical therapy.

References

  • Longstreth GF. Epidemiology of hospitalization for acute upper gastro- intestinal hemorrhage: a population-based study. Am J Gastroenterol 1995; 90: 206-210.
  • Gilbert DA. Epidemiology of upper gastrointetinal bleeding. Gastrointest Endosc 1990;36(5 Suppl):S8-13.
  • Longstreth GF, Feitelberg SP. Outpatient care of selected patients with acute non-variceal upper gastrointestinal haemorrhage. Lancet 1995;345:108-11.
  • Ferguson CB, Mitchell RM. Nonvariceal upper gastrointestinal bleeding: standard and new treatment. Gastroenterol Clin North Am 2005;34: 607-21.
  • Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med 1994;331: 717-27.
  • Hunt PS, Hansky J, Korman MG. Mortality in patients with haemateme- sis and melaena: a prospective study. Br Med J 1979; 1: 1238-1240.
  • Barkun A, Bardou M, Marshall JK. Nonvariceal Upper GI Bleeding Con- sensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003;139:843-57.
  • Julapalli VR, Graham DY. Appropriate use of intravenous proton pump inhibitors in the management of bleeding peptic ulcer. Dig Dis Sci 2005; 50:1185-93.
  • Consensus statement on therapeutic endoscopy and bleeding ulcers. Consensus Development Panel. Gastrointest Endosc 1990;36(5 Suppl): S62-5.
  • Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mor- tality from acute upper gastrointestinal haemorrhage in the United King- dom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995;311:222-6.
  • Halland M, Young M, Fitzgerald MN, et al. Characteristics and outcomes of upper gastrointestinal hemorrhage in a Tertiary Referral Hospital. Dig Dis Sci 2010;55:3430-5.
  • Loperfido S, Baldo V, Piovesana E, et al. Changing trends in acute up- per-GI bleeding: a population-based study. Gastrointest Endosc 2009;70:212-24.
  • Kapsoritakis AN, Ntounas EA, Makrigiannis EA, et al. Acute upper gas- trointestinal bleeding in central Greece: the role of clinical and endosco- pic variables in bleeding outcome. Dig Dis Sci 2009;54:333-41.
  • Theocharis GJ, Arvaniti V, Assimakopoulos SF, et al. Acute upper gastro- intestinal bleeding in octogenarians: clinical outcome and factors related to mortality. World J Gastroenterol 2008;14:4047-53.
  • Rahme E, Barkun A, Nedjar H, et al. Hospitalizations for upper and lo- wer GI events associated with traditional NSAIDs and acetaminophen among the elderly in Quebec, Canada. Am J Gastroenterol 2008;103: 872-82.
  • Van Leerdam ME, Vreeburg EM, Rauws EA, et al. Acute upper GI blee- ding: did anything change? Time trend analysis of incidence and outco- me of acute upper GI bleeding between 1993/1994 and 2000. Am J Gas- troenterol 2003;98:1494-9.
  • Paspatis GA, Matrella E, Kapsoritakis A, et al. An epidemiological study of acute upper gastrointestinal bleeding in Crete, Greece. Eur J Gastro- enterol Hepatol 2000;12:1215-20.
  • Ohmann C, Imhof M, Ruppert C, et al. Timetrends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 2005;40:914-20.
  • Özen E, Tekin F, Oruç N, Özütemiz Ö, et al. Varis dışı üst gastrointesti- nal kanamalı 412 olgunun irdelenmesi. Akademik Gastroenteroloji Der- gisi 2007;6:62-7.
  • Blatchford O, Davidson LA, Murray WR, et al. Acute upper gastrointes- tinal haemorrhage in west of Scotland: case ascertainment study. BMJ 1997;315:510-4.
  • Yavorski RT, Wong RK, Maydonovitch C, et al. Analysis of 3, 294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol 1995;90:568-73.
  • Ramsoekh D, van Leerdam ME, Rauws EA, Tytgat GN. Outcome of pep- tic ulcer bleeding, nonsteroidal anti-inflammatory drug use, and Helico- bacter pylori infection. Clin Gastroenterol Hepatol 2005;3:859-64.
  • Thomopoulos KC, Vagenas KA, Vagianos CE, et al. Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years. Eur J Gastroenterol Hepatol 2004;16:177-82.
  • Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta- analysis. Lancet 2002;359:14-22.
  • Chan FK, To KF, Wu JC, et al. Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non- steroidal anti-inflammatory drugs: a randomised trial. Lancet 2002;359: 9-13.
  • Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nons- teroidal antiinflammatory drugs. N Engl J Med 1999;340:1888-99.
  • Silverstein FE, Graham DY, Senior JR, et al. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis re- ceiving nonsteroidal anti-inflammatory drugs. Ann Intern Med 1995; 123:241-9.
  • Czernichow P, Hochain P, Nousbaum JB, et al. Epidemiology and cour- se of acute upper gastro-intestinal haemorrhage in four French geograp- hical areas. Eur J Gastroenterol Hepatol 2000;12:175-81.
  • Jyotheeswaran S, Shah AN, Jin HO, et al. Prevalence of Helicobacter pylori in peptic ulcer patients in greater Rochester, NY: is empirical trip- le therapy justified? Am J Gastroenterol 1998;93:574-8.
  • García Rodríguez LA, Hernández-Díaz S, de Abajo FJ. Association bet- ween aspirin and upper gastrointestinal complications: systematic revi- ew of epidemiologic studies. Br J Clin Pharmacol 2001;52:563-71.
  • Padussis JC, Pappas TN. Management of bleeding peptic ulcer. Pryor AD, Pappas TN, Branch MS (editors). Gastrointestinal Bleeding. Springer Science Business Media, 2010: 39-64.
  • Arroyo MT, Forne M, de Argila CM, et al. The prevalence of peptic ulcer not related to Helicobacter pylori or non-steroidal anti-inflammatory drug use is negligible in southern Europe. Helicobacter 2004;9:249-54.
  • Nishikawa K, Sugiyama T, Kato M, et al. Non-Helicobacter pylori and non-NSAID peptic ulcer disease in the Japanese population. Eur J Gas- troenterol Hepatol 2000;12:635-40.
  • Graham DY, Hepps KS, Ramirez FC, et al. Treatment of Helicobacter pylori reduces the rate of rebleeding in peptic ulcer disease. Scand J Gas- troenterol 1993;28:939-42.
  • Lai KC, Hui WM, Wong WM, et al. Treatment of Helicobacter pylori in patients with duodenal ulcer hemorrhage a long-term randomized, con- trolled study. Am J Gastroenterol 2000;95:2225-32.
  • Van Leerdam ME. Epidemiology of acute upper gastrointestinal blee- ding. Best Pract Res Clin Gastroenterol 2008;22:209-24.
  • Targownik LE, Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993-2003. Clin Gas- troenterol Hepatol 2006;4:1459-66.
  • Barkun A, Sabbah S, Enns R, et al. The Canadian Registry on Nonvarice- al Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): Endosco- pic hemostasis and proton pump inhibition are associated with impro- ved outcomes in a real-life setting Am J Gastroenterol 2004;99:1238-46.
  • Ateş F, Karıncaoğlu M, Aladağ M. Varis dışı kanamalı 524 olgunun de- ğerlendirilmesi. Journal of Inonu University Medical 2008;15:14-8.
  • Karadağ F. Üst gastrointestinal kanamalı hastaların genel değerlendiril- mesi. Uzmanlık tezi, İstanbul: Göztepe Eğitim ve Araştırma Hastanesi, Aile Hekimliği Bölümü, 2008;45-50.
  • Rockall TA, Logan RF, Devlin HB, Northfield TC. Influencing the prac- tice and outcome in acute upper gastrointestinal haemorrhage. Steering Committee of the National Audit of Acute Upper Gastrointestinal Hae- morrhage. Gut 1997;41:606-11.
  • Romagnuolo J, Barkun AN, Enns R, et al. Simple clinical predictors may obviate urgent endoscopy in selected patients with nonvariceal upper gastrointestinal tract bleeding. Arch Intern Med 2007;167:265-70.
  • Jensen DM, Kovacs TO, Jutabha R, et al. Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 2002;123:407-13.
  • Bleau BL, Gostout CJ, Sherman KE, et al. Recurrent bleeding from pep- tic ulcer associated with adherent clot: a randomized study comparing endoscopic treatment with medical therapy. Gastrointest Endosc 2002;56:1-6.

Varis dışı üst gastrointestinal sistem kanamalı hastaların demografik ve klinik özellikleri

Year 2012, Volume: 20 Issue: 2, 32 - 39, 01.08.2012
https://doi.org/10.17940/endoskopi.74828

Abstract

Giriş ve Amaç:Varis dışı üst gastrointestinal sistem kanaması sık karşılaşılan önemli acillerden biridir. Bu çalışmada varis dışı üst gastrointestinal sistem kanamalı hastalarda demografik ve klinik özelliklerin de¤erlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 2005-2010 yılları arasında Varis dışı üst gastrointestinal sistem kanaması nedeniyle endoskopi yapılarak izlenmiş olan toplam 330 hasta demografik özellikleri, etyoloji, risk faktörleri, tedavi ve mortalite yönünden retrospektif incelendi. Bulgular: 228'i (%69.1) erkek, 102'si (%30.9) kadın olup yaş ortalaması 59.9 (17-99) idi. Hastaların 84'ü (%25.5) sigara, 12'si (%7) alkol, 292'si (%88.5) ilaç; (148'i (%44.8) nonste-roid anti-inşamatuvar ilaç, 113'ü (%34.2) aspirin) kullanıyordu. En sık hi-pertansiyon (n=96, %29.1) olmak üzere eşlik eden hastalıklar mevcuttu. En-doskopi hastaların 156'sına (%47.3) ilk 12 saatte, 117'sine (%35.5) ilk 12-24 saatte, 57'sine (%17.3) 24 saat sonrasında yapılmıştır. 84 (%25.5) hastaya en sık (%88.1) adrenalin enjeksiyonu olmak üzere endoskopik tedavi uygulan-mıştır. Hastaların 122'sine (%37) üreaz testi yapılmış, 107'sinde (%87) Heli-kobakter pozitif olarak bulunmuş. ‹lk 12 saatte 0.81±1.0, totalde 1.8±2.1 eritrosit süspansiyonu verilmiştir. En sık rastlanan kanama nedenleri; 257'de (%77.9) peptik ülser, 119'da (%36.1) mide ülseri, 138'de (%41.8) duodenal ülser) ve erozif gastrittir (n=203, %61.5). Rockall skorlamasına göre 61 (%18.5) hasta düşük risk, 260 (%78.8) hasta orta risk ve 9 (%2.7) hasta yük-sek riskliydi. Forrest evrelemesine göre ço¤u evre 3 ülsere sahipti (n=153, %40.9). Evre 2B ülserlerse mortaliteyle pozitif koreleydi. 7 hastaya (%2.1) cerrahi tedavi gerekti, 6'sında (%1.8) ölüm gerçekleşti. Sonuç: Varis dışı üst gastrointestinal kanama erkeklerde ve yaşlılarda daha sık görülmekte olup en sık nedeni peptik ülserdir. Yarısından fazlasında nonsteroid anti-inşamatuvar ilaç ve aspirin kullanımı risk faktörü olarak saptandı. Mortalite, cerrahi ve eritrosit süspansiyon replasmanı ihtiyacı oldukça düşük saptandı. Bunun ne-deni erken (ilk 24 saat) endoskopik inceleme ve müdahalenin yüksek oran-da olmasından kaynaklanabilir.

References

  • Longstreth GF. Epidemiology of hospitalization for acute upper gastro- intestinal hemorrhage: a population-based study. Am J Gastroenterol 1995; 90: 206-210.
  • Gilbert DA. Epidemiology of upper gastrointetinal bleeding. Gastrointest Endosc 1990;36(5 Suppl):S8-13.
  • Longstreth GF, Feitelberg SP. Outpatient care of selected patients with acute non-variceal upper gastrointestinal haemorrhage. Lancet 1995;345:108-11.
  • Ferguson CB, Mitchell RM. Nonvariceal upper gastrointestinal bleeding: standard and new treatment. Gastroenterol Clin North Am 2005;34: 607-21.
  • Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med 1994;331: 717-27.
  • Hunt PS, Hansky J, Korman MG. Mortality in patients with haemateme- sis and melaena: a prospective study. Br Med J 1979; 1: 1238-1240.
  • Barkun A, Bardou M, Marshall JK. Nonvariceal Upper GI Bleeding Con- sensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003;139:843-57.
  • Julapalli VR, Graham DY. Appropriate use of intravenous proton pump inhibitors in the management of bleeding peptic ulcer. Dig Dis Sci 2005; 50:1185-93.
  • Consensus statement on therapeutic endoscopy and bleeding ulcers. Consensus Development Panel. Gastrointest Endosc 1990;36(5 Suppl): S62-5.
  • Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mor- tality from acute upper gastrointestinal haemorrhage in the United King- dom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995;311:222-6.
  • Halland M, Young M, Fitzgerald MN, et al. Characteristics and outcomes of upper gastrointestinal hemorrhage in a Tertiary Referral Hospital. Dig Dis Sci 2010;55:3430-5.
  • Loperfido S, Baldo V, Piovesana E, et al. Changing trends in acute up- per-GI bleeding: a population-based study. Gastrointest Endosc 2009;70:212-24.
  • Kapsoritakis AN, Ntounas EA, Makrigiannis EA, et al. Acute upper gas- trointestinal bleeding in central Greece: the role of clinical and endosco- pic variables in bleeding outcome. Dig Dis Sci 2009;54:333-41.
  • Theocharis GJ, Arvaniti V, Assimakopoulos SF, et al. Acute upper gastro- intestinal bleeding in octogenarians: clinical outcome and factors related to mortality. World J Gastroenterol 2008;14:4047-53.
  • Rahme E, Barkun A, Nedjar H, et al. Hospitalizations for upper and lo- wer GI events associated with traditional NSAIDs and acetaminophen among the elderly in Quebec, Canada. Am J Gastroenterol 2008;103: 872-82.
  • Van Leerdam ME, Vreeburg EM, Rauws EA, et al. Acute upper GI blee- ding: did anything change? Time trend analysis of incidence and outco- me of acute upper GI bleeding between 1993/1994 and 2000. Am J Gas- troenterol 2003;98:1494-9.
  • Paspatis GA, Matrella E, Kapsoritakis A, et al. An epidemiological study of acute upper gastrointestinal bleeding in Crete, Greece. Eur J Gastro- enterol Hepatol 2000;12:1215-20.
  • Ohmann C, Imhof M, Ruppert C, et al. Timetrends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 2005;40:914-20.
  • Özen E, Tekin F, Oruç N, Özütemiz Ö, et al. Varis dışı üst gastrointesti- nal kanamalı 412 olgunun irdelenmesi. Akademik Gastroenteroloji Der- gisi 2007;6:62-7.
  • Blatchford O, Davidson LA, Murray WR, et al. Acute upper gastrointes- tinal haemorrhage in west of Scotland: case ascertainment study. BMJ 1997;315:510-4.
  • Yavorski RT, Wong RK, Maydonovitch C, et al. Analysis of 3, 294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol 1995;90:568-73.
  • Ramsoekh D, van Leerdam ME, Rauws EA, Tytgat GN. Outcome of pep- tic ulcer bleeding, nonsteroidal anti-inflammatory drug use, and Helico- bacter pylori infection. Clin Gastroenterol Hepatol 2005;3:859-64.
  • Thomopoulos KC, Vagenas KA, Vagianos CE, et al. Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years. Eur J Gastroenterol Hepatol 2004;16:177-82.
  • Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta- analysis. Lancet 2002;359:14-22.
  • Chan FK, To KF, Wu JC, et al. Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non- steroidal anti-inflammatory drugs: a randomised trial. Lancet 2002;359: 9-13.
  • Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nons- teroidal antiinflammatory drugs. N Engl J Med 1999;340:1888-99.
  • Silverstein FE, Graham DY, Senior JR, et al. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis re- ceiving nonsteroidal anti-inflammatory drugs. Ann Intern Med 1995; 123:241-9.
  • Czernichow P, Hochain P, Nousbaum JB, et al. Epidemiology and cour- se of acute upper gastro-intestinal haemorrhage in four French geograp- hical areas. Eur J Gastroenterol Hepatol 2000;12:175-81.
  • Jyotheeswaran S, Shah AN, Jin HO, et al. Prevalence of Helicobacter pylori in peptic ulcer patients in greater Rochester, NY: is empirical trip- le therapy justified? Am J Gastroenterol 1998;93:574-8.
  • García Rodríguez LA, Hernández-Díaz S, de Abajo FJ. Association bet- ween aspirin and upper gastrointestinal complications: systematic revi- ew of epidemiologic studies. Br J Clin Pharmacol 2001;52:563-71.
  • Padussis JC, Pappas TN. Management of bleeding peptic ulcer. Pryor AD, Pappas TN, Branch MS (editors). Gastrointestinal Bleeding. Springer Science Business Media, 2010: 39-64.
  • Arroyo MT, Forne M, de Argila CM, et al. The prevalence of peptic ulcer not related to Helicobacter pylori or non-steroidal anti-inflammatory drug use is negligible in southern Europe. Helicobacter 2004;9:249-54.
  • Nishikawa K, Sugiyama T, Kato M, et al. Non-Helicobacter pylori and non-NSAID peptic ulcer disease in the Japanese population. Eur J Gas- troenterol Hepatol 2000;12:635-40.
  • Graham DY, Hepps KS, Ramirez FC, et al. Treatment of Helicobacter pylori reduces the rate of rebleeding in peptic ulcer disease. Scand J Gas- troenterol 1993;28:939-42.
  • Lai KC, Hui WM, Wong WM, et al. Treatment of Helicobacter pylori in patients with duodenal ulcer hemorrhage a long-term randomized, con- trolled study. Am J Gastroenterol 2000;95:2225-32.
  • Van Leerdam ME. Epidemiology of acute upper gastrointestinal blee- ding. Best Pract Res Clin Gastroenterol 2008;22:209-24.
  • Targownik LE, Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993-2003. Clin Gas- troenterol Hepatol 2006;4:1459-66.
  • Barkun A, Sabbah S, Enns R, et al. The Canadian Registry on Nonvarice- al Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): Endosco- pic hemostasis and proton pump inhibition are associated with impro- ved outcomes in a real-life setting Am J Gastroenterol 2004;99:1238-46.
  • Ateş F, Karıncaoğlu M, Aladağ M. Varis dışı kanamalı 524 olgunun de- ğerlendirilmesi. Journal of Inonu University Medical 2008;15:14-8.
  • Karadağ F. Üst gastrointestinal kanamalı hastaların genel değerlendiril- mesi. Uzmanlık tezi, İstanbul: Göztepe Eğitim ve Araştırma Hastanesi, Aile Hekimliği Bölümü, 2008;45-50.
  • Rockall TA, Logan RF, Devlin HB, Northfield TC. Influencing the prac- tice and outcome in acute upper gastrointestinal haemorrhage. Steering Committee of the National Audit of Acute Upper Gastrointestinal Hae- morrhage. Gut 1997;41:606-11.
  • Romagnuolo J, Barkun AN, Enns R, et al. Simple clinical predictors may obviate urgent endoscopy in selected patients with nonvariceal upper gastrointestinal tract bleeding. Arch Intern Med 2007;167:265-70.
  • Jensen DM, Kovacs TO, Jutabha R, et al. Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 2002;123:407-13.
  • Bleau BL, Gostout CJ, Sherman KE, et al. Recurrent bleeding from pep- tic ulcer associated with adherent clot: a randomized study comparing endoscopic treatment with medical therapy. Gastrointest Endosc 2002;56:1-6.
There are 44 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Dilek BAHADIR () This is me

Mehmet Yalniz () This is me

Ulvi Demirel () This is me

Cem AYGÜN () This is me

İbrahim Halil BAHÇECİOĞLU () This is me

Publication Date August 1, 2012
Published in Issue Year 2012 Volume: 20 Issue: 2

Cite

APA (), D. B., (), M. Y., (), U. D., (), C. A., et al. (2012). Varis dışı üst gastrointestinal sistem kanamalı hastaların demografik ve klinik özellikleri. Endoskopi Gastrointestinal, 20(2), 32-39. https://doi.org/10.17940/endoskopi.74828
AMA () DB, () MY, () UD, () CA, () İHB. Varis dışı üst gastrointestinal sistem kanamalı hastaların demografik ve klinik özellikleri. Endoskopi Gastrointestinal. August 2012;20(2):32-39. doi:10.17940/endoskopi.74828
Chicago (), Dilek BAHADIR, Mehmet Yalniz (), Ulvi Demirel (), Cem AYGÜN (), and İbrahim Halil BAHÇECİOĞLU (). “Varis dışı üst Gastrointestinal Sistem Kanamalı hastaların Demografik Ve Klinik özellikleri”. Endoskopi Gastrointestinal 20, no. 2 (August 2012): 32-39. https://doi.org/10.17940/endoskopi.74828.
EndNote () DB, () MY, () UD, () CA, () İHB (August 1, 2012) Varis dışı üst gastrointestinal sistem kanamalı hastaların demografik ve klinik özellikleri. Endoskopi Gastrointestinal 20 2 32–39.
IEEE D. B. (), M. Y. (), U. D. (), C. A. (), and İ. H. B. (), “Varis dışı üst gastrointestinal sistem kanamalı hastaların demografik ve klinik özellikleri”, Endoskopi Gastrointestinal, vol. 20, no. 2, pp. 32–39, 2012, doi: 10.17940/endoskopi.74828.
ISNAD (), Dilek BAHADIR et al. “Varis dışı üst Gastrointestinal Sistem Kanamalı hastaların Demografik Ve Klinik özellikleri”. Endoskopi Gastrointestinal 20/2 (August 2012), 32-39. https://doi.org/10.17940/endoskopi.74828.
JAMA () DB, () MY, () UD, () CA, () İHB. Varis dışı üst gastrointestinal sistem kanamalı hastaların demografik ve klinik özellikleri. Endoskopi Gastrointestinal. 2012;20:32–39.
MLA (), Dilek BAHADIR et al. “Varis dışı üst Gastrointestinal Sistem Kanamalı hastaların Demografik Ve Klinik özellikleri”. Endoskopi Gastrointestinal, vol. 20, no. 2, 2012, pp. 32-39, doi:10.17940/endoskopi.74828.
Vancouver () DB, () MY, () UD, () CA, () İHB. Varis dışı üst gastrointestinal sistem kanamalı hastaların demografik ve klinik özellikleri. Endoskopi Gastrointestinal. 2012;20(2):32-9.