Nonvariceal upper gastrointestinal system bleeding: What has been changed in the last 25 years?

Yıl 2019, , 20 - 23, 15.04.2019

Muhammed Kaya Züleyha Akkan Çetinkaya , Gökhan Dindar Umut Polat Murat Öztürkler Mesut Sezikli

https://doi.org/10.17940/endoskopi.554064

Öz

Background and Aims: In our study, we aimed to investigate patients with nonvariceal upper gastrointestinal system bleeding who underwent esophagogastroduodenoscopy within the past one year and compared them against cases from the year 1993 and 2008. Materials and Methods: All patients diagnosed with nonvariceal upper gastrointestinal system bleeding who underwent esophagogastroduodenoscopy in the Gastroenterology Clinic of S.B.U. Derince Training and Research Hospital in the last one year were retrospectively reviewed. Demographic data, comorbidities, and esophagogastroduodenoscopy results of 160 patients were analyzed. The results were compared with data from 1993 and 2008. Results: In our patient cohort, the male:female ratio was 2:1 and the mean age was 59.8 years. The most common cause of bleeding was gastritis, followed by peptic ulcers. Ulcers were most commonly seen in the bulbus region. The presence of active bleeding was more common in bulbus ulcers compared to the antrum. The mean age and the proportion of women in our patient cohort were higher than in the 1993 and 2008 data. Additionally, duodenal and gastric ulcers were significantly reduced, while gastritis increased in patients from the last year as compared with those in 1993 and 2008. Conclusion: Nonvariceal upper gastrointestinal bleeding is more common in males and in older patients. The mean age of the patients increased and the frequency of ulcers decreased owing to the increase in life expectancy and success of Helicobacter pylori treatment over the past 25 years. Due to current treatment approaches, mortality rates associated with gastrointestinal system bleeding can be reduced.

Anahtar Kelimeler

Gastrointestinal system bleeding, endoscopy, nonvariceal bleeding

Varis dışı üst gastrointestinal sistem kanamaları: Son 25 yılda ne değişti?

Öz

Giriş
ve Amaç: Çalışmamızda kliniğimizde son 1 yılda varis dışı
üst gastrointestinal sistem kanaması tanısıyla özofagogastroduodenoskopi yapılan
vakaların incelenmesi, 1993 ve 2008 yılındaki verilerle karşılaştırılması
amaçlanmıştır. Gereç ve Yöntem:
S.B.Ü. Derince Eğitim ve Araştırma Hastanesi Gastroenteroloji Kliniği’nde son 1
yılda varis dışı üst gastrointestinal sistem kanama tanısıyla özofagogastroduodenoskopi
yapılan tüm hastalar, retrospektif olarak taranmıştır. Tespit edilen toplam 160
hastanın demografik verileri, komorbiditeleri ve özofagogastroduodenoskopi sonuçları
analiz edilmiştir. Elde edilen sonuçlar aynı bölgede elde edilen 1993 ve 2008
verileri ile karşılaştırılmıştır. Bulgular:
Erkek kadın oranı 2:1, ortalama yaş 59.8’dir. En sık gastritler, ikinci olarak
peptik ülser saptanmıştır. Ülserler en sık bulbusta görülmüştür. Bulbus
ülserlerinde antruma göre aktif kanama bulguları daha sıktır. 1993 ve 2008
verilerine göre yaş ortalaması ve kadınların oranı artış göstermektedir.
Duodenal ve gastrik ülserler anlamlı ölçüde azalırken gastritlerin oranı
artmaktadır. Sonuç: Varis dışı üst gastrointestinal
sistem kanamaları erkeklerde ve ileri yaşta daha fazladır. Son 25 yılda artan
yaşam süresi ve Helicobacter pylori
tedavi başarısındaki artışa bağlı olarak hastaların ortalama yaşları artmakta,
ülser sıklığı azalmaktadır. Güncel tedavi yaklaşımları sayesinde gastrointestinal
sistem kanamalarına bağlı mortalite oranları azaltılabilir.

Anahtar Kelimeler

Gastrointestinal sistem kanaması, endoskopi, varis dışı kanama

Kaynakça

• 1. Colle I, Wilmer A, Le Moine O, Debruyne R, Delwaide J, Dhondt E, et al. Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children. Acta Gastroenterol Belg 2011;74:45-66. 2. Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med 2008;359:928-37. 3. Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992;102:139-48. 4. Biecker E. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding. World J Gastrointest Pharmacol Ther2015;6:172-82. 5. Kao CY, Sheu BS, Wu JJ. Helicobacter pylori infection: An overview of bacterial virulence factors and pathogenesis. Biomed J 2016;39:14-23. 6. Pang SH, Leung WK, Graham DY. Ulcers and gastritis. Endoscopy 2008;40:136-9. 7. Matsui H, Shimokawa O, Kaneko T, Nagano Y, Rai K, Hyodo I. The pathophysiology of non-steroidal anti-inflammatory drug (NSAID)-induced mucosal injuries in stomach and small intestine. J Clin Biochem Nutr 2011;48:107-11. 8. Samuel R, Bilal M, Tayyem O, Guturu P. Evaluation and management of Non-variceal upper gastrointestinal bleeding. Dis Mon 2018;64:333-43. 9. Sezikli M, Tiftikçi A, Çetinkaya ZA, et al. Son 15 yılda akut üst gastrointestinal sistem kanaması olan hastaların endoskopik bulgularında ne değişti? Akademik Gastroenteroloji Dergisi 2008;7:152-5.
• 10. Laine L. Approaches to nonsteroidal anti-inflammatory drug use in the high-risk patient. Gastroenterology 2001;120:594-606. 11. Telaku S, Kraja B, Qirjako G, Prifti S, Fejza H. Clinical outcomes of nonvariceal upper gastrointestinal bleeding in Kosova. Turk J Gastroenterol 2014;25(Suppl 1):110-5. 12. Bayindir Bilman F, Ozdemir M, Baysal B, Guzel Kurtoglu M. Prevalence of H. pylori in gastric biopsy specimen in the southeastern region of Turkey. J Infect Dev Ctries 2016;10:1177-82. 13. Loperfido S, Baldo V, Piovesana E, Bellina L, Rossi K, Groppo M, et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc 2009;70:212-24. 14. Akkan Çetinkaya Z, Sezikli M, Bünül F, Şirin G. A revision of patients who underwent gastroscopy because of non-variceal upper gastrointestinal bleeding in the last year. Kocaeli Med J 2013;2:11-4. 15. Sung JJ, Chiu PC, Chan FKL, Lau JY, Goh KL, Ho LH, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut 2018;67:1757-1768. Epub 2018 Apr 24. 16. Blair SD, Janvrin SB, McCollum CN, Greenhalgh RM. Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg 1986;73:783-5. 17. Zakko L, Rustagi T, Douglas M, Laine L. No benefit from platelet transfusion for gastrointestinal bleeding in patients taking antiplatelet agents. Clin Gastroenterol Hepatol 2017;15:46-52. 18. Yen HH, Yang CW, Su WW, Soon MS, Wu SS, Lin HJ. Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful endoscopic therapy. BMC Gastroenterol 2012;12:66. 19. Khuroo MS, Yattoo GN, Javid G, Khan BA, Shah AA, Gulzar GM, et al. A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med 1997;336:1054-8. 20. Javid G, Masoodi I, Zargar SA, Khan BA, Yatoo GN, Shah AH, et al. Omeprazole as adjuvant therapy to endoscopic combination injection sclerotherapy for treating bleeding peptic ulcer. Am J Med 2001;111:280-4.