The effect of altitude difference on gastrointestinal bleeding in the chronic period

Abstract

Aim: The susceptibility to gastrointestinal bleeding is observed with an increase in altitude. There is no recommendation regarding altitude in terms of drug selection and dose to be used in diseases requiring antiaggregant and anticoagulant use. In this study, we aimed to determine whether there is a difference between gastrointestinal bleeding requiring hospitalization due to the use of antiaggregant and/or anticoagulant therapy between two populations living at different altitudes. Material and Method: This retrospective study was performed in two secondary care hospitals. Patients from Group B living in villages with an altitude of 9842 ft and above and Group F patients living in an area with an altitude of 30 ft were included. Patient’s demographic data, co-morbid diseases, antiaggregant and anticoagulant use, hemoglobin, hematocrit, MCV values and platelet count were noted. Results: The study included a total of 118 patients with gastrointestinal bleeding. There was no statistically significant difference between the groups in terms of the drugs used by the patients, the types and numbers of drugs. Conclusion: We found that there was no significant difference between the groups with different altitudes in terms of drugs used by patients with gastrointestinal bleeding, drug types and numbers.

Keywords

• Gastrointestinal bleeding
• high altitude
• antiagreggran
• anticoagulant

References

1. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42: 373-498.
2. Caprio FZ, Sorond FA. Cerebrovascular disease: primary and secondary stroke prevention. Med Clin North Am 2019; 103: 295-308.
3. Gremmel T, Michelson AD, Frelinger III AL, Bhatt DL. Novel aspects of antiplatelet therapy in cardiovascular disease. Res Pract Thromb Haemost 2018; 2 : 439-49.
4. Buckley LF, Rybak E, Aldemerdash A, Cheng JW, Fanikos J. Direct oral anticoagulants in patients with atrial fibrillation and renal impairment, extremes in weight, or advanced age. Clin Cardiol 2017; 40: 46-52.
5. Villain C, Liabeuf S, Metzger M, et al. Impact of age on cardiovascular drug use in patients with chronic kidney disease. Clin Kidney J 2020; 13: 199-207.
6. Fruehauf H, Vavricka SR, Lutz TA, et al. Evaluation of acute mountain sickness by unsedated transnasal esophagogastroduodenoscopy at high altitude. Clin Gastroenterol Hepatol 2020; 18: 2218-25.
7. Wu TY, Ding SQ, Liu JL, et al. High-altitude gastrointestinal bleeding: an observation in Qinghai-Tibetan railroad construction workers on Mountain Tanggula. World J Gastroenterol 2007; 13: 774-80.
8. Waeber B, Kayser B, Dumont L, Lysakowski C, Tramer MR, Elia N. Impact of study design on reported incidences of acute mountain sickness: a systematic review. High Alt Med Biol 2015; 16: 204-15.

9. Cerit M, Erdoğan M. Yüksek irtifa fizyolojisi ve adaptasyonun askeri fiziksel hazırlık seviyesine etkilerinin değerlendirilmesi. Kara Harp Okulu Bilim Dergisi 2019; 1: 1-15.
10. Wang SH, Chen YC, Kao WF, et al. Epidemiology of acute mountain sickness on Jade Mountain, Taiwan: an annual prospective observational study. High Alt Med Biol 2010; 11: 43-49.
11. Richalet JP, Julia C, Lhuissier FJ. Evaluation of the Lake Louise Score for acute mountain sickness and its 2018 Version in a cohort of 484 trekkers at high altitude 2021; 22: 353-61.
12. Wu TY, Ding SQ, Liu JL, et al. Who should not go high: chronic disease and work at altitude during construction of the Qinghai-Tibet railroad 2007; 8: 88-107.
13. Khanna K, Mishra KP, Ganju L, Kumar B, Singh SB. High-altitude-induced alterations in gut-immune axis: a review. Int Rev Immunol 2018; 37: 119-26.
14. Gassmann M, Mairbäurl H, Livshits L, et al. The increase in hemoglobin concentration with altitude varies among human populations. Ann N Y Acad Sci 2019; 1450: 204-20.
15. Hudson JG, Bowen AL, Navia P, et al. The effect of high altitude on platelet counts, thrombopoietin and erythropoietin levels in young Bolivian airmen visiting the Andes. Int J Biometeorol 1999; 43: 85-90.
16. Li K, Gesang L, He C. Mechanism of apoptosis involved in gastric mucosal lesions in Tibetans with high-altitude polycythemia. Exp Ther Med 2017; 14: 3780- 3787.
17. Aksel G, Çorbacıoğlu ŞK, Özen C. High-altitude illness: Management approach. Turk J Emerg Med 2019; 19: 121-6.
18. Aktaş HŞ. The role and importance of antiagregan, anticoagulant drugs in the etiology of upper gastrointestinal system bleeding in elderly. Haydarpaşa Numune Med J 2019; 59: 250-255.
19. Lenti MV, Pasina L, Cococcia S, et al. Mortality and risk factors for gastrointestinal bleeding in elderly patients. Eur J Intern Med 2019; 61: 54-61.
20. Mahajan P, Chandail VS. Etiological and endoscopic profile of middle aged and elderly patients with upper gastrointestinal bleeding in a tertiary care hospital in North India: a retrospective analysis. J Midlife Health 2017; 8: 137-41.
21. Heikura IA, Burke LM, Bergland D, Uusitalo ALT, Mero AA, Stellingwerff. Impact of energy availability, health, and sex on hemoglobin-mass responses following live-high-train-high altitude training in elite female and male distance athletes. Int J Sports Physiol Perform 2018; 13: 1090-6.
22. Akunov A, Sydykov A, Toktash T, Doolotova A, Sarybaev A. Hemoglobin changes after long-term intermittent work at high altitude. Front Physiol 2018; 9: 1152.
23. Moore LG. Measuring high-altitude adaptation. J Appl Physiol 2017; 123: 1371-85.
24. Storz JF, Cheviron ZA. Physiological genomics of adaptation to high-altitude hypoxia. Annu Rev Anim Biosci 2021; 9: 149-71.
25. Mieske K, Flaherty G, O’Brein T. Journeys to high altitude-risks and recommendations for travelers with preexisting medical conditions. J Travel Med 2010; 17: 48-62.
26. Amatya B, Lakhey PJ, Pandey P. Perforation peritonitis at high altitude. JNMA J Nepal Med Assoc 2018; 56: 625-8.
27. Vearrier D, Greenberg MI. Occupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance. Clin Toxicol (Phila) 2011; 49: 629-40.
28. Agarwal A, Benias P, Gutierrez OIB, et al. Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience. Endosc Int Open 2018; 6: 1439-44.
29. Lv M, Zheng X, Wu T, et al. A new score for predicting acute gastrointestinal bleeding in patients administered oral antiplatelet drugs. Front Pharmacol 2021; 11: 2245.
30. Solakoğlu T, Köseoğlu H, Atalay R, et al. Impact of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs on hospital outcomes in patients with peptic ulcer bleeding. Saudi J Gastroenterol 2014; 20: 113-9.