CLASIFICACION DE FORREST ULCERA PEPTICA PDF

Endoscopía: presencia de úlcera péptica, tamaño de la úlcera superior a 2 Clasificación de Forrest: Estigmas endoscópicos de sangrado reciente y. Manifestaciones Clínicas 70% Asintomáticas Epigastralgia Mecanismo Etiopatogénicos Ulcera del Canal Pilorico Epigastralgia que empeora. La ulcera péptica consiste en una pérdida de sustancia de 5mm o más, en la pared gástrica o duodenal, que se extiende en profundidad mas.

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Morales Uribe 1S.

Sierra Sierra 2A. Arango Durango 2 and G. Facultad de Medicina Universidad de Antioquia.

We included patients older than 15 years of age from two reference centers. We studied some demographic variables, history, clinical presentation, treatment and mortality. We explored the association betwen those variables and death. The mean age was Three hundred and fifty nine patients A total of The main causes of bleeding were peptic ulcer patients, Forty four patients died 9.

Patient who presented with bleeding due to other causes during hospitalization has a higher mortality risk than those whose complaints were related to gastrointestinal bleeding RR 2. An increasing number of comorbidities such as those described in the Rockall Score, were also associated with a higher risk of mortality RR 2.

Forrest classification

Intrahospital upper GI bleeding and the presence of comorbilities ares risk factors for a fatal outcome. Identifying patients with a higher risk would help improve the management of patients with UGIB.

Se exploraron las asociaciones de estas variables con el desenlace muerte.

Upper gastrointestinal bleeding is a common medical emergency and a frequent cause of morbidity and mortality. Peptic ulcers have been recognized as the leading cause of UGIB 2,5,6although recent studies have shown a decrease in the percentage 7,8. The use of proton pump inhibitors PPIs and the eradication of the Helicobacter pylori has decreased in recent decades, as has the percentage of patients who present with a reoccurrence of bleeding; however, the mortality rate has remained stable despite these and other developments, such as endoscopic treatment 9,10probably due to the increase in the average age of patients and the frequent and continuous use of nonstero idal anti-inflammatory drugs NSAIDs ulcra, The literature has reported numerous prognostic factors associated with death due to upper gastrointestinal bleeding UGIB.

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The inclusion criteria included patients who were older than 15 years of age, who were admitted to a hospital with a diagnosis of UGIB or developed UGIB during hospitalization, and who underwent upper gastrointestinal endoscopy EGD. To gather information, we used a form that included the variables of age, gender, period between admission and the conduction of endoscopy, hemodynamic status at admission, history of gastrointestinal bleeding, clinical presentation, comorbidities, use of a nasogastric tube, endoscopic diagnosis, duration of hospitalization, treatment and mortality.

The hemodynamic status was defined as unstable if the patient had a systolic blood pressure below 90 mmHg. The use of a nasogastric tube referred to its use at admission to confirm the presence of an upper acute bleeding or as part of UGIB management.

Hospital bleeding referred to the upper gastrointestinal bleeding that occurred in patients who were hospitalized for causes other than GI bleeding and who presented with bleeding during hospitalization. For analysis of the data, we used the statistical program SPSS We conducted a univariate analysis to explore the behavior of the variables, the quality of the data and the presence of external values.

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This analysis used descriptive statistics, such as means, proportions, standard deviations and ranges. We also conducted a bivariate analysis to explore the associations between some independent variables and the main outcome mortality.

This was performed using the chi-square statistic and the Mann Whitney U test. The general characteristics of the patients are shown in Table I. The average age was The youngest patient was 15 years old, and the oldest was 93 years old.

The most frequent reason for consultation was hematemesis One hundred and eight patients Some comorbidities and history factors were smoking Three hundred and nine patients We conducted an EGD within 24 hours in Erosive disease was responsible for Table II shows these and other results.

The pharmacological treatment received by the patients had the following distribution: Those patients were injected with adrenaline alone. We performed band ligation in 15 3. We also performed a new endoscopic evaluation in 79 This figure includes patients who underwent endoscopy for suspected reoccurrence of bleeding who were at risk for a reoccurrence of bleeding during the first endoscopy and cases that did not have a satisfactory first evaluation.

From this group, eight patients We conducted an angiographic evaluation in three patients 0. In one patient, we observed a bleeding of the forerst artery, which we controlled with embolization. In another patient, we observed active bleeding from the left gastric artery; however, we were not able to control this with embolization, and it required a gastrectomy for gastric carcinoma. The arteriography of the third patient did not show any bleeding or vascular malformation, and the recovery was successful without further treatment.

The diagnoses of these patients were gastric carcinoma 5 casesgastric ulcer 1 caseduodenal ulcer 1 caseDieulafoy’s lesion 1 caseerosive gastritis 1 caseand anastomotic mouth ulcer 1 case. We were not able to control the bleeding of the patient with a duodenal ulcer in the first procedure, and immediate surgery was indicated. The Dieulafoy’s lesion clasificaciom not identified in the endoscopy and required surgical treatment. The reoccurrence of bleeding was also an indication for surgery.

During the period of the study, another three patients were operated with urgency for ulcer disease without an endoscopy. Forest patients who presented with bleeding while hospitalized for another ulccera remained hospitalized for The mortality according to the value and its comparison with the probability of death according to the Rockall scale are also shown in Tables III and IV.

Table V shows the exploratory bivariate analysis of some variables that could be related to the probability of death. Patients who bleed during hospitalization for a different cause had a higher risk of dying than those patients who were seen for UGIB RR 2.

The rising value of the comorbidities assigned by Rockall was equally associated with the probability of death RR 2. The general characteristics of the studied group, including age, gender, history of previous bleeding, clinical presentation and comorbidities, were similar to literature reports The number of patients older than 60 years corresponded to half of the group; this percentage has increased according to recent studies 13, Current protocols suggest that an early risk stratification of patients according to clinical and endoscopic criteria, and the practice of early endoscopy before 24 hoursallow for a prompt and reliable release of those patients with a low risk and improve the prognosis of high-risk patients.

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Peptic ulcer disease has been recognized as the leading cause of UGIB 1,3,7,14, The classic study of Rockall, with more than 4. However, some question whether the incidence of ulcers is decreasing, or perhaps less published 7,8. This may reflect the widespread and protocol-based use of infusions of proton pump inhibitors beginning when the patient is admitted. Although the pharmacological approach is the cornerstone of treatment, interventional endoscopy is an excellent complement in patients who continue to have active bleeding, and a few cases require interventional radiology or even surgery.

In the studied group, the interventional endoscopy therapy was unimodal-injection epinephrine. The efficacy of this treatment is suboptimal and must be used in combination with other methods The current trend is to conduct a second endoscopy only in high-risk patients clinical or endoscopicthose in whom the first EGD was technically difficult or impossible and those with a reoccurrence of bleeding, which represented There was a significant difference between the observed deaths and the probability of death in patients with a pre-endoscopic Rockall score greater than or equal to four and with a post-endoscopic score greater than or equal to six.

This is probably due to the small number of patients with these values. For the lower values, the Rockall score offers a good predictive capacity in this group.

The mortality rate of this group is not different from other publicationsThe literature presents multiple risk factors associated with death, and some authors have suggested scores to classify the risk of patients with UGIB. In the exploration of risk in this group, we found two variables associated with death: A second article from the same authors mentions some of these comorbidities These findings should prompt the identification of patients who present with a higher risk of developing a fatal outcome; this will contribute to the improvement of the management of patients with UGIB, including an early therapeutic intervention.

Acute upper gastrointestinal haemorrhage.

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Br Med Bull ; Acute Upper GI Bleeding: Am J Gastroenterol ; Esrailian E, Gralnek IM. Nonvariceal Upper Gastrointestinal Bleeding: Gastroenterol Clin N Am ; Tariq SH, Mekhjian G. Incidence of and mortality from acute upper Gastrointestinal haemorrhage in the United Kingdom. Management of Acute Bleeding from a Peptic Ulcer.

N Engl Clasifucacion Med ; The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc ; Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur J Gastroenterol Hepatol ; Am Coll of Clasificacioh ; Acute upper gastrointestinal bleeding in octogenarians: Clinical outcome and factors related to mortality.

World J Gastroenterol 7;