老年人的胃、十二指肠溃疡

近年来社会人口迅速高龄化,日本1986年的调查,60岁以上的老年人多达1842万人,占全人口的15.2％,老年人的胃、十二指肠溃疡患者随之增加。一般认为,老年人的胃溃疡较多,而十二指肠溃疡也不少,巨大的十二指肠溃疡出血也颇常见。作者等将1976年1月至1985年12月间经首次胃内窥镜检查诊断为胃、十二指肠溃疡的患者3696例作了分析,就老年人胃、十二指肠溃疡病的特点进行探讨。发生率 3696例中60岁以上者752例,占20.4％,与其在全人口中的比率(15.2％)相比,其发生率较高。作者等的资料,胃溃疡所占比例从10～19岁的17.1％。逐渐增加到80～89岁86.5％;而十二指     

老年消化性溃疡出血120例护理体会

2000年1月至2002年1月,我科共收治老年消化性溃疡出血者120例,由于正确治疗及精心护理,患者恢复良好,现将护理体会报告如下。 临床资料:本组120例中,男90例,女30例,年龄60～83岁,平均72岁。120例患者均经纤维胃镜检查确诊为消化性溃疡。其中胃溃疡出血52例,十二指肠溃疡出血30例,复合性溃疡出血38例。保守治疗117例,3例转外科手术治疗。120例均于2天内出血停止,无1例死亡。 急救与护理:①快速建立两条以上静脉通路,保证在短时间内补充足量的液体及药物。因失血静脉穿刺困难者行静脉切开,失血性休克患者争取在1小时内输入2000ml左右液体,根据血压调整输液输血速度,使休克及早控制。②当患者     

产后失血性休克患者的急救与护理

临床上把胎儿娩出24小时内阴道流血量达400ml以上者称产后出血;产后出血性休克是由于大量失血导致有效循环量骤减而引起的周围循环衰竭。严重产后出血发生休克是引起产妇死亡的原因之一。2000年1月～2001年1月,我院抢救成功9例,现将急救护理过程及体会报告如下。 临床资料:本组宫缩乏力6例,胎盘、胎膜残留2例,软产     

441例老年人上消化道出血临床分析

本文对我院1976～1990年间60岁以上的急性消化道出血住院患者441例作临床分析,以引起人们的重视。临床资料:本组男性347例,女性94例。于60～69岁年龄组多见(占69.85％),病史最长50年,最短为2小时,首次出血者334例,二次以上出血者107例,其中6次出血者2例,8次出血者3例,出血于冬春季节多见。临床表现:患者可有黑便、呕血、呕血兼黑便、上腹隐痛或闷胀、头晕、出冷汗、昏厥、休克、胸闷、心悸等不同表现。出血原因:本组经纤维胃镜、胃肠钡餐及手术而确诊的238例中,主要病因依次为,十二指肠溃疡(109     

失血性休克并瞳孔散大抢救成功五例

失血性休克是创伤患者经常发生的综合征,一旦瞳孔散大,抢救成功者不多见,我院于2004年1月～2005年1月抢救成功5例失血性休克并瞳孔散大患者,现报道如下。1资料与方法1.1一般资料本组5例,其中男4例,女1例;年龄20～56岁,平均44岁;多发复合伤3例,胸部刀刺伤1例,消化道出血1例;手术4例,非手术1例,其中手术前已发生昏迷并瞳孔散大者1例,手术后发生者3例;伴肺损伤4例;瞳孔散大持续时间:5h～12h,平均8h,昏迷时间:8h～40d。入院时头颅CT排除脑挫裂伤及颅内血肿。1.2方法所有患者采用锁骨下静脉置管术,评价循环容量;早期补充红细胞悬液,迅速提高血细…     

老年人上消化道出血154例临床分析

目的探讨老年人上消化道出血的临床特点。方法回顾性分析我院2003年1月～2007年12月间收治的154例以上消化道出血为主要表现的老年病人的临床特点,并与同期中青年病例比较。结果与中青年人相比,老年人上消化道出血存在明显诱因者较少见（39．6％）,出血方式表现为呕血者较少见（21．6％）,其伴随疾病（49．4％）和并发症（21.4％）较多,再出血率（16．9％）和死亡率（11．7％）较高。出血病因中,老年人以胃溃疡最多见（27．9％）,其次为十二指肠溃疡（18．8％）及胃癌（18．2％）;而中青人以十二指肠溃疡（34．3％）最多见,其次为胃溃疡（16．3％）及胃癌（10．6％）。老年人胃溃疡及胃癌出血的发生率均高于中青年人,而十二指肠溃疡出血的发生率则低于中青年人（P〈O．05）。结论老年人上消化道出血以消化性溃疡多见,胃溃疡及胃癌出血的发生率较高,伴随疾病和并发症多,再出血率和死亡率高。     

改进式断流术治疗门脉高压症并出血

1986年2月至1998年2月,我院采用改进式门奇静脉完全断流术治疗门脉高压症并出血患者50例,疗效满意,现报告如下临床资料:本组男35例,女15例;年龄22～76岁,平均44岁。大量出血20例,中量出血20例,小量出血10例;出血1次者35例、2次10例、3次5例。有肝硬化病史者38例,病史不详者12例。除13例因出血未触及脾脏外,余均有程度不同的脾肿大。19例有程度不同的腹水,余腹水征均阴性。入院时严重休克15例、中度休克10例、轻度休克5例。血色素低于70g/L20例、70～100g/L15例、100g/L以上者15例;外周血白细胞除5例正常外,余均在40×109/L以下。大便潜血…     

老年人急性上消化道出血146例病因探讨

目的探讨老年人急性上消化道出血的病因。方法将2012年1月至2015年12月武定县人民医院收治的146例老年人急性上消化道出血患者设为老年组,并将同时期我院接收的146例青壮年上消化道出血患者设为青壮年组。比较并分析两组患者的上消化道出血的病因。结果老年组急性上消化道出血的病因主要有胃溃疡、急性胃黏膜病变,以及胃癌或食管癌,且各项病因所占比例均高于青壮年组(P0.05)。结论导致老年人急性上消化出血的病因主要有胃溃疡、急性胃黏膜病变,以及胃癌或者食管癌的等。     

大肠镜检查234例中老年人下消化道出血原因分析

我们1994年6月～1999年10月对234例以便血为主诉的中老年人患者进行了大肠镜检查,现将结果分析于下。临床资料　男166例,女68例,年龄45～72岁,其中45岁以下者53例,45～60岁62例,>60岁者19例。发病至就诊时间3天～10年。全部病例均以便血为主要临床主诉,部分病例伴有粘液血便、腹泻、里急后重、腹痛、腹胀、腹部包块、肠梗阻。有休克症状的大出血者8例,血红蛋白降至100ｇ/Ｌ以下的中等量出血者53例,其余133例属轻度出血。器械与方法　全部病例均采用日本Ｏｌｙｍｐｕｓ20Ⅰ型大肠镜进行检查。中等量以上出血者一般在出血停止,休克症状改善后…     

老年人胃溃疡的X线特征

近３年来,我院收治老年人胃溃疡９１例,现报告如下,并讨论Ｘ线特征。一般资料：本组男６８例,女２３例;年龄６０～８７岁。病程＜１年者５３例,１～５年者３５例,２～４年者３例,最长１例达４０年。有烟酒嗜好４８例。临床表现以上腹部隐痛不适、呕吐为主。其中有...     

Source of upper gastrointestinal bleeding in patients with esophageal varices seen at endoscopy

Many claim that upper gastrointestinal hemorrhage in patients with varices is frequently not of variceal origin. Such teaching is contrary to our experience. We therefore reviewed the records of 127 consecutive patients with 165 episodes of acute upper gastrointestinal bleeding who were found to have esophageal varices by endoscopy. Varices were the only potential site of the index bleed in 101 of the 127 patients (79.5%). In addition to varices, other potential sites of bleeding were gastric ulcer in 9 (7%), Mallory-Weiss tear in 4 (3.1%), duodenal ulcer in 3 (2.3%), and multiple gastroduodenal erosions in 10 (7.8%). We used the characteristics of the clinical presentation (e.g., varix seen bleeding) and the known natural course of the variceal bleeding to attempt to define the site of bleeding in the group with more than one potential site. In 15 we could make a judgment as to the likely source: In 9 it was variceal and in 6 nonvariceal. When varices are seen at endoscopy in a patient with a major hemorrhage, they are responsible for the bleeding in greater than 80% of cases.     

Gastroduodenal ulcer incidence in patients with venous thromboembolism

The presence of peptic ulcer disease implies a high risk of bleeding in patients on heparin therapy. We reviewed our experience with 166 consecutive patients admitted because of venous thromboembolism. Of these 166 patients, 29 were referred for upper gastrointestinal endoscopy in order to detect the presence of any lesion that might contraindicate heparin therapy. A gastric ulcer was found in 10 patients, a duodenal ulcer in 11, and gastric erosions with signs of bleeding in 3 patients. Given the unexpectedly high frequency of ulcer in these patients, an upper gastrointestinal endoscopy was routinely performed early in the course of admission in 50 consecutive patients with venous thromboembolism. A gastric ulcer was found in 5 patients (10%), a duodenal ulcer in 7 (14%), and erosions in 2. Five of these patients had an unsuspected ulcer. A case can be made for prophylactic antiulcer therapy for all patients placed on anticoagulants for venous thromboembolism. Upper gastrointestinal endoscopy is indicated in patients with ulcer symptoms, in those with a previous history of peptic ulcer disease, and perhaps, in patients developing occult blood in the stools while on treatment with anticoagulants.     

Endoscopic hemostasis by using the TriClip for peptic ulcer hemorrhage: a pilot study

BACKGROUND: The feasibility, efficacy, and safety of the TriClip in the management of peptic ulcer hemorrhage in human beings are scarcely reported in the literature. OBJECTIVE: A pilot study was conducted to assess the feasibility, efficacy, and safety of the TriClip endoscopic clipping device in the control of peptic ulcer hemorrhage. DESIGN: Prospective evaluation. SETTING: Regional government hospital. PATIENTS: From July 2004 to January 2005, patients older than 16 years and with Forrest type I and IIa peptic ulcer hemorrhages were included in the study. INTERVENTIONS: TriClips were used for initial hemostasis. Salvage procedures, including adrenalin injection, heat probe application, argon plasma coagulation, or surgery will be carried out appropriately if TriClip failed to control bleeding alone. An endoscopy was repeated 24 hours later for the security of the TriClip and for any endoscopic evidence of recurrent bleeding. A follow-up endoscopy was performed 8 weeks later to assess ulcer healing. MAIN OUTCOME MEASUREMENTS: Procedure time, successful hemostatic rate, number of clips used, ulcer recurrent bleeding rate, complications, and ulcer healing rate were measured. LIMITATIONS: No comparative arm; pilot study only. RESULT: A total of 27 cases (11 women, 16 men) were included in the study, with a median age of 70 years (range 18-88 years). There were 19 cases of duodenal ulcer and 8 cases of gastric ulcer, with median size of 8 mm (range 2-20 mm). The rate of successful hemostasis in the first endoscopy by TriClips alone was 81.5% (22/27), with a median procedure time of 10 minutes (range 3-30 minutes). In the second endoscopy, the endoscopic recurrent bleeding rate was 14.8% (4/27) and the TriClips were found dislodged in 11 patients (40.7%). The permanent hemostasis rate was 67% (18/27). The overall failure rate was 33% (9/27). Three patients required blood transfusion before the first endoscopy. There was no morbidity or mortality observed in all cases. All ulcers healed after 8 weeks. CONCLUSIONS: The use of the TriClip is feasible in the initial control of peptic ulcer hemorrhage. However, we could not detect any obvious advantages in arresting bleeding vessels by using this new clipping device.     

北京地区25年来消化性溃疡及胃癌发病情况的演变

目的探讨25年来十二指肠球部溃疡(DU)、胃溃疡、胃癌及幽门螺杆菌(Hp)感染在胃镜检查中发生的改变。方法分析1980年1月至2004年12月于我院进行胃镜检查的所有病例,共计104987例。选择全部DU、胃溃疡、经病理证实的胃癌病例为研究对象,分为10～<20岁、20～<30岁、30～<40岁、40～<50岁、50～<60岁、60～<70岁、70～<80岁及≥80岁8个年龄组。结果DU共13684例,平均检出率为13.03%,1999年以后呈下降趋势;胃溃疡共4398例,平均检出率为4.19%,1996年以后呈下降趋势;胃癌共1732例,检出率波动于1.02%～2.36%之间,平均为1.68%,无明显变化。检出DU、胃溃疡、胃癌的平均年龄1980年时分别为39.9岁、47.2岁和55.5岁,2004年分别为43.3岁、55.2岁和61.1岁,其平均年龄均呈上升趋势。Hp的平均检出率为43.54%,1995年以后呈下降趋势。结论DU、胃溃疡、胃癌的检出年龄呈上升趋势;DU、胃溃疡及Hp的检出率近年呈下降趋势,胃癌的检出率无明显变化。     

Combined Upper and Lower Gastrointestinal Endoscopy: A Prospective Study in Alcoholic and Nonalcoholic Cirrhosis

Upper gastrointestinal hemorrhage is one of the more important complications of cirrhosis. Most of the available data regarding the prevalence of upper and lower gastrointestinal sites of bleeding in cirrhotic patients have been obtained in individuals with alcoholic cirrhosis evaluated in the course of an acute gastrointestinal bleeding episode. Few data exist, however, as to the prevalence of either potential bleeding sites or of normal endoscopic findings in hemodynamically stable individuals with cirrhosis of any etiology. Five hundred ten cirrhotic subjects, who were evaluated for possible liver transplantation (OLTx) between January 1985 and June 1987, were included in this study. Seventy-five had alcoholic cirrhosis and 435 had nonalcoholic cirrhosis of various etiologies. Of these 510 patients, 412 underwent combined upper and lower gastrointestinal endoscopy and 98 underwent upper gastrointestinal endoscopy alone. Gastritis, gastric and duodenal ulcer disease were found significantly (each at least p less than 0.025) more often in patients with alcoholic liver disease than in those with nonalcoholic liver disease. The prevalence of the various lower gastrointestinal lesions in both groups was similar. Of particular interest is the fact that in alcoholic cirrhotics, the prevalence of gastritis, gastric ulcer and duodenal ulcer disease was unrelated to the degree of portal hypertension, whereas in the nonalcoholic cirrhotics the prevalence of gastritis and duodenal ulcer disease but not gastric ulcer disease was associated significantly with the degree of portal hypertension as assessed by the presence or absence of large esophageal varices, ascites, and hepatic encephalopathy.     

Incidence and pattern of peptic ulcer bleeding in a defined geographical area. DUSUK Study Group.

Despite the introduction of effective medical treatment for peptic ulcer disease, no decrease in the incidence of bleeding has been observed. Unfortunately, most incidence studies rely on a questionable case ascertainment and poor data. We therefore conducted a prospective study, to achieve an unbiased estimate of incidence and pattern of peptic ulcer bleeding in Düsseldorf (Germany). In a 1-year period all patients with endoscopically verified peptic ulcer bleeding who were admitted to the departments of internal medicine or surgery in nine hospitals or seen by nine general practitioners offering endoscopic service were included in the study. Incidence rates were calculated in accordance with sociodemographic variables and expressed per 100,000 person-years of observation. The overall incidence of peptic ulcer bleeding was 51.4, with almost even rates for gastric (26.5) and duodenal (24.9) ulcer. Age was associated with an increased likelihood of bleeding in gastric ulcer patients of 19 per decade from about 40 years onwards (duodenal ulcer, 15). The incidence was about twice as high in men as in women (relative risk = 1.9). The pattern of peptic ulcer bleeding was similar in gastric and duodenal ulcers with regard to ulcer size, multiple lesions, and bleeding activity at endoscopy. However, patients with gastric ulcer bleeding had significantly more often accompanying or underlying diseases. No significant differences were observed between gastric and duodenal ulcer bleeding with regard to nonsteroidal antiinflammatory drug intake and ulcer history. The incidence rates in our study are in the upper range of the literature and comparable to rates from the USA and UK both before and after the introduction of H2 blockers. We hypothesize that the persistently high incidence rate is a superposition of two trends: higher incidences due to a more elderly and diseased population and more NSAID intake, and lower incidences due to effective medical treatment.     

Can clinical features predict the likelihood of finding abnormalities when using capsule endoscopy in patients with GI bleeding of obscure origin?

BACKGROUND: Capsule endoscopy is becoming the investigation of choice for GI bleeding of obscure etiology. This study examined whether clinical or other features predict an increased likelihood of finding a lesion in patients with this type of bleeding. METHODS: Clinical and other data were collected prospectively for 92 patients undergoing capsule endoscopy for GI bleeding of obscure origin. Patients were divided into two groups: those with overt bleeding (42 patients) and those with anemia alone (50 patients). The relationship between these data and the findings at capsule endoscopy was examined. RESULTS: A definite or probable cause of bleeding was found in 60 patients (angiodysplasias 47, tumor 7, ulcer 3, gastric antral vascular ectasia 2). There was no difference between the two groups with respect to age, gender, mode of presentation, duration of bleeding, or need for transfusion. Lesions were found as often in patients who had only one preceding endoscopy and colonoscopy as in those who had multiple procedures. Colonic cleansing and cecal imaging by the capsule did not influence the result. Hospitalized patients were more likely to have an actively bleeding lesion detected. CONCLUSIONS: Capsule endoscopy is equally useful in patients with overt and occult GI bleeding of obscure origin. Capsule endoscopy should be performed early in the evaluation of these patients.     

急性非静脉曲张上消化道出血临床特征分析

目的分析急性非静脉曲张上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANNUGIB)病因构成、内镜下表现,探讨影响患者预后的危险因素。方法收集我院2005年1月-2010年12月已确诊因急性非静脉曲张上消化道出血(AN-VUGIB)首次入院且资料完整的患者临床资料,共计858例。出院后随访30 d,并将死亡或出院后30 d为临床研究终点,回顾性分析ANVUGIB临床特征。结果 (1)老年组发病率明显高于青、中年组,急性胃黏膜病变占老年组发病病因首位,而青、中年组中十二指肠球部溃疡占首位。(2)出血后行急诊胃镜(≤48 h)检查内镜下有出血征象明显多于>48 h的胃镜检查。(3)女性在十二指肠球部溃疡比率明显高于男性,复合性溃疡比率较男性高,男性在胃溃疡、胃癌、急性胃黏膜病变以及食管癌和Mallory-Wiess综合征比率高于女性。(4)老年组病死率明显高于青、中年组(6.8%、0、1.9%),老年组再出血发生率高于青、中年组(9.3%、4.4%、4.9%)。结论 ANVUGIB以高龄男性多见,青、中年组发病病因中十二指肠球部溃疡占首位,老年组发病病因以急性胃黏膜病变为首位。ANVUGIB老年患者死亡率和再出血率均高于青、中年组,急诊胃镜有助于ANVUGIB的诊断。     

Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer.

BACKGROUND: Although endoscopic injection therapy is effective in controlling initial haemorrhage from peptic ulcer, between 10% to 30% of patients suffer rebleeding. AIM: To assess the factors that may predict the failure of endoscopic injection in patients bleeding from high risk gastric ulcer. SUBJECTS: One hundred and seventy eight patients admitted for a gastric ulcer with a bleeding or a non-bleeding visible vessel were included. METHODS: Patients received endoscopic therapy by injection for adrenaline and polidocanol. Twelve clinical and endoscopic variables were entered into a multivariate logistic regression model to ascertain their significance as predictive factor of therapeutic failure. RESULTS: Eighty seven per cent (155 of 178) of patients had no further bleeding after endoscopic therapy. Endoscopic injection failed in 23 (13%) patients: 20 (12%) continued to bleed or rebleed, and three (1%) patients could not be treated because of inaccessibility of the lesion. Logistic regression analysis showed that therapeutic failure was significantly related to: (1) the presence of hypovolaemic shock (p = 0.09, OR 2.38, 95% CI: 0.86, 6.56), (2) the presence of active bleeding at endoscopy (p = 0.02, OR 2.98, 95% CI: 1.12, 7.91), (3) ulcer location high on the lesser curvature (p = 0.04, OR 2.79, 95% CI: 1.01, 7.69), and (4) ulcer size larger than 2 cm (p = 0.01, OR 3.64, 95% CI: 1.34, 9.89). CONCLUSION: These variables may enable identification of those patients bleeding from gastric ulcer who would not benefit from injection therapy.     

Time-trends in the epidemiology of peptic ulcer bleeding

OBJECTIVE: Despite the introduction of effective medical treatment of peptic ulcer disease, bleeding is still a frequent complication. The aim of this study was to investigate whether the incidence and the risk profile of peptic ulcer haemorrhage have changed within a 10-year period. MATERIAL AND METHODS: In a prospective epidemiological and observational study the incidence and risk profile of peptic ulcer haemorrhage in Düsseldorf, Germany were compared between two time periods (period A: 1.3.89-28.2.90 and period B: 1.4.99-31.3.2000), involving nine hospitals with both surgical and medical departments. Patients with proven peptic ulcer haemorrhage at endoscopy or operation were included in the study; those with bleeding under defined severe stress conditions were excluded. RESULTS: No differences in bleeding ulcer incidence were observed between periods A and B (51.4 per 100,000 person-years versus 48.7), or for duodenal ulcer (24.9 versus 25.7) or for gastric ulcer bleeding (26.5 versus 23.0). A marked increase in incidence rates was observed with increasing age. In period B, patients with bleeding ulcers were older (56% versus 41% 70 years or older), were usually taking non-steroidal anti-inflammatory drugs (NSAIDs) (45% versus 27%) and were less likely to have a history of ulcer (25% versus 59%) compared with patients in period A. CONCLUSIONS: The persisting high incidence of peptic ulcer disease is a superimposing of two trends: a higher incidence in the growing population of elderly patient with a higher intake of NSAIDs and a lower incidence among younger patients due to a decrease in incidence and improved medical treatment.