上消化道出血病因趋势及相关因素分析

目的探讨近10年来上消化道出血（upper gastrointestinal bleeding，UGB）的病因构成、发病趋势及与几个相关因素的关系。方法对1995～2004年期间在我院行胃镜检查并明确病因的l909例上消化道出血病人的临床资料进行统计分析。结果①上消化道出血主要病因依次为十二指肠球部溃疡、食管胃底静脉曲张、胃溃疡、出血性胃炎、胃癌、复合性溃疡。其中十二指肠球部溃疡的发病呈上升趋势，胃癌所致出血则有下降趋势。②发生上消化道出血以中年组最多，其次是青年组，老年组最少，且青年人发病呈上升趋势。③上消化道出血男性病人明显多于女性病人。④上消化道出血及常见病因的发病多见于春秋冬季，夏季最少，但无统计学意义。结论十二指肠球部溃疡是上消化道出血最主要病因，且有上升趋势，其次是食管胃底静脉曲张、胃溃疡，而胃癌的发病构成有下降。上消化道出血的分布与年代变化、年龄、性别、季节等因素相关。     

青年士兵上消化道出血相关因素分析

上消化道出血是部队战士的常见病。我院自1988年1月至1998年10月间共收治上消道出血的青年士兵218例,本文着重对上消化道出血与战士兵龄、籍贯、发病季节、诱发因素、吸烟的关系及上消化道出血的病因进行回顾性分析,从中发现青年士兵上消化道出血的发病特点及规律,为部队防治此类疾病作参考。临床资料一、一般资料:218例中男性206例,女性12例;年龄16～20岁99例,21～25岁119例;南方籍战士82例,北方籍战士136例;1年兵龄130例(其中新兵87例),2年兵龄36例,3年兵龄34例,3年以上兵龄18例。二、诱发因素:218例患者中未发现诱因者98例,有明显诱因者1…     

上消化道出血合并肺栓塞4例临床和相关因素分析

目的探讨上消化道出血合并肺栓塞的临床特点及相关因素。方法对本院2000－2003年收治的4例上消化道出血合并肺栓塞患者进行回顾性分析。结果上消化道出血与肺栓塞之间可能存在相关因素：出血导致机体凝血机制异常、止血药物的不规范或大量使用、消化道出血患者长期卧床制动等。结论消化道出血患者有并发肺栓塞可能，重视相关危险因素，对预防和早期诊断肺栓塞以及改善预后较为重要。     

肝硬化上消化道出血与相关因素分析

对肝炎后肝硬化E消化道出血怎样选择最佳服药时间或最佳手术时间，应引起重视。     

86例重度食管静脉曲张患者上消化道出血的相关因素分析

目的：探讨重度食管静脉曲张患者出血与临床的相关因素。方法：86例分为出血组和未出血组,分别比较年龄、凝血酶原时间（PT）、凝血因子、肝纤维化指标（HA、CG、PCⅢ、IVC、LN、SA）、血小板计数（BPC）、脾厚度及斜径、Child-Pugh分级有胃镜下的形态学变化。结果：出血组PT延长,HA升高,BPC减少,Child-Pugh C级,胃镜下红色征与未出血组比较有显著性差异。P值分别为＜0．02、＜0．05、＜0．05、＜0．05、＜0．01。结论：PT、HA、BPC、Child-Pugc C级及胃镜下红色征可作为预测出血的主要因素。     

老年性上消化道出血病因分析

目的探讨老年人上消化道出血的原因。方法对我院2002年12月-2006年12月的病例进行病因分析。结果本组老人以消化性溃疡占首位，其次是慢性胃炎，而肿瘤为第三位。结论老年人上消化道出血的主要病因是消化性溃疡、胃黏膜糜烂及胃癌。     

102例老年人急性上消化道出血病因分析

目的探讨老年人上消化道出血的病因。方法回顾性总结102例老年人急性上消化道出血的病因,与同期住院非老年人上消化道出血患者150例就出血病因进行对比分析。结果老年组患者胃溃疡33例,占32.4%,十二指肠球部溃疡21例,占20.5%;急性胃黏膜病变32例,占31.4%;食管癌及胃癌11例,占10.8%;食管静脉曲张2例,占2.0%;原因不明3例,占2.9%。非老年组患者胃溃疡38例,占25.3%;十二指肠球部溃疡67例,占44.6%;急性胃黏膜病变25例,占16.7%;食管静脉曲张12例,占8.0%;食管癌及胃癌5例,占3.3%;食管贲门黏膜撕裂症2例,占1.3%;胃息肉1例,占0.7%。结论老年人上消化道出血主要病因为消化性溃疡、胃黏膜糜烂、肿瘤。     

肝硬化合并上消化道出血病因探讨——附80例分析

肝硬化合并上消化道出血病因探讨──附８０例分析张桂华，陈玉林（徐州市第六人民医院内科徐州２２１００６）肝硬化门静脉高压引起的食管胃底静脉曲张破裂出血，是肝硬化门脉高压的主要并发症之一，但自从急诊胃镜开展以来，发现肝硬化合并上消化道出血除食管胃底静脉曲...     

1520例上消化道出血病因和临床特点分析

目的研究近6年本院收治的上消化道出血患者的病因结构变化及临床发病特点。方法 对我院消化内科2004年至2009年1520例上消化道出血病人的临床资料进行回顾性调查分析。结果 （1）男性多于女性,男：女=3.4：1,平均年龄52.8岁（14～102岁）。死亡38例（2.5%）,52.6%死于大出血,47.4%死于非出血相关性疾病。（2）上消化道出血前5位病因依次是消化性溃疡、食管胃底静脉曲张、胃癌、食管-贲门黏膜撕裂症和急性胃黏膜病变。（3）大于60岁老年病人发病率呈上升趋势。2004～2009年发病情况如下：31.1%、31.9%、32.4%、42.7%、38.1%、50.5%,胃癌是其首要病因（21.6%）。结论 与过去参考文献相比,食管胃底静脉曲张发病不断上升,而急性胃黏膜病变发病明显下降。随年龄增加,十二指肠溃疡发病降低,胃溃疡和胃癌发病增加。老年病人占上消化道出血病人比例越来越大,尤其是合并严重基础疾病的老年病人有高危死亡风险,成为了临床治疗的重点。     

上消化道出血急诊胃镜173例病因分析

我院急救中心近3年半共收治急性上消化道出血184例,其中173例于发病后48h内经急诊胃镜检查明确病因,分析如下.临床资料一般资料 男115例,女58例,年龄18～76岁,其中年龄<20岁7例,20～29岁30例,30～39岁34例.40～49岁46例,50～59岁28例,>60岁     

Epidemiology of acute upper gastrointestinal bleeding

Acute upper gastrointestinal bleeding is an important emergency situation. Population-based epidemiology data are important to get insight in the actual healthcare problem. There are only few recent epidemiological surveys regarding acute upper gastrointestinal bleeding. Several surveys focusing on peptic ulcer disease showed a significant decrease in admission and mortality of peptic ulcer disease. Several more recent epidemiological surveys show a decrease in incidence of all cause upper gastrointestinal bleeding. The incidence of peptic ulcer bleeding remained stable. Peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, responsible for about 50% of all cases, followed by oesophagitis and erosive disease. Variceal bleeding is the cause of bleeding in cirrhotic patients in 50-60%. Rebleeding in upper gastrointestinal bleeding occurs in 7-16%, despite endoscopic therapy. Rebleeding is especially high in variceal bleeding and peptic ulcer bleeding. Mortality ranges between 3 and 14% and did not change in the past 10 years. Mortality is increasing with increasing age and is significantly higher in patients who are already admitted in hospital for co-morbidity. Risk factors for peptic ulcer bleeding are NSAIDs use and H. pylori infection. In patients at risk for gastrointestinal bleeding and using NSAIDs, a protective drug was only used in 10%. COX-2 selective inhibitors do cause less gastroduodenal ulcers compared to non-selective NSAIDs, however, more cardiovascular adverse events are reported. H. pylori infection is found in about 50% of peptic ulcer bleeding patients. H. pylori should be tested for in all ulcer patients and eradication should be given.     

Influence of climatic factors in the incidence of upper gastrointestinal bleeding

BACKGROUND AND AIM: Previous reports have indicated seasonal fluctuations in the incidence of peptic ulcer activity, but the reasons for the seasonal pattern are not clear. We assessed the seasonal incidence of hematemesis caused by peptic ulcers or gastroesophageal varices, and the correlations between those and climatic factors. METHODS: We examined the number of cases of upper gastrointestinal (GI) bleeding caused by gastric ulcer (GU), duodenal ulcer (DU), or gastroesophageal varices (varix) diagnosed by urgent endoscopies between 1 January 1996 and 31 December 1999 in our hospital (Tokyo Metropolitan Bokutou Hospital). We evaluated the monthly and seasonal incidence of them and investigated correlations among the incidence and climatic factors. RESULTS: Four hundred and forty-one patients participated in this study, including 275 patients with GU (62.4%), 51 (11.6%) with DU, and 115 (26.0%) with varix. The number of cases of hematemesis caused by GU showed significant monthly and seasonal fluctuations (P = 0.0002, P = 0.0018): it decreased in summer and increased in autumn-winter. Moreover, there were inverse relations between the monthly number of cases of hematemesis caused by GU and the mean temperature (P = 0.0016) and vapor pressure (P = 0.0013), and a parallel relation to the mean atmospheric pressure (P = 0.0057). In contrast, the number of cases of hematemesis caused by DU and varices did not show any monthly or seasonal fluctuations. CONCLUSIONS: We found that the incidence of hematemesis because of GU had an inverse relationship to temperature and vapor pressure, and had a parallel relation to atmospheric pressure. Therefore, climatic factors may play an important role in hemorrhage from GU.     

Treatment of upper gastrointestinal bleeding in 2020: New techniques and outcomes

The clinical outcome of upper gastrointestinal bleeding has improved due to advances in endoscopic therapy and standardized peri‐endoscopy care. Apart from validating clinical scores, artificial intelligence‐assisted machine learning models may play an important role in risk stratification. While standard endoscopic treatments remain irreplaceable, novel endoscopic modalities have changed the landscape of management. Over‐the‐scope clips have high success rates as rescue or even first‐line treatments in difficult‐to‐treat cases. Hemostatic powder is safe and easy to use, which can be useful as temporary control with its high immediate hemostatic ability. After endoscopic hemostasis, Doppler endoscopic probe can offer an objective measure to guide the treatment endpoint. In refractory bleeding, angiographic embolization should be considered before salvage surgery. In variceal hemorrhage, banding ligation and glue injection are first‐line treatment options. Endoscopic ultrasound‐guided therapy is gaining popularity due to its capability of precise localization for treatment targets. A self‐expandable metal stent may be considered as an alternative option to balloon tamponade in refractory bleeding. Transjugular intrahepatic portosystemic shunting should be reserved as salvage therapy. In this article, we aim to provide an evidence‐based comprehensive review of the major advancements in endoscopic hemostatic techniques and clinical outcomes.     

内镜治疗在急性非静脉曲张上消化道出血中的应用

急性非静脉曲张上消化道出血是临床常见的急危重症。内镜技术在急性非静脉曲张上消化道出血的治疗中有重要价值。近年此领域有了持续的新进展。本文即就内镜治疗对急性非静脉曲张上消化道出血的适宜治疗患者、治疗时机以及治疗方法和策略等方面给予简述。     

Acute upper gastrointestinal bleeding in octogenarians： Clinical outcome and factors related to mortality

AIM： To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding （AUGIB） in octogenarians.
METHODS： We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups： Group A （65-80 years old） and Group B （〉 80 years old）. RESULTS： Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B 147 patients. Co-morbidity was more common in octogenarians （P = 0.04）. The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians （P = 0.05） and more patients died in the group of octogenarians compared to the younger age group （P = 0.02）. Inability to perform endoscopic examination （P = 0.002）, presence of high risk for rebleeding stigmata （P = 0.004）, urea on admission （P = 0.036）, rebleeding （P = 0.004） and presence of severe co-morbidity （P 〈 0.0001） were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality （P = 0.032）.
CONCLUSION： While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.     

急性非静脉曲张性上消化道出血临床分析

目的分析非静脉曲张性上消化道出血的临床特征。方法回顾分析我院消化内科2009年1月-2011年12月期间收治的经胃镜证实的301例非静脉曲张性上消化道出血病例,分析总结非静脉曲张性上消化道出血的常见病因及临床诊治情况。结果非静脉曲张性上消化道出血的常见病因依次为消化性溃疡、消化道肿瘤、急性胃黏膜病变,内科保守治疗的有效率为96.35%(290/301),内镜下止血成功率93.55%(58/62)。结论消化性溃疡是非静脉曲张性上消化道出血最常见的病因。在消化道出血的救治中,急诊内镜、选择性血管造影以及内外科的紧密配合与协作发挥着重要作用。