中国上消化道出血的临床流行病学分析

目的 探讨中国上消化道出血的病因构成、临床特点及相关因素,探讨特殊人群的病因构成.方法 运用循证医学方法,检索中文数据库中有关上消化道出血病因相关分析的文献并获取全文,根据严格的纳入和排除标准对文献进行筛选,然后进行数据提取、汇总及分析.结果 (1)此项研究共纳入上消化道出血患者15733例;(2)十二指肠球部溃疡、胃溃疡、急性胃黏膜病变、恶性肿瘤、食管静脉曲张是中国上消化道出血的主要病因,分别占31.2％、15.2％、12.0％、11.7％、11.3％;(3)2000至2006年与2006至2011年相比,十二指肠球部溃疡、胃溃疡、急性胃黏膜病变、食管静脉曲张、恶性肿瘤的构成比分别是32.3％、15.1％、12.1％、7.2％、12.5％及29.7％、15.4％、11.1％、15.3％、10.9％;(4)男性患者明显多于女性患者,比例为3.25:1;(5)老年人上消化道出血的主要病因依次为胃溃疡、恶性肿瘤、急性胃黏膜病变、十二指肠球部溃疡、食管静脉曲张,小儿上消化道出血的主要病因依次为十二指肠球部溃疡、胃溃疡、急性胃黏膜病变.结论 消化性溃疡、急性胃黏膜病变、恶性肿瘤、食管静脉曲张是中国上消化道出血的主要病因.近5年上消化道出血的病因构成有明显变化.     

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。     

老年上消化道出血80例临床分析

目的探讨老年人上消化道出血的病因及临床特点。方法回顾性分析我院收治的155例上消化道出血患者临床资料,根据患者年龄将患者分为老年组（80例）和非老年组（75例）,比较两组之间的病因、合并症及预后等。结果老年组上消化道出血病因依次为消化性溃疡、急性胃黏膜病变、上消化道肿瘤及食管胃底静脉曲张破裂。老年组以胃溃疡为主占28.8%,而非老年组为13.8%,非老年组以十二指肠球部溃疡为主,占50.7%,老年组为18.8%,两组比较差异均有统计学意义（P〈0.05）;老年组合并症、再出血率及病死率均明显高于非老年组（P〈0.05）。结论老年人上消化道出血以消化性溃疡最为多见,伴发病多、预后差,应加强对老年上消化道出血的防治,以获得良好预后。     

老年人急性非静脉曲张性上消化道出血病因分析

目的分析老年急性非静脉曲张性上消化道出血(ANVUGIB)的病因。方法对解放军总医院消化内科2011年1月至2015年12月期间收治的233例老年ANVUGIB患者的临床资料进行回顾性分析。结果 233例老年ANVUGIB患者,年龄60~96(74.38±8.86)岁。最常见的病因为消化性溃疡(111例,占47.6%),内胃溃疡49例,十二指肠溃疡43例,复合溃疡19例。排在第二、三位的病因分别为消化系恶性肿瘤(74例,占31.8%)、急性胃黏膜病变出血(20例,占8.6%)。老年ANVUGIB的危险因素中,非甾体抗炎药(NSAIDs)及抗凝药物相关消化道出血占28.8%。性别亦是危险因素之一。结论消化性溃疡是老年ANVUGIB最常见的病因,NSAIDs及抗凝药物相关消化道出血是其最常见的危险因素。     

上消化道出血322例分析

目的探讨上消化道出血的原因和相关因素。方法回顾性分析我科2年来322例上消化道出血的临床资料。结果322例中通过检查有明确病因者293例,主要病因依次为消化性溃疡、急性胃粘膜病变、食管胃底静脉曲张、胃癌;男性明显高于女性;消化性溃疡占各年龄组上消化道出血的首位,中、青年组以十二指肠溃疡多见,老年组以胃溃疡多见;胃癌位于老年组上消化道出血的第二位,显著高于中、青年组(P<0.01)。结论上消化道出血的病人以消化性溃疡、胃癌、食道胃底静脉曲张、急性胃粘膜病变为最常见的病因,性别、年龄等均为上消化道出血的相关因素。     

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。     

426例上消化道出血的病因分析

目的:探讨我院近4年来上消化道出血(UGIB)的病因构成及相关因素分析。方法 :收集2013—2016年间我院收治的426例UGIB住院患者的临床资料,按年龄分为青年组、中年组和老年组,对病因及相关因素进行回顾性分析。结果:(1)平均年龄(54.1±17.1)岁,男女比例2.98∶1。青年组、中年组、老年组占比依次为24.9%、31.7%、43.4%。(2)消化性溃疡、食管胃底静脉曲张、急性胃黏膜病变为住院患者UGIB常见病因,分别占67.4%、21.4%、3.8%,2015—2016年较2013—2014年食管胃底静脉曲张占比下降,急性胃黏膜病变占比上升(均P0.05)。(3)胃溃疡以中老年为主(84.3%),十二指肠溃疡以青年组居多(43.6%)(P0.01)。食管胃底静脉曲张以中老年为主(94.5%)(P0.01),急性胃黏膜病变、胃癌以老年人为多见(81.3%、80.0%)(P0.01)。(4)消化性溃疡患者中幽门螺杆菌(Hp)感染137例(48.6%),39例(13.8%)长期口服非甾体类消炎药(NSAIDs)、抗凝剂、糖皮质激素类药物,Hp感染并NSAIDs服用者7例(2.5%)。食管胃底静脉曲张病因以肝硬化为主(98.9%),其中乙型肝炎(乙肝)后肝硬化占40.0%,主要以中年患者多见(66.7%)(P0.01)。急性胃黏膜病变患者中有口服NSAIDs及糖皮质激素类药物者6例(37.5%)。门脉高压性胃病患者病因也以乙肝后肝硬化为主(75.0%)。结论:UGIB以消化性溃疡为首要病因,近2年来静脉曲张总占比下降,急性胃黏膜病变占比上升。肝硬化、Hp感染、NSAIDs、抗凝剂、激素类药物的使用为UGIB主要因素。     

老年人上消化道出血临床特征及病因分析

目的分析老年人上消化道出血的临床特征、病因及预后。方法回顾性分析2010年10月-2012年10月我院消化科上消化道出血病例246例,分为两组:老年组87例、非老年组159例,对比两组在临床症状、失血严重程度、并存疾病、病因及预后的差异。结果老年组与非老年组呕血或黑便的发生率无明显差异(P>0.05)。老年组收缩压均值高于非老年组,脉搏与休克指数均值低于后者,并存疾病率较后者高,差异有统计学意义(P<0.01)。老年人上消化道出血的前五位病因依次为消化性溃疡(31例,35.6%)、食管胃底静脉曲张(20例,23.0%)、急性胃黏膜病变(17例,19.5%)、胃癌(13例,14.9%)、食管贲门黏膜撕裂综合征(2例,2.3%)。Blatchford评分老年组64例(73.6%)为中高危,与非老年组比较差异无统计学意义(P>0.05)。结论老年组呕血或黑便的发生率与非老年组相近,失血严重程度低于非老年组,并存疾病率高于非老年组。消化性溃疡、食管胃底静脉曲张、急性胃黏膜病变、胃癌、食管贲门黏膜撕裂综合征为老年人前五位的上消化道出血病因。两组预后评估均较差。     

64层螺旋CT扫描及其重建技术在儿童上消化道出血中的诊断价值

目的探讨分析64层螺旋CT扫描及其重建技术在儿童上消化道出血中的诊断价值。方法回顾性收集我院上消化道出血患儿50例,运用64层螺旋CT扫描及其重建技术进行分析。结果 CT检查示50例上消化道出血患儿中以急性胃黏膜病变及十二指肠溃疡为主要病因,其百分比分别为34.0%、24.0%,与胃镜结果比较CT诊断的敏感度为96.0%、准确度为92.6%。年龄越小的患儿急性胃黏膜病变发病越多,年龄大的患儿则更容易发生十二指肠溃疡(P0.05)。结论 64层螺旋CT扫描及其重建技术能够较好地用于诊断儿童上消化道出血,且能提高患儿配合度。     

急性非静脉曲张性上消化道出血评分系统的研究进展

正急性上消化道出血是指Treitz韧带近端的消化道,即食管、胃、十二指肠、胆道及胰管病变引起的急性出血,也包括胃空肠吻合术后吻合口附近病变引起的出血。临床上根据病因的不同,可将其分为急性静脉曲张性和非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)两类。     

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。     

Factors influencing mortality from bleeding peptic ulcers

The mortality, causes of death, and the factors that are influencing deaths from bleeding acute and chronic peptic ulcers were evaluated retrospectively. During a 2-year period (1986-87) 272 patients were endoscoped for acute gastrointestinal hemorrhage and were found to have bled from a peptic ulcer (chronic gastric ulcers, 90; chronic duodenal ulcers, 114; acute gastroduodenal ulcers, 66; stomal ulcers, 2). The overall mortality was 9.6% (n = 26) (gastric ulcers, 6.7%; duodenal ulcers, 11.4%; acute ulcers, 10.6%). Statistically significant factors adversely affecting prognosis for gastric ulcer were re-bleeding, need for operation and serious intercurrent illness; for duodenal ulcer were units of transfused blood, re-bleeding, signs of recent hemorrhage at endoscopy, need for operation, and serious intercurrent illness; and for acute ulcer were increasing age, shock, units of transfused blood, re-bleeding, and serious intercurrent illness. Multivariate analysis was only attempted for duodenal ulcers because of sample sizes; it suggested that active bleeding or visible vessel at endoscopy, re-bleeding, and serious intercurrent illness were independent factors for mortality. From this study it is apparent that the major determinants of a fatal outcome in bleeding peptic ulcer diseases were serious intercurrent illness and rebleeding. As it must be anticipated that patients with these particular problems are at high risk of a poor outcome, it follows that it is important they have access to skilled treatment as provided by a specialist team in an intensive care ward. It also follows that every effort should be made to keep ulcers in remission to free the ulcer patient of potentially lethal complications.     

Duodenal mucosal injury with nonsteroidal antiinflammatory drugs

The effect of nonsteroidal antiinflammatory drugs (NSAIDs) on duodenal mucosa was assessed both retrospectively and prospectively. In 444 patients with duodenal ulcer, the incidence of upper gastrointestinal bleeding was five times higher in 56 patients who were treated with NSAIDs than in those who did not receive NSAIDs. Indomethacin and naproxen had the most potent damaging effects. In a control group of patients with gastric ulcer, nine out of 134 had taken NSAIDs. The incidence of bleeding in these patients was three times higher than in those who were not on NSAIDs. The effect of indomethacin, 150 mg/day, on the upper gastrointestinal tract was examined in a prospective study of 75 patients with acute musculoskeletal disorders. Endoscopy after 1 week of therapy showed that 45% had mucosal damage in the duodenum, and this was as frequent and as severe as the gastric mucosal damage. In most instances, the duodenal damage was erosive duodenitis.     

Gastrointestinal Haemorrhage,Gastric Ulcer and Aspirin

In 1,634 admissions for acute gastroduodenal haemorrhage, the diagnosis was chronic peptic ulcer in two thirds, and “acute lesion” in one quarter. The age incidence of female gastric ulcer was bimodal, with peaks in the fifth and seventh decades. This was in conformity with previous observations of a younger group of female gastric ulcer patients in this community. A high proportion of this younger group took aspirin preparations regularly. 66% of the ulcer and "acute lesion" groups had taken aspirin before haemorrhage. However, in nearly 50% this was part of a regular habit of aspirin taking and in only 17% was it an isolated event. More of the “acute lesion” group took isolated aspirin before bleeding than the ulcer groups but the difference was not significant. The significance of isolated aspirin taking in the aetiology of acute gastroduodenal haemorrhage has been exaggerated by a failure to distinguish it from regular aspirin intake. In both males and females there was a significant association of gastric ulcer bleeding and regular aspirin consumption compared with the duodenal ulcer and “acute lesion” groups. Isolated aspirin taking occurred in those with pre-existing ulcer as well as those with “acute lesions”.     

Acute upper gastrointestinal hemorrhage in patients with chronic renal disease

In order to reassess the role of duodenal ulcers as a cause of acute upper gastrointestinal hemorrhage in patients with chronic renal failure, 20 consecutive patients with moderate to severe chronic renal failure and a comparison group of patients without renal disease who were seen for acute upper gastrointestinal hemorrhage were reviewed. Gastric bleeding sites (gastric ulcer in 35 percent and gastritis in 20 percent) rather than duodenal ulcers were the most common sources of bleeding and were significantly associated with the use of ulcerogenic drugs. Patients with renal disease in whom acute upper gastrointestinal hemorrhage developed had significantly more morbidity and a trend toward higher mortality than the comparison group of patients without renal disease. It is concluded that gastric mucosal lesions, at least in part due to the use of ulcerogenic drugs, are the most common cause of significant acute upper gastrointestinal hemorrhage in patients with chronic renal failure.     

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.     

Incidence and Pattern of Peptic Ulcer Bleeding in a Defined Geographical Area

Ohmann C, Thon K, Hengels K-J, Imhof M, Düsuk Study Group. Incidence and pattern of peptic ulcer bleeding in a defined geographical area. Scand J Gastroenterol 1992;27:571-581.

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 endoseopically 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,(1(10 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 H, 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.     

Post-bulbar and coexisting ulceration: unique features of peptic ulcer in Hyderabad.

Post-bulbar ulceration is uncommon, but a pilot study in Hyderabad showed a high incidence. We therefore carried out a prospective endoscopic study of the distribution of peptic ulceration and its relation to symptoms and demography. Of the 360 consecutive patients referred for endoscopy, 113 (92 men, 21 women) had peptic ulceration. Median age 35 years, median duration one year. Five patients (4%) had gastric ulcer, 77 (68%) had duodenal ulcer, and 31 (28%) had coexisting gastric and duodenal ulcer. The duodenal ulcer was found in the pyloric canal in 14% of patients, in the bulb in 80%, and the post-bulbar region in 56% of patients. Sixty seven per cent of duodenal ulcers were located at more than one site. The incidence of post-bulbar v bulbar ulcer was 1:1.5. Deformed bulb was seen in 50% of duodenal ulcer patients, but haemorrhage and stenosis were uncommon. Except for nocturnal pain, there were no differences in symptoms between the groups. Forty two per cent of patients smoked, 15% chewed tobacco, and 18% drank alcohol; almost all were men. Sixty four per cent drank tea. The staple diet (85%) was rice, and 70% used tamarind and spices daily. Duodenal ulcer was three times more common than gastric ulcer with a high incidence of post-bulbar and coexisting ulcer. It affected a younger and predominantly male population, and was not associated with a higher rate of complication.     

Endoscopy for the diagnosis of acute upper gastrointestinal bleeding

Diagnostic gastroscopy was performed on 337 patients for acute upper gastrointestinal bleeding, with 88% (296 of 337) diagnostic accuracy. Peptic ulcer disease was the cause of bleeding in 43% of the cases, erosive gastritis in 16%, and oesophagitis in 11%. Of the 289 patients, 40% had associated lesions, the commonest being gastritis (31), hiatal hernia (24), oesophageal varices (16), and oesophagitis (16). An oesophageal site of the bleeding was most often detected in the patients under 50 years of age (p less than 0.001) and a gastric site among those over 70 years (p less than 0.05). Mallory-Weiss lesions were significantly more often the cause of bleeding among the youngest patients than in other age groups (p less than 0.001). The bleeding lesion was located in the stomach in 60% of the women and in 42% of the men (p less than 0.01) and in the duodenum in 13% and 28% (p less than 0.01), respectively. The principal causes of this difference was the high incidence of gastritis in the women and duodenal ulcer in the men.     

Upper GI bleeding in healthy full-term infants: a case-control study

OBJECTIVE: The aim of this case-control study was to evaluate the frequency and the type of mucosal lesions in newborn babies with upper GI bleeding (UGIB), the diagnostic role and safety of upper GI endoscopy, and the recognition of risk factors associated with the hemorrhagic event. METHODS: A population of 5180 infants born from June, 1988 to May, 1997 was examined. A case was defined as any patient who had UGIB within 4 days of delivery. The diagnosis was made by endoscopic examination in an endoscopy room. The following parameters were determined: amniotic fluid features, funicular blood pH, Apgar index at 5 min, neonatal weight, body length, gestational age, and the presence of other pathologies. Biochemical profiles were also evaluated. Clinical and demographic data of the mothers of the newborn babies were analyzed. Sera of cases and the respective parents were tested for gastrin and pepsinogen. As a control group, 53 full-term healthy infants matched for sex and age were randomly selected from the population of infants born in our pediatric department. RESULTS: Sixty-four of 5180 newborn babies (1.23%) suffered from UGIB within 26.5 +/- 20 h of life. In 53 of 64 cases (mean age = 24.2 +/- 25.5 h) it was possible to carry out an endoscopic examination. In one case, endoscopy was limited to the esophagus because of the presence of multiple mucosal ulcers and substenosis of the viscus. Esophageal damage was observed in 24/53 patients. The esophageal lesions were isolated in nine cases, and occurred jointly with gastric or duodenal damage in 14 cases and one, respectively. Gastric and duodenal lesions were seen in 43/52 and 1/52 patients, respectively. There were 17 cases of gastric ulcers and one case of duodenal ulcer. Blood clots were observed in 14 gastric ulcer patients; in one case there was evidence of active bleeding at the margins of a gastric ulcer. There was no significant difference with regard to the demographic and clinical characteristics of the cases and controls. Median values of serum gastrin of the cases and controls were similar. Median serum pepsinogen was significantly higher in the case group. CONCLUSIONS: UGIB in the newborn babies is often associated with clinically relevant mucosal lesions of the upper GI tract. The evolution, after treatment with antisecretory drugs, is generally rapid and favorable, with clinical recovery usually obtained within 24-48 h. The higher serum pepsinogen levels may only represent a significant risk factor of mucosal lesions and complications.