Bleeding pattern before admission as guideline for emergency endoscopy

In a prospective study of 539 patients admitted because of hematemesis and melena the bleeding pattern before admission was compared with the findings obtained on emergency endoscopy and the subsequent clinical course. Ranked in order of prognostic importance, red hematemesis with melena, black hematemesis with melena, and red hematemesis alone increased the probability of massive hemorrhage. Moreover, black hematemesis with melena was the superior predictor of bleeding ulcer, the commonest lesion carrying the risk of massive hemorrhage. In contrast, in patients with melena or black hematemesis alone massive hemorrhage occurred comparatively infrequently. The order of prognostic importance was supported by the transfusion requirement. In screening for a potentially life-threatening ulcer hemorrhage, emergency endoscopy is recommended in patients with black hematemesis with melena or with red hematemesis with or without melena. In patients presenting with black hematemesis or melena alone endoscopy may be postponed to the next convenient daytime.     

微米大黄炭胃镜下喷洒治疗消化性溃疡出血的临床观察

目的:观察胃镜下喷洒微米大黄炭治疗消化性溃疡出血的临床疗效.方法:90例消化性溃疡并出血的患者随机分为微米大黄炭组(治疗组)和去甲肾上腺素组(对照组),各45例,胃镜下观察两组患者的平均止血时间和止血成功率以及术后患者黑便、呕血的次数、血红蛋白量.结果:治疗组平均止血时间较对照组明显减少(P＜0.01),止血成功率明显升高(P＜0.01),达到96%;治疗组治疗后平均黑便、呕血的次数较对照组明显减少(P＜0.05);两组患者平均血红蛋白量比较无统计学差异(P＞0.05);治疗组止血疗效高于对照组(P＜0.01).结论:胃镜下喷洒微米大黄炭是治疗消化性溃疡出血的一种安全有效的治疗方法.     

Le profil étiologique des hémorragies digestives hautes extériorisées dans la région de Marrakech

In the absence of a national or regional observatory of gastrointestinal bleeding, few data are available concerning upper gastrointestinal bleeding in Morocco. We have performed a prospective study at the gastroenterology department of the Mohamed VI UHC in Marrakech for a period of 36 months; we gathered 186 cases of hematemesis and/or melena in order to study the epidemiological aspects of upper gastrointestinal bleeding in the Marrakech region. The upper gastrointestinal bleeding represented 3.64% of all indications of gastrointestinal endoscopy and 52.54% of all GI bleeding hospitalized during the same period. The male sex was dominant (sex-ratio: 1.8). The main age was 48 years ranging from 15 to 80 years with a peak incidence between 20 and 40 years. Associated diseases were liver cirrhosis in 9% of the cases, end stage renal failure in 3.2% of the cases and chronic epigastric pain with 15% of the cases, a peptic ulcer disease known in 5% of the cases and a recent use of NSAIDs in 16.3% of the cases. The upper gastrointestinal bleeding was revealed by hematemesis and melena concomitant in 32%, hematemesis only in 21% and melena only isolated in 11% of the cases. Gastrointestinal endoscopy performed after a mean delay of 16 hours of admission was conclusive in 88.70% of the cases. Etiology was mainly peptic ulcer disease (32.25% of the cases) and rupture of esophageal varices in 27.4% of the cases. Endoscopic treatment was performed in 32% of patients, and hemostasis was obtained in 98.5% of the cases after the first endoscopic procedure. Rebleeding or persistent bleeding was noted in 10.3% of the cases. Surgery was necessary in 2.6% of the cases. The overall mortality was 6.23%, and 67% of the patients who died had a rupture of esophageal or gastric varices in the source of bleeding.     

雷贝拉唑预防心血管病患者阿司匹林引起的消化性溃疡

目的 探讨雷贝拉唑对小剂量阿司匹林引起消化性溃疡的预防作用.方法 纳入2010年6月~2012年2月,患心血管病需抗血小板治疗的患者166例,随机分为对照组（n=83）和观察组（n=83）.对照组单用阿司匹林（100 mg,qd）;观察组在服用等剂量阿司匹林肠溶片同时服用雷贝拉唑钠肠溶胶囊（20 mg,qd）.对比两组患者出现上腹不适、上腹痛、烧心、反酸等消化道不适症状,同时比较两组胃镜下黏膜表现变化和呕血、黑便等消化道出血临床症状.结果 对照组和观察组分别出现消化道症状37例（44.6%）和4例（4.8%）,对照组胃肠黏膜损伤患者29例（34.9%）,其中消化性溃疡12例（14.5%）,观察组发生胃黏膜损伤患者仅6例（7.2%）,其中消化性溃疡1例（1.2%）,观察组的消化道症状发生率、胃肠粘膜损伤率以及消化性溃疡发生率均显著低于对照组,差异均有统计学意义（P均＜0.05）.随访3个月和6个月时患者呕血、黑便等消化道出血情况观察组均小于对照组,差异有统计学意义（P＜0.05）.结论 雷贝拉唑钠肠溶可降低小剂量阿司匹林治疗中发生溃疡出血的风险.     

Peptic Ulcer in Infants: Three Case Reports and a Review of the Japanese Literature

Abstract: Three cases of peptic ulcer in children under two years of age are reported, and 33 cases of infants with peptic ulcer reported in Japan between 1955 and March, 1989 are reviewed. Case 1 was an 8-month-old male complaining of melena, and endoscopic examination showed a gastric ulcer on the lesser curvature of the antrum. Cases 2 and 3 were a 15-month-old mule and an 18-month-old male, respectively, with complaints of melena and hematemesis. Endoscopic examination revealed an active duodenal ulcer in both cases. All 3 infants were successfully treated with H₂ blocker and/or antacid. In these 3 cases, infection or drugs were speculated to be predisposing factors, and the fathers of these three infants all had histories of duodenal ulcer. Among 33 cases of infants under 2 years old with peptic ulcer in Japan, 9 had a gastric ulcer and 24 had a duodenal ulcer. Seventeen were treated with conservative therapy and 16 were operated on because of perforation or bleeding. We should always keep in mind that peptic ulcer does occur in infancy, and that endoscopic examination should be promptly performed when peptic ulcer is suspected.     

Pathologies digestives hautes associées aux anti-inflammatoires non stéroïdiens

Objective

assess the pathology of the upper digestive tract associated with NSAIDs.

Patients and methods

it is a prospective study from June 2012 to July 2014 including, patients under treatment with nonsteroidal anti-inflammatory drug. They were seen in consultation for gastrointestinal symptoms (abdominal pain, dyspepsia, hematemesis, melena, vomiting), and had undergone upper endoscopy. NSAIDs were considered as the cause of endoscopic lesions if taken during the preceding two weeks. Gastric biopsy in search of Helicobacter pylori was not systematic.

Results

A total of 142 patients were recruited, among them 72 men (50.7%). The average age was 48.8 years. There were 45 patients with hypertension (31.7%), and 11with valvular disease (7.7%). Twenty-six patients had rheumatic disease, or 16.2%. NSAID use was resulting from self-medication in 34% of cases. Ibuprofen was the most antiinflammatory used (50%). The most frequent indication for endoscopy was epigastric pain (64%), followed by hematemesis and / or melena (29.6 %). The duration of NSAID use was more than 12 months in 29 patients (20.4%), between one and three months for 27 patients (19%) and one to 14 days in 52 patients (36.6%). Peptic ulcer disease was observed in 61 patients (42.9%). Twenty-six patients (18.3%) were taking two NSAIDs and 14 of them had a peptic ulcer (53.8%). The acid acetyl salicylic low dose (<300 mg) was used in 26 patients (18.3%), of which 12 presented a peptic ulcer (46.1%) and three gastrointestinal bleeding (11.5%). Dyspepsia was observed in 18 patients (12.7%). The risk of peptic ulcer was associated with male gender (OR = 1.4 95% CI: 0.7 to 2.7), more than 12 months NSAID taking (OR = 4.9 95% CI 1.3 to 10.9).

     

Hematemesis and melena in Cambridge

Summary 1. An analysis is made of 170 consecutive admissions for hematemesis and melena in a period of 20 months in 1950-52. Of these, 154 cases are regarded as being proved or probable cases of peptic ulcer. The mortality in these 154 cases was 15 (9.7 per cent).2. The over-all picture of the peptic ulcer cases is in accordance with the present trends of an increasing proportion of middle-aged and elderly men, and confirms the almost complete disappearance of the acute gastric ulcer of young women as a source of serious gastric bleeding.3. There were 34 cases of probable peptic ulcer which were X-ray-negative. The different sex distribution, the short dyspeptic history, the good prognosis, and the clinical history of hematemesis rather than melena are all adduced as reasons for considering that most of these patients had shallow acute gastric ulcers.4. The mortality is related to the total blood loss, and is associated with the occurrence of brisk recurrent hemorrhage after admission to hospital. Of other factors investigated, the most significant one was the presence or development of other diseases, or of complications of the ulcer.5. This, as well as the comparative smallness of the number of cases, is thought to account for some anomalies in the age distribution of the deaths.I am indebted to the consultant staff of Addenbrooke's Hospital for access to their patients, and particularly to Dr. Laurence Martin for his stimulating interest in the subject of gastrointestinal bleeding.     

Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

AIM： To investigate acute nonvariceal bleeding in the upper gastrointestinal （GI） tract and evaluate the effects of endoscopic hemoclipping. METHODS： Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS： The 68 cases （male：female = 42：26, age from 9 to 70 years, average 54.4） presented with hernatemesis in 26 cases （38.2%）, melena in nine cases （13.3%）, and both in 33 cases （48.5%）. The causes of the bleeding included gastric ulcer （29 cases）, duodenal ulcer （11 cases）, Dieulafoy＇s lesion （11 cases）, Mallory-Weiss syndrome （six cases）, post-operative （three cases）, post-polypectomy bleeding （five cases）, and post-sphincterotomy bleeding （three cases）; 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery （three cases had peptic ulcers, one had Dieulafoy＇s lesion, and two were caused by sphincterotomy）; three patients died （two had Dieulafoy＇s lesion and one was caused by sphincterotomy）; and one had recurrent bleeding with Dieulafoy＇s lesion 10 mo later, but in a different location. CONCLUSION： Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.     

Incidence and outcome of overt gastrointestinal bleeding in patients undergoing bone marrow transplantation

The purpose of this study was to determine the prevalence, clinical patterns, and outcomes of gastrointestinal bleeding in consecutive patients treated at one bone marrow transplant center. We reviewed the clinical course of 579 consecutive bone marrow transplant recipients who underwent therapy from January 1986 through December 1993. These patients were evaluated for overt gastrointestinal bleeding, defined as hematemesis, melena, hematochezia, or a combination. Overt gastrointestinal bleeding was identified in 43 of 579 patients (7.4%), including 25 men and 18 women undergoing transplantation for hematologic disorders (N=29) and solid tumors (N=14). After high-dose cytotoxic chemotherapy, patients were given allogeneic (N=10) or autologous (N=33) hematopoietic progenitor cell support obtained from bone marrow, peripheral blood, or both. H₂ blockers, sucralfate, or a combination were administered to all patients as prophylactic therapy. Bleeding manifestations included hematemesis (N=24), melena (N=8), hematochezia (N=7), and combinations (N=4). The median time from bone marrow infusion to the onset of overt gastrointestinal bleeding was 7.5 days (range: 0–45 days). Fourteen patients had evidence of orthostatic hypotension attributable to gastrointestinal bleeding. Esophagogastroduodenoscopy was performed in 26 patients; 18 had diffuse esophagitis and gastritis. Two patients with bleeding ulcers underwent successful electrocautery. Colonoscopy was performed in five patients and revealed a cecal ulcer in one subject, tumor recurrence in one patient, and colitis in another. No patients underwent surgical intervention. Only one patient died as a result of gastrointestinal bleeding. Overt gastrointestinal bleeding is uncommon in patients undergoing bone marrow transplantation; most episodes are self-limited and do not contribute to overall mortality. Endoscopy is primarily diagnostic as most patients do not have lesions amenable to therapeutic procedures.     

Prognostic factors in upper gastrointestinal bleeding

In this study we examined factors of possible prognostic value about outcome in a consecutive series of 2217 patients with hematemesis and melena. Death occurred in 189 (8.5%) patients, and 243 (11%) patients experienced rebleeding. Death was significantly associated with rebleeding, age over 60 years, and the finding of blood in the stomach at endoscopy. Rebleeding was significantly associated with melena, identification of a gastric or duodenal ulcer, endoscopic stigmata of hemorrhage such as blood, clot, and active bleeding, and the finding of shock at admission. However, female gender, previous history of ulceration, or indigestion of ulcerogenic drugs, especially nonsteroidal antiinflammatory drugs, were poor predictors of either death or rebleeding. We conclude that the identification of patients at a high risk could contribute to improved management of patients with gastrointestinal bleeding, including early therapeutic intervention.     

Oral Proton Pump Inhibitors Are as Effective as Endoscopic Treatment for Bleeding Peptic Ulcer: A Prospective,Randomized, Controlled Trial

In managing patients with bleeding peptic ulcers, it has been reported that pharmacologic treatment can be an alternative to endoscopic treatment. We compared the hemostasis rates of the endoscopic treatment, hemoclipping, and the phamacologic treatment, oral proton pump inhibitors (PPIs), in bleeding peptic ulcer. A randomized prospective study was performed on 129 bleeding peptic ulcer patients with hematemesis or melena. Sixty-two patients were treated by endoscopic hemoclipping and subsequently H₂ receptor antagonists were injected intravenously (hemoclipping group), and 67 patients were treated with an oral PPI without endoscopic treatment (PPI group). The 24-hr gastric pH test was performed sequentially following the treatment. The initial hemostasis rate of the hemoclipping group was 93.5% (58/62) and the rebleeding rate was 6.9% (4/58), and the hemostasis rate of the PPI group was 92.5% (62/67) and the rebleeding rate was 7.5% (5/67), which were not different. The 24-hr gastric pH was 4.54 ± 2.56 in the hemoclipping group and 5.97 ± 1.30 in the PPI group (P < 0.037). In the bleeding peptic ulcer patients, the hemostasis rate with the oral administration of PPIs was not different from that with the endoscopic hemoclipping treatment.     

消化性溃疡出血急诊内镜检查220例分析

１９９０年１月～１９９５年２月．对２２０例消化性溃疡出血病人进行了急诊内镜检查。急诊内镜检查在 ２４～４８ ｈ内完成。内镜所见的出血类型参照Ｆｏｒｒｅｓｔ所建议的分类标准，其中ＦⅠａ４例（１．８％）．ＦⅠｂ２８例（１２．７％），ＦⅡａ２８例（１２．７％）．ＦⅡｂ１２０例（５４．５％）和ＦⅢ ４０例（１８．２％）。结果显示，球部溃疡出血明显多于胃溃疡（６１８％比２９．１％， Ｐ ＜０． ００５）；出血发生率与年龄有明显关系，以中年组发生率最高，占６０％．依次为青年组（２９．１％），老年组（１０．９％）。出血征象ＦⅠａ以老年组居多．其他各型均以中年组占多数。     

Etiology and course of acute bleeding esophageal ulcers.

Twenty (2%) of 1,140 patients with acute gastrointestinal bleeding had esophageal ulcers. Patients with esophageal ulcers most commonly had either melena (40%) or melena and hematemesis (40%). Fifty percent had orthostatic hypotension, and 80% required transfusions. Ulcers were associated with nonsteroidal anti-inflammatory drugs (NSAIDs) use in 50%, hiatal hernia in 60%, and esophagitis in 40%. Endoscopic stigmata of recent hemorrhage consisted of oozing blood (35%) and adherent clot (25%). Six patients had multiple ulcers. The majority of ulcers (90%) were in the distal esophagus. Nine patients were endoscopically treated without complications except for rebleeding in 1 patient. Endoscopic therapy was associated with decreased duration of hospitalization. Overall mortality was 45% in these patients, but no deaths were related to bleeding. Although uncommon, esophageal ulcers are a cause of significant acute gastrointestinal bleeding that appears to respond to endoscopic treatment.     

Incidence and etiology of acute non-malignant upper gastrointestinal bleeding in northern Greece

AIM: To evaluate the incidence and etiology of acute non-malignant upper gastrointestinal bleeding (ANMUGIB) in northern Greece due to increased use of non-steroidal anti-inflammatory drugs (NSAIDs), including low-dose aspirin (L-A), exposure and geographical variability of Helicobacter pylori (Hp) seroprevalence. METHODS: A retrospective study of 110 patients admitted for hematemesis or melena during a 6-month period. All patients had undergone a gastrointestinal (GI) endoscopy during hospitalization. The presence of Hp was identified by biopsies and a (13)C-urea breath test in the case of Hp(-) biopsy bleeding peptic ulcer (BPU). The activity of ANMUGIB was assessed according to Forrest's classification. Statistical analysis was made by the chi(2)-test and Yates' correction. RESULTS: Most patients were in the two medium age groups with no significant difference between them (P < 0.001). NSAID or L-A (100 mg/day) use was reported in 42.73% of patients in a ratio 1:1 (P > 0.1) and Hp infection was found in 29.09% of patients. BPU, with approximately two-thirds in the bulb, erosions and varices were the most frequent sources. Hp infection was found in 60.65% of BPU, 65.57% were related to NSAIDs or L-A and 8.19% were non-Hp non-NSAID/L-A BPU. Flat spots were most commonly found with a significant difference (P < 0.001) to other stigmata of recent bleeding, except for clean base. CONCLUSIONS: In northern Greece, persons aged over 40 years are prone to ANMUGIB with a non-significant relationship to males. Hp infection and medication use, such as NSAIDS and L-A, are deeply involved in its etiology. Non-Hp non-NSAID/L-A BPU are a small proportion. ANMUGIB seems to have a generally good prognosis.     

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.     

Helicobacter pylori and risk of ulcer bleeding among users of nonsteroidal anti-inflammatory drugs: a case-control study.

BACKGROUND & AIMS: Peptic ulcer complications related to use of nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common serious adverse drug reactions. Whether Helicobacter pylori infection potentiates this gastrointestinal toxicity of NSAIDs is still unresolved. In this study, we investigated the role of H. pylori as a cause of bleeding peptic ulcer among NSAID users. METHODS: A case-control study of current users (n = 132) of NSAIDs (including acetylsalicylic acid), admitted because of bleeding peptic ulcer, was performed. Controls were 136 NSAID users without gastrointestinal complications. H. pylori was diagnosed by either increased levels of serum immunoglobulin G or by 13C-urea breath test. RESULTS: Fifty-eight (44%) case subjects had a bleeding gastric ulcer, 54 (41%) had a bleeding duodenal ulcer, 12 (9%) had both gastric and duodenal ulcers, and 8 (6%) had hemorrhagic gastritis. H. pylori was present in 75 (57%) cases compared with 59 (43%) controls. The adjusted odds ratio of bleeding peptic ulcer among NSAID users associated with H. pylori infection was 1.81 (95% confidence interval, 1.02-3.21). H. pylori accounted for approximately 24% of bleeding peptic ulcers among elderly NSAID users. CONCLUSIONS: NSAID users infected with H. pylori have an almost twofold increased risk of bleeding peptic ulcer compared with NSAID users without H. pylori.     

消化性溃疡患者非甾体类抗炎药服用史和幽门螺杆菌感染的协同致病性分析

目的了解服用非甾体类抗炎药(NSAIDs)和幽门螺杆菌(H.pylori)感染在消化性溃疡及合并上消化道出血发病中是否具有协同作用。方法应用病例对照研究,于1999年7月至2004年12月选取吉林大学中日联谊医院的803例消化性溃疡患者(其中208例溃疡合并上消化道出血者)与同一时期就诊的2061例非胃十二指肠疾病患者,进行NSAIDs服用史的调查和H.pylori感染的检测。结果服用NSAIDs合并H.pylori感染者患胃溃疡的OR值明显高于单纯服用NSAIDs者和单纯H.pylori感染者患胃溃疡的OR值之和;服用NSAIDs合并H.pylori感染的胃溃疡及十二指肠溃疡患者发生上消化道出血的OR值均低于单纯服用NSAIDs和单纯H.pylori感染的胃溃疡患者和十二指肠溃疡患者发生上消化道出血的OR值之和;与无溃疡未服NSAIDs者比较,偶尔服药者溃疡出血与短期服药者及长期服药者比较,差异无统计学意义。结论NSAIDs和H.pylori感染在胃溃疡的形成中具有协同作用;在溃疡合并上消化道出血的发病中无协同作用;溃疡合并上消化道出血与服用NSAIDs的时间长短无关。     

Gastrointestinal bleeding: dyspeptic symptoms and clinical course in relation to use of non-steroidal antiinflammatory drugs

To study the symptoms of NSAID-associated gastroduodenal bleeding, 94 patients (median age 71 years, range 19-90), were included in a prospective, clinical trial where hematemesis or melena from gastroduodenal ulceration or haemorrhagic/erosive gastritis were the inclusion criteria. NSAID use within one month was studied in relation to subjective symptoms prior to admission and to clinical course of the episode. Significantly fewer of the NSAID users (n = 54) than the non-users (n = 40) had experienced prior peptic ulceration or dyspeptic symptoms. Otherwise, no differences were seen between users and non-users, as regards pre-admission epigastric pain, heartburn or nausea. Also, the clinical course was similar in the two groups. We also found sporadic and regular NSAID use to be similar in this respect. These data do not support the alleged masking of ulcer symptoms by NSAIDs in bleeding ulcers.     

Risk of ulcer bleeding in patients infected with Helicobacter pylori taking non-steroidal anti-inflammatory drugs

OBJECTIVE: To determine whether Helicobacter pylori is an independent risk factor for bleeding peptic ulcer in users of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin. DESIGN: A prospective matched case-control study. SETTING: Odense University Hospital, Denmark. SUBJECTS: 132 patients with a bleeding peptic ulcer (n=124) or haemorrhagic gastritis (n=8) at endoscopy who had taken an NSAID in the previous week and 136 controls who had taken NSAIDs without gastrointestinal complications. The controls were recruited from rheumatology and geriatric outpatient clinics. MEASUREMENTS: H pylori status assessed by serology and 13C-urea breath test and regarded as positive if either test was positive. Data on potential confounding factors including smoking and alcohol were collected by interview. MAIN RESULT: H pylori was present in 57% of cases and 43% of controls. The adjusted odds ratio of bleeding from a peptic ulcer owing to H pylori infection in NSAID users was 1.81 (95% CI 1.02 to 3.21) and was similar in aspirin and non-aspirin NSAID users. Peptic ulcer bleeding was also statistically significantly associated with a history of previous ulcer bleeding, dyspepsia within the previous 3 months, drinking alcohol but not with smoking. About 16% of bleeding peptic ulcers in NSAID users could be attributed to H pylori infection. CONCLUSION: NSAID users infected with H pylori have an almost doubled risk of bleeding peptic ulcer compared with uninfected NSAID users.     

Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

OBJECTIVE: Gastrointestinal bleeding occurs in a number of patients with hereditary hemorrhagic telangiectasia (HHT) and may lead to a high transfusion need. The aim of this study was to estimate the occurrence and severity of gastrointestinal bleeding in a geographically well defined HHT population. METHODS: All HHT families in the county of Fyn, Denmark, (470,000 population) have been identified. Probands and their first degree relatives, and all descendants from probands for whom one parent had HHT were eligible for inclusion in the study. A total of 77 patients with HHT were identified; of these, 76 patients (mean age: 52 yr) were evaluated and interviewed with regard to gastrointestinal bleeding, that is, a history of either hematemesis or melena. Patients charts were reviewed. RESULTS: A total of 25 HHT patients (33%) had a history of either hematemesis or melena. Of these, 12 (48%) had received blood transfusions. Seven patients had severe bleeding (that is, > or =6 units of blood within 6 months before inclusion in the study). Endoscopy had been performed in 16 of the 25 (64%) patients. Telangiectatic lesions were documented in nine at upper endoscopy and in one at sigmoidoscopy. Telangiectatic lesions were observed in all patients with severe bleeding, but in two patients epistaxis is likely to have contributed to the anemia. Among 51 HHT patients without a history of gastrointestinal bleeding, only five (10%) had previously received blood transfusions; however, none fulfilled the definition of severe bleeding. In the HHT population 29 patients were > or =60 yr old, but all patients with severe bleeding were > or =60 yr. CONCLUSIONS: A history of gastrointestinal bleeding is common in patients with HHT (33%). This study documents that 25% of HHT patients > or =60 yr suffer from severe gastrointestinal bleeding.