An audit of upper gastrointestinal bleeding at Seremban Hospital

We retrospectively analyzed all patients presenting with upper gastrointestinal bleeding to Seremban Hospital over a one-year period. A quarter of the oesophagogastro-duodenoscopies (OGD) performed were performed as emergency for upper gastrointestinal tract bleeding. Gastric ulcers and duodenal ulcers were the two most common findings. Our results suggest that there is a male preponderance of 2:1, the Chinese were more likely to be affected and the elderly (> 60 years) were at highest risk.     

Specialized gastrointestinal units for the management of upper gastrointestinal haemorrhage

In 1986, 292 patients were admitted to a joint medical-surgical gastrointestinal unit with upper gastrointestinal haemorrhage. Fourteen patients died (4.8%) a mortality considerably lower than recorded in most series. The low mortality may result from the use of a specialized gastrointestinal unit to which all patients with upper gastrointestinal haemorrhage are admitted and managed with strict protocols for resuscitation, transfusion and surgery.     

Reduction in mortality from upper gastrointestinal haemorrhage

A study of 2377 cases of haemorrhage from the upper gastrointestinal tract shows a significant fall in mortality rate--from 15.5% in the period of retrospective study from 1961 to 1970 to 7% in the prospective study from 1972 to 1982. The fall in mortality rate from non-variceal bleeding was from 12.8% to 5%. In the second five years of the prospective study, the total mortality rate was 5.8%, with 4.5% for non-variceal haemorrhage. This improvement occurred despite a significant rise in the proportion of patients of 60 years of age and over, and was particularly evident in patients with bleeding chronic gastric ulcers. There was also a significant reduction in mortality in the 60 years and over age group in the latter five years of the prospective study. The data suggest that there were three aspects of management which were important in the reduction of mortality. These were early fibreoptic endoscopic diagnosis, improved resuscitation and postoperative care, and early control of bleeding from oesophageal varices by balloon tamponade and surgery in selected cases. These complicated procedural aspects of management are best applied in a special unit for the treatment of patients with haemorrhage from the upper gastrointestinal tract. It is concluded that there has been significant progress in the treatment of this problem during the last decade.     

国产奥曲肽联合奥美拉唑治疗急性非静脉曲张性上消化道大出血疗效观察

目的观察国产奥曲肽联合奥美拉唑治疗急性非静脉曲张性上消化道大出血（ANVUGIB）的疗效。方法将85例ANVUGIB患者随机分为治疗组：国产奥曲肽首剂0.1 mg静脉推注,50μg/h微泵静脉维持,奥美拉唑40 mg静脉推注Q 12 h;对照组：奥美拉唑40 mg静脉推注Q 12 h。用药72 h。观察患者的呕血、黑便及生命体征变化,比较两组的止血有效率和显效率,分析国产奥曲肽对ANVUGIB的临床疗效。结果治疗组24 h和48 h止血有效率和显效率显著高于对照组（P〈0.05）。结论国产奥曲肽联合奥美拉唑静脉应用有助提高ANVUGIB疗效,且经济适用。     

The metabolic effects of moderately severe upper gastrointestinal haemorrhage in man.

The metabolic effects of moderately severe gastrointestinal haemorrhage were investigated in man. Before resuscitation, patients had raised circulating concentrations of glucose, lactate, alanine, glycerol and cortisol. After urgent operation for haemorrhage, metabolite concentrations were similar to those of control patients having elective abdominal surgery, but insulin concentrations were higher and cortisol lower in haemorrhage patients. There were no significant differences in nitrogen excretion between haemorrhage patients and their controls, but urinary 3-methyl-histidine excretion by haemorrhage patients was lower indicating decreased muscle protein breakdown. Decreased amino acid release from muscle might account for previously reported imparied wound healing after haemorrhage.     

An audit of fatal acute pancreatitis.

Acute pancreatitis has a mortality of about 10%: this figure has not changed over the last 20 years. A retrospective audit of fatal acute pancreatitis was performed in a teaching hospital with a catchment population of about 750,000 patients to examine patient characteristics. Using Hospital Activity Analysis code 577.0, all fatal cases of acute pancreatitis were studied in a six-year period 1987-93. Additionally, all post mortem diagnoses of acute pancreatitis were traced. The overall post mortem rate in Nottingham at the time of the study was about 35%. All available records, X-ray and biochemical data were studied and appropriate information recorded and analysed for 65 fatal cases. Only 15% were post mortem diagnoses, lower than in previous series; 72% had respiratory and 67% had renal complications. Only 34% had been admitted to the intensive care unit. A third of patients had had surgery; 67% of these was some form of external drainage. Of the 14 patients with proven gallstone pancreatitis only three had endoscopic retrograde cholangiopancreatography; 42% of patients had idiopathic disease. Not all the patients diagnosed ante mortem had the full biochemical predicted severity criteria analysed: pO2 and calcium analysis was performed in about 80%. Pre-mortem diagnoses of pancreatitis was achieved more frequently than in other comparable series.     

Mortality in acute upper gastrointestinal haemorrhage: a six-year survey from the University Hospital of Wales

In a retrospective survey of normal hospital practice, 583 patients were admitted between March 1972 and 1978 because of haematemesis or melaena. Sixty (10·3%) of these patients died; most deaths occurred in elderly patients (mean age 75 years) 75% of whom had a serious medical problem which complicated the situation. Malignancy, cardiovascular disease and respiratory problems were the most commonly associated factors. The attitude towards both emergency investigation and surgical intervention was very conservative and any reduction in mortality would require a concerted effort to deal with the special problems in elderly patients who are at particular risk.     

Acute upper gastrointestinal haemorrhage with negative barium-meal x-ray findings: follow-up investigation.

One-hundred and one patients admitted to hospital with acute upper gastrointestinal haemorrhage whose initial barium-meal X-ray examination revealed no abnormality have been followed up 5 to 14 years later. Forty-five were symptom-free, and 8 had dyspepsia, but the barium-meal X-ray findings were still normal. Disease of the lower oesophagus, the stomach or the duodenum was found in 20, 16 of whom had a chronic peptic ulcer and two had gastric carcinoma. There was a poor prognosis for those gastric-ulcer patients whose diagnosis had been missed initially.     

Diffuse nodular hyperplasia of Brunner's gland presenting as upper gastrointestinal haemorrhage

Brunner's gland adenoma is a very unusual cause of upper gastrointestinal bleeding. We report a 16-year-old boy who presented with upper gastrointestinal haemorrhage from diffuse nodular hyperplasia of Brunner's gland without involvement of the first part of the duodenum. The patient was managed conservatively during his hospital stay, and was doing well without any recurrence after nine months of follow-up.     

国产奥曲肽治疗非曲张静脉上消化道大出血疗效观察

目的探讨非曲张静脉上消化道大出血内科常规治疗同时应用国产奥曲肽的临床疗效。方法 70例非曲张静脉上消化道大出血患者,入院后予以常规内科治疗基础上,应用国产奥曲肽,首剂奥曲肽0.1mg静脉注射后,继之以奥曲肽25μg/h输液泵维持,出血停止24h后停用。结果 70例中61例于72h内出血停止,有效止血率87.14%,无效9例。结论在常规内科治疗的同时应用国产奥曲肽治疗非曲张静脉上消化道大出血,止血成功率高,不良反应轻微,使用安全,价格较便宜,值得在基层医院推广应用。