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| 1 | Diagnosis and therapy of non-variceal upper gastrointestinal bleeding显示文摘Non-variceal upper gastrointestinal bleeding(UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions,erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor(PPI) therapy. These drugs are highly effective but the best route of application(oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal antiinflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased. | Erwin Biecker | 2015 | World Journal of Gastrointestinal Pharmacology and Therapeutics2015，6，4： | 17 |
| 2 | Upper gastrointestinal bleeding in Scotland 2000-2010: Improved outcomes but a significant weekend effect显示文摘AIM: To assess numbers and case fatality of patients with upper gastrointestinal bleeding(UGIB),effects of deprivation and whether weekend presentation affected outcomes.METHODS: Data was obtained from Information Services Division(ISD) Scotland and National Records of Scotland(NRS) death records for a ten year period between 2000-2001 and 2009-2010. We obtained data from the ISD Scottish Morbidity Records(SMR01) database which holds data on inpatient and daycase hospital discharges from non-obstetric and nonpsychiatric hospitals in Scotland. The mortality data was obtained from NRS and linked with the ISD SMR01 database to obtain 30-d case fatality. We used 23 ICD-10(International Classification of diseases) codes which identify UGIB to interrogate database. We analysed these data for trends in number of hospital admissions with UGIB,30-d mortality over time and assessed effects of social deprivation. We compared weekend and weekday admissions for differences in 30-d mortality and length of hospital stay. We determined comorbidities for each admission to establish if comorbidities contributed to patient outcome. RESULTS: A total of 60643 Scottish residents were admitted with UGIH during January,2000 and October,2009. There was no significant change in annual number of admissions over time,but there was a statistically significant reduction in 30-d case fatality from 10.3% to 8.8%(P < 0.001) over these 10 years. Number of admissions with UGIB was higher for the patients from most deprived category(P < 0.05),although case fatality was higher for the patients from the least deprived category(P < 0.05). There was no statistically significant change in this trend between 2000/01-2009/10. Patients admitted with UGIB at weekends had higher 30-d case fatality compared with those admitted on weekdays(P < 0.001). Thirty day mortality remained significantly higher for patients admitted with UGIB at weekends after adjusting for comorbidities. Length of hospital stay was also higher overall for patients admitted at the weekend when compared to weekdays,although only reached statistical significance for the last year of study 2009/10(P < 0.0005). CONCLUSION: Despite reduction in mortality for UGIB in Scotland during 2000-2010,weekend admissions show a consistently higher mortality and greater lengths of stay compared with weekdays. | Asma Ahmed Matthew Armstrong Ishbel Robertson Allan John Morris Oliver Blatchford Adrian J Stanley | 2015 | World Journal of Gastroenterology2015，21，38： | 4 |
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