• Title/Summary/Keyword: Gastrointestinal bleeding.

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Risk Stratification for Patients with Upper Gastrointestinal Bleeding (상부위장관 출혈 환자에서 위험의 계층화와 이에 따른 치료 전략)

  • Lee, Bong Eun
    • The Korean journal of helicobacter and upper gastrointestinal research
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    • v.18 no.4
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    • pp.225-230
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    • 2018
  • Upper gastrointestinal (GI) bleeding (UGIB) is the most common GI emergency, and it is associated with significant morbidity and mortality. Early identification of low-risk patients suitable for outpatient management has the potential to reduce unnecessary costs, and prompt triage of high-risk patients could allow appropriate intervention and minimize morbidity and mortality. Several risk-scoring systems have been developed to predict the outcomes of UGIB. As each scoring system measures different primary outcome variables, appropriate risk scores must be implemented in clinical practice. The Glasgow-Blatchford score (GBS) should be used to predict the need for interventions such as blood transfusion or endoscopic or surgical treatment. Patients with GBS ${\leq}1$ have a low likelihood of adverse outcomes and can be considered for early discharge. The Rockall score was externally validated and is widely used for prediction of mortality. The recently developed AIMS65 score is easy to calculate and was proposed to predict in-hospital mortality. The Forrest classification is based on endoscopic findings and can be used to stratify patients into high- and low-risk categories in terms of rebleeding and thus is useful in predicting the need for endoscopic hemostasis. Early risk stratification is critical in the management of UGIB and may improve patient outcome and reduce unnecessary health care costs through standardization of care.

A Case Report of Subi-jeon in a Patient with Hemorrhagic Anemia Due to Lower Gastrointestinal Hemorrhage (하부위장관출혈로 인한 출혈성 빈혈 환자에 대한 수비전 치험 1례 : 증례보고)

  • Suh, Won-joo;Lee, Yu-jin;Lee, Hyun-ku;Cho, Ki-ho;Moon, Sang-kwan;Jung, Woo-sang;Kang, Seung-chul
    • The Journal of Internal Korean Medicine
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    • v.41 no.4
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    • pp.699-704
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    • 2020
  • Introduction: This case report addressed the effect of Korean medicine treatments on a patient with hemorrhagic anemia due to lower gastrointestinal bleeding. Case report: An 83-year-old male with lower gastrointestinal bleeding was treated with Korean medicine, including the herbal medication Subi-jeon. We evaluated the improvements of symptoms by hemoglobin levels and numbers of transfusions. From the 6th day of taking the herbal medicine to discharge, a hemoglobin level of 7 g/dL or higher was maintained and the patient did not require blood transfusion. Conclusions: This clinical case study suggests that Subi-jeon might be effective in cases of hematosis of lower gastrointestinal bleeding.

Risk of Gastrointestinal Bleeding Associated with Use of Low-dose Aspirin in Korean Children (소아에서 소용량 아스피린의 장기간 사용에 의한 위.장관 출혈 위험성에 대한 연구)

  • Bae, Sun-Hwan;Son, Dong-Woo;Park, Kyung-Hee
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.6 no.1
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    • pp.10-16
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    • 2003
  • Purpose: To evaluate the risk of gastrointestinal bleeding associated with use of low-dose aspirin in children. Methods: Among about 250 children who received low-dose aspirin (5 mg/kg/day) under the diagnosis of Kawasaki disease, from March 1995 to May 2001, at Eul-Ji general hospital, 100 children were enrolled in this study. We reviewed the medical records and interviewed the children's parents over the phone to confirm the existence of gross gastrointestinal bleeding. Results: The age of the children at the beginning of medication ranged 4~118 months. About 75% of them was younger than 3 years old. The duration of medication ranged 0.5~17 months. About 70% of the children took the medicine for 2~3 months. Only 1 child (1%) had hematochezia during medication without any accompanying gastrointestinal symptom, and cimetidine for 1 week had cleared up the bleeding. The total duration of medication of 100 children was 341.5 months, and only 1 child had gastrointestinal bleeding. This translates into a rate of clinically significant gastrointestinal bleeding of 3.5 episodes/100 children/year. Conclusion: The long-term use of low-dose aspirin is safe, but, is associated with the risk of gastrointestinal bleeding in children. Careful follow-up and efforts to reduce the risk of gastrointestinal bleeding are necessary during long-term low-dose aspirin therapy in children.

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A Case of Gastric Lipoma with Upper Gastrointestinal Bleeding (상부위장관 출혈을 동반한 위 지방종 1예)

  • Gu, Min Geun;Kim, Kook Hyun;Park, Byung Sam;Jung, Sung Yun;Jeong, Yo Han;Lee, Dong Won;Shin, Hyeong Chan;Gu, Mi Jin
    • Journal of Yeungnam Medical Science
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    • v.30 no.2
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    • pp.132-135
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    • 2013
  • Gastric lipoma is a typical benign submucosal tumor that is usually asymptomatic and is generally detected incidentally when performing gastroscopy. However, depending on its size and location, an atypical gastrointestinal lipoma can cause abdominal pain, diarrhea, constipation, intestinal obstruction, intussuception and life-threatening gastrointestinal bleeding. We report herein a case of gastric lipoma with bleeding in a 43-year-old man. The gastroscopy showed a $4{\times}4$ cm ulcero-fungating submucosal mass at the anterior wall of the gastric antrum. Laparoscopic gastric wedge resection was performed and the lesion was diagnosed as gastric lipoma.

Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment

  • Giuseppe Galloro;Angelo Zullo;Gaetano Luglio;Alessia Chini;Donato Alessandro Telesca;Rosa Maione;Matteo Pollastro;Giovanni Domenico De Palma;Raffaele Manta
    • Clinical Endoscopy
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    • v.55 no.3
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    • pp.339-346
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    • 2022
  • Since the earliest reports, advanced clipping systems have been developed, and it is possible to choose among many models with different structural and technical features. The main drawback of through-the-scope clips is their small size, which allows the compression of limited amounts of tissue needed for large-size vessel treatment. Therefore, the over-the-scope clip system was realized, allowing a larger and stronger mechanical compression of large tissue areas, with excellent results in achieving a definitive hemostasis in difficult cases. Many studies have analyzed the indications and efficacy of two-pronged endoclips and have shown good results for initial and permanent hemostasis. The aim of this review was to provide updated information on indications, positioning techniques, and results of clip application for endoscopic treatment of upper gastrointestinal non-variceal bleeding lesions.

Identifying Small Bowel Gastrointestinal Stromal Tumor as the Culprit Lesion in Obscure Gastrointestinal Bleeding: Emphasis on Angiographic Findings (원인불명의 위장관 출혈을 보인 소장 위장관 기질종양 식별: 혈관조영술 소견의 강조)

  • Hyung In Choi;Min Jeong Choi;Bong Man Kim;Hwan Namgung;Seung Kyu Choi
    • Journal of the Korean Society of Radiology
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    • v.83 no.2
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    • pp.400-405
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    • 2022
  • Gastrointestinal stromal tumors (GISTs) are not uncommon and often cause gastrointestinal bleeding. GISTs occurring in the small intestine are occasionally difficult to identify by endoscopy and CT. In this case, the patient underwent CT three times before surgery, and the lesion was found to be located in a different area of the abdominal cavity on each CT scan. Moreover, the lesion was missed in the first two CT images because it was difficult to distinguish it from the nearby collapsed small intestine. The lesion was eventually detected through angiography; however, the correct diagnosis and treatment were delayed for 3 years because it was mistaken for a vascular malformation, which is the most common cause of obscure GI bleeding in elderly patients. This report emphasizes the need for interventional radiologists to be updated and vigilant of the angiographic features of GISTs to make an accurate diagnosis and establish a management strategy.

Endoscopic Management with Ethanol Injection in a Child with Gastric Dieulafoy Lesion (Dieulafoy 병변 소아의 내시경적 치료 1례)

  • Kim, Hyun-Jin;Shin, Jee-Seon;Seo, Jeong-Wan
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.6 no.2
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    • pp.187-191
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    • 2003
  • The Dieulafoy's lesion is a rare cause of recurrent massive gastrointestinal bleeding in children. The bleeding results from an abnormally large submucosal artery that protrudes through a small mucosal defect. The lesion is commonly found on proximal stomach. Surgical intervention was believed to be the best treatment in the past, but recent advancement in endoscopy has made effective hemostasis possible. We report a case of a 9-year-old boy with underlying mycoplasma pneumonia with effusion who presented with massive upper gastrointestinal bleeding. Bleeding was controlled with endoscopic treatment by epinephrine and ethanol injection and the patient was successfully treated.

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Juvenile Polyp associated with Hypovolemic Shock Due to Massive Lower Gastrointestinal Bleeding

  • Kim, Dong Yeop;Bae, Joon Yeol;Ko, Kyung Ok;Cheon, Eun Jung;Lim, Jae Woo;Song, Young Hwa;Yoon, Jung Min
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.22 no.6
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    • pp.613-618
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    • 2019
  • Juvenile polyps are the most common types of polyps in children, and patients usually present with lower gastrointestinal (GI) bleeding as the predominant symptom. These lesions, which are referred to as hamartomas, usually measure approximately 2 cm in size and are benign tumors located mainly in the rectum and sigmoid colon. The most common symptom of a juvenile polyp is mild intermittent rectal bleeding. It is rare for anemic patients because the amount of blood loss is small and often not diagnosed immediately. We present the case of a 6-year-old girl with a juvenile polyp in the distal transverse colon, who developed hypovolemic shock due to massive lower GI bleeding. Pediatricians must perform colonoscopy for thorough evaluation of polyps, because their location and size can vary and they can cause massive bleeding.