PURPOSE: This study was performed to assess the clinical usefulness of transabdominal ultrasonography (TUS) in detecting peptic ulcer disease (PUD) in children. METHODS: Twenty-four patients (19 boys, 5 girls; mean age, 10.6±4.5 years [range, 3.0–17.9 years]) who were admitted to the hospital for acute abdomen or gastrointestinal bleeding and diagnosed with PUD by endoscopy and who underwent TUS were included. Clinical data were retrospectively collected by reviewing patient medical records. Gastric ulcer (GU) was suspected when the gastric wall exceeded 8 mm in thickness and had lost its five-layer structure on TUS. Duodenal ulcer (DU) was suspected if the duodenal wall thickness exceeded 5 mm. RESULTS: Sensitivity of TUS in diagnosing PUD was 66.7% for GU and 38.9% for DU. Mean age and body weight of the 11 patients suspected with PUD on TUS were 10.9±4.4 years and 38.1±17.2 kg, respectively. For 13 patients without suspected PUD, they were 12.1±4.1 years and 39.6±17.0 kg, respectively. There was a significant difference in height, weight, and body mass index between patients who were suspected to have PUD and those who were not suspected on TUS (p=0.014, 0.008, and 0.005, respectively). A significant difference in the sensitivity of TUS in diagnosing PUD was found between patients under 30 kg and those over 30 kg (88.9% and 20.0%, respectively; p=0.003). CONCLUSION: TUS investigation of the stomach and duodenum is an efficient method for PUD detection in children with low body weight. TUS can be used in preliminary diagnostic work-up before further invasive tests.
Abdomen, Acute ; Body Mass Index ; Body Weight ; Child* ; Diagnosis* ; Duodenal Ulcer ; Duodenum ; Endoscopy ; Female ; Hemorrhage ; Humans ; Medical Records ; Methods ; Peptic Ulcer* ; Retrospective Studies ; Stomach ; Stomach Ulcer ; Ultrasonography*

BACKGROUND/AIMS: Gastrointestinal (GI) bleeding is a life-threatening complication in critically ill patients. The aim of this study was to determine the efficacy of bedside endoscopy in an intensive care unit (ICU) setting, and to compare the outcomes of early endoscopy (within 24 hours of detecting GI bleeding) with late endoscopy (after 24 hours). METHODS: We retrospectively reviewed the medical records of patients who underwent bedside endoscopy for nonvariceal upper GI bleeding and lower GI bleeding that occurred after ICU admission at Seoul National University Hospital from January 2010 to May 2015. RESULTS: Two hundred and fifty-three patients underwent bedside esophagogastroduodenoscopy (EGD) for upper GI bleeding (early, 187; late, 66) and 69 underwent bedside colonoscopy (CS) for lower GI bleeding (early, 36; late, 33). Common endoscopic findings were peptic ulcer, and acute gastric mucosal lesion in the EGD group, as well as ischemic colitis and acute hemorrhagic rectal ulcers in the CS group. Early EGD significantly increased the rate of finding the bleeding focus (82% vs. 73%, p = 0.003) and endoscopic hemostasis (32% vs. 12%, p = 0.002) compared with late EGD. However, early CS significantly decreased the rate of identifying the bleeding focus (58% vs. 82%, p = 0.008) and hemostasis (19% vs. 49%, p = 0.011) compared with late CS due to its higher rate of poor bowel preparation and blood interference (38.9% vs. 6.1%, p = 0.035). CONCLUSIONS: Early EGD may be effective for diagnosis and hemostatic treatment in ICU patients with GI bleeding. However, early CS should be carefully performed after adequate bowel preparation.
Colitis, Ischemic ; Colonoscopy ; Critical Illness* ; Diagnosis ; Endoscopy* ; Endoscopy, Digestive System ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Intensive Care Units ; Medical Records ; Peptic Ulcer ; Retrospective Studies ; Seoul ; Ulcer

Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.
Anastomosis, Surgical ; adverse effects ; Anticoagulants ; therapeutic use ; Bariatric Surgery ; adverse effects ; Catheterization ; China ; Conservative Treatment ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Endoscopy, Gastrointestinal ; methods ; Extracorporeal Membrane Oxygenation ; Gastrectomy ; adverse effects ; Gastric Bypass ; adverse effects ; Gastric Mucosa ; pathology ; Gastric Stump ; physiopathology ; surgery ; Gastrointestinal Hemorrhage ; etiology ; prevention & control ; surgery ; Hemostasis, Surgical ; adverse effects ; methods ; Hemostatic Techniques ; Heparin ; therapeutic use ; Humans ; Intermittent Pneumatic Compression Devices ; Intestine, Small ; pathology ; Laparoscopy ; adverse effects ; Margins of Excision ; Peptic Ulcer ; etiology ; therapy ; Postoperative Complications ; diagnosis ; prevention & control ; therapy ; Pulmonary Embolism ; etiology ; therapy ; Stents ; Stockings, Compression ; Thrombectomy ; Thrombolytic Therapy ; Venous Thrombosis ; etiology ; prevention & control ; therapy

Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to be associated with serious upper gastrointestinal complications, such as peptic ulcer, bleeding, perforation, and obstruction. Recently, attention has been mainly focused on the small bowel injuries caused by NSAIDs, and new endoscopic techniques such as capsule endoscopy and double balloon endoscopy can help in detecting such injuries. This article reviewed the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of small bowel injuries caused by NSAIDs. Small bowel injures by NSAIDs might occur with a similar frequency and extent as those observed in the upper gastrointestinal tract. The pathogenesis of NSAID-induced enteropathy is complex and not clearly understood. The various lesions observed in the small bowel, including petechiae, reddened folds, loss of villi, erosions, and ulcers can be detected by capsule endoscopy. A drug that could prevent or treat NSAID-induced enteropathy has not yet been developed. Therefore, further investigations should be performed to elucidate the pathogenesis of such enteropathy and develop suitable preventive and treatment strategies.
Anti-Inflammatory Agents, Non-Steroidal ; Capsule Endoscopy ; Diagnosis ; Endoscopy ; Epidemiology ; Hemorrhage ; Peptic Ulcer ; Purpura ; Ulcer ; Upper Gastrointestinal Tract

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a sideviewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.
Arm* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Diagnosis ; Electrocoagulation ; Endoscopes ; Epinephrine ; Fibrin Tissue Adhesive ; Hemobilia ; Hemodynamics ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Ligation ; Methods ; Peptic Ulcer ; Shock ; Sphincterotomy, Endoscopic

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a sideviewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.
Arm* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Diagnosis ; Electrocoagulation ; Endoscopes ; Epinephrine ; Fibrin Tissue Adhesive ; Hemobilia ; Hemodynamics ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Ligation ; Methods ; Peptic Ulcer ; Shock ; Sphincterotomy, Endoscopic

BACKGROUND/AIMS: Angiodysplasia is important in the differential diagnosis of upper gastrointestinal bleeding (UGIB), but the clinical features and outcomes associated with UGIB from angiodysplasia have not been characterized. We aimed to analyze the clinical characteristics and outcomes of angiodysplasia presented as UGIB. METHODS: Between January 2004 and December 2013, a consecutive series of patients admitted with UGIB were retrospectively analyzed. Thirty-five patients with bleeding from angiodysplasia were enrolled. We compared them with an asymptomatic control group (incidental finding of angiodysplasia in health screening, n = 58) and bleeding control group (simultaneous finding of angiodysplasia and peptic ulcer bleeding, n = 28). RESULTS: When patients with UGIB from angiodysplasia were compared with the asymptomatic control group, more frequent rates of nonantral location and large sized lesion (≥ 1 cm) were evident in multivariate analysis. When these patients were compared with the bleeding control group, they were older (mean age: 67.94 ± 9.16 years vs.55.07 ± 13.29 years, p = 0.03) and received less transfusions (p = 0.03). They also had more frequent rate of recurrence (40.0% vs. 20.7%, p = 0.02). CONCLUSIONS: Non-antral location and large lesions (≥ 1 cm) could be risk factors of UGIB of angiodysplasia. UGIB due to angiodysplasia was more common in older patients. Transfusion requirement would be less and a tendency of clinical recurrence might be apparent.
Angiodysplasia* ; Diagnosis, Differential ; Endoscopy ; Hemorrhage* ; Humans ; Mass Screening ; Multivariate Analysis ; Peptic Ulcer ; Recurrence ; Retrospective Studies ; Risk Factors*

Despite the generally declining trend in the incidence of peptic ulcers, peptic ulcer bleeding remains a prevalent and clinically significant condition. Additionally, despite the development of therapeutic endoscopy and acid-suppressive therapy, the overall mortality associated with peptic ulcer bleeding has remained at about 6% to 14%. Management of acute peptic ulcer bleeding requires prompt resuscitation, risk assessment, early endoscopic evaluation, and early initiation of pharmacotherapy. Advances in therapeutic endoscopic techniques and antisecretory therapies in the past few decades have reduced the incidence of recurrent bleeding and the mortality rate associated with this disease. Strategies to prevent recurrence have been defined for various causes of peptic ulcer bleeding. This article reviews the current diagnosis and management of acute peptic ulcer bleeding.
Diagnosis* ; Disease Management ; Drug Therapy ; Endoscopy ; Hemorrhage* ; Incidence ; Mortality ; Peptic Ulcer Hemorrhage ; Peptic Ulcer* ; Recurrence ; Resuscitation ; Risk Assessment

Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding.
Adult ; Aneurysm/*diagnosis/etiology ; Arteries ; Embolization, Therapeutic ; Gastroscopy ; Head and Neck Neoplasms/complications/*diagnosis ; Hepatic Artery/diagnostic imaging ; Humans ; Male ; Neurofibromatosis 1/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*etiology ; Radiography

BACKGROUND/AIMS: The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk factors of rebleeding in Forrest type IIB peptic ulcer. METHODS: Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December 2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic ulcer with adherent clots were enrolled. RESULTS: Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs. 10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group. However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641). In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1; p=0.025). CONCLUSIONS: In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding was use of aspirin and/or NSAID.
Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Cohort Studies ; Female ; *Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Peptic Ulcer/complications/diagnosis ; Peptic Ulcer Hemorrhage/etiology/*therapy ; Prospective Studies ; Proton Pump Inhibitors/therapeutic use ; Recurrence ; Risk Factors ; Treatment Outcome