2016, Number 4
Influence of comorbidity on patients evolution with upper gastrointestinal bleeding from peptic ulcer
Language: Spanish
References: 34
Page: 551-562
PDF size: 122.74 Kb.
ABSTRACT
Introduction: Despite the endoscopic therapy advances, morbidity and mortality of patients with gastrointestinal bleeding are high.Objective: To determine if there is relationship between comorbidity and its severity with short-term developments in the ulcerative patient presenting acute upper gastrointestinal bleeding episode.
Material and Methods: We performed an observational, descriptive, prospective and longitudinal research in the Central Military Hospital "Dr. Luis Díaz Soto" between September 2013 and March 2015. 103 patients that bled due to peptic ulcer were included. The bleeding stigmas were identified by means of Forrest classification, correspondently; endoscopic therapy was applied and assessed using the Charlson Comorbidity Index. Comparisons between the groups with and without comorbidity and gravely ill regarding treatment results, rebleeding, surgery and mortality were made.
Results: Male patients predominated (69.9%) and older than 60 years old (62.7 ± 17.8 years). 58.3% presented comorbidity. The condition most prevalent was ischemic heart disease (21.4%). Among patients with co-morbidity existed higher probability of finding during endoscopy of acute bleeding stigmata or recent bleeding (RR = 1 2; IC 95% = 0.48-2.98). The rebleeding risk was higher among those who had moderate comorbidity (RR = 1. 5; 95% CI: 0.25-8.97; (p = 0.006). The need for surgery was not related to co-morbidity. Mortality was precocious (21.4%) and was related to the coexistence of hepatic cirrhosis.
Conclusions: The greater influence of co-morbid diseases occurs on bleeding relapse and mortality.
REFERENCES
Corzo Maldonado MA, Guzmán Rojas P, Bravo Paredes EA, Gallegos López RC, Huerta Mercado-Tenorio J, Surco Ochoa Y, et al. Factores de riesgo asociados a la mortalidad por hemorragia digestiva alta en pacientes de un hospital público: Estudio caso control.Rev Gastroenterol Perú [Internet]. 2013; 33:223-9 pp. [Citado 2015 Oct 10]. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1022- 51292013000300004&nrm=iso
Dicu D, Pop F, Ionescu D, Dicu T. Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit. Am J Emerg Med [Internet]. 2013 Jan, 31(1):94-9 pp. [Citado 2015 Oct 23]. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S0735-6757(12)00334-8
Castillo-Elera C, Montenegro-Idrogo JJ, Montañez-Valverde R, Callupe-Huamán G, Huayta-Córdova G, Rivera-Fernández G, et al. Incidencia y factores asociados en la recurrencia de sangrado ulceroso post inyectoterapia con adrenalina. Rev Gastroenterol Perú [Internet]. 2012; 32:351-6 pp. [Citado 2015 Nov 12]. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1022- 51292012000400003&nrm=iso
Winograd Lay R, Williams Guerra E, Rodríguez Álvarez D, Ramos Contreras JY, Guisado Reyes Y, Angulo Pérez O, et al. Endoscopía en la atención a pacientes con hemorragia digestiva alta no varicosa. Rev Cubana Med Mil [Internet]. 2015; 44:187- 94 pp. [Citado 2016 Ene 23]. Disponible en: http://scieloprueba.sld.cu/scielo.php?script=sci_arttext&pid=S0138- 65572015000200007&nrm=iso
Pozo González A, Corimayta Gutierrez Y, Jaime Carballo Y, Barbán Fernández L, Brizuela Pérez SM. Características clínicas del sangramiento digestivo alto. AMC [Internet]. 2010; 14. [Citado 2015 Nov 16]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1025- 02552010000300008&nrm=iso
Bae S, Kim N, Kang JM, Kim D-S, Kim K-M, Cho YK, et al. Incidence and 30-day mortality of peptic ulcer bleeding in Korea. Eur J Gastroenterol Hepatol [Internet]. 2012; 24(6):675-82 pp.. [Citado 2016 May 23]. Disponible en: http://journals.lww.com/eurojgh/Fulltext/2012/06000/Incidence_and_30_day_mortali ty_of_peptic_ulcer.10.aspx
Al-Mallah M, Bazari RN, Jankowski M, Hudson MP. Predictors and outcomes associated with gastrointestinal bleeding in patients with acute coronary syndromes. J Thromb Thrombolysis [Internet]. 2007 Feb; 23(1):51-5 pp. [Citado 2015 Nov 04]. Disponible en: http://link.springer.com/article/10.1007/s11239-006-9005- 8/fulltext.html?view=classic
Lanas A, Aabakken L, Fonseca J, Mungan ZA, Papatheodoridis GV, Piessevaux H, et al. Clinical predictors of poor outcomes among patients with nonvariceal upper gastrointestinal bleeding in Europe. Aliment Pharmacol Ther [Internet]. 2011 Jun; 33(11):1225-33 pp. [Citado 2016 Ene 18]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2011.04651.x/full
Wilcox CM, Cryer BL, Henk HJ, Zarotsky V, Zlateva G. Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting. Clin Exp Gastroenterol [Internet]. 2009; 2:21-30 pp. [Citado 2015 Mar 31]. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108636/#
Morales Uribe CH, Sierra Sierra S, Hernández Hernández AM, Arango Durango AF, López GA. Hemorragia digestiva alta: factores de riesgo para la mortalidad en dos centros urbanos en Latinoamérica. Rev Esp Enferm Dig [Internet]. 2011; 103(1):20-4 pp. [Citado 2015 Jun 09]. Disponible en: http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=4619314&TO =RVN&Eng=1
Hernández Ortega A, Sánchez Cruz J, Álvarez Díaz M, Figueroa Vázquez A, Yanes Castellanos L. Comportamiento del sangramiento digestivo alto en pacientes endoscopiados. Rev Méd Electrón [Internet]. 2006; 28(4). [Citado 2016 May 29]. Disponible en: http://www.revmatanzas.sld.cu/revista%20medica/ano%202006/vol4%202006/tema 05.htm
Luo JC, Leu HB, Hou MC, Huang CC, Lin HC, Lee FY, et al. Cirrhotic patients at increased risk of peptic ulcer bleeding: a nationwide population-based cohort study. Aliment Pharmacol Ther [Internet]. 2012;36(6):542-50 pp. [Citado 2015 01 18]. Disponible en: http://dx.doi.org/10.1111/j.1365-2036.2012.05225.x
Ang D, Teo EK, Tan A, Ibrahim S, Tan PS, Ang TL, et al. A comparison of surgery versus transcatheter angiographic embolization in the treatment of nonvariceal upper gastrointestinal bleeding uncontrolled by endoscopy. Eur J Gastroenterol Hepatol [Internet]. 2012 Aug; 24(8):929-38 pp. [Citado 2015 May 28]. Disponible en: www.gastrojournal.org/article/S0016-5085(12)61929-5/pdf
Bang CS, Baik GH, Kim JH, Kim JB, Suk KT, Yoon JH, et al. Peptic ulcer disease in liver cirrhosis and chronic hepatitis: impact of portal hypertension. Scand J Gastroenterol [Internet]. 2014; 49(9):1051-7 pp. [Citado 2015 Nov 01]. Disponible en: http://informahealthcare.com/doi/abs/10.3109/00365521.2014.923501
Laursen SB, Hansen JM, Hallas J, Schaffalitzky de Muckadell OB. The excess longterm mortality in peptic ulcer bleeding is explained by nonspecific comorbidity. Scand J Gastroenterol [Internet]. 2015; 50(2):145-52 pp. [Citado 2016 Ene 18]. Disponible en: http://dx.doi.org/10.3109/00365521.2014.992365