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Recurrence of acute upper GI bleeding due to tumors

The most recent issue of the Alimentary Pharmacology & Therapeutics investigates the short-term success and long-term recurrence acute upper GI bleeding due to tumors, with or without endoscopic therapy.

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Scant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours.

Dr Sheibani and colleagues determined the presentation, endoscopic findings, treatment and outcomes in patients with upper gastrointestinal bleeding from malignant tumors and identify risk factors associated with rebleeding.

Consecutive patients that were hospitalized with hematemesis, melena or hematochezia and underwent upper endoscopy were identified retrospectively by reviewing an endoscopy database.

The team of doctors studied patients with upper gastrointestinal bleeding due to biopsy-proven malignant tumors.

Tumors were the source of bleeding in 106 of 2,166 patients with upper gastrointestinal bleeding.

The research team reported that the tumors were of esophageal, gastric, and duodenal origin.

At presentation, 84 did not have known cancer previously, and 79 had metastatic disease.

At endoscopy, 32 had active bleeding
Alimentary Pharmacology & Therapeutics

The team noted that 77 received transfusions at index hospitalization.

At endoscopy, 32 had active bleeding.

The doctors noted that among actively bleeding patients, hemostasis was achieved in 12 of 14 receiving endoscopic therapy and all 18 not receiving endoscopic treatment.

Hospitalization for rebleeding occurred in 50 of 103 at a median of 30 days.

The team observed that age 60 years, and hemodynamic instability were associated with rebleeding.

Dr Sheibani's team commented, "Patients presenting with tumor-associated upper gastrointestinal bleeding have substantial blood loss, with three-quarters requiring transfusion at presentation."

"Initial hemostasis occurs in almost all patients, with or without endoscopic therapy, but rebleeding requiring repeat hospitalization occurs in approximately half the patients, and is more common in patients who are ≤60 years of age and have hemodynamic instability at presentation."

Aliment Pharmacol & Ther 2013:38(2) : 144-150
09 July 2013

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