Upper gastrointestinal hemorrhage

Guess HA, West R, Strand LM, et al. Fatal upper gastrointestinal hemorrhage or perforation among users and nonusers of nonsteroidal antiinflammatory drugs in Saskatchewan, Canada... 

Macrolide antibiotics such as erythromycin directly stimulate motilin receptors on gastrointestinal smooth muscle and promote the onset of a migrating motor complex. Intravenous erythromycin (3 mg/kg) is beneficial in some patients with gastroparesis however, tolerance rapidly develops. It may be used in patients with acute upper gastrointestinal hemorrhage to promote gastric emptying of blood before endoscopy. 

The physiological purpose of nausea is to discourage food intake, and vomiting is meant to expel food or other toxic substances present in the upper part of the gastrointestinal tract. Protracted vomiting may not only cause electrolyte imbalance, dehydration, or a malnutrition syndrome, but may also lead to mucosal laceration and upper gastrointestinal hemorrhage (Mallory-Weiss syndrome). 

Cook, D.J., Guyatt, G.H., Salena, B.J., Laine, L.A. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage A metaanalysis. Gastroenterology 1992 102 139-148... 

E. G. Bergman, C.A. Wolski, K. Eatal upper gastrointestinal hemorrhage of perforation among users and nonusers of nonsteroidal anti-inflammatory drugs in Saskatchewan, Canada 1983. J. Clin. Epidemiol. 1988, 41, 35-45. Meyboom, R.H.B. Hekster, Y.A. Antoine, C.G. Gribnau,... 

Two recently published articles have helped to clarify this point a systematic review of randomized clinical trials on the upper gastrointestinal safety of celecoxib (90) and a population-based retrospective cohort comparison of the rate of upper gastrointestinal hemorrhages in over 40 000 NSAID-naive elderly users of non-selective NSAIDs, celecoxib, or rofecoxib with the rate in 100 000 patients who had not been exposed to NSAIDs (91). 

This study has provided further evidence that the risk of upper gastrointestinal hemorrhage with COX-2 inhibitors is significantly lower than with conventional NSAIDs, whether or not they are taken with misoprostol. The apparently greater risk of gastrointestinal hemorrhage with rofecoxib than with celecoxib needs... 

Gastrointestinal adverse effects are particularly frequent, and affect some 14-25% of patients the incidence of the most serious, peptic ulcer and bleeding were 0.16-0.34% and 0.16-0.17%, respectively (1). A prospective 12-week endoscopic study documented better gastrointestinal tolerability with diclofenac than naproxen (SEDA-20, 92). Upper gastrointestinal hemorrhage has been associated with transdermal application of diclofenac, with massive bleeding in two of four patients (SEDA-21, 104). 

Battistella M, Mam dam i MM, Juurlink DN, Rabeneck L, Laupacis A. Risk of upper gastrointestinal hemorrhage in warfarin users treated wifii nonselective NSAIDs or COX-2 ii iibitors. Arch Intern Med (2005) 165,189-92. 

No adverse reactions to clove have been reported in the normal dosage range (a decoction of 1-3 g). Overdose of clove has resulted in symptoms of nausea, diarrhea, vomiting, and upper gastrointestinal hemorrhage. Cases of severe overdoses have been reported to cause changes in liver function, difficulty breathing, loss of consciousness, or death (Bensky et al. 2004). 

Aina R, Oliva VL, Therasse E, et al. (2001) Arterial embolo-therapy for upper gastrointestinal hemorrhage outcome assessment. J Vase Interv Radiol 12 195-200... 

Longstreth GF (1995) Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage a population-based study. Am J Gastroenterol 90 206-210... 

Elta GH (2002) Acute nonvariceal upper gastrointestinal hemorrhage. Curr Treat Options Gastroenterol 5 147-152... 

Lang EV, Picus D, Marx MV, et al. (1992) Massive upper gastrointestinal hemorrhage with normal findings on arteriography value of prophylactic embolization of the... 

Warfarin In a large population-based, nested case-control study from Canada 2151 cases of upper gastrointestinal hemorrhage were identified in almost 135 000 subjects > 66 years of age receiving warfarin continuously [129 ]. When matched with up to 10 age- and sex-matched controls, cases were 3.84 times more likely (95% Cl = 2.33, 6.33) to have recently received co-trimoxazole. Ciprofioxacin use also significantly increased the risk of hemorrhage (OR = 1.94 95% Cl = 1.28, 2.95) but use of amoxicillin, nitrofurantoin or norfi-oxacin did not. Co-trimoxazole inhibits CYP2C9, responsible for metabolism of the 5-enantiomer of warfarin. 

A 53-year-old man with liver cirrhosis had a large upper gastrointestinal hemorrhage and was given propofol 100 mg for induction of anesthesia 1 hour later he was noted to have green urine. No other medications or recent food could have caused this. 

Schenker MP, Duszak R Jr, Soulen MC, Smith KP, Baum RA, Cope C et al. (2001) Upper gastrointestinal hemorrhage and transcatheter embolotherapy clinical and technical factors impacting success and survival. J Vase Interv Radiol 12 1263-1271... 

The variability of practice in the management of upper gastrointestinal hemorrhage and stress ulceration may be, in part, a reflection of regional differences in disease prevalence and severity, but is probably as much due to variations in individual clinicians assessment and application of published evidence. It has been suggested that improved outcomes in specialist units are attributable to the development and implementation of clear protocols and guidelines as much as technical resources and prowess, and there is therefore a clear need for practice guidelines in both of these areas. 

Collins R, Langman MJS. Treatment with histamine H2 antagonists in acute upper gastrointestinal hemorrhage implications of randomized trials. N Engl J Med 1985 313 660-666. 

Henry DA, O Connell DL. Effect of fibrinolytic inhibitors on mortality from upper gastrointestinal hemorrhage. Br Med J 1989 298 1142-1146. 

Imperiale TF, Birgisson S. Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute non-variceal upper gastrointestinal hemorrhage a meta-analysis. Ann Intern Med 1997 127 1062-1071. 

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