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The patient with acute gastrointestinal problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Rebecca Maindonald, Adrian Jugdoyal
The incidence rate of 1.33 cases/1000 population equates to approximately 85,000 cases/year in the UK, or one gastrointestinal bleed every 6 minutes (NCEPOD 2015). Patients with any acute GI bleed should only be admitted to hospitals with 24/7 access to on-site endoscopy and interventional radiology. Gastric erosion/acute stress ulceration can be another complication associated with any critically ill patient, with lesions ranging from mild erosion to acute ulceration and perforation.
Topical Therapy: Cyanoacrylates and Other Modalities
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
Jensen et al.109 studied the same clotting factors and failed to demonstrate reliable hemostasis in standard ulcers or gastric erosion whether applied at laparotomy or endoscopically. It is unclear why the results of the two groups of investigators differ. This author would be somewhat concerned about rebleeding following clot lysis. This question remains for clinical studies to determine. It is unlikely that this can be studied in animal models because it is difficult to produce chronic bleeding with or without heparinization. There is a great tendency for animal models to stop bleeding. The rebleeding rate in the dog even when heparinized is not universal. The possibility of clotting factors becoming a clinical modality in the control of GI bleeding remains to be determined. The polylumen tube, as designed by Linscheer and Fazio,107 has merit if multiple agents are utilized in endoscopic therapy. In most of the therapeutic endeavors, a cleaning jet with a liquid, plus drying with carbon dioxide, was necessary before the application of the therapeutic agent.
Natural History and Complications
Published in Julian Tudor Hart, Hypertension, 2018
Risks from cerebral haemorrhage are probably increased by aspirin. Cerebral haemorrhage can be diagnosed reliably only by CT scanning (still not available in about half of all UK health districts), but because thrombotic and embolic strokes occur about five times more often than haemorrhagic strokes,15 unselective use of aspirin still seems justified by improved outcome overall, at least until CT scanning becomes routinely available throughout the UK. Although increased risk from gastric erosion is small, it is nevertheless real. It is probably reduced by use of enteric coated aspirin.25 Dosage remains controversial, with some experts still advocating 300 mg daily, and others 75 mg daily. Aspirin has a powerful and remarkably sustained effect on platelet adhesiveness, still measurable 4 weeks after a single dose. As gastrointestinal haemorrhage is measurably increased even at a dose of 75 mg daily, the larger dose of 300 mg daily may be optimal until the experts agree.
Gastric erosion in laparoscopic gastric banding
Published in Scandinavian Journal of Gastroenterology, 2020
Naman S. Shetty, Gaurav Ghosh, David Wan
Laparoscopic gastric banding (LAGB) was first introduced in 1993 and consisted of placement of an inflatable gastric band, the diameter of which can be controlled by a subcutaneous port via a connecting tube, below the gastroesophageal junction resulting in the creation of a gastric pouch [1]. LAGB is the least invasive and frequently used procedure to treat morbid obesity (BMI > 40 kg/m2) [2]. Complications of LAGB include port-tubing disconnection, port infection, incisional hernia, band slippage, gastric band erosion with intragastric band migration, and gastric perforation [3]. Gastric erosion is a serious complication of laparoscopic gastric banding seen in 0.3–14% of patients [3].
Usefulness of the ReShape intragastric balloon for obesity
Published in Baylor University Medical Center Proceedings, 2019
Sakolwan Suchartlikitwong, Passisd Laoveeravat, Thammasak Mingbunjerdsuk, Wasawat Vutthikraivit, Amr Ismail, Sameer Islam, Ebtesam Islam
Nausea was the most common side effect and occurred in 23% of patients (Table 3). Two patients required balloon removal because of severe nausea and vomiting at week 4 and week 8. Other minor complications included heartburn (3%) and gastric erosion (3%). Two patients had major complications. One had balloon migration causing small bowel obstruction and required surgery to remove the balloon. The other patient had a gastric ulcer requiring two units of red blood cell transfusion; however, this patient also had a history of Helicobacter pylori and nonsteroidal anti-inflammatory drug use.
Are there advantages of daprodustat over erythropoiesis-stimulating agents (ESAs) in treating anemia associated with chronic kidney disease (CKD)?
Published in Expert Opinion on Pharmacotherapy, 2022
The incidence of adverse effects with daprodustat and darbepoetin alfa was also similar in the trial of subjects not undergoing dialysis with the most common adverse effect being hypertension. In subjects not undergoing dialysis, the incidence of esophageal or gastric erosion was significantly higher (P = 0.005) in the daprodustat group (70/1937, 3.6%) than in the darbepoetin group (41/1933, 2.4%). Cancer-related death or tumor progression was also significantly higher (P = 0.04) with daprodustat (3.6%) than with darbepoetin (2.5%) [2].