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Gastroenterology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
For an upper GI bleed, there are two scoring systems that need to be calculated. The Glasgow–Blatchford score is used to identify patients at risk of needing immediate endoscopic management for their bleeding. The Rockall score is used to identify patients at high risk of an adverse outcome after an acute upper GI bleed.
Upper gastrointestinal emergencies
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
The Glasgow-Blatchford Score (GBS) is a screening tool that can be used to assess the likelihood that a patient with UGI bleeding will need intervention in the form of a blood transfusion or OGD. It is less subjective than clinician assessment and can be simply calculated using Table 8.1. A score of 6 or more indicates >50% need for intervention.
Gastrointestinal Bleeding
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Acute upper gastrointestinal bleeding is often self-limiting. In the majority of patients, urgent endoscopy is not warranted. There is little controversy that endoscopic hemostatic treatment should be made available to those with exigent bleeding and hypotension. In those who are stable or respond to volume resuscitation, the role of urgent endoscopy is less well defined. Early randomized controlled trials that compared urgent (within 6–12 hours of admissions) to early endoscopy (generally the next morning) consisted of small numbers of patients and were without risk categorization. Observational studies, with their inherent bias, produced conflicting results. A large cohort study from Europe showed a higher mortality in those who underwent endoscopy within 6 hours irrespective of their hemodynamic status. To detect a small difference in clinical outcomes, a large trial size is required. Only high-risk patients should be included in such a trial. Urgent endoscopy in low risk patients would likely lead to their early discharge, reduce hospital resource utilization, and have no impact on clinical outcomes. The strengths of the study are: 1) a randomized trial; 2) predicted high risk patients who were not too sick (those with ongoing bleeding and shock refractory to volume resuscitation excluded); 3) the use of a validated risk score (the Glasgow Blatchford score has been extensively validated and shown to be better than other risk scores in the prediction in the need for intervention); 4) an intention-to-treat analysis; and 5) mortality as the primary outcomes. There are, however, limitations when we interpret trial results. The reported mortality in the trial was lower than that in a validation cohort, and the waiting time in ER before trial inclusion suggest that the trial selected a lower risk group. The low proportion of patients with esophago-gastric varices also limits its generalizability to areas with high prevalence of liver cirrhosis. In patients with stable hemo-dynamics, but at predicted high risk of further bleeds and deaths, we can safely initiate medical therapy and perform endoscopy the next morning.
Massive transfusion in upper gastrointestinal bleeding: a new scoring system
Published in Annals of Medicine, 2019
Yi-Chuan Chen, Chen-Ju Chuang, Kuang-Yu Hsiao, Leng-Chieh Lin, Ming-Szu Hung, Huan-Wen Chen, Shung-Chieh Lee
Based on patient clinical features and endoscopic findings, the Rockall score, ranging from 0 to 11, was calculated for each patient [19,20]. Meanwhile, the modified Glasgow Blatchford score (mGBS), ranging from 0 to 16, was also calculated. The Glasgow Blatchford score (GBS) (range, 0–23) is a risk-scoring system for evaluating the need for clinical intervention in patients with UGIB [21,22]. Modified GBS (mGBS), which eliminated the subjective criteria of GBS (i.e. syncope, melena and the prior history of co-existent liver disease or heart failure) was comparable with GBS in predicting the needs for clinical interventions [23,24].
Identification of risk factors for upper gastrointestinal bleeding in intensive care unit patients (GIBICU study)
Published in Scandinavian Journal of Gastroenterology, 2022
Alexander Poszler, Evelyn Nguyen, Matthias Christoph Braunisch, Sebastian Rasch, Mohamed Abdelhafez, Jörg Ulrich, Johannes Wiessner, Roland M. Schmid, Tobias Lahmer
Following these considerations, not only the determination of the best time point to perform an EGD but also risk stratification strategies are crucial in clinical decision-making to improve the patient outcome of critically ill patients. Scoring strategies like the Glasgow-Blatchford-Score (mGBS) or the Admission Rockall Score (ARS) have been established to predict the probability of the need for endoscopic treatment and moreover the prognosis and the probability of rebleeding complications [4,6,7].
Hypotension develops one to two hours before other symptoms in peptic ulcer rebleeding; a matched cohort study
Published in Scandinavian Journal of Gastroenterology, 2021
Nikolaj Vestergaard Carlsen, Stig Borbjerg Laursen, Ove B. Schaffalitzky de Muckadell
Peptic ulcer bleeding (PUB) is common with an annual incidence ranging from 19.4 to 57.0 per 100,000 [1,2]. Several studies indicate a decline in PUB incidence from the end of the twentieth century to the present [2–4] perhaps explained by a decrease in rate of H. pylori-infection [4]. However, PUB continues to be associated with significant mortality rates ranging from 7.6% to 11% in northern Europe [4,5]. Another feared complication is rebleeding which occurs in 10–15% of PUB patients and is associated with a three to five fold increase in mortality [5–8]. Active bleeding during endoscopy, ulcer localized to duodenum or lesser gastric curvature, and hemodynamic instability at hospital admission are associated with highrisk of rebleeding [9–11]. Despite development of several risk scores such as Glasgow-Blatchford Score (GBS), Rockall Score, AIMS65 and Baylor bleeding Score (BBS) to date no risk score have been able to predict rebleeding with acceptable accuracy [12–15]. Blood pressure and heart rate are two easily accessible vital parameters in the evaluation of blood circulation and represent one of the cornerstones in observation of PUB patients admitted to hospital. High-volume blood loss is normally associated with a decrease in blood pressure and compensating tachycardia [16]. Currently, there is no recommendation regarding frequency of blood pressure and heart rate measurements in the guidelines on management of non-variceal upper gastrointestinal bleeding from the European Society of Gastrointestinal Endoscopy (ESGE), the American College of Gastroenterology (ACG), and the International Consensus Group [17–19]. Our aim was to examine the time course in possible changes in blood pressure and heart rate prior to detection of rebleeding. Based on these findings we wanted to clarify how often blood pressure and heart rate should be monitored in patients with PUB in order to ensure early detection of rebleeding.