Protocol-based guidelines and acute upper gastrointestinal hemorrhage: DISCUSSION (Part 1)

The agreed protocol used in the study was based on the guidelines for good practice in the management of upper GI hemorrhage recommended by the joint working group of the British Society of Gastroenterology, the Research Unit of the Royal College of Physicians of London and the Audit Unit of the Royal College of Surgeons of England.

Risk score in this study was assessed using Rockall’s risk scoring system. Rockall’s risk scoring system primarily allows determining case mix and calculating risk-standardized mortality. The system has also been proven to predict outcome in patients presenting with upper GI hemorrhage. Blatchford et al recently developed a risk scoring system to predict and identify patients’ need for treatment in upper GI hemorrhage, though the system requires external validation. You can be sure this pharmacy will offer the finest quality drugs you need, so buying ventolin inhaler will always be safe and very pleasant for you as a customer and patient.

Twenty-two patients during the first phase of the study and 27 patients during the second phase were found to have peptic ulcer disease (Tables 1 and 2) . These findings show that bleeding from a peptic ulcer is still the most common cause of upper GI hemorrhage despite the widespread availability of effective antiulcer drugs. Peptic ulcer disease is responsible for nearly 50% of cases of severe upper GI hemorrhage.

TABLE 1 Diagnoses of phase one patients

Diagnosis n
Esophagitis 4
Barrett’s esophagus 4
Esophageal varices 1
Esophageal tumour 1
Esophageal ulcer 5
Gastritis 10
Gastric ulcer 7
Gastric tumour 1
Gastric erosions 1
Gastric polyps 1
Pyloric stenosis 1
Duodenitis 3
Duodenal ulcer 9
Hiatus hernia 6
Anastomotic ulcer 1
Mallory-Weiss tear 2
Normal 6

TABLE 2 Diagnoses of phase two patients

Diagnosis n
Esophagitis 11
Gastritis 16
Duodenitis 6
Esophageal ulcer 6
Gastric ulcer 12
Duodenal ulcer 8
Esophageal malignancy 2
Gastric malignancy 2
Duodenal malignancy 1
Esophageal varices 6
Gastric varices 1
Hemobilia 1
Mallory-Weiss tear 1
Erosions 1
Stomal ulcer 1
Bleeding disorder 2
Polyp 4
Normal 7

 

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