Characteristics of nonvariceal upper gastrointestinal hemorrhage in patients with chronic kidney disease

Chang Seok Bang, Yong Seop Lee, Yun Hyeong Lee, Hotaik Sung, Hong Jun Park, Hyun Soo Kim, Jin Bong Kim, Gwang Ho Baik, Yeon Soo Kim, Jai Hoon Yoon, Dong Joon Kim, Ki Tae Suk

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Abstract

AIM: To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage (NGIH) in patients with chronic kidney disease (CKD). METHODS: From 2003 to 2010, a total of 72 CKD patients (male n = 52, 72.2%; female n = 20, 27.8%) who had undergone endoscopic treatments for NGIH were retrospectively identified. Clinical findings, endoscopic features, prognosis, rebleeding risk factors, and mortality-related factors were evaluated. The characteristics of the patients and rebleeding-related data were recorded for the following variables: gender, age, alcohol use and smoking history, past hemorrhage history, endoscopic findings (the cause, location, and size of the hemorrhage and the hemorrhagic state), therapeutic options for endoscopy, endoscopist experience, clinical outcomes, and mortality. RESULTS: The average size of the hemorrhagic site was 13.7 ± 10.2 mm, and the most common hemorrhagic site in the stomach was the antrum (n = 21, 43.8%). The most frequent method of hemostasis was combination therapy (n = 32, 44.4%). The incidence of rebleeding was 37.5% (n = 27), and 16.7% (n = 12) of patients expired due to hemorrhage. In a multivariate analysis of the risk factors for rebleeding, alcoholism (OR = 11.19, P = 0.02), the experience of endoscopists (OR = 0.56, P = 0.03), and combination endoscopic therapy (OR = 0.06, P = 0.01) compared with monotherapy were significantly related to rebleeding after endoscopic therapy. In a risk analysis of mortality after endoscopic therapy, only rebleeding was related to mortality (OR = 7.1, P = 0.02). CONCLUSION: Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD, especially when a patient is an alcoholic.

Original languageEnglish
Pages (from-to)7719-7725
Number of pages7
JournalWorld Journal of Gastroenterology
Volume19
Issue number43
DOIs
Publication statusPublished - 2013

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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    Bang, C. S., Lee, Y. S., Lee, Y. H., Sung, H., Park, H. J., Kim, H. S., Kim, J. B., Baik, G. H., Kim, Y. S., Yoon, J. H., Kim, D. J., & Suk, K. T. (2013). Characteristics of nonvariceal upper gastrointestinal hemorrhage in patients with chronic kidney disease. World Journal of Gastroenterology, 19(43), 7719-7725. https://doi.org/10.3748/wjg.v19.i43.7719