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New Trends and Advances in Non-Variceal Gastrointestinal Bleeding
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New Trends and Advances in Non-Variceal Gastrointestinal Bleeding

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (30 April 2020) | Viewed by 36300

Special Issue Editor

Prof. Dr. Angel Lanas

E-Mail Website
Guest Editor
Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón, CIBERehd, Zaragoza, Spain
Interests: gastrointestinal (GI) bleeding; peptic ulcers; obscure GI bleeding; colonic bleeding; Non-steroidal anti-inflammatory drugs; anticoagulants; antiplatelet agents; therapy; diagnosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Non-variceal gastrointestinal (GI) bleeding is a major problem in clinical practice, and despite advances in diagnosis and instrumental or pharmacological treatment, morbidity and mortality associated with this type of bleeding are still high.

A growing aging population consuming NSAIDs, antiplatelet agents, and anticoagulants are changing the face of the typical picture of upper GI bleeding seen only a few years ago, where H. pylori-related peptic ulcer was the most frequent cause of GI bleeding. Today, lower GI bleeding is more frequent than upper GI bleeding, probably as a result of the wide use of antisecretory agents, and a decrease in H. pylori infection. Obscure gastrointestinal bleeding is also frequent and represents a serious clinical challenge. This Issue focused on non-variceal GI bleeding should provide both original and review studies dealing with the most recent advances in the diagnostic and therapeutic procedures or pharmacological approaches for any type of non-variceal GI bleeding located in the upper, mid, or lower GI tract. Studies focused on new trends in epidemiology, pathogenesis, etiology, mucosal damaging agents, or prognostic tools, including those dealing with artificial inteligence or articial neural networks, are also welcome. Finally, approaches or new ideas on the clinical management of frequent causes of gastrointestinal bleeding can be considered.

Prof. Dr. Angel Lanas
Guest Editor

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Keywords

  • Gastrointestinal bleeding
  • Peptic ulcer
  • Endoscopic treatment
  • NSAIDs
  • Anticoagulants
  • Antiplatelets
  • Colonic bleeding
  • Small bowel bleeding

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Published Papers (6 papers)

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Research

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10 pages, 658 KiB  
Article
No Differences in Gastrointestinal Bleeding Risk among Clopidogrel-, Ticagrelor-, or Prasugrel-Based Dual Antiplatelet Therapy
by Viviana Laredo, Carlos Sostres, Sandra García, Patricia Carrera-Lasfuentes, Pablo Revilla-Marti and Ángel Lanas
J. Clin. Med. 2020, 9(5), 1526; https://doi.org/10.3390/jcm9051526 - 18 May 2020
Cited by 7 | Viewed by 4180
Abstract
The risk for gastrointestinal bleeding from dual antiplatelet therapy (DAPT) with new antiplatelets (prasugrel/ticagrelor) compared to clopidogrel is unclear. Aim: To determine the risk and type of major (gastrointestinal bleeding requiring hospitalization) and minor (anemia and iron deficiency) gastrointestinal events with different types [...] Read more.
The risk for gastrointestinal bleeding from dual antiplatelet therapy (DAPT) with new antiplatelets (prasugrel/ticagrelor) compared to clopidogrel is unclear. Aim: To determine the risk and type of major (gastrointestinal bleeding requiring hospitalization) and minor (anemia and iron deficiency) gastrointestinal events with different types of DAPT. Methods: Retrospective observational cohort study of patients who started DAPT after percutaneous coronary intervention. Follow-up was censored after 12 months of DAPT, when a major gastrointestinal event occurred, or when DAPT was discontinued. Results: Among 1,327 patients (54.03% were treated with clopidogrel-based DAPT, 38.13% with ticagrelor-based DAPT, and 7.84% with prasugrel-based DAPT), 29.5% had at least one gastrointestinal event. Patients taking clopidogrel-DAPT were older, with more comorbidities, and higher gastrointestinal risk compared to those taking other DAPT regimens. Adjusted hazard ratios (HRs) showed no between-group differences in the risk for major (clopidogrel vs. new antiplatelets: HR 0.996; 95% confidence interval 0.497–1.996) and minor (HR 0.920; 0.712–1.189) gastrointestinal events. Most patients received proton pump inhibitors while on DAPT (93.3%) and after withdrawal (83.2%). Conclusion: Prasugrel- or ticagrelor-based DAPT was not associated with increased gastrointestinal bleeding risk when compared to clopidogrel-DAPT. New antiplatelets do not necessarily need to be restricted to patients with low gastrointestinal risk. Full article
(This article belongs to the Special Issue New Trends and Advances in Non-Variceal Gastrointestinal Bleeding)
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12 pages, 255 KiB  
Article
Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational Study
by Luis A. García Rodríguez, Angel Lanas, Montse Soriano-Gabarró, Pareen Vora and Lucía Cea Soriano
J. Clin. Med. 2020, 9(4), 928; https://doi.org/10.3390/jcm9040928 - 28 Mar 2020
Cited by 13 | Viewed by 4665
Abstract
Estimates of the effect of proton pump inhibitors (PPIs) on risks of upper and lower gastrointestinal bleeding (UGIB and LGIB) among low-dose aspirin users in routine clinical practice are variable (UGIB) or lacking (LGIB). We aimed to establish these risks in the same [...] Read more.
Estimates of the effect of proton pump inhibitors (PPIs) on risks of upper and lower gastrointestinal bleeding (UGIB and LGIB) among low-dose aspirin users in routine clinical practice are variable (UGIB) or lacking (LGIB). We aimed to establish these risks in the same observational study population. Using UK primary care data, we followed 199,049 new users of low-dose aspirin (75–300 mg/day) and matched non-users at start of follow-up to identify incident UGIB/LGIB cases. In nested case–control analyses, adjusted odds ratios (ORs) were calculated for concomitant PPI use vs. past (discontinued) PPI use among current low-dose aspirin users. For UGIB (n = 987), ORs (95% CIs) were 0.69 (0.54–0.88) for >1 month PPI use and 2.65 (1.62–4.3) for ≤1 month PPI use. Among the latter group, ORs (95% CIs) were 3.05 (1.75–5.33) for PPI initiation after start of aspirin therapy, and 1.66 (0.63–4.36) for PPI initiation on/before start of aspirin therapy. For LGIB (n = 1428), ORs (95% CIs) were 0.98 (0.81–1.17) for >1 month PPI use and 1.12 (0.73–1.71) for ≤1 month PPI use. Among low-dose aspirin users, maintaining PPI use (>1 month) was associated with a significantly reduced UGIB risk. Neither short nor long-term PPI use affected LGIB risk. Full article
(This article belongs to the Special Issue New Trends and Advances in Non-Variceal Gastrointestinal Bleeding)
12 pages, 1060 KiB  
Article
Endoscopist’s Judgment Is as Useful as Risk Scores for Predicting Outcome in Peptic Ulcer Bleeding: A Multicenter Study
by Enric Brullet, Pilar Garcia-Iglesias, Xavier Calvet, Michel Papo, Montserrat Planella, Albert Pardo, Félix Junquera, Silvia Montoliu, Raquel Ballester, Eva Martinez-Bauer, David Suarez and Rafel Campo
J. Clin. Med. 2020, 9(2), 408; https://doi.org/10.3390/jcm9020408 - 3 Feb 2020
Cited by 10 | Viewed by 2375
Abstract
Background: Guidelines recommend using prognostic scales for risk stratification in patients with non-variceal upper gastrointestinal bleeding. It remains unclear whether risk scores offer greater accuracy than clinical evaluation. Objective: Compare the diagnostic accuracy of the endoscopist’s judgment against different risk-scoring systems (Rockall, Glasgow–Blatchford, [...] Read more.
Background: Guidelines recommend using prognostic scales for risk stratification in patients with non-variceal upper gastrointestinal bleeding. It remains unclear whether risk scores offer greater accuracy than clinical evaluation. Objective: Compare the diagnostic accuracy of the endoscopist’s judgment against different risk-scoring systems (Rockall, Glasgow–Blatchford, Baylor and the Cedars–Sinai scores) for predicting outcomes in peptic ulcer bleeding (PUB). Methods: Between February 2006 and April 2010 we prospectively recruited 401 patients with peptic ulcer bleeding; 225 received endoscopic treatment. The endoscopist recorded his/her subjective assessment (“endoscopist judgment”) of the risk of rebleeding and death immediately after endoscopy for each patient. Independent evaluators calculated the different scores. Area under the receiver-operating-characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values were calculated for rebleeding and mortality. Results: The areas under ROC curve of the endoscopist’s clinical judgment for rebleeding (0.67–0.75) and mortality (0.84–0.9) were similar or even superior to the different risk scores in both the whole group and in patients receiving endoscopic therapy. Conclusions: The accuracy of the currently available risk scores for predicting rebleeding and mortality in PUB patients was moderate and not superior to the endoscopist’s judgment. More precise prognostic scales are needed. Full article
(This article belongs to the Special Issue New Trends and Advances in Non-Variceal Gastrointestinal Bleeding)
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Review

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17 pages, 682 KiB  
Review
Non-Vitamin K Antagonist Oral Anticoagulants and the Gastrointestinal Bleeding Risk in Real-World Studies
by Larisa Anghel, Radu Sascău, Anca Trifan, Ioana Mădălina Zota and Cristian Stătescu
J. Clin. Med. 2020, 9(5), 1398; https://doi.org/10.3390/jcm9051398 - 9 May 2020
Cited by 9 | Viewed by 3769
Abstract
In the present study, we aimed to provide evidence from high-quality real world studies for a comprehensive and rigorous analysis on the gastrointestinal bleeding (GIB) risk for non-vitamin K antagonist oral anticoagulants (NOACs). We performed a systematic search of MEDLINE, EMBASE and PUBMED, [...] Read more.
In the present study, we aimed to provide evidence from high-quality real world studies for a comprehensive and rigorous analysis on the gastrointestinal bleeding (GIB) risk for non-vitamin K antagonist oral anticoagulants (NOACs). We performed a systematic search of MEDLINE, EMBASE and PUBMED, and of 286 records screened, we included data from 11 high-quality real-world studies, coordinated by independent research groups over the last 3 years, that reported major GIB events in patients given NOACs or vitamin K antagonists for patients with nonvalvular atrial fibrillation. The lowest risk of gastrointestinal bleeding was with apixaban compared with warfarin (hazard ratio (HR) for GIB for apixaban ranging between 0.45 (95% confidence interval (CI) 0.34 to 0.59) and 1.13 (95% CI 0.79 to 1.63)). Apixaban was associated with a lower risk of GI bleeding than dabigatran ((HR ranging between 0.39 (95% CI 0.27 to 0.58) and 0.95 (95% CI 0.65 to 1.18)) or rivaroxaban ((HR ranging between 0.33 (95% CI 0.22 to 0.49) and 0.82 (95% CI 0.62 to 1.08)). The results of our study confirm a low or a similar risk for major GIB between patients receiving apixaban or dabigatran compared with warfarin, and apixaban appears to be associated with the lowest risk of GIB. Full article
(This article belongs to the Special Issue New Trends and Advances in Non-Variceal Gastrointestinal Bleeding)
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9 pages, 212 KiB  
Review
Endoscopic Ultrasound-Guided Treatments for Non-Variceal Upper GI Bleeding: A Review of the Literature
by Claudio Giovanni De Angelis, Pablo Cortegoso Valdivia, Stefano Rizza, Ludovica Venezia, Felice Rizzi, Marcantonio Gesualdo, Giorgio Maria Saracco and Rinaldo Pellicano
J. Clin. Med. 2020, 9(3), 866; https://doi.org/10.3390/jcm9030866 - 21 Mar 2020
Cited by 14 | Viewed by 3295
Abstract
Endoscopic injection of glues, clotting factors, or sclerosing agents is a well-known therapy for the treatment of non-variceal upper gastrointestinal bleeding (NVUGIB), but less is known about endoscopic ultrasound (EUS)-guided treatments. In this setting, literature data are scarce, and no randomized controlled trials [...] Read more.
Endoscopic injection of glues, clotting factors, or sclerosing agents is a well-known therapy for the treatment of non-variceal upper gastrointestinal bleeding (NVUGIB), but less is known about endoscopic ultrasound (EUS)-guided treatments. In this setting, literature data are scarce, and no randomized controlled trials are available. We performed a review of the existing literature in order to evaluate the role of EUS-guided therapies in the management of NVUGIB. The most common treated lesions were Dieulafoy’s lesions, pancreatic pseudoaneurysms, and gastrointestinal stromal tumors (GISTs). Mostly, the treatments were performed as a salvage option after failure of conventional endoscopic hemostatic attempts, showing good efficacy and a good safety profile, also documented by Doppler monitoring of treated lesions. EUS-guided therapies may be an effective option in the treatment of refractory NVUGIB, thus avoiding radiological or surgical management. Nevertheless, available literature still lacks robust data. Full article
(This article belongs to the Special Issue New Trends and Advances in Non-Variceal Gastrointestinal Bleeding)
24 pages, 9280 KiB  
Review
Diagnosis and Management of Non-Variceal Gastrointestinal Hemorrhage: A Review of Current Guidelines and Future Perspectives
by Sobia Mujtaba, Saurabh Chawla and Julia Fayez Massaad
J. Clin. Med. 2020, 9(2), 402; https://doi.org/10.3390/jcm9020402 - 2 Feb 2020
Cited by 29 | Viewed by 16997
Abstract
Non-variceal gastrointestinal bleeding (GIB) is a significant cause of mortality and morbidity worldwide which is encountered in the ambulatory and hospital settings. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GIB, small bowel bleeding (also formerly referred to as obscure GIB) [...] Read more.
Non-variceal gastrointestinal bleeding (GIB) is a significant cause of mortality and morbidity worldwide which is encountered in the ambulatory and hospital settings. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GIB, small bowel bleeding (also formerly referred to as obscure GIB) or lower GIB. Although the etiologies of GIB are variable, a strong, consistent risk factor is use of non-steroidal anti-inflammatory drugs. Advances in the endoscopic diagnosis and treatment of GIB have led to improved outcomes. We present an updated review of the current practices regarding the diagnosis and management of non-variceal GIB, and possible future directions. Full article
(This article belongs to the Special Issue New Trends and Advances in Non-Variceal Gastrointestinal Bleeding)
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