Fonseca Jorge, Alves Carlos C, Neto Rosa, Arroja Bruno, Vidal Rosário, Macedo Guilherme, Nunes Ana A, Rego Ana, Carvalho Joao, Banhudo António, Curado António, Lima Paula N, Baranda Joao, Ribeiro Filipe
Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal.
Gastroenterol Hepatol. 2012 Jun-Jul;35(6):377-85. doi: 10.1016/j.gastrohep.2012.02.012. Epub 2012 May 30.
Nonvariceal upper gastrointestinal bleeding (NVUGIB) is associated with important mortality. More information is needed in order to improve NVUGIB management. The aims of this study were: (a) characterizing Portuguese patients and clinical approaches used in NVUGIB, (b) comparing management used in Portugal with management globally used in European countries, (c) identify factors associated with management options, and (d) identify factors associated with adverse outcome.
ENERGiB was an observational, retrospective cohort study, on NVUGIB with endoscopic evaluation, carried across Europe. This study focuses on Portuguese patients of the ENERGiB study. Patients were managed according to routine care. Later, data were collected from files. Multivariate/univariate analyses were conducted on predictive factors of poor outcome and clinical decisions.
Patients (n=404) were mostly men (66.8%), mean age 68, with co-morbidities (72%), frequently on NSAIDs/aspirin. Most were assisted by general medical (57.8%) or surgical team (20.6%), only 19.4% by gastroenterology/GI-bleeding team. PPI was largely used. Gastric/duodenal ulcers, erosive gastritis and esophagitis were the main bleeding causes. 10% had bleeding persistence/recurrence. Death occurred in 24 patients, 20 from a non-bleeding related cause. Poor outcomes were related with age >65, co-morbidities, fresh blood haematemesis, shock/syncope, bleeding through previous nasogastric tube, massive fluid replacement or transfusions besides erythrocytes.
This study contributed to characterization of Portuguese patients and NVUGIB episodes in real clinical setting and identified factors associated with a poor outcome. It also identified differences, especially in the organization of GI bleeding teams, which might help us to improve the management of these patients.
非静脉曲张性上消化道出血（NVUGIB）与较高的死亡率相关。为改善NVUGIB的管理，需要更多信息。本研究的目的是：（a）描述葡萄牙NVUGIB患者及所用的临床方法；（b）将葡萄牙的管理方法与欧洲国家普遍采用的管理方法进行比较；（c）确定与管理选择相关的因素；（d）确定与不良结局相关的因素。
ENERGiB是一项在欧洲开展的关于NVUGIB并进行内镜评估的观察性、回顾性队列研究。本研究聚焦于ENERGiB研究中的葡萄牙患者。患者按照常规护理进行管理。随后，从病历中收集数据。对不良结局的预测因素和临床决策进行多变量/单变量分析。
患者（n = 404）大多为男性（66.8%），平均年龄68岁，伴有合并症（72%），经常服用非甾体抗炎药/阿司匹林。大多数患者由普通内科（57.8%）或外科团队（20.6%）诊治，只有19.4%由胃肠病学/胃肠道出血团队诊治。质子泵抑制剂（PPI）广泛使用。胃/十二指肠溃疡、糜烂性胃炎和食管炎是主要出血原因。10%的患者有出血持续/复发情况。24例患者死亡，20例死于非出血相关原因。不良结局与年龄>65岁、合并症、呕新鲜血、休克/晕厥、经既往鼻胃管出血、除红细胞外大量补液或输血有关。
本研究有助于在实际临床环境中描述葡萄牙患者及NVUGIB发作情况，并确定与不良结局相关的因素。它还发现了差异，尤其是在胃肠道出血团队的组织方面，这可能有助于我们改善这些患者的管理。
