The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 483
Slide Session
K-UG-21 Upper GI Tract
C-Reactive Protein as a Predictive Indicator of Rebleeding in Patients with Acute Variceal Bleeding
EunYoung Kim1, Jae Myung Park1, Seung Bae Yoon1, Chul-Hyun Lim1, Jin Su Kim1, Yu Kyung Cho1, Bo-In Lee1, In Seok Lee1, Sang Woo Kim1, Myung-Gyu Choi1
The Catholic University of Korea, Seoul St. Mary`s Hospital, Korea1
Background: Rebleeding occurs in 20% to 40% of acute variceal bleeding (AVB) patients and directly relates to higher mortality. C-reactive protein (CRP) has been reported as a prognostic indicator in various disorders. We investigated whether the initial CRP level can provide prognostic information for the risk of rebleeding in AVB patients.
Methods: Between January 2009 and July 2014, 190 patients with AVB, initially eval- uated for intravenous CRP level, were analyzed. The clinical characteristics, endoscopic features, and CRP levels were compared between the patients with and without 30- day rebleeding. Dichotomized CRP level using ROC curve was analyzed in relation with 30-day rebleeding risk factors
Results: The incidence of 30-day rebleeding was 20.5%. The 30-day mortality was 28.2% and 6.6% in rebleeding and non-rebleeding group, respectively (p=0.001). The median CRP level was signifi cantly different between the rebleeding and non-rebleed- ing group (1.07 and 0.25, respectively; p<0.001). The area under the ROC curve of CRP level was 0.66 for rebleeding, which determined the cut off value as 0.27. Of the 22 variables studied using a logistic regression model, high CRP level, more volume of PRC transfusion, low albumin level and non-viral etiology of cirrhosis were associated with the high risk of rebleeding. In multivariate analysis, initial CRP level > 0.27 (odds ratio, 4.86; CI 1.99-13.3; p<0.01) was independently associated with 30-day rebleeding after adjustment for age, serum albumin and etiology of cirrhosis.
Conclusions: CRP level can be a useful screening indicator for predicting the risk of 30-day rebleeding in the patients with AVB.
K-UG-22 Upper GI Tract
The Characteristics of Malignant Gastric Ulcer Bleeding Compared with Benign Gastric Ulcer Bleeding
Sang Dong Kim1, Hyun Soo Kim1, Dong Wook Lee1, Seung Woo Jeon2, Chang Yoon Ha3, Si Hyung Lee4, Kyung Sik Park5, Jin Tae Jung6, Chang Heon Yang7, Youn Sun Park8 Daegu Fatima Hospital, Korea1, Kyungpook National University Hospital, Korea2, Gyeongsang National University Hospital, Korea3, Yeungnam University College of Medicine, Korea4, Keimyung University Dongsan Medical Center, Korea5, Catholic University of Daegu School of Medicine, Korea6, Medical center of Dongguk University, Korea7, Soon Chun Hyang University Hospital, Korea8
Background: Bleeding occurs in up to 10% of patients with gastric cancer and it shows quite different patterns compared with benign gastric ulcer bleeding. The aim of this study is to fi nd the characteristics of gastric cancer bleeding compared with benign gastric ulcer bleeding.
Methods: Between February 2011 and December 2013, 56 patients with malignant gastric ulcer bleeding and 793 patients with benign gastric ulcer bleeding were entered in this study. A prospective study was performed to compare the baseline character- istics, endoscopic fi ndings, kinds of hemostasis, transfusion, rebleeding, complications and mortality between two groups.
Results: Previous gastric ulcer history and chronic alcoholisms are more common in benign group. Initial hemoglobin level is signifi cant lower (7.4±2.5 vs. 8.9±2.9 g/
dl, p<0.05) and transfusion is performed more frequently (76.4 % vs. 15.1%, p<0.05) in malignant group. Hemostasis was performed less frequently (36.4% vs. 58.3%, p<0.05) and cautery method (rather than hemoclip) tends to be used in malignant group. Re-bleeding rate is similar in both groups (7.3% vs. 6.4%). The complication rate is similar in both groups (7.3% vs. 5.9%, p=0.624) but mortality tends to be slight higher (5.5% vs. 3.3%, p=0.061) in malignant group.
Conclusions: Although hemostasis is not performed in malignant gastric ulcer bleed- ing, re-bleeding rate is similar compared with benign group. Malignant gastric ulcer bleeding tends to have a higher mortality regardless of similar complication rate with benign gastric ulcer bleeding (Clinical trial: KCT0000514).
K-UG-23 Upper GI Tract
Does Discharge Hemoglobin Affect Outcome of Patients with Acute Non-Variceal Upper Gastrointestinal Bleeding?
Jae Min Lee1, Hoon Jai Chun1, In Kyung Yoo1, Seung Joo Nam1, Seung Han Kim1, Hyuk Soon Choi1, Eun Sun Kim1, Bora Keum1, Yoon Tae Jeen1, Hong Sik Lee1, Chang Duck Kim1, Ho Sang Ryu1
Korea University Anam Hospital, Korea1
Background: Many patients with gastrointestinal bleeding show anemia and usually need red blood cell transfusion. But clinicians are concerned about low hemoglobin affects prognosis and clinical outcome after discharge. This study aimed to assess whether discharge hemoglobin infl uence on outcomes, or not, in patient with acute non-variceal gastrointestinal bleeding.
Methods: Retrospective analysis was carried out on patients who had upper gas- trointestinal bleeding between January 2011 and December 2012. We analyzed the patients who had lowest hemoglobin below 10 g/dL during hospitalization. Patients with variceal bleeding, stroke, or cardiovascular disease were excluded. We divided the patients into two groups by discharge hemoglobin (Low discharge hemoglobin group;
8 g/dL = hemoglobin and compared clinical outcomes and hemoglobin level changes.
Results: A total of 212 patients with upper gastrointestinal bleeding were undergone the endoscopic hemostasis during study periods. One hundred two patients were sat- isfi ed the inclusion criteria. Fifty patients discharged with hemoglobin level under 10 g/dL and fi fty two patients discharged with hemoglobin level over 10 g/dL. Patients in low discharge hemoglobin group showed a lower consumption of pRBC and shorter hospital days than patients in high discharge hemoglobin group. Hemoglobin levels were not fully recovered at out-patient department until 7 days after discharge. But, most patients showed hemoglobin recovery at 45 days after discharge.
Conclusions: In patients with acute gastrointestinal bleeding, discharge hemoglobin between 8 to 10 g/dL was showed favorable outcomes during out-patient department follow-up. It seems to be tolerable level without additional pRBC transfusion. Our re- sult can increase the evidence available to support restrictive transfusion strategies in patients with acute non-variceal upper gastrointestinal bleeding.
K-UG-24 Upper GI Tract
Long-Term Prognosis of Nodular Gastritis in Korean Adults with Helicobacter pylori Infection
Jiwan KIM1, Sun-Young LEE1, Jeong-Hwan KIM1, In-Kyung SUNG1, Hyung Seok PARK1, Chan Sup SHIM1, Choon Jo JIN1
Konkuk University School of Medicine, Korea1
Background: Nodular gastritis (NG) is strongly associated with the presence of Hel- icobacter pylori infection. This study compared the prognosis of NG between Korean
adults with and without successful eradication.
Methods: Of the 1475 subjects who were diagnosed with NG during upper gastroin- testinal (UGI) endoscopy at our center since August 2005, Korean adults who under- went follow-up UGI endoscopy after 1 year were included in the study. Changes in the size and location of the nodules, UGI symptoms, hemorrhagic spots, and pathological fi ndings were analyzed.
Results: None of the 137 NG patients progressed to gastric cancer during the fol- low-up period. Regression of the nodules was noted in 14 (73.7%) of 19 eradicated subjects, and in 10 (8.5%) of 118 non-eradicated subjects (p<0.001). An antral nodule location (p<0.001) and absence of UGI symptoms (p<0.001) were more frequently noted in NG subjects who improved without eradication. Multivariate analysis revealed an association between H. pylori eradication and the NG prognosis (OR=0.012, 95%
CI=0.001-0.098, p<0.001).
Conclusion: In Korean adults with NG, H. pylori eradication is the factor most signif- icantly associated with NG nodule regression, although there was a tendency among asymptomatic subjects with antrally located NG to improve spontaneously even with- out eradication. H. pylori eradication should be considered for the improvement of NG in Korean adults.
