Endoscopía temprana como determinante pronóstico en hemorragia digestiva alta
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2017
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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La hemorragia digestiva alta es una patología con una alta incidencia en la población mundial y en el Ecuador, con una alta morbi-mortalidad asociada, lo cual hace importante el establecer un correcto abordaje de la misma en las áreas de emergencia hospitalaria, lo cual incluye la realización de una videoendoscopía digestiva alta (VEDA) dentro de las primeras 24 horas de ingreso, la misma que no se viene realizando en el Ecuador y que por lo tanto no se cuenta con cifras que nos permitan establecer el impacto de este procedimiento sobre la morbi-mortalidad de los pacientes con hemorragia digestiva alta. Objetivo: Valorar la utilidad de la exploración endoscópica temprana como determinante pronóstico en la hemorragia digestiva alta. Materiales y Métodos: Se utilizaron datos de las historias clínicas de todos los pacientes con diagnóstico de hemorragia digestiva alta (HDA) que acudieron al servicio de Medicina Interna en el área de Emergencia del Hospital Luis Vernaza. Se utilizó la VEDA temprana para evaluar la asociación entre la HDA, el origen del sangrado y el impacto sobre mortalidad y morbilidad asociada. Además se analizaron los factores de riesgos asociados como edad, el género, los años de evolución de la enfermedad, la ingesta o toma de antiinflamatorios no esteroides (AINES) y la positividad de Helicobacter pylori en las biopsias. Resultados: El 21,7% (25/115) de pacientes tenía edades entre los 18 y 49 años, el 58,3% (67/115) entre 50 y 79 años, y el 20% restante (23/115) eran mayores de 80 años. El 53% (61/115) de pacientes eran hombres y el 47% (54/115) mujeres. Las tres principales etiologías de la HDA son la gastropatía erosiva 34,8%, la úlcera péptica 21,7% y las varices esofágicas 7,8%. El 40,9% de pacientes (47/115) presentaron algún tipo de complicación: 31 pacientes con shock hipovolémico (65.97%), 5 con insuficiencia renal (10.63%), 3 con neumonía (6.38%) y 8 con 2 complicaciones asociadas (17.02%). A 22 pacientes (19.1%) se les realizó VEDA temprana y a 93 pacientes (80,9%) se les realizó VEDA tardía. La tasa de mortalidad fue del 4,55% (1/22) en VEDA temprana y de 3,23% (3/93) en la VEDA tardía. El realizar VEDA temprana disminuye el tiempo de hospitalización por HDA (p= 0,006) en comparación con aquellos a los que se les realiza VEDA tardía. Realizar una VEDA temprana no representa ninguna significancia estadística (p= 0,927) en relación a la tasa de resangrado que se presenta en aquellos pacientes a los que se les practica una VEDA tardía. Conclusiones: Se obtuvo como conclusión, que aquellos pacientes sometidos a una VEDA temprana tuvieron menor tiempo de estadía hospitalaria; y que no hay diferencia alguna el realizar una VEDA temprana sobre una tardía en cuanto a disminuir la tasa de mortalidad y de resangrado
Upper gastrointestinal bleeding is a pathology with a high incidence in the world population and in Ecuador, with a high associated morbidity and mortality, which makes it important to establish a correct approach to it in the hospital emergency areas, which includes (VEDA) within the first 24 hours of hospitalization, the same that has not been performed in Ecuador and therefore there are no figures that allow us to establish the impact of this procedure on the morbidity and mortality of patients with upper gastrointestinal bleeding. Objective: To evaluate the usefulness of early endoscopic examination as a prognostic determinant in upper gastrointestinal bleeding. Materials and Methods: Data from the medical records of all patients diagnosed with upper gastrointestinal bleeding (HDA) who came to the Internal Medicine service in the Emergency area of the Luis Vernaza Hospital were used. Early VEDA was used to assess the association between HDA, the source of bleeding, and the impact on mortality and associated morbidity. In addition, we analyzed the associated risk factors such as age, gender, years of disease progression, nonsteroidal anti-inflammatory drug intake (NSAIDs) and Helicobacter pylori positivity in biopsies. Results: 21.7% (25/115) of patients had ages between 18 and 49 years, 58.3% (67/115) between 50 and 79 years, and the remaining 20% (23/115) were older than 80 years. 53% (61/115) of patients were men and 47% (54/115) women. The three main etiologies of HDA are erosive gastropathy 34.8%, peptic ulcer 21.7% and esophageal varices 7.8%. 40.9% of patients (47/115) presented some type of complication: 31 patients with hypovolemic shock (65.97%), 5 with renal insufficiency (10.63%), 3 with pneumonia (6.38%) and 8 with 2 associated complications (17.02%). Twenty-two patients (19.1%) underwent early VEDA and 93 patients (80.9%) underwent late VEDA. The mortality rate was 4.55% (1/22) in early VEDA and 3.23% (3/93) in late VEDA. Early VEDA reduces hospitalization time for HDA (p = 0.006) compared to those who are given late VEDA. Performing an early VEDA does not represent any statistical significance (p = 0.927) in relation to the rate of rebleeding that occurs in those patients who have a late VEDA. Conclusions: It was concluded that those patients who had an early VEDA had a shorter hospital stay; and that there is no difference in performing an early VEDA on a late VEDA in terms of decreasing mortality and rebleeding rates.
Upper gastrointestinal bleeding is a pathology with a high incidence in the world population and in Ecuador, with a high associated morbidity and mortality, which makes it important to establish a correct approach to it in the hospital emergency areas, which includes (VEDA) within the first 24 hours of hospitalization, the same that has not been performed in Ecuador and therefore there are no figures that allow us to establish the impact of this procedure on the morbidity and mortality of patients with upper gastrointestinal bleeding. Objective: To evaluate the usefulness of early endoscopic examination as a prognostic determinant in upper gastrointestinal bleeding. Materials and Methods: Data from the medical records of all patients diagnosed with upper gastrointestinal bleeding (HDA) who came to the Internal Medicine service in the Emergency area of the Luis Vernaza Hospital were used. Early VEDA was used to assess the association between HDA, the source of bleeding, and the impact on mortality and associated morbidity. In addition, we analyzed the associated risk factors such as age, gender, years of disease progression, nonsteroidal anti-inflammatory drug intake (NSAIDs) and Helicobacter pylori positivity in biopsies. Results: 21.7% (25/115) of patients had ages between 18 and 49 years, 58.3% (67/115) between 50 and 79 years, and the remaining 20% (23/115) were older than 80 years. 53% (61/115) of patients were men and 47% (54/115) women. The three main etiologies of HDA are erosive gastropathy 34.8%, peptic ulcer 21.7% and esophageal varices 7.8%. 40.9% of patients (47/115) presented some type of complication: 31 patients with hypovolemic shock (65.97%), 5 with renal insufficiency (10.63%), 3 with pneumonia (6.38%) and 8 with 2 associated complications (17.02%). Twenty-two patients (19.1%) underwent early VEDA and 93 patients (80.9%) underwent late VEDA. The mortality rate was 4.55% (1/22) in early VEDA and 3.23% (3/93) in late VEDA. Early VEDA reduces hospitalization time for HDA (p = 0.006) compared to those who are given late VEDA. Performing an early VEDA does not represent any statistical significance (p = 0.927) in relation to the rate of rebleeding that occurs in those patients who have a late VEDA. Conclusions: It was concluded that those patients who had an early VEDA had a shorter hospital stay; and that there is no difference in performing an early VEDA on a late VEDA in terms of decreasing mortality and rebleeding rates.
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Hemorragia gastrointestinal, Endoscopía, Hospital Luis Vernaza, Cantón Guayaquil, Ecuador