Background: Epidemiology of Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB) such as peptic ulcer bleeding, Mallory-Weiss tear, erosive gastritis/duodenitis, oesophagitis/oesophageal ulcer is well known among general population. However, data is lacking about its trend among Cirrhotic population in literature. No large database study is available to compare prevalence, predictors, and outcomes of NVUGIB among Cirrhotic patients. We [...]

Background: Over the last two decades concerns have been raised about the potential risk of blood transfusion over the benefits. General restrictive red blood cell (RBC) transfusion approach for anemic hospitalized patients (thresh hold of 7 gm %) has been adopted by American hematology society (AHS) in 2012. It is important to recognize that guidelines [...]

Background: Widespread use of new oral anticoagulants (NOAG) for Atrial Fibrillation (A-Fib) has increased the annual incidence of gastrointestinal bleed (GIB) in recent years. These NOAG agents in our study include Rivaroxaban, Apixaban and Dabigatran. Convenience of use, quick onset, broad therapeutic window and eliminating need for frequent monitoring makes NOAGs attractive for A-Fib associated [...]

Background: Given its ability to identify obscure bleeding at a rate of 0.1-0.5 mL/min, technetium-labeled red cell scans have long been considered the most sensitive radiographic test for gastrointestinal bleeding. They are routinely compared to computed tomography angiography, which detects bleeding at a minimum rate of 0.5 mL/min or greater. We conducted a clinical quality [...]

Background: UGIB is a common cause of inpatient admissions often associated with morbidity and an overall mortality rate approaching 10%. Since therapy is different, it is important to differentiate between variceal and non-variceal GI bleeding. While both will often need volume resuscitation, proton pump inhibitors (PPI), judicious transfusion and early endoscopy, patients with variceal bleeding [...]

Background: The “weekend effect” is a term to define worse outcomes among patients that present to the hospital on weekends. For upper gastrointestinal bleed (UGIB) some of these outcomes include increased mortality and increased length of stay (LOS). A 2018 meta-analysis suggests that mortality is higher for non-variceal bleed than for variceal bleed for weekend [...]

Case Presentation: A 65 year old African American male with a past medical history of non-obstructive CAD and chronic hepatitis C with cirrhosis presented to the emergency room with one episode of hematochezia.  Vital signs on presentation were significant for BP 104/61 and HR 103. A digital rectal exam revealed bright red blood. Labs were [...]

Case Presentation: A 72 year-old male patient with recent deceased donor renal transplant was on combined immune suppression with prednisone, tacrolimus and MMF. He Had multiple comorbidities but no previous history of IBD or autoimmune disease. He presented with normocytic anemia (hemoglobin 6.5 g/dL), weakness, anorexia and diarrhea. He was found to have ulcerated hemorrhoids [...]

Case Presentation: A 76 year-old male with a history of diverticulitis, T2DM, HTN, persistent atrial fibrillation and compensated alcoholic cirrhosis presented for recurrent gastrointestinal bleeding (GIB). He initially presented to an outside hospital six months prior for shortness of breath and found to be anemic requiring 4 units of packed red blood cells (PRBCs). Since [...]

Case Presentation: A 67-year-old male with a history of Graves’ disease, paroxysmal atrial fibrillation status post cardiac ablation not on anticoagulation, and chronic ibuprofen use presented to the emergency department with progressive dizziness, fatigue. He noted 10 days of black stools. Additionally, patient’s wife reported he had confusion that started yesterday. Patient presented stable on [...]