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Prevalence of mid-gastrointestinal bleeding in patients with acute overt gastrointestinal bleeding: multi-center experience with 1,044 consecutive patients

  • Original Article—Alimentary Tract
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Abstract

Background

Video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) enable the detection of small intestinal lesions.

Aim

To examine causes of acute overt gastrointestinal (GI) bleeding and the prevalence of mid-GI bleeding, defined as small intestinal bleeding from the ampulla of Vater to the terminal ileum, in a multi-center experience in Japan in the VCE/DBE era.

Methods

Data were collected retrospectively from consecutive patients with acute overt GI bleeding in ten participating hospitals. All patients were examined by esophagogastroduodenoscopy and/or colonoscopy. When the source of bleeding was not identified after these procedures, patients suspected to have mid-GI bleeding were referred to our hospital and VCE/DBE was performed to determine the source of bleeding.

Results

Of the 1044 patients with acute overt GI bleeding, 524 (50.2%) patients were diagnosed with upper GI bleeding, 442 (42.3%) with lower GI bleeding, and 13 (1.2%) with mid-GI bleeding. Gastric ulcer was the most common cause of bleeding (20.4%). Among cases of mid-GI bleeding, ulcers were found in 4 (30.8%) patients, erosions in 3 (23.1%), angiodysplasia in 3 (23.1%), submucosal tumor in 2 (15.4%), and hemangioma in one (7.7%). Seven lesions were located in the jejunum, 5 in the ileum, and one in both the jejunum and ileum. Analysis of age-related cause showed that the prevalence of mid-GI bleeding among younger patients under 40 years of age was higher (5%) than in other age groups (1–2%).

Conclusion

mid-GI bleeding is rare among Japanese patients with acute overt GI bleeding.

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Acknowledgments

The authors thank the following hospitals and physicians for participating in this study: National Hospital Organization Minamiwakayama Medical Center (Dr. Yasuto Kobayashi), Nagayoshi General Hospital (Dr. Kenjiro Ohtani), Meiwa Hospital (Dr. Kazuo Okabayashi), Moriguchi Keijinkai Hospital (Dr. Masahiro Sakaguchi), PL Hospital (Dr. Nobuo Itagaki), Izumi Municipal Hospital (Dr. Kiyotaka Yukimoto), Osaka City Juso Hospital (Dr. Hiroko Nebiki), Baba Meomorial Hospital (Dr. Junichi Hara), Fujiidera Municipal Hospital (Dr. Sadahiko Hiratani), and Nakatsu Hospital (Dr. Kiyoshi Ashida).

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Authors and Affiliations

  1. Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan

    Hirotoshi Okazaki, Yasuhiro Fujiwara, Satoshi Sugimori, Yasuaki Nagami, Natsuhiko Kameda, Hirohisa Machida, Hirokazu Yamagami, Tetsuya Tanigawa, Kenji Watanabe, Kazunari Tominaga, Toshio Watanabe, Nobuhide Oshitani & Tetsuo Arakawa

  2. Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan

    Masatsugu Shiba

Authors
  1. Hirotoshi Okazaki
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  2. Yasuhiro Fujiwara
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  3. Satoshi Sugimori
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  4. Yasuaki Nagami
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  5. Natsuhiko Kameda
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  6. Hirohisa Machida
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  7. Hirokazu Yamagami
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  8. Tetsuya Tanigawa
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  9. Masatsugu Shiba
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  10. Kenji Watanabe
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  11. Kazunari Tominaga
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  12. Toshio Watanabe
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  13. Nobuhide Oshitani
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  14. Tetsuo Arakawa
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Corresponding author

Correspondence to Yasuhiro Fujiwara.

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Okazaki, H., Fujiwara, Y., Sugimori, S. et al. Prevalence of mid-gastrointestinal bleeding in patients with acute overt gastrointestinal bleeding: multi-center experience with 1,044 consecutive patients. J Gastroenterol 44, 550–555 (2009). https://doi.org/10.1007/s00535-009-0039-5

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  • DOI: https://doi.org/10.1007/s00535-009-0039-5

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