title: Characteristics of nonvariceal upper gastrointestinal hemorrhage in patients with chronic kidney disease.
abstract: OBJECTIVE
  To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage (NGIH) in patients with chronic kidney disease (CKD).
  
  
  METHODS
  From 2003 to 2010, a total of 72 CKD patients (male n = 52, 72.2%; female n = 20, 27.8%) who had undergone endoscopic treatments for NGIH were retrospectively identified. Clinical findings, endoscopic features, prognosis, rebleeding risk factors, and mortality-related factors were evaluated. The characteristics of the patients and rebleeding-related data were recorded for the following variables: gender, age, alcohol use and smoking history, past hemorrhage history, endoscopic findings (the cause, location, and size of the hemorrhage and the hemorrhagic state), therapeutic options for endoscopy, endoscopist experience, clinical outcomes, and mortality.
  
  
  RESULTS
  The average size of the hemorrhagic site was 13.7 ± 10.2 mm, and the most common hemorrhagic site in the stomach was the antrum (n = 21, 43.8%). The most frequent method of hemostasis was combination therapy (n = 32, 44.4%). The incidence of rebleeding was 37.5% (n = 27), and 16.7% (n = 12) of patients expired due to hemorrhage. In a multivariate analysis of the risk factors for rebleeding, alcoholism (OR = 11.19, P = 0.02), the experience of endoscopists (OR = 0.56, P = 0.03), and combination endoscopic therapy (OR = 0.06, P = 0.01) compared with monotherapy were significantly related to rebleeding after endoscopic therapy. In a risk analysis of mortality after endoscopic therapy, only rebleeding was related to mortality (OR = 7.1, P = 0.02).
  
  
  CONCLUSIONS
  Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD, especially when a patient is an alcoholic.
authors.affiliation: Chang Seok Bang, Yong Seop Lee, Yun Hyeong Lee, Jin Bong Kim, Gwang Ho Baik, Yeon Soo Kim, Jai Hoon Yoon, Dong Joon Kim, Ki Tae Suk, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 200-704, South Korea.
authors.forename: Chang Seok
authors.initials: CS
authors.lastname: Bang
authors.forename: Yong Seop
authors.initials: YS
authors.lastname: Lee
authors.forename: Yun Hyeong
authors.initials: YH
authors.lastname: Lee
authors.forename: Hotaik
authors.initials: H
authors.lastname: Sung
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Jin Bong
authors.initials: JB
authors.lastname: Kim
authors.forename: Gwang Ho
authors.initials: GH
authors.lastname: Baik
authors.forename: Yeon Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Jai Hoon
authors.initials: JH
authors.lastname: Yoon
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Suk
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000150:complications; D016009:Chi-Square Distribution; D002983:Clinical Competence; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
keywords: Alcoholics; Chronic kidney diseases; Endoscopy; Gastrointestinal hemorrhage; Peptic ulcer