Water quality improves after lawn fertilizer ban

The study appears in the August issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

A peptic ulcer is a break in the lining of the stomach or duodenum, which is the beginning of the small intestine. The leading cause of peptic ulcers is an infection of the stomach by bacteria known as Helicobactor pylori. Other common causes are the chronic use of anti-inflammatory medicines and cigarette smoking. A peptic ulcer may bleed when either stomach acid or the ulcer penetrates and disrupts a blood vessel located just beneath it. Upper endoscopy, a procedure in which a thin, flexible tube with a light and a camera on the end is inserted through the mouth to help visualize the esophagus, stomach, and duodenum, is performed by a physician to diagnose and treat peptic ulcer bleeding. Upper endoscopy also helps physicians evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is the best method for detecting the cause of bleeding from the upper gastrointestinal tract and is more accurate than X-ray in detecting inflammation, ulcers, and tumors of the esophagus, stomach, and duodenum.

In 2006, there were an estimated 220,000 hospital discharges for upper gastrointestinal bleeding, with more than 118,000 of these attributed to peptic ulcer disease. Among patients with bleeding ulcers, the inpatient mortality (death) rate was 2.5 percent, the average length of hospital stay was 4.9 days, and the average hospital charges exceeded $28,000. Early upper endoscopy, defined as endoscopy performed within one day of the patient presenting with peptic ulcer bleeding, has been proposed as an intervention to improve efficiency and outcomes for these patients; however, the use and outcomes have not been studied in a national, U.S.-based sample.

The motivation for performing early endoscopy is that it offers the potential for therapy to stop the bleeding and/or to assess an individual's risk of rebleeding if the bleeding has stopped. Endoscopic therapy delivered to an ulcer that is either actively bleeding or one at high risk of rebleeding can reduce bleeding-related morbidity and the need for surgical intervention. Furthermore, endoscopic findings can predict patients at low risk of rebleeding and thus potentially allow cost-effective assessment and treatment of such patients.

"We set out to determine the prevalence and associated outcomes of early versus delayed endoscopy in patients with bleeding peptic ulcers and found that endoscopic intervention in elderly patients within 24 hours of presentation reduced the length of hospital stay by two days compared to those whose endoscopy was delayed," said study lead author Gregory S. Cooper, MD, University Hospitals Case Medical Center, Cleveland, Ohio. "Patients who received an early endoscopy also were less likely to require surgery. Using a large cohort, these results are consistent with the known beneficial effects of this practice.

By American Society for Gastrointestinal Endoscopy