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Significance of Forrest..
Significance of Forrest..
Significance of Forrest..
Introduction
Prediction of the risk in the patients with
upper gastrointestinal bleeding has been the
subject of study for a several decades. In the
United States, more than 500.000 new cases of
the peptic ulcer disease have been diagnosed per
year, while according to the estimation, around 4
million people have a recurrent form of the peptic
ulcer disease (1,2,3). Upper gastrointestinal bleeding represents a common emergency in clinical
practice (4) with an incidence of 50-170 per 100
000 people on year basis (5). Bleeding from
peptic ulcer occur in 50% up to 70% cases of
patients admitted with upper gastrointestinal
bleeding (6,7). Acute gastrointestinal bleeding
emerges with symptoms of haematemesis or
melaena, or with both symptoms. Around 20%
patients with peptic ulcer bleeding are admitted
in hospital with melaena, 30% have signs of
haematemesis, while 50% of patients have both
symptoms (8,9). Haematochesis, as a symptom
of bleeding from gastric or duodenal ulcer
appears in 5% of patients (8,9,10). At least 80%
38
II : Stigmata of
recent haemorrhage
II a: Visible vessel
II b: Adherent clot
II c: Dark base
(haematin covered
lesion)
SRH = stigmata of recent hemorrhage
Major SRH = Forrest la, 1b, 2a and 2b
Mild SRH = Forrest 2c and 3
I b: Oozing
haemorrhage
III: Lesions
without
active
bleeding
(No signs of
recent
haemorrhage)
scor
e
6,5 - 8.0
8,0 10,0
10,0 25,0
> 25,0
level of haemoglobin (g/L) m
120 130
100 120
< 100
level of haemoglobin (g/L) w
100 120
< 100
value of systolic blood pressure (mmHg)
100 109
90 99
<90
Rapid pulse > 100 / minute
Melaena
Syncope
Liver failure
Cardiac failure
score
2
3
4
6
1
3
6
1
6
1
2
3
1
1
2
2
2
Results
General characteristics of examined patients
with haemorrhage and ulcer are presented in Table 4.
Wald
df
p.
Exp(B)
95.0% C.I.
Lower Upper
Haemat
-0.082 0.012
emesis
sex
Women with
rebleeding
Women without
rebleeding
Men with
rebleeding
Men without
rebleeding
Total
Haemat
emesis
Melaena
syncope
17
17
18
28
41
54
17
Sex
Age
(years)
Women
28
42
69.310.6
17.8
Men
39
58
66.811.7
15.3
Total
67
100
67.811.3
11
16.5
Total number of
patients (n=67)
Number of
rebleeding
Percentage of
rebleeding
1 (1,49%)
0%
11 (16,42%)
18,18%
30 (44,78%)
13,33%
18 (26,87%)
27,78%
7 (10,45%)
0%
Table 8. Connection of the clinical manifestation of the bleeding and occurrence of rebleeding
B
Blatchford
0.311
Wald
3.618
df
1
Exp(B)
0.057
1.365
95.0% C.I.
Lower
Upper
0.991
1.882
Initial Rockall
2.885
3.907
0.048
17.899
1.025
312.682
Definitive Rockall
-3.241
5.475
0.019
0.039
0.003
0.591
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1.
2.
3.
4.
5.
6.
7.
42
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JC, Plum F, editors. Cecil textbook of medicine.
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British Society of Gytroenterology Endoscopy
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Longstreth GF. Epidemiology of hospitalization for
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Blatchford O, Davidson LA, Murray WR, Blatchford
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upper gastrointestinal hemorrhage at a Canadian
communityhospital.
Am
J
Gastroenterol.
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43