engraftment by donor lymphocytes in an immunologically compromised host can result in donor t-cell activation against host major histocompatibility complex antigens, with resultant gvhd. the acute form of gvhd (agvhd) is characterized by erythroderma, cholestatic hepatitis, and enteritis. the intestinal symptoms of agvhd include crampy abdominal pain and watery diarrhea, often with blood. the c...

Critically ill patients are at risk of developing stress ulcers in the upper digestive tract. Multiple risk factors have been associated with the development of this condition, with variable risk of association. Decades of research have suggested the benefit of using pharmacologic prophylaxis to reduce the incidence of clinically important upper gastrointestinal bleeding, with no reduction in o...

PURPOSE To resolve discrepancies in previous systematic overviews and provide estimates of the effect of stress ulcer prophylaxis on gastrointestinal bleeding, pneumonia, and mortality in critically ill patients. DATA IDENTIFICATION Computerized search of published and unpublished research, bibliographies, pharmaceutical and personal files, and conference abstract reports. STUDY SELECTION I...

aneurysms of gastric vessels (dieulafoy`s disease, caliber-persistent artery) are thought to be of malformative rather than degenerative origin. they are usually single, located in the submucosa, usually on the lesser curvature, and characterized by a large tortuous vessel surmounted by a small defect in the overlying mucosa. when the lesion perforates, massive and sometimes fatal hemorrhage ma...

a 50-year-old lady presented with bloody vomiting and melena since four days prior to admission. her medical history was significant only for hypertension which was controlled by a 5 mg daily dose of amlodipine. she occasionally took nsaids. on admission, the physical exam revealed only mild tachycardia and pallor. hemoglobin was 9.7 g/dl, which subsequently declined to 7.9 g/dl. the first uppe...

Consider a protocol to identify patients needing prophylaxis inthe ICU Many patients may enter the hospital already on a PPI for reflux disease or prevention of gastrointestinal side effects from other medications. This Clinical Inquiry shows that only certain patients in the hospital will benefit from prophylaxis for stress ulcers and have less bleeding. Therefore, consider using a protocol to...

Bacterial infection is a common complication in cirrhotic patients. The portal hypertension as well as the immune depression observed in these patients can explain this high incidence of bacterial infection. Because of the high probability of cirrhotic patients to develop infections, antibiotic prophylaxis is warranted in some conditions, such as upper gastrointestinal bleeding or after spontan...

Stress ulcer lesions of upper gastrointestinal tract are well recognized in patients undergoing open cardiac surgery. Gastrointestinal bleeding following cardiac surgery is infrequent with significant morbidity and mortality. The pathogenesis of mucosal lesions and subsequent haemorrhage is complex and multifactorial. The diagnosis as well as the treatment of this complication remains a challen...