UGI HEMORRHAGE AND ENDOSCOPIC HEMOSTASIS

上消化道出血和内镜止血

• 批准号: 2770360
• 负责人: DENNIS MICHAEL JENSEN
• 金额: $ 32.25万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 1984
• 资助国家: 美国
• 起止时间: 1984-04-01 至 2000-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2770360
• 关键词: Helicobacter; antiinflammatory agents; combination chemotherapy; disease /disorder proneness /risk; gastrointestinal disorder chemotherapy; gastrointestinal hemorrhage; gastroscopy; health care cost /financing; hemostasis; histopathology; hospital patient care; human subject; human therapy evaluation; longitudinal human study; peptic ulcer; relapse /recurrence; therapy

Four clinical research studies will evaluate patients with severe upper gastrointestinal bleeding (UGIB) from peptic ulcers of Dieulafoy's lesions. In studies I-III which are blinded, multicenter randomized trials, our hypothesis is that combination therapy (epinephrine injection +bipolar electrocoagulation-BP)will be significantly better than single therapy (BP) for initial hemostasis, reduction in early rebleeding rates, and reduction in hospital costs of car. Specific aims of Study I are to determine whether; 1) combination therapy stops active bleeding from ulcers or prevents rebleeding from ulcers with non-bleeding visible vessels (NBVV) more often than single therapy, 2) there is any increased risk of combination therapy, 3) there are characteristic profiles of patients with these lesions who are affected most or least by combination therapy, and 4) there are differences in the estimated costs of hospital care (direct and indirect). The specific aims of Study II are 1) to determine whether combination therapy for ulcers with adherent, non-bleeding clots prevents rebleeding more often than medical therapy, 2) there is any increased risk, and 3) there are differences in direct and indirect costs of hospital care. Specific aims for study III are 1) to determine whether combination therapy for Dieulafoy's lesion with active bleeding or non-bleeding visible vessel prevents further bleeding more often than bipolar electrocoagulation alone, 2) there is any increased risk, and 3) there are differences in direct and indirect costs of hospital care. Specific aims of Study IV are to determine 1) the long-term recurrence rates of lesion bleeding (ulcer or Dieulafoy's) and the endoscopic-clinical characteristics of the recurrence, 2) the effect of Helicobacter pylori eradication on rates of ulcer recurrence, ulcer rebleeding and other complications, 3) the effect of non-steroidal anti-inflammatory drug (NSAID) ingestion during follow-up on lesion recurrence and 4) the direct and indirect costs of patients during long-term follow-up. All studies are multicentric and prospective, have data entry onto CURE computer file, and have comprehensive analysis of different outcomes stratified by lesion and treatment. These studies will significantly expand our knowledge about bleeding ulcers and Dieulafoy's lesions; the impact of different endoscopic treatments on routine outcomes and cost of care for these patients; the patterns of recurrence of these lesions; and the long-term response of patients with these lesions to NSAID ingestion and treatment of H. pylori.

四项临床研究将评估重度上消化道疾病患者 消化道出血（UGIB）来自Dieulafoy病损的消化性溃疡。 在盲法、多中心随机试验的研究I-III中，我们 假设是联合治疗（肾上腺素注射+双极 电凝-BP）将显著优于单一治疗（BP） 用于初始止血，降低早期再出血率， 医院的汽车费用。 研究一的具体目标是确定 是否; 1）联合治疗停止溃疡的活动性出血，或 预防溃疡伴非出血可见血管（NBVV）的再出血 比单一治疗更常见，2）有任何增加的风险 联合治疗，3）有患者的特征性概况， 这些病变受联合治疗影响最大或最小，以及4） 医院护理的估计费用（直接和 间接）。 研究II的具体目标是：（1）确定 联合治疗具有粘连性、非出血性凝块的溃疡， 再出血比药物治疗更频繁，2）有任何增加 风险; 3）医院的直接和间接成本存在差异 在乎 研究III的具体目的是：1）确定是否结合 Dieulafoy病伴活动性出血或不出血的治疗 血管比双极电凝更常防止进一步出血 单独，2）有任何增加的风险，3）有差异， 医院护理的直接和间接费用。 研究IV的具体目标是 确定1）病变出血（溃疡）的长期复发率 或Dieulafoy的）和内窥镜临床特征， 复发，2）根除幽门螺杆菌对 溃疡复发、溃疡再出血等并发症，3）疗效 随访期间非甾体抗炎药（NSAID）摄入量 4）患者的直接和间接费用 在长期随访中。 所有研究均为多中心前瞻性研究， 将数据输入CURE计算机文件，并对 根据病变和治疗分层的不同结局。 这些研究将 大大扩展了我们对出血性溃疡和Dieulafoy's 病变;不同内镜治疗对常规结局的影响 这些患者的护理费用;这些复发的模式 病变;以及这些病变患者对NSAID的长期反应 H.幽门。