UGI HEMORRHAGE AND ENDOSCOPIC HEMOSTASIS

四项临床研究将评估重症上丘脑患者 Dieulafoy皮损消化性溃疡所致的胃肠道出血(UGIB)。 在I-III项多中心随机盲法试验中，我们的 假设是联合治疗(肾上腺素注射+双相情感障碍 电凝治疗(BP)将明显优于单一治疗(BP) 用于初始止血、降低早期再出血率和减少 在医院的车费。我研究的具体目标是确定 是否；1)联合治疗止住了溃疡的活动性出血或 通过非出血可见血管(NBVV)防止溃疡再次出血 通常比单一治疗更常见，2)有任何增加的风险 联合治疗，3)患者有特征性的特点 受联合治疗影响最大或最小的皮损，以及4) 医院护理的估计费用存在差异(直接和 间接)。研究二的具体目的是：1)确定 对有粘连、无出血凝块的溃疡进行联合治疗可防止 再次出血比药物治疗更频繁，2)有任何增加 风险，3)医院的直接成本和间接成本存在差异 关心。研究III的具体目标是：1)确定联合 活动性出血或非出血的Dieulafoy病的治疗 血管比双极电凝更能防止进一步出血 单独来说，2)有任何增加的风险，以及3)在 医院护理的直接和间接成本。第四项研究的具体目标是 确定1)病变出血(溃疡)的长期复发率 或Dieulafoy‘s)和内窥镜下的临床特征。 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 随访期间非类固醇抗炎药(NSAID)的摄入情况 关于病变复发和4)患者的直接和间接费用 在长期的随访中。所有研究都是多中心和前瞻性的， 将数据录入治愈计算机文件，并对其进行综合分析 根据损伤和治疗对不同的结果进行分层。这些研究将 显著扩展我们对出血溃疡和Dieulafoy‘s的知识 病变；不同内窥镜治疗对常规结果的影响 以及这些患者的护理费用；这些患者的复发模式 病变；以及患有这些病变的患者对非甾体抗炎药的长期反应 幽门螺杆菌的摄入和治疗。

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.