Page 66 - Magyar Gasztroenterológiai Társaság 2020. november 6–7. – ONLINE KONGRESSZUS

Előadáskivonatok / Abstracts

Hospital, Szombathely; 5. 1st Dept. of Internal Medicine, CI95% 2.1-4.1; p<0.001), endoscopic intervention (OR 1.4,
Petz A Teaching Hospital, Gyor; 6. 2nd Dept. of Internal CI95% 1.1-1.9; p=0.033), mortality (OR 9.0, CI95% 4.7-17.2;
Medicine, St. Rafael Teaching Hospital, Zalaegerszeg; 7. p<0.001) and hospitalization length (p<0.001).
Dept. of Gastroenterology, St. Pantaleon Hospital, Conclusion: Incidence rates of acute upper GI bleeding in
Dunaujvaros; 8. McGill University Health Center, Montreal Western Hungary are in line with international trends. The
General Hospital, Canada ASA-score, GBS and RS predicted outcomes and
transfusion requirements. We observed higher mortality
Introduction: Acute upper gastrointestinal (GI) bleeding is rates, which can partially be explained by the high
associated with significant morbidity and mortality. comorbidity rates in this population, but warrant optimization
Aims: Our aim was to evaluate characteristics and of the management of acute non-variceal upper GI bleeding.
prognostic factors in the management of acute upper GI
bleeding in a large multi-center study from Hungary. 84. USE OF EVIDENCE-BASED MANAGEMENT
Methods: The present prospective one–year study involved GUIDELINES IMPROVE THE OUTCOME OF ACUTE
six major community hospitals in Western Hungary covering PEDIATRIC PANCREATITIS
2,3
1
a population of 1,263,365 persons in 2016. Data collection Lasztity N. , Mosztbacher D. 2,3,4 , Juhász F. , Tokodi I. ,
5
6
7
included demographic characteristics, vital signs at Tészás A. , Vass I. , Gárdos L. , Szentesi A. 2,11 , Demcsák
6
8
9
3
9
admission, comorbidities, medications, time to hospital A. , Tóth A. , Tél B. , Csoszánszki N. , Tomsits E. , Hegyi
8
admission and endoscopy, laboratory results, endoscopic P. 2,10,11,12 , Párniczky A. 2,4,13
management, including endoscopic therapy and second look 1. Szent János's Hospital and North Buda Unified Hospitals,
endoscopy, risk assessment using Glasgow-Blatchford Budapest; 2. Institute for Translational Medicine, Medical
Score (GBS), Rockall Score (RS) and the American Society School, University of Pécs, Pécs; 3. First Department of
of Anesthesiologists (ASA) Physical Status Score, Pediatrics, Semmelweis University, Budapest; 4. Clinical
transfusion requirements, length of hospital stay and Medicine Doctoral School, University of Szeged, Szeged; 5.
mortality. St. György University Teaching Hospital of Fejér County,
Results: 688 cases (incl. 117 in-hospital cases) of acute Székesfehérvár; 6. Department of Pediatrics, Medical
upper non-variceal GI bleeding were registered in the 1-year School, University of Pécs,; 7. Department of Pediatrics, Zala
study period, resulting an estimated incidence rate of 54.42 County Hospital Szent Rafael, Zalaegerszeg; 8. Department
(CI95% 50.5-58.6) per 100,000 population per year in of Pediatrics, University of Szeged, Szeged; 9. Second
Western Hungary. Time from symptom onset to presentation Department of Pediatrics, Semmelweis University, Budapest;
at the Emergency Department (ER) was <6 hours in 35.9% 10. Division of Translational Medicine, First Department of
and <12 hours in 52.7% of the cases (n=571). Time from Medicine, Medical School, University of Pécs; 11. First
hospitalization to endoscopy was < 6 hours in 55.7% and Department of Medicine, University of Szeged, Szeged; 12.
<12h in 71.8% (n=678). Top 5 diagnoses were duodenal Hungarian Academy of Sciences-University of Szeged,
ulcer (20.6%), gastric ulcer (19.0%), gastroesophageal reflux Momentum Gastroenterology Multidisciplinary Research
disease (GERD) (11.1%), erosive gastritis/duodenitis (9.9%) Group; 13. Heim Pál National Insitute of Pediatric, Budapest
and Mallory-Weiss syndrome (8.2%), while malignancy in the
upper GI track and arteriovenous malformation (AVM) were Introduction: The incidence of pediatric acute pancreatitis
present in 4.0% and 3.8%. Forrest stage was Ia-b, IIA-b-c in (APP) is rising and have a significant effect on the life of the
7.1%, 17.6%, 15.7%, 13.0% and 13.6% of the cases (n=323). children and parents. Pediatric pancreatitis (PP) requires up-
Helicobcter pylori positivity was observed in 30.6% (71/232) to-date and evidence-based treatment approaches. The
of the tested cases. Therapeutic intervention on initial EPC/HPSG evidence-based guidelines provides the current
endoscopy was performed in 37.1%, while 35.9% of patients state of the art of the diagnosis and management of PP.
required second look endoscopy. Intravenous proton-pump Aims: The aim of this study was to analyze the clinical
inhibitor (PPI) was the initial medical therapy in 78.8% of characteristics of APP in a prospectively collected,
patients (16.4% received 72h iv PPI perfusor therapy). Blood multicentric cohort and to compare the management to the
transfusion was given to 65.7% of the patients. major recommendations of the EPC/HPSG evidence-based
Hospitalization stay exceeded 7 days in 50.3, while 5.3% of guidelines for PP.
the patients required surgical treatment. Mortality was 11.6% Methods: Hungarian Pancreatic Study Group launched an
among patients with bleeding episode presenting outside the international, multicentric, observational trial (APPLE-
hospital, while the overall mortality rate (including in-hospital Analysis of Pediatric Pancreatitis, ISRCTN89664974) with
bleedings) was 13.5%. Longer time to presentation at the ER the aim of collecting prospective clinical data and biological
predicted transfusion requirements (p=0.038), while samples from children with PP.46 children suffering from
weekend presentation was associated with transfusion APP have been enrolled from 14 centers. Conservative
(p=0.047), surgery (p=0.016) and mortality (p=0.021). treatment of APP in the first 24-48 hours were analyzed on
Presentation with vegetative symptoms at admission (i.e. the outcome parameters by dividing the cohort into two
tachycardia, hypotension or syncope) was associated with groups. 1. guideline group: the EPC/HPSG evidence-based
increased transfusion needs (p<0.001), longer in-hospital guidelines for PP served as a gold standard 2. non-guideline:
stay (p<0.001) and mortality (p=0.017). Patients on other, individual therapeutic strategy (mostly based on local
anticoagulant, antithrombotic or non-steroidal anti- experience) for the therapy of APP.
inflammatory drug (NSAID) medications had higher Results: In the first 24-48 hours of the treatment the
transfusion needs (p<0.001) and longer in-hospital stay guideline’s recommended intravenous fluid (IVF)
(p=0.004), but no increased mortality (p=0.571). The GBS replacement (1.5-2 times of the maintenance) was
was predictive of transfusion (AUC: 0.82; cut-off: GBS administered in 17/46(37%) cases. Majority of the
>7points; sensitivity: 71.9% specificity: 78%), while mortality patients(29/46, 63%) received the maintenance IVF or less.
was strongly associated with the post-endoscopic RS (AUC: There was no significant difference in the severity of APP
0.75; cut-off: RS >5points; sensitivity: 68.8% specificity: between the guideline and non-guideline groups(p=0.45). Nil
68.9%). Presence of comorbidities and ASA stage correlated per os diet was used in 18 patients(72.2%), while 20 patients
with transfusion requirements (ASA 1-2 vs. ASA 3-4: OR 2.9, with mild APP were fed per os. Enteral tube feeding was
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64 Central European Journal of Gastroenterology and Hepatology
Volume 6, Supplementum 2 / November 2020