{"id":1831,"date":"2007-10-01T01:00:00","date_gmt":"2007-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/caracteristiques-epidemiologiques-et-pronostic-des-hemorragies-digestives-hautes-hdh-dorigine-ulcereuse-hu-etude-prospective-multicentrique-de-langh\/"},"modified":"2018-10-20T18:39:44","modified_gmt":"2018-10-20T16:39:44","slug":"caracteristiques-epidemiologiques-et-pronostic-des-hemorragies-digestives-hautes-hdh-dorigine-ulcereuse-hu-etude-prospective-multicentrique-de-langh","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/caracteristiques-epidemiologiques-et-pronostic-des-hemorragies-digestives-hautes-hdh-dorigine-ulcereuse-hu-etude-prospective-multicentrique-de-langh\/","title":{"rendered":"Caract\u00e9ristiques \u00e9pid\u00e9miologiques et pronostic des h\u00e9morragies digestives hautes (HDH) d\u2019origine ulc\u00e9reuse (HU): \u00e9tude prospective multicentrique de l\u2019ANGH."},"content":{"rendered":"

2007<\/strong><\/p>\n

B Nalet (1); JL Payen (2); D Grasset (3); N Abdelli (4); M Picon Coste (5); V Duffournet (6); J Butel (7); S de Montigny Lenhardt (8); R Benoit (9); G Macaigne (10); B Lambare (11); O Danne (12); J Laberenne (13); M Kaassis (14); A Glibert (15);
\n(1) Montelimar – FRANCE; (2) Montauban – FRANCE; (3) Vannes – FRANCE; (4) Chalons en Champagne – FRANCE; (5) Aix en Provence – FRANCE; (6) Annecy – FRANCE; (7) Abbeville – FRANCE; (8) Aubagne – FRANCE; (9) Montlucon – FRANCE; (10) Lagny Sur Marne – FRANCE; (11) Evry – FRANCE; (12) Pontoise – FRANCE; (13) Seclin – FRANCE; (14) Cholet – FRANCE; (15) Tarbes – FRANCE;<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02007-06-17 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

But : D\u00e9crire les caract\u00e9ristiques \u00e9pid\u00e9miologiques des HU \u00e0 partir d\u2019une cohorte de patients \u00e9tudi\u00e9s dans un observatoire de l\u2019ANGH du 1er mars 2005 au 28 F\u00e9vrier 2006.
\nM\u00e9thode : Dans 53 centres de l\u2019ANGH, les patients accueillis en urgence pour une HDH communautaire ont \u00e9t\u00e9 inclus dans une \u00e9tude \u00e9pid\u00e9miologique et de pratique. A partir des 3194 patients, nous avons recueilli sp\u00e9cifiquement les donn\u00e9es concernant les HU.
\nR\u00e9sultats : Nous avons collig\u00e9 969 \u00e9pisodes d\u2019HU (30,3% de la cohorte globale) li\u00e9s \u00e0 un ulc\u00e8re gastrique (UG) (370, 38,2%) ou \u00e0 un ulc\u00e8re duod\u00e9nal (UD) (513, 52,9%) ou \u00e0 un UG ou UD associ\u00e9 \u00e0 d\u2019autres l\u00e9sions(52 et 34, 5,4% et 3,5% ). Il y avait 632 hommes (65%) et 337 femmes (35%). 348 (36%) avaient moins de 60 ans ; 339 (35%) entre 60 et 79 ans. 317 avaient plus de 80 ans. La pr\u00e9sentation \u00e9tait une h\u00e9mat\u00e9m\u00e8se dans la plupart des cas (56,58%).. Le taux d\u2019h\u00e9moglobine moyen \u00e0 l\u2019admission \u00e9tait de 8,6gr n\u00e9cessitant une transfusion moyenne de 3,3 culots chez 686 patients (70%). 98 (10%) avaient un ant\u00e9c\u00e9dent d\u2019h\u00e9morragie digestive rapport\u00e9 64 fois (6,6%) \u00e0 un ulc\u00e8re. 86 (8,8%) avaient une cirrhose et 180 (18,5%) un ant\u00e9c\u00e9dent d\u2019ulc\u00e8re. Le score de Rockall moyen \u00e9tait de 4,8. 630 patients (65%) avaient un ou plusieurs traitements associ\u00e9s. 187(19%) prenaient des AINS. Les AINS les plus utilis\u00e9s \u00e9taient le KETOPROFENE(58) puis le DICLOFENAC(23).Seuls 5 prenaient des anti-cox2. Avec les AINS, 17% avaient un traitement pr\u00e9ventif par IPP qu\u2019ils aient ou non un ant\u00e9c\u00e9dent d\u2019ulc\u00e8re bien que 93(49,7%) aient plus de 60 ans. 280 patients(29%) prenaient de l\u2019aspirine, 233 (24%) \u00e0 vis\u00e9e anti-agr\u00e9gante et 47 pour d\u2019autres \u00e9tiologies . 106(10,9%) \u00e9taient trait\u00e9s par AVK avec de l\u2019aspirine(18%) et sans IPP(16%) .96(10%) \u00e9taient trait\u00e9s par anti-agr\u00e9gants plaquettaires associ\u00e9s \u00e0 de l\u2019aspirine une fois sur trois. Durant l\u2019endoscopie, 26(2,7%) avaient une h\u00e9morragie en jet, 248(25%) un vaisseau visible et \/ou un caillot adh\u00e9rent, 342(35%) n\u2019avaient pas de stigmate h\u00e9morragique .Un geste h\u00e9mostatique a \u00e9t\u00e9 r\u00e9alis\u00e9 265 fois (27%) dont 88 soit 35% des cas pour les ulc\u00e8res avec vaisseau visible ou caillot adh\u00e9rent. Il y a eu 122 r\u00e9cidives h\u00e9morragiques (12,6%).Parmi les facteurs pr\u00e9dictifs, on retient un score de Rockall sup\u00e9rieur \u00e0 5, la transfusion, par contre l\u2019\u00e2ge et les traitements associ\u00e9s n\u2019\u00e9taient pas corr\u00e9l\u00e9s au risque de r\u00e9cidive. Le recours \u00e0 la chirurgie a \u00e9t\u00e9 n\u00e9cessaire dans 51 cas (5,3%) dont 42 fois pour un ulc\u00e8re duod\u00e9nal. Il n\u2019\u00e9tait pas li\u00e9 \u00e0 l\u2019\u00e2ge ni au type de traitement associ\u00e9 mais \u00e9tait significativement diminu\u00e9 en cas de traitement par IPP avant l\u2019admission.8 patients sont d\u00e9c\u00e9d\u00e9s dans les suites op\u00e9ratoires.55 patients sont d\u00e9c\u00e9d\u00e9s (5,6%),12 par r\u00e9cidive h\u00e9morragique ou ses cons\u00e9quences. Dans 49 cas (89%) les d\u00e9c\u00e8s \u00e9taient associ\u00e9s \u00e0 des comorbidit\u00e9s importantes et li\u00e9s \u00e0 des causes extra-digestives.
\nConclusions : En comparaison avec notre cohorte de r\u00e9f\u00e9rence, regroupant toutes les causes d\u2019HDH, nous constatons : que les HU surviennent plus souvent chez des patients prenant des AINS (19% versus 11%) ; qu\u2019il n\u2019y a pas de diff\u00e9rence pour la prise d\u2019aspirine, d\u2019AVK ou d\u2019anti-agr\u00e9gants ; que le pourcentage de patients transfus\u00e9s et le nombre de transfusions est identique ; que le pourcentage de gestes th\u00e9rapeutiques endoscopiques est le m\u00eame ; que la mortalit\u00e9 est plus faible (5,6% versus 8,4%) malgr\u00e9 un recours plus important \u00e0 la chirurgie(5,3%versus3%) ; que les recommandations relatives \u00e0 l\u2019utilisation des IPP en fonction de l\u2019\u00e2ge et des ant\u00e9c\u00e9dents ne sont pas assez bien suivies.<\/p>\n","protected":false},"excerpt":{"rendered":"

2007 B Nalet (1); JL Payen (2); D Grasset (3); N Abdelli (4); M Picon Coste (5); V Duffournet (6); J Butel (7); S de Montigny Lenhardt (8); R Benoit (9); G Macaigne (10); B Lambare (11); O Danne (12); J Laberenne (13); M Kaassis (14); A Glibert (15); (1) Montelimar – FRANCE; (2) Montauban […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[18],"class_list":["post-1831","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-18"],"yoast_head":"\nCaract\u00e9ristiques \u00e9pid\u00e9miologiques et pronostic des h\u00e9morragies digestives hautes (HDH) d\u2019origine ulc\u00e9reuse (HU): \u00e9tude prospective multicentrique de l\u2019ANGH. - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/caracteristiques-epidemiologiques-et-pronostic-des-hemorragies-digestives-hautes-hdh-dorigine-ulcereuse-hu-etude-prospective-multicentrique-de-langh\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Caract\u00e9ristiques \u00e9pid\u00e9miologiques et pronostic des h\u00e9morragies digestives hautes (HDH) d\u2019origine ulc\u00e9reuse (HU): \u00e9tude prospective multicentrique de l\u2019ANGH. - 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