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Gastrointestinal bleeding in stroke
E F Wijdicks1, J R Fulgham, K P Batts
1Department of Neurology, Saint Marys Hospital, Mayo Clinic, Rochester, Minn. 55905.
Insights
Gastrointestinal bleeding after stroke is uncommon and rarely fatal. Many cases are linked to medications like NSAIDs or anticoagulants, not stress ulcers.
Area of Science:
- Neurology
- Gastroenterology
- Internal Medicine
Background:
- Stroke patients face systemic complications, including gastrointestinal bleeding.
- The exact causes of gastrointestinal hemorrhage post-stroke remain unclear.
- Previous assumptions linked this bleeding to stress ulcers without specific investigation.
Purpose of the Study:
- To investigate the causes of gastrointestinal bleeding in patients following ischemic or hemorrhagic stroke.
- To identify associated factors and outcomes of gastrointestinal hemorrhage in stroke survivors.
Main Methods:
- Retrospective review of 17 patients with gastrointestinal hemorrhage and stroke (1976-1994).
- Analysis of patient presentation, associated causes, and outcomes.
- Compilation of endoscopic findings and review of gastric biopsies.
Main Results:
- Common presentations included hematemesis, decreased hemoglobin, and orthostatic hypotension.
- Endoscopic findings revealed erosions, gastritis, and ulcers; one gastric adenocarcinoma was noted.
- Identified causes included nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, anticoagulation, and Helicobacter pylori.
Conclusions:
- Gastrointestinal bleeding after stroke is typically not severe and has minimal impact on mortality.
- Medication-induced gastrointestinal hemorrhage is a significant, potentially underappreciated, factor in stroke patients.
Background And Purpose:
Patients with ischemic or hemorrhagic stroke are at risk for systemic complications. The reasons why gastrointestinal bleeding occurs after stroke are unknown and have intuitively been attributed to stress ulcers. No study to date has addressed causes of gastrointestinal hemorrhage in stroke.
Methods:
Between 1976 and 1994, 17 patients identified from the Mayo Clinic medical record system as having gastrointestinal hemorrhage and ischemic stroke (n = 14) or intracerebral hemorrhage (n = 3) were reviewed for presentation, associated causes, and outcome. Results of the endoscopic procedures were compiled, and available gastric biopsies were reviewed.
Results:
In 17 patients with gastrointestinal bleeding after stroke, sudden hematemesis, a decrease in hemoglobin level, or orthostatic hypotension was found as a presenting feature. One patient presented with massive hematemesis, exsanguination, and cardiac arrest. Endoscopic findings were available in 14 patients and included gastroesophageal erosions, hemorrhagic gastritis, and gastric ulcer. In one patient, an adenocarcinoma of the gastric cardia was found. Putative pathogenetic agents were found in 16 of 17 patients and included a long history of nonsteroidal anti-inflammatory drugs (n = 6), acetylsalicylic acid (n = 3), grossly prolonged anticoagulation (n = 4), Helicobacter pylori (n = 2), and corticosteroids (n = 1).
Conclusions:
Gastrointestinal bleeding after stroke is rarely severe and may not contribute significantly to mortality. Medication-induced gastrointestinal hemorrhage may be underappreciated in this setting.