Medical Mistake Claims - Simpson Millar LLP

Low survival rates in GI Bleeds still a problem

Author: Neil Fearn  Bullet  Dated: 04/04/2013

Despite major advances in the management of gastrointestinal bleeds over the last 50 years - not least the development of the fibre optic endoscope, a camera that allows doctors to look inside the gut - there's been hardly any improvement in survival rates. Fifty thousand people end up in hospital every year in the UK because of bleeding from the top end of the gut and around 1 in 10 of them will die.

There are lots of underlying causes for GI bleeding, including cancers and liver disease, but the majority of GI bleeds are due to ulcers - which are often a side effect of taking aspirin and other non-steroidal anti-inflammatories like ibuprofen, naproxen and diclofenac.

Approximately 30-40% of people that present with GI bleeding attend because they are taking aspirin or an anti-inflammatory drug like aspirin. There is little awareness of the dangers of gastric bleeds. A lot of people take aspirin and painkillers like aspirin, are not aware of the risks.

Most people would associate ulcers with pain and most often there's no pain at all, the first sign is usually of the black, tarry and very foul smelling loose black stool when they go to the toilet which is an indication of bleeding. If the bleeding is very active then they can also vomit blood as well.

The location of the bleed can be pinpointed by using an endoscope - a camera to look inside the gut - and treatments include stopping the bleeding with clips, heat or injections of adrenalin.

The National Institute for Health and Clinical Excellence hopes to change that with new guidelines on managing GI bleeds - guidelines which hospitals in England, Wales and Northern Ireland will be expected to follow. Scotland has had similar guidance in place for the last few years.

David Patch is a Consultant Hepatologist at the Royal Free Hospital in London and has a special interest in this type of bleeding. He says somebody who's had a significant bleed should be endoscoped within 6 hours. We know from the British Society of Gastroenterology audit that around 50% of hospitals in the UK, who have accident and emergency units, don't offer an on-call bleeding rota. In his opinion patients whose needs cannot be met at smaller hospitals should be transferred to specialist units where they can be treated promptly.

Tariq Iqbal who's a consultant gastroenterologist at the University of Birmingham is evaluating a new kind of treatment called Hemospray. At the moment GI bleeding is often stopped by placing a metal clip onto the leaking vessel, but it can be hard to find the culprit when everything is swamped in blood. This is where Hemospray is proving useful - it's a powder that can be sprayed over the bleeding area to stop or slow bleeding by accelerating the natural clotting process.

It is delivered by carbon dioxide canister which jets this powder through a plastic catheter which is put down the endoscope – a bit like a dry powder fire extinguisher - effectively hosing down the area where you think the bleeding's coming from.

However, most people who take anti-inflammatory drugs have no side-effects, or only minor ones. When taken appropriately, the benefit usually far outweighs the potential harms. In particular, many people take a short course of an anti-inflammatory medication for all sorts of painful conditions. However, side-effects, and sometimes very serious possible adverse effects, can occur.

It is well recognised that anti-inflammatory drugs can sometimes cause the lining of the stomach to bleed and that there are certain groups that are at increased risks of complications and for whom the use of anti inflammatory painkillers should be kept to an absolute minimum. Further, if anti inflammatory medication is prescribed then another medicine may also be prescribed to protect the lining of the stomach from the effects of the anti-inflammatory.

Nevertheless, a doctor may fail to consider previous medical history when prescribing anti-inflammatories, or fail to prescribe in conjunction medication to protect the stomach lining, or fail to give appropriate advice. There may be a failure to recognise the symptoms of a perforated ulcer resulting in a delay in treatment with catastrophic consequences, when had a proper diagnosis been made at the outset and appropriate treatment given, then surgery may have been avoided with no long term sequelae.

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