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"Approximately 60% of patients who die due to melanoma have gastrointestinal metastases at autopsy, yet ante mortem diagnosis is uncommon. The small bowel is the most frequent intestinal site of metastasis and prognosis is very poor with a median survival after operation was 6.2 months (range: 1-42 months). Bowel metastases may appear radiologically as polypoid mucosal lesions, submucosal nodules, diffuse infiltration with thickening of the intestinal wall, or serosal implants. Bowel obstruction due into intussusceptions is common clinical presentation of gastrointestinal metastasis; other presentation include gastrointestinal bleeding, perforation and large masses.We reported a case of m eta static melanoma to small bowel, whose had hematemesis melena, abdominal pain, diarrhea and weight loss without primary cutaneus melanoma. Gastroduodenoscopy appeared normal. The ultrasonography of bowel showed a"doughnut" configuration with concentric rings of bowel wall. Left lateral decubitus abdominal radiographies showed free air appearances. Laparatorny reported three location of invaginalion (intussuception) with multiple polyposis at ileo-jejttnal segment (29 pieces of polyp) and jejunum perforation. Resection and end-to end anastomosis of the. affected segment had been performed with no serious complication after this. Miscroscopical examination of specimen showed metasiatic melanoma malignant in 3 lymph nodes. Eight weeks later patients died with distant metastases to brain."

"Non steroidal anti-inflammatory drugs (NSAIDS) are now commonly used in clinical practice. On the other hands, this drug could result severe complication such as bleeding and perforation. In such condition, proton pump inhibitor can be used to stop bleeding than H, antagonists. We reported one cases of upper gastrointestinal bleeding due to NSAID gastropathy that was unresponsive to Ranitidine. The treatment was suitable to proton pump inhibitor that could overcome upper gastrointestinal bleeding."

"Backgrounds: Gastrointestinal bleeding such as hematemesis or melena are common conditions in clinical practice and endoscopic service. The mortality rate due to gastrointestinal bleeding is relatively high. In this study, we evaluate the causes of hematemesis melena for the last 5 years and the factors associated with the bleeding.Methods: The study was done retrospectively. We obtained data from medical record of patients that performed endoscopy of upper gastrointestinal tract in Division of Gastroenterology, Department of Internal medicine, Cipto Mangunkusumo hospital (Jakarta, Indonesia) during the period of 2001 to 2005.Results: Of 4.154 patients who underwent upper gastrointestinal tract endoscopy from 2001 to 2005, we found that 837 patients (20.1%) were due to upper gastrointestinal bleeding. They were 552 male (65.9%) and 285 female patients (34.1%). Mean age of male patients was 52.7 ± 15.82 years, while for female patients was 54.46 ± 17.6 years. Of 837 patients who came due to hematemesis were 150 patients (17.9%), melena were 310 patients (37.8%), both melena and hematemesis were 371 patients (44.3%), 557 cases (66.5 %) due to non varices. Endoscopic results showed that 280 cases (33.4%) were due to esophageal varices. In general, this study had demonstrated that esophageal varices was the most frequent cause of upper gastrointestinal bleeding. We found 229 cases of esophageal varices were coincidence with portal hypertensive gastropathy. While ulcer was found in 225 cases (26.9%) and most of them were gastric ulcer (51.1%). Of gastrointestinal bleeding caused by esophageal varices, most were grade HI in 138 cases (49.3%). The incidence of bleeding of bleeding were found more frequently in patients age group of 40 - 60 years (389 cases; 46.5%), > 60 years (305 cases; 36.2%), < 40 years (242 cases; 16.8%). The causes of bleeding in patients whose age > 60 years, most were caused by ulcer (37.4%). In this study, we also found that cancer as the cause of gastrointestinal bleeding in 26 cases (3.1%). Gastrointestinal cancer comprised of gastric cancer in 15 cases (57.7%), duodenal cancer in 7 cases (26.9%), and esophageal cancer in 4 patients (15.4%).Conclusion: The most frequent cause of upper gastrointestinal bleeding was esophageal varices and usually had reached stage HI. The non variceal cause of bleeding was gastric cancer. Upper gastrointestinal malignancy was also found to be the etiology of bleeding in this study."

"Introduction: Portal hypertension may cause gastrointestinal complications; one of the most serious is a ruptured esophageal varices. Portal hypertension is also the main cause of hypersplenism, which in turn could lead to pancytopenia. Despite adequate therapy, some cases of hypersplenism could not be resolved. Partial splenic embolization (PSE) is an effective alternative method to treat this condition. Method: We reported two cases of hypersplenism treated with PSE. The first case was a 10- year-old girl with pancytopenia and a history of recurrent esophageal ligation. The second case was a 32-year-old man with recurrent episodes of hematemesis for two years before admission. Results: After the PSE procedure, the first patient’s white blood cell and platelet doubled in one month after procedure and stable at follow-up three months later, with no complaint of hematemesis. The second patient’s platelet doubled five days after the procedure. The first patient developed a complication of a splenic abscess, but after antibiotic administration and pus drainage, the condition was resolved. Conclusion: PSE is an effective method to treat hypersplenism secondary to the hypertensive portal. Treatment goals successfully achieved include improvement in blood count and control of bleeding. There are risks following PSE, but with adequate treatment, it can be overcome. Keywords: hypersplenism, partial splenic embolization, portal hypertension, pancytopenia"

"Dual antiplatelet therapy (DAPT) is the mainstay of secondary prevention treatment for acute coronary syndrome (ACS) and ischemic stroke, especially after coronary intervention. DAPT consists of aspirin and P2Y12 receptor inhibitor (e.g. clopidogrel), and the use of DAPT has been increased over time. The most serious and common adverse effect is gastrointestinal bleeding. Guidelines in managing such condition are available among Gastroenterologist Societies and Cardiologist Societies. Most guidelines are consistent with each other to continue the use of aspirin while withholding P2Y12. However, European Society of Cardiologist (ESC) guideline in 2017 recommends P2Y12 receptor inhibitor as the preferred antiplatelet for patient with upper gastrointestinal bleeding. This review will look on the guidelines and other supporting evidence for the justification on the antiplatelet of choice."

"Based on its relation to the liver sinusoid, increased pressure of portal vein can occur at three levels: presinusoid, sinusoid ,and postsinusoid. Obstruction of the presinusoid veins can be caused by extra-hepatic condition such as venous thrombosis.

We reported a case of portal hypertension with esophageal varices bleeding was a result of obstruction due to thrombosis of the splenic vein and portal vein under hypercoagulant conditions due to thrombocyto-sis. The management of esophageal varices was sclerotherapy while for overcome the thrombosis the patient was given hydroxy urea."

"More than 95% colorectal cancers arise from neopiastic adenomatous polyps (adenomas). The malignant potential of polyps depends on size, amounts, histological type and degree of dysplasia. The prevalence of adenoma increases with age. Patient whose age more than 40 years old with rectal bleeding as presenting symptom should never be ascribed solely to coexisting haemorrhoids without a through evaluation of the colon and rectum.We reported a case of hematochezia due to colorectal polyps with coexisting hemorrhoids as suspected bleeding source. Colonoscopy examination demonstrated colorectal adenomatous polyps in rectum and sig-moid. Polypectomy was done and tissue biopsy result was tubular adenoma with mild dysplasia."

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Latar Belakang: Perdarahan akut gastrointestinal bagian atas memiliki angka mortalitas dan morbiditas yang signifikan. Asam traneksamat telah terbukti bermanfaat dalam kasus perdarahan postoperatif dan postpartum. Namun, data mengenai efektivitas asam traneksamat untuk kasus ini masih terbatas.

Metode: Kami telah melakukan uji klinis terkontrol acak tersamar. Pasien yang memenuhi kriteria adalah dewasa (usia ≥ 18 tahun) dengan gejala hematemesis, melena, atau keduanya baik yang datang ke unit gawat darurat atau sedang dirawat di rumah sakit antara 1 Juli 2018 sampai 31 Desember 2019. Pasien secara acak dimasukan ke dua kelompok (asam traneksamat dan plasebo). Luaran utama yang diamati adalah perdarahan ulang yang didefinisikan sebagai kejadian hematemesis, melena, atau keduanya yang berkaitan dengan takikardia atau syok hipovolemik atau pengurangan hemoglobin > 2 g/dL setelah keberhasilan terapi endoskopi atau farmakologis. Perdarahan ulang ini diamati sampai 28 hari pascarandomisasi. Uji klinis ini teregistrasi di clinicaltrials.gov, NCT03540368Hasil: Terdapat 42 pasien yang masuk dalam uji klinis ini, 19 di kelompok asam traneksamat dan 23 di plasebo. Penggunaan asam traneksamat tidak berhubungan dengan penurunan kejadian perdarahan ulang (hazard ratio 1,055 [IK 95% 0,284 – 3,923]) maupun mortalitas (hazard ratio 0,960 [IK 95% 0,218 – 4,229]). Terdapatsatu kasus tromboemboli pada masing-masing kelompok. Uji klinis dihentikan lebih awal karena kemungkinan futilitas yang signifikan dan risiko kejadian tromboemboli.Kesimpulan: Tidak diperoleh perbedaan bermakna frekuensi perdarahan ulang kasus perdarahan akut saluran cerna bagian atas antara kelompok asam traneksamat dibandingkan plasebo.

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Background: Acute upper gastrointestinal bleeding (AUGIB) has a significant mortality and morbidity rate. Tranexamic acid has been shown to be beneficial in postoperative and postpartum hemorrhage cases. However, there are limited data exist regarding the effectiveness of tranexamic acid in AUGIB.

Method: We carried out a double-blind randomized controlled trial. Eligible patients were adults (aged  ≥ 18 years) with hematemesis, melena, or both who presented to the emergency department or were hospitalized between July 1, 2018 and December 31, 2019. Patients were randomly assigned to two treatment groups (tranexamic acid or placebo). The primary endpoint was rebleeding, defined as the occurrence of hematemesis, melena, or both associated with tachycardia or hypovolemic shock or reduction in hemoglobin (> 2 g/dL) after successful endoscopic or pharmacological therapy. The occurrence of rebleeding was monitored up to 28 days after randomization. This study was registered at clinicaltrials.gov, NCT03540368Results: Forty-two patients were enrolled, 19 to the tranexamic acid and 23 to the placebo group. Tranexamic acid use was not associated with a reduction in rebleeding (hazard ratio 1.055 [95% CI 0.284 – 3.923]) or mortality (hazard ratio 0.960 [95% CI 0.218 – 4.229]). One thromboembolic event occurred in each group. Clinicaltrials were terminated early because of the significant possibility of futility, and the risk of thromboembolic events.Conclusion: No significant difference was noted in the frequency of rebleeding after AUGIB between patients treated with tranexamic acid compared with placebo.

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