Muhammad Ali Aziz
Bronxcare Health System, USATitle: Gastrointestinal bleeding in patients with acute ischemic stroke
Abstract
Stroke, an infarction of the central
nervous system (CNS), is a significant cause of morbidity and mortality
globally. Among its complications, gastrointestinal bleeding (GIB) presents
substantial challenges. This review summarizes the current understanding of GIB
in AIS, covering its incidence, pathophysiology, risk factors, morbidity,
mortality, and management strategies.
The incidence of GIB in AIS ranges
from 1.5% to 7.8%, with diverse ethnic and regional variations. GIB typically
manifests within one week post-stroke onset, affecting both upper and lower
gastrointestinal tracts. Pathophysiological mechanisms linking stroke to GIB
include vagal hyperactivity, systemic inflammation, oxidative stress, and
autonomic dysregulation, culminating in stress ulcerogenesis and mucosal
injury. Risk factors for GIB in AIS include advanced age, male gender, prior
peptic ulcer disease, stroke severity, hypertension, atrial fibrillation,
infection, and comorbidities such as renal and hepatic insufficiency.
GIB in AIS significantly elevates
morbidity and mortality, with implications for neurological deterioration,
prolonged hospitalization, functional disability, and increased one-year
mortality. Management of GIB in AIS involves risk stratification via endoscopic
evaluation, considering patients' bleeding risk against the need for
antithrombotic therapy. While endoscopy aids in localization and control of
bleeding sources, medical therapies like proton pump inhibitors and enteral
nutrition may complement management strategies. Following risk stratification,
thrombolytic therapy and anticoagulation may be cautiously considered in
selected AIS patients with recent GIB.
In conclusion, GIB in AIS poses
significant clinical challenges, warranting a comprehensive understanding of
its epidemiology, mechanisms, and management strategies to mitigate its impact
on patient outcomes.
Biography
Muhammad Ali Aziz is a third year
Internal Medicine resident at Bronxcare Health System, NY, USA. Born and raised
in Pakistan, Muhammad completed his medical school from King Edward Medical
University in Lahore, before moving to New York for his residency. Muhammad has
a passion for teaching and research and has a keen interest in Gastroenterology
and Cardiology, always striving to make meaningful contributions in his field.
Muhammad is excited to participate in the conference and engage with fellow professionals
to share insights and collaborate on innovative ideas.
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