Lower gastrointestinal bleeding (LGIB) is a common emergency, defined nowadays as bleeding of colorectal origin. It predominantly affects elderly patients in whom it is associated with increased morbidity and mortality....Lower gastrointestinal bleeding (LGIB) is a common emergency, defined nowadays as bleeding of colorectal origin. It predominantly affects elderly patients in whom it is associated with increased morbidity and mortality. The main causes include diverticulosis, anorectal disorders, angiodysplasias, ischemic colitis, post-endoscopic resection complications, and tumor-related bleeding. Clinically, lower gastrointestinal bleeding (LGIB) presents with episodes of hematochezia or melena, or sometimes as occult bleeding. Initial assessment of clinico-biological severity and risk of recurrence is essential to determine the need for hospitalization and the timing of diagnostic procedures. Colonoscopy is the reference diagnostic and therapeutic procedure, ideally performed within 24 hours with CT angiography reserved for cases of hemodynamic instability. In case of failure, therapeutic escalation includes repeat endoscopy, arterial embolization, and, as a last resort, surgery. Early multidisciplinary management helps reduce morbidity, mortality, and recurrence.
Jullien S, Mazuyer M, Turmel L
… +4 more, Lang S, Boccara F, Soulat-Dufour L, Cohen A
Rev Prat
· 2026 May · PMID 42227630
Heart failure is a chronic disease that leads to disabling symptoms and recurrent hospitalizations, mainly for acute heart failure episodes, having a major impact on patients' quality of life. An effective treatment is a...Heart failure is a chronic disease that leads to disabling symptoms and recurrent hospitalizations, mainly for acute heart failure episodes, having a major impact on patients' quality of life. An effective treatment is available but not always accessible, for miscellaneous reasons including difficulties in understanding the prescription and in reaching guideline-directed medical therapies to the optimal tolerated dose.Patient education is a key component of heart failure management, enabling patients to develop individual skills in self-monitoring acute heart failure symptoms and to improve their compliance to treatment, dietary and physical activity. The primary objective of patient education is to encourage patients' empowerment and improve their quality of life. These objectives defined by the care team need to be modulated to patients' expectations, specific needs and level of health literacy, as patients are mainly elderly and exposed to several chronic diseases.The heart failure care pathway is changing with the emerging of new methods such as telemonitoring and specialized nurses. Thus, it is crucial to maintain patient education as a major component of patient care.
Pediatric acute ischemic stroke is a neurological emergency with potentially severe consequences. Early recognition is essential to allow timely reperfusion treatment within the therapeutic window. The "Pediatric Stroke...Pediatric acute ischemic stroke is a neurological emergency with potentially severe consequences. Early recognition is essential to allow timely reperfusion treatment within the therapeutic window. The "Pediatric Stroke Alert" pathways are crucial. MRI is the gold standard to differentiate stroke from common mimics. Thrombolysis and mechanical thrombectomy are possible if performed within appropriate timeframes. Tenecteplase use in children remains experimental and further studies are needed to adapt the treatment protocols to the pediatric patients. Arteriopathies, particularly inflammatory focal cerebral arteriopathy, are the most frequent causes. Long-term neurodevelopmental follow-up is mandatory because of the damaging impact of stroke in the children lives.
Type 1 diabetes in children is an increasingly condition, even in young children. Medical care combines insulin therapy, a balanced diet meeting nutritional children's needs, physical activity and therapeutic education o...Type 1 diabetes in children is an increasingly condition, even in young children. Medical care combines insulin therapy, a balanced diet meeting nutritional children's needs, physical activity and therapeutic education of patients and caregivers. Blood glucose monitoring can be performed using capillary blood tests or use of continuous monitoring glucose sensors help providing comfort and accuracy. Insulin treatment follows a basal bolus regiment which can be delivered by insulin pen or insulin pump. Functional insulin therapy is often proposed and consists in adjusting insulin dose according to the amount of carbohydrates consumed. Hybrid closed-loop system incorporates an algorithm that adapts insulin doses delivered by the pump based on the patient's blood glucose level. It helps glycemic control and reducing diabetes burden. Preclinical diagnosis of diabetes could help preventing diabetic ketoacidosis, improving metabolic control and proposing treatments that can delay appearance of diabetes symptoms and need of insulin. It represents a major challenge for following years.
Suspected small bowel bleeding is defined as a gastrointestinal bleeding, overt or occult (iron-deficiency anemia), with unremarkable high-quality upper endoscopy and colonoscopy. The main causes are vascular lesions (an...Suspected small bowel bleeding is defined as a gastrointestinal bleeding, overt or occult (iron-deficiency anemia), with unremarkable high-quality upper endoscopy and colonoscopy. The main causes are vascular lesions (angiodysplasia) and inflammatory lesions (Crohn's disease). Diagnosis is primarily based on capsule endoscopy, which has an optimal yield if performed within 48 hours on bleeding onset. Deep enteroscopy often allows targeted treatment, but its availability is limited. If the capsule endoscopy is not contributive as well, the bleeding is referred to as obscure gastrointestinal bleeding. Management is not consensual. Treatment of the anemia and surveillance may be an option. It is reasonable course of action to repeat endoscopies, optimizing them, particularly in the event of recurrence.
Non-portal hypertension-related upper gastrointestinal bleeding (UGIB) remains one of the most common emergencies in gastroenterology, accounting for the majority of UGIB cases in Western countries.Its incidence is estim...Non-portal hypertension-related upper gastrointestinal bleeding (UGIB) remains one of the most common emergencies in gastroenterology, accounting for the majority of UGIB cases in Western countries.Its incidence is estimated at 50-150 cases per 100.000 population per year, with a mortality rate that remains between 5% and 10% despite advances in diagnostic and therapeutic strategies. Clinical presentation is often abrupt, typically as hematemesis or melena, requiring prompt and structured management including initial resuscitation, diagnostic and therapeutic endoscopy, and secondary prevention.In recent years, the therapeutic armamentarium available to the endoscopist has expanded with the introduction of innovative devices such as over-the-scope clips, hemostatic powders, and gels. Several randomized trials have refined the optimal timing of endoscopy and compared the efficacy of various techniques.
Acute gastrointestinal bleeding is a medical emergency in which early management, including pre-hospital care, is crucial for prognosis. The patient's history and clinical examination should focus on identifying signs of...Acute gastrointestinal bleeding is a medical emergency in which early management, including pre-hospital care, is crucial for prognosis. The patient's history and clinical examination should focus on identifying signs of severity requiring immediate medical intervention. The pharmalogical treatment of upper gastrointestinal bleeding depends on the suspected cause: proton pump inhibitors for peptic ulcers, splanchnic vasoconstrictors and antibiotics in cases of portal hypertension. Risk stratification using validated scoring systems helps identify low-risk patients eligible for outpatient management. A restrictive transfusion strategy (hemoglobin < 7 g/dL) is recommended. For upper gastrointestinal bleeding, endoscopy should be performed within 24 hours (within 12 hours in patients with portal hypertension). For lower gastrointestinal bleeding, computed tomography angiography is useful for locating active bleeding, while colonoscopy remains the gold standard procedure.
Gastrointestinal bleeding (GIB) is a frequent and potentially life-threatening emergency. It is defined as any bleeding originating from the digestive tract, either overt (hematemesis, hematochezia, melena) or occult. Fr...Gastrointestinal bleeding (GIB) is a frequent and potentially life-threatening emergency. It is defined as any bleeding originating from the digestive tract, either overt (hematemesis, hematochezia, melena) or occult. From a nosological perspective, GIB is classified into upper GIB (proximal to the Treitz ligament), lower GIB (colonic or anorectal origin), suspected small bowel bleeding (SSBB), mid-GIB (jejunal or ileal lesions), and obscure GIB (no source identified despite complete evaluation). Over the past 20 years, the incidence of upper GIB has declined by 30-50%, mainly due to Helicobacter pylori eradication, proton pump inhibitors use, and reduced tobacco consumption. Conversely, lower GIB is increasing, and in some countries has surpassed upper GIB in frequency. Hospital mortality has decreased from about 10% to 5-7% owing to advances in diagnostics, therapeutic endoscopy, and healthcare organization. Cirrhotic patients and the elderly remain at particularly high risk.
The prevalence of maternal obesity is steadily increasing, affecting a significant proportion of pregnancies. Beyond well-known obstetric complications, this condition exposes the newborn to immediate risks (perinatal mo...The prevalence of maternal obesity is steadily increasing, affecting a significant proportion of pregnancies. Beyond well-known obstetric complications, this condition exposes the newborn to immediate risks (perinatal mortality, congenital malformations, macrosomia) and the child to long-term consequences (obesity, metabolic disorders, and neurodevelopmental issues). Since lifestyle interventions during pregnancy show limited efficacy on child outcomes, prevention strategies must focus on the preconception period and the promotion of breastfeeding. This is an underestimated public health issue that requires collective action by health authorities and practitioners.