Background: Gastrointestinal bleeding is one of the main presentations in emergency department admissions. Although there has been much improvement in prevention, diagnosis, and treatment recently, patients with GIB still have high morbidity and mortality. This study aimed to analyze the scientific articles on gastrointestinal bleeding published between 1980 and 2020 using statistical and bibliometric methods. Methods: Articles about gastrointestinal bleeding published between 1980 and 2020 were downloaded using the Web of Science database and analyzed using statistical methods. Network visualization maps were used to identify trending topics. Correlation studies were evaluated using Spearman’s correlation coefficient. Nonlinear regression analysis (exponential model) was used to estimate the number of articles in future years. Results: A total of 12 568 publications about gastrointestinal bleeding were found. Forty percent (n = 5033) of these publications were articles. The top 3 contributing countries to the literature were the United States of America (1646, 32.7%), the United Kingdom (433, 9%), and Germany (391, 7.7%). The top three journals with the most publications were Gastrointestinal Endoscopy (172), American Journal of Gastroenterology (165), and Digestive Diseases and Sciences (161). The effect of countries’ gross domestic product levels on article productivity on gastrointestinal bleeding was significant (r = 0. 770, P < .001). Conclusion: In this comprehensive study, a summary of 5033 articles was presented. We think that these detailed analyses will be a quick source to show the past, present, and future of this subject to those who are currently working on gastrointestinal bleeding. Cite this article as: Kudu E, Danış F. The evolution of gastrointestinal bleeding: A holistic investigation of global outputs with bibliometric analysis. Turk J Gastroenterol. 2022;33(12):1012-1024.

Objective: Falls are a leading cause of traumatic brain injury in older adults, with ground-level falls being the most common mechanism. Despite the increasing use of head computed tomography (CT) in older adults with ground-level falls, there is an ongoing debate regarding the necessity of routine neuroimaging in all cases. The falls decision rule was developed to safely exclude clinically important intracranial bleeding without head CT in older adults. This study aims to validate the falls decision rule externally and assess its accuracy in identifying low-risk patients while reducing unnecessary imaging. Methods: This prospective cohort study at a Level-1 trauma center enrolled consecutive patients aged ≥ 65 years presenting within 48 h of a ground-level fall. Patient management, including the decision to perform head CT, was determined independently by the treating emergency physician. Patients were followed up for 42 days to identify clinically important intracranial bleeding cases. The rule’s diagnostic performance was evaluated using sensitivity, specificity, and predictive values using 95% confidence intervals (CI). Results: A total of 800 patients were included, with a median age of 78 years (IQR 72–85), and 59.9% were female. Clinically important intracranial bleeding was identified in 6.1% (n = 49) of patients. Head CT was performed in 67.6% of cases, identifying 43 initial hemorrhages, with six additional cases detected during follow-ups. The falls decision rule demonstrated 97.9% sensitivity (95% CI 89.1–99.9), 31.9% specificity (95% CI 28.6–35.4), and 99.5% negative predictive value (95% CI 97.1–99.9), potentially reducing CTs by one-third. Conclusion: This validation confirms the falls decision rule’s high sensitivity and negative predictive value for identifying low-risk older adults after ground-level falls, potentially reducing unnecessary CT scans by approximately one-third. This approach could alleviate ED overcrowding and resource strain while ensuring diagnostic safety.

End tidal carbon dioxide (EtCO₂) is measured to confirm the placement of an endotracheal tube and evaluate the efficacy of cardiopulmonary resuscitation (CPR), and as an assistive tool for terminating CPR. However, there are no highly accurate or definitive recommendations for its use when deciding on the termination of CPR. We aimed to merge EtCO₂ values with existing termination of resuscitation (TOR) rules to obtain a more accurate combination for terminating resuscitation. This observational, prospective study included non-traumatic adult patients who were admitted to a tertiary university hospital Emergency Medicine Department due to cardiac arrest. EtCO₂ cutoff values (at 5, 10, and 20 min) were integrated into currently used TOR parameters (arrest was not witnessed, no bystander CPR was provided, no return of spontaneous circulation (ROSC) after full advanced life support care in the field, and no shock was delivered) and the extended TOR rule was created. These extended TOR rules were compared at three different times (5, 10, and 20 min) for specificity and positive predictive value for ROSC. We included a total of 86 cases. The cutoff value of EtCO₂ from ROC analysis was 19.5, 23.5, and 20.5 mmHg at 5, 10, and 20 min, respectively. “The extended TOR rule created with the 20-min EtCO2 cutoff (20.5 mmHg) was the most accurate in detecting ROSC (−) patients. The specificity was 100% (95% CI 63.1–100.0) sensitivity was 20.0% (95% CI 9.1–35.7), positive predictive value was 100% and negative predictive value was 20.0% (95% CI 17.6–22.6) for ROSC (−) patients. The parameters of this rule were as follows: arrest was not witnessed, no bystander CPR was provided, no ROSC after full advanced life support care in the field, no shock was delivered, and EtCO₂ value at 20 min of resuscitation <20.5 mmHg. Integration of EtCO₂ values into the classically used TOR criteria increases the specificity to 100% without a significant decrease in sensitivity. These results need to be validated in larger groups before this rule is used clinically. EtCO₂ seems to be a beneficial tool in establishing new TOR rules.

In this editorial, we comment on the article by Ali et al published in the recent issue of the World Journal of Clinical Cases. This case report shed light on a particularly rare manifestation of this disease-primary gastrointestinal tuberculosis (GTB) presenting as gastric outlet obstruction. GTB presents diagnostic challenges due to its nonspecific symptoms and lack of highly accurate diagnostic algo rithms. This editorial synthesizes epidemiological data, risk factors, pathogenesis, clinical presentations, diagnostic methods, and therapies to raise awareness about GTB. GTB constitutes 1%-3% of all tuberculosis cases globally, with 6%-38% of patients also having pulmonary tuberculosis. Pathogenesis involves various modes of Mycobacterium tuberculosis complex entry into the gastrointestinal system, with the terminal ileum and ileocecal valve commonly affected. Clinical presentation varies, often resembling other intra-abdominal pathologies, necessitating a high index of suspicion. Diagnostic tools include a combination of biochemical, microbiological, radiological, and endoscopic assessments. Anti-tubercular medication remains the cornerstone of treatment, supplemented by surgical intervention in severe cases. Multidisciplinary management involving gastroenterologists, surgeons, pulmonologists, and infectious disease specialists is crucial for optimal outcomes. Despite advancements, timely diagnosis and mana gement challenges persist, underscoring the need for continued research and collaboration in addressing primary GTB.

Objective: Acute coronary syndrome (ACS) is a critical condition requiring rapid evaluation in the emergency department. The hemoglobin-to-red cell distribution width ratio (HRR) has emerged as a potential prognostic biomarker, reflecting the combined effects of hemoglobin and red cell distribution width. This study aims to evaluate the prognostic value of HRR in patients presenting to the emergency department with ACS. Material and Methods: A retrospective cohort study was conducted at a single center, involving adult patients who were diagnosed with acute coronary syndrome upon presentation to the emergency department. HRR was calculated as the ratio of hemoglobin to red cell distribution width, and its association with 30-day cardiac mortality (CM), all-cause mortality (ACM), and major adverse cardiovascular events (MACE) was analyzed using Receiver Operating Characteristics (ROC) curve analysis. Results: The study included 688 patients, with a mean age of 61.9±12.3 years and 57% males. Lower HRR was significantly associated with higher 30-day CM, ACM, and MACE rates. ROC curve analysis showed HRR had acceptable discriminatory power with AUC values of 0.764 for 30-day CM, 0.718 for 30-day ACM, and 0.739 for 30-day MACE. An HRR cut-off value of 0.9 was determined, with sensitivities of 87.8%, 90.2%,and 88.7%, and specificities of 47.6%, 48.4%, and 48.9% for CM, ACM, and MACE, respectively. Conclusion: HRR is a useful prognostic marker for 30-day outcomes in ACS patients. Its easy accessibility and rapid availability makes it a practical tool for risk stratification in the emergency department.