Acute upper gastro intestinal bleeding

Česká verzia

Authors: J. Lata; R. Kro upa; I. Novotný; T. Vaňásek
Authors place of work: Interní hepatogastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jan Lata, CSc.
Published in the journal: Vnitř Lék 2009; 55(Suppl 1)(Supplementum 1): 29-33

Summary

In gastroenterology, upper gastro intestinal bleeding is a severe acute situ ati on. Mortality is abo ut 10% and has not changed importantly over the last decades. The incidence of bleeding and its mortality incre ase with incre asing age, co- morbiditi es and polytherapy. Peptic ulcers of the stomach and duodenum are the most frequent ca uses (42– 50%). 5– 20% are pati ents with portal hypertensi on‑related bleeding. Upper gastro intestinal bleeding requires a specific therape utic appro ach. Endoscopic examinati on is essenti al; apart from di agnosis, it also enables management of the so urce of bleeding in most cases. Endoscopy also enables evalu ati on of the severity of the conditi on ca using the bleeding and estimati on of the risk of relapse. Endoscopic tre atment is indicated in nonvarice al bleeding with visible bleeding or significant stigmata. Most frequently used endoscopic tre atments include endoscopic adrenalin injecti on, thermoco agulati on, endoscopic clipping and endoscopic tissue glue injecti on. Pharmacotherapy in nonvarice al bleeding sho uld aim at incre asing stomach pH and stabilizati on of co agulati on and normal thrombocyte activity. Intraveno us applicati on of omeprazole followed by continuo us infusi on over 72 ho urs appe ars to be the most effective. Continuo us or recurrent bleeding requires repe at endoscopy and a consultati on with a surge on. Therapy of portal hypertensi on‑related bleeding involves initi ati on of pharmacotherapy (terlipresin 1mg every 4 ho urs for 3– 5 days or somatostatin) in combinati on with endoscopic tre atment (sclerotherapy or varice al ligati on) as so on as possible following hospital admissi on. Implantati on of the Transjugular Intrahepatic Portosystemic Shunt (TIPS) is recommended in case of the second unsuccessful endoscopic tre atment. Secondary preventi on after successful tre atment is imperative (endoscopic eradicati on of varices + non‑selective beta‑blockers). Furthermore, liver transplantati on sho uld always be considered in these pati ents.

Key words:
acute gastro intestinal bleeding – peptic ulcer – oesophage al varices

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