Vnitr Lek 2009, 55(Suppl 1):29-33

Acute upper gastrointestinal bleeding

J. Lata^*, R. Kroupa, I. Novotný, T. Vaňásek

Interní hepatogastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jan Lata, CSc.

In gastroenterology, upper gastrointestinal bleeding is a severe acute situation. Mortality is about 10% and has not changed importantly over the last decades. The incidence of bleeding and its mortality increase with increasing age, co-morbidities and polytherapy. Peptic ulcers of the stomach and duodenum are the most frequent causes (42-50%). 5-20% are patients with portal hypertension-related bleeding. Upper gastrointestinal bleeding requires a specific therapeutic approach. Endoscopic examination is essential; apart from diagnosis, it also enables management of the source of bleeding in most cases. Endoscopy also enables evaluation of the severity of the condition causing the bleeding and estimation of the risk of relapse. Endoscopic treatment is indicated in nonvariceal bleeding with visible bleeding or significant stigmata. Most frequently used endoscopic treatments include endoscopic adrenalin injection, thermocoagulation, endoscopic clipping and endoscopic tissue glue injection. Pharmacotherapy in nonvariceal bleeding should aim at increasing stomach pH and stabilization of coagulation and normal thrombocyte activity. Intravenous application of omeprazole followed by continuous infusion over 72 hours appears to be the most effective. Continuous or recurrent bleeding requires repeat endoscopy and a consultation with a surgeon. Therapy of portal hypertension-related bleeding involves initiation of pharmacotherapy (terlipresin 1mg every 4 hours for 3-5 days or somatostatin) in combination with endoscopic treatment (sclerotherapy or variceal ligation) as soon as possible following hospital admission. Implantation of the Transjugular Intrahepatic Portosystemic Shunt (TIPS) is recommended in case of the second unsuccessful endoscopic treatment. Secondary prevention after successful treatment is imperative (endoscopic eradication of varices + non-selective beta-blockers). Furthermore, liver transplantation should always be considered in these patients.

Keywords: acute gastrointestinal bleeding; peptic ulcer; oesophageal varices

Received: February 23, 2009; Published: February 1, 2009  Show citation