Treatment of acute non-variceal upper gastrointestinal bleeding Varise baǧli olmayan akut gastrointestinal kanamalarda tedavi
SENDROM, cilt.16, sa.5, ss.71-78, 2004 (Scopus)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 16 Sayı: 5
- Basım Tarihi: 2004
- Dergi Adı: SENDROM
- Derginin Tarandığı İndeksler: Scopus
- Sayfa Sayıları: ss.71-78
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Gastrointestinal bleeding is a common problem in emergency medical practice and should be considered potentially life-threatening until proven otherwise. Upper gastrointestinal bleeding is defined as hemorrhages originating proximal to the ligament of Treitz. Non-variceal causes account for approximately 90% of all the cases of upper gastrointestinal bleeding. Peptic ulcer is the commonest cause of acute non-variceal bleeding. Approximately 80% of the cases pursue a benign course without rebleeding in hospital and specific treatment is not required. The remaining 20% have severe bleeding due to erosion of major arteries. The role of drug treatment in addition to endoscopic therapy is unclear. It is reasonable to administer a proton pump inhibitor at presentation, although the evidence for improved outcome is relatively unsupported. There is currently no evidence that other drug therapies are effective. Endoscopic therapy for non-variceal hemorrhage is safe and effective. It is probable, but not proven, that combination of a topical thermal agent with an injectable formulation is the best option. Thermal hemostasis is effective using either the heat probe or multipolar electrocoagulation. The best injection material is probably either fibrin glue or thrombin, which triggers formation of a stable blood clot at the site of the arterial defect. Rebleeding should be treated first by further endoscopic intervention, although clinical judgement should dictate when urgent surgery is required for high risk cases. In addition, some patients having persistent bleeding or high risk for surgery require angiographic control of the bleeding foci.