Current therapy for nonvariceal upper gastrointestinal bleeding

Abstract

Upper gastrointestinal bleeding continues to plague physicians despite the discovery of Helicobacter pylori and advances in medical therapy for peptic ulcer disease. Medical therapy with new nonsteroidal anti-inflammatory medications and somatostatin/octreotide and intravenous proton pump inhibitors provides hope for reducing the incidence of and treating bleeding peptic ulcer disease. Endoscopic therapy remains the mainstay for diagnosis and treatment of upper gastrointestinal bleeding. Many methods of endoscopic hemostasis have proven useful in upper gastrointestinal hemorrhage. Currently, combination therapy with epinephrine injection and bicap or heater probe therapy is most commonly employed in the United States. Angiography and embolization play a role primarily when endoscopic therapy is unsuccessful.

Nonvariceal upper gastrointestinal bleeding

“…As stated before, 80% of NUGB spontaneously resolve, so treatment is primarily to prevent recurrence [2,3,31]. Recent recommendations for medical and early endoscopic treatment show a 90% clinical success rate of controlling NUGB in many series [2][3][4][5]. Similarly, angiography shows an 80% clinical success rate of controlling bleeding (8% of the total) [3,10,[42][43][44].…”

“…An overall mortality rate for NUGB remains relatively constant at 6-10%, with rates increasing for such factors as age and co-morbid conditions [1,2,4]. Mortality rates of 3% have been reported in subgroups of patients less than 60 years of age and greater than 20% in patients older than 80 years [5]. A recent reduction in the incidence of peptic ulcer disease partially attributed to advances in gastric acid suppression and new cyclooxygenase (COX-2) inhibitors have unfortunately not correlated with a decrease in the overall mortality of NUGB or the incidence of rebleeding [7].…”

“…GI bleeding accounts for approximately 20% of emergency room visits and 5% of all emergency room admissions, accounting for approximately 2% of all hospital admissions [1,2]. The incidence of nonvariceal upper GI bleeding (NUGB) is estimated at 100-300 cases/100,000 of the population per year in the USA [2][3][4][5]. NUGB may manifest with many different clinical presentations including hematemesis, hematochezia, melena, anemia, or hemodynamic instability.…”

Evaluation of 364 Cases With Non-Variceal Gastrointestinal System Bleeding

“…Günşar ve arkadaşlarının (20) çalışmasında aspirin ve diğer NSAİİ kullanımı %50 olarak saptanmıştır. Nonsteroid antiinflamatuar ilaçların kullanımı üst GİS kanama ile başvuran hastaların %30-50'sinde mevcuttur (5,6).…”

“…Mortaliteyle ilişkili diğer faktörler nüks kanama, yandaş hastalık varlığı (kardiyak hastalık, kronik karaciğer hastalığı, solunum sistemi veya merkezi sinir sistemi hastalığı, renal yetersizlik), peptik ülser veya geçirilmiş cerrahi girişim öyküsü, hematemezle prezentasyon, hipotansiyon gelişimi ve özofagus varis kanamasıdır (4). Özellikle yaşlı hastalarda nonsteroit antiinflamatuar ilaçların (NSAİİ) daha fazla kullanımı ve gis has hasiyetine bağlı olarak kanamalarda ve mortalitenin 4-5 kat arttığı bildirilmiştir (5,6).…”