Upper gastrointestinal haemorrhage: an update

Abstract

Upper gastrointestinal (GI) haemorrhage is a common cause for admission to hospital and is associated with a mortality of around 10%. Prompt assessment and resuscitation are vital, as are risk stratification of the severity of bleeding, early involvement of the multidisciplinary team and timely access to endoscopy, preferably within 24 h. The majority of bleeds are due to peptic ulcers for whichHelicobacter pyloriand non-steroidal anti-inflammatory agents are the main risk factors. Although proton pump inhibitors (PPIs) are widely used before endoscopy, this is controversial. Pre-endoscopic risk stratification with the Glasgow Blatchford score is recommended as is the use of the Rockall score postendoscopy. Endoscopic therapy, with at least two haemostatic modalities, remains the mainstay of treating high-risk lesions and reduces rebleeding rates and mortality. High-dose PPI therapy after endoscopic haemostasis also reduces rebleeding rates and mortality. Variceal oesophageal haemorrhage is associated with a higher rebleeding rate and risk of death. Antibiotics and vasopressin analogues are advised in suspected variceal bleeding; however, endoscopic variceal band ligation remains the haemostatic treatment of choice. Balloon tamponade remains useful in the presence of torrential variceal haemorrhage or when endoscopy fails to secure haemostasis, and can be a bridge to further endoscopic attempts or placement of a transjugular intrahepatic portosystemic shunt. This review aims to provide an update on the latest evidence-based recommendations for the management of acute upper GI haemorrhage.

Rational Use of Nonsteroidal Anti-Inflammatory Drugs. Clinical Guidelines

“…К сожалению, НПВП могут вызывать широкий спектр неблагоприятных явлений (НЯ), представляющих серьезную угрозу здоровью и жизни пациентов. В частности, по данным российских и зарубежных исследований [6][7][8][9][10][11][12], не менее 40-50% случаев развития кровотечений из верхних отделов желудочно-кишечного тракта (ЖКТ), потребовавших эндоскопического или хирургического гемостаза, связаны с приемом НПВП. Поэтому рациональное использование НПВП обязательно должно включать методы эффективной профилактики лекарственных осложнений.…”

“…Пациенты, получающие НПВП, погибают вследствие осложнений со стороны ЖКТ в 2-3 раза чаще, в сравнении с людьми, не принимающими препараты этой группы [96,97]. В настоящее время в развитых странах, на фоне снижения частоты ассоциированных с Helicobacter pylori язв, именно НПВП рассматриваются как основная причина развития желудочно-кишечных кровотечений [9][10][11].…”

Systematic review with meta‐analysis: the efficacy of tranexamic acid in upper gastrointestinal bleeding

“…It is a common medical emergency worldwide with overall mortality ranging between 5% and 14% in Europe and North America 2 . Mortality increases with increasing age, co‐existing comorbidities as well as with re‐bleeding episodes 2,3 . Despite great advances made in the management of patients presenting with upper gastrointestinal bleeding, mortality rates remain high 3,4 …”

“…Upper gastrointestinal bleeding usually presents with haematemesis, which is the vomiting of blood, or the passage of melena or dark, tarry stools resulting from alteration of blood in the gastrointestinal (GI) tract. Although therapeutic endoscopy is of critical importance in patients who require this procedure, 3 the use of pre‐ and post‐ endoscopy medical therapy is also very important with regard to optimising patient management.…”

“…The role of tranexamic acid in upper gastrointestinal bleeding has been controversial 3,10 . A meta‐analysis published in 2014 found that tranexamic acid may have a beneficial effect on mortality, but the authors called for additional research on the topic due to some methodological weaknesses of the primary studies 11 .…”