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Diagnosis and therapy of non-variceal upper gastrointestinal bleeding
- Source :
- World journal of gastrointestinal pharmacology and therapeutics. 6(4)
- Publication Year :
- 2015
-
Abstract
- Non-variceal upper gastrointestinal bleeding (UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions, erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor (PPI) therapy. These drugs are highly effective but the best route of application (oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal anti-inflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased.
- Subjects :
- medicine.medical_specialty
Gastrointestinal bleeding
biology
medicine.drug_class
business.industry
Peptic
Proton-pump inhibitor
Review
Helicobacter pylori
biology.organism_classification
medicine.disease
Gastroenterology
Surgery
Discontinuation
Melena
Internal medicine
medicine
Upper gastrointestinal bleeding
medicine.symptom
Angiodysplasia
business
Subjects
Details
- ISSN :
- 21505349
- Volume :
- 6
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- World journal of gastrointestinal pharmacology and therapeutics
- Accession number :
- edsair.doi.dedup.....2e9cc2f5d62c43f4645fcd1ab846d76b