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Peptic upper gastrointestinal bleeding: diagnosis and treatment. A monocentric experience on a 5 years period

I Sporea1, Daniela Lazăr, Alina Popescu

  • 1Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, Romania. isporea@umft.ro

Romanian Journal of Internal Medicine = Revue Roumaine De Medecine Interne
|December 25, 2010
PubMed

Insights

Upper gastrointestinal hemorrhages are frequently caused by peptic ulcers and can be effectively treated with endoscopic hemostasis. Combined endoscopic therapies are increasingly replacing monotherapy for improved outcomes in managing these critical bleeding events.

Area of Science:

  • Gastroenterology
  • Endoscopy
  • Hemorrhage Management

Background:

  • Upper gastrointestinal hemorrhage (UGH) is a significant clinical challenge.
  • Peptic ulcers are the predominant cause of UGH, necessitating effective management strategies.

Purpose of the Study:

  • To evaluate the efficacy of endoscopic hemostasis for upper gastrointestinal hemorrhages.
  • To analyze trends in endoscopic treatment modalities over a five-year period.

Main Methods:

  • Retrospective analysis of 810 patients with UGH admitted to an Endoscopy Department.
  • Assessment of peptic ulcers using the Forrest classification.
  • Documentation of endoscopic hemostasis techniques, including epinephrine injection, clipping, and thermocoagulation.

Main Results:

  • Peptic ulcers accounted for 82.6% of UGH cases.
  • Endoscopic hemostasis was performed in 40% of patients.
  • Combined therapy (injection + clip/thermocoagulation) and monotherapy (epinephrine injection) were utilized, with a trend towards reduced epinephrine monotherapy.
  • Rebleeding occurred in 19.8% of cases, with a 3.6% fatal outcome and 2.7% requiring surgery.

Conclusions:

  • Endoscopic hemostasis is highly effective for the majority of UGH cases in experienced centers.
  • Endoscopic bitherapy (e.g., adrenaline injection with clipping or coagulation) is increasingly favored over epinephrine monotherapy for ulcer hemostasis.
Abstract

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