Gastrointestinale Blutung

Gastrointestinale Blutungen sind insgesamt häufig – in ihrem klinischen Erscheinungsbild sind sie jedoch sehr unterschiedlich und sie bedürfen einer differenzierten Diagnostik und Therapie. Der folgende Artikel befasst sich mit dem Management, der Diagnostik und der Therapie gastrointestinaler Blutungen [1].

Schlüsselwörter

Ösophagusvarizen - portaler Hypertonus - transjugulärer portosystemischer Shunt

• Literatur

• 1 Götz M, Anders M, Biecker E. et al. S2k-Leitlinie 021/028: Gastrointestinale Blutung. Stand 05/2017. Im Internet: http://www.awmf.org/leitlinien/detail/ll/021-028.html Stand: 25.01.2018
• 2 Gralnek IM, Dumonceau JM, Kuipers EJ. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1-a46 doi:10.1055/s-0034-1393172
• 3 Koch A, Buendgens L, Dückers H. et al. [Bleeding origin, patient-related risk factors, and prognostic indicators in patients with acute gastrointestinal hemorrhages requiring intensive care treatment. A retrospective analysis from 1999 to 2010]. Med Klin Intensivmed Notfmed 2013; 108: 214-222
• 4 Hreinsson JP, Gumundsson S, Kalaitzakis E. et al. Lower gastrointestinal bleeding: incidence, etiology, and outcomes in a population-based setting. Eur J Gastroenterol Hepatol 2013; 25: 37-43
• 5 Denzer U, Beilenhoff U, Eickhoff A. et al. [S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021-022]. Z Gastroenterol 2015; 53: E1-E227
• 6 Villanueva C, Colomo A, Bosch A. et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368: 11-21
• 7 Sreedharan A, Martin J, Leontiadis GI. et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev 2010; (07) CD005415
• 8 Seo YS, Park SY, Kim MY. et al. Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage. Hepatology 2014; 60: 954-963
• 9 Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F. et al. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding – an updated Cochrane review. Aliment Pharmacol Ther 2011; 34: 509-518
• 10 Seshasai SR, Wijesuriya S, Sivakumaran R. et al. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 2012; 172: 209-216
• 11 McQuaid KR, Laine L. Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials. Am J Med 2006; 119: 624-638
• 12 Caldeira D, Barra M, Ferreira A. et al. Systematic review with meta-analysis: the risk of major gastrointestinal bleeding with non-vitamin K antagonist oral anticoagulants. Aliment Pharmacol Ther 2015; 42: 1239-1249
• 13 Gallagher AM, van Staa TP, Murray-Thomas T. et al. Population-based cohort study of warfarin-treated patients with atrial fibrillation: incidence of cardiovascular and bleeding outcomes. BMJ Open 2014; 4: e003839
• 14 Hansen ML, Sorensen R, Clausen MT. et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med 2010; 170: 1433-1441
• 15 Sung JJ, Lau JY, Ching JY. et al. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 2010; 152: 1-9
• 16 Biondi-Zoccai GG, Lotrionte M, Agostoni P. et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J 2006; 27: 2667-2674
• 17 Burger W, Chemnitius JM, Kneissl GD. et al. Low-dose aspirin for secondary cardiovascular prevention – cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation – review and meta-analysis. J Intern Med 2005; 257: 399-414
• 18 Qureshi W, Mittal C, Patsias I. et al. Restarting anticoagulation and outcomes after major gastrointestinal bleeding in atrial fibrillation. Am J Cardiol 2014; 113: 662-668
• 19 Laine L, Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol 2010; 105: 2636-2641 quiz 2642
• 20 Jaeckle T, Stuber G, Hoffmann MH. et al. Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT. Eur Radiol 2008; 18: 1406-1413
• 21 Frattaroli FM, Casciani E, Spoletini D. et al. Prospective study comparing multi-detector row CT and endoscopy in acute gastrointestinal bleeding. World J Surg 2009; 33: 2209-2217
• 22 García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A. et al. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol 2013; 23: 1181-1190
• 23 Pennazio M, Spada C, Eliakim R. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376
• 24 Elmunzer BJ, Young SD, Inadomi JM. et al. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol 2008; 103: 2625-2632 doi:10.1111/j.1572-0241.2008.02070.x quiz 2633
• 25 Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 2009; 7: 33-47 doi:10.1016/j.cgh.2008.08.016 quiz 1–2
• 26 Huang SP, Wang HP, Lee YC. et al. Endoscopic hemoclip placement and epinephrine injection for Mallory-Weiss syndrome with active bleeding. Gastrointest Endosc 2002; 55: 842-846
• 27 Swanson E, Mahgoub A, MacDonald R. et al. Medical and endoscopic therapies for angiodysplasia and gastric antral vascular ectasia: a systematic review. Clin Gastroenterol Hepatol 2014; 12: 571-582
• 28 Akhtar K, Byrne JP, Bancewicz J. et al. Argon beam plasma coagulation in the management of cancers of the esophagus and stomach. Surg Endosc 2000; 14: 1127-1130
• 29 Kato M, Jung Y, Gromski MA. et al. Prospective, randomized comparison of 3 different hemoclips for the treatment of acute upper GI hemorrhage in an established experimental setting. Gastrointest Endosc 2012; 75: 3-10
• 30 Beggs AD, Dilworth MP, Powell SL. et al. A systematic review of transarterial embolization versus emergency surgery in treatment of major nonvariceal upper gastrointestinal bleeding. Clin Exp Gastroenterol 2014; 7: 93-104
• 31 DʼAmico G, Pasta L, Morabito A. et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients. Aliment Pharmacol Ther 2014; 39: 1180-1193
• 32 Dhiman RK, Saraswat VA, Choudhuri G. et al. Endosonographic, endoscopic, and histologic evaluation of alterations in the rectal venous system in patients with portal hypertension. Gastrointest Endosc 1999; 49: 218-227
• 33 Ghoshal UC, Biswas PK, Roy G. et al. Colonic mucosal changes in portal hypertension. Trop Gastroenterol 2001; 22: 25-27
• 34 Chen LS, Lin HC, Lee FY. et al. Portal hypertensive colopathy in patients with cirrhosis. Scand J Gastroenterol 1996; 31: 490-494
• 35 Bhardwaj A, Kedarisetty CK, Vashishtha C. et al. Carvedilol delays the progression of small oesophageal varices in patients with cirrhosis: a randomised placebo-controlled trial. Gut 2017; 66: 1838-1843
• 36 Leithead JA, Rajoriya N, Tehami N. et al. Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation. Gut 2015; 64: 1111-1119
• 37 Mookerjee RP, Pavesi M, Thomsen KL. et al. Treatment with non-selective beta blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure. J Hepatol 2016; 64: 574-582
• 38 Bañares R, Albillos A, Rincón D. et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002; 35: 609-615
• 39 Escorsell A, Pavel O, Cardenas A. et al. Esophageal balloon tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A multicenter randomized, controlled trial. Hepatology 2016; 63: 1957-1967
• 40 Qi X, Jia J, Bai M. et al. Transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a meta-analysis. J Clin Gastroenterol 2015; 49: 495-505
• 41 Barrio J, Ripoll C, Bañares R. et al. Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents. Eur J Radiol 2005; 55: 120-124
• 42 Bureau C, Pagán JCG, Layrargues GP. et al. Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int 2007; 27: 742-747
• 43 Lo EA, Wilby KJ, Ensom MH. Use of proton pump inhibitors in the management of gastroesophageal varices: a systematic review. Ann Pharmacother 2015; 49: 207-219
• 44 Brown MR, Jones G, Nash KL. et al. Antibiotic prophylaxis in variceal hemorrhage: timing, effectiveness and Clostridium difficile rates. World J Gastroenterol 2010; 16: 5317-5323
• 45 Bernard B, Cadranel JF, Valla D. et al. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology 1995; 108: 1828-1834
• 46 Bleichner G, Boulanger R, Squara P. et al. Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage. Br J Surg 1986; 73: 724-726
• 47 Hou MC, Lin HC, Liu TT. et al. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology 2004; 39: 746-753
• 48 Hsieh WJ, Lin HC, Hwang SJ. et al. The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding. Am J Gastroenterol 1998; 93: 962-966