PL EN


Preferences help
enabled [disable] Abstract
Number of results
2013 | 9 | 1 | 15–24
Article title

Farmakoterapia krwawienia pochodzenia nieżylakowego z górnego odcinka przewodu pokarmowego

Content
Title variants
EN
Pharmacological therapy of non-variceal upper gastrointestinal bleeding
Languages of publication
PL
Abstracts
EN
Upper gastrointestinal bleeding is a common gastroenterological emergency requiring proper management and urgent treatment. The vast majority of these haemorrhages are due to peptic ulcers, erosive gastritis and esophagitis as well as oesophageal and gastric varices. Diagnostic and/or therapeutic endoscopy is recommended within 24 h of presentation in all patients with symptoms of upper gastrointestinal bleeding. Initial pharmacological treatment includes volume resuscitation, hemodynamic stabilization and proton pump inhibitor (PPI) (bolus 80 mg) administration prior to endoscopy to downstage the bleeding lesion. In patients on anticoagulants correction of coagulopathy is recommended prior to endoscopy. High-doses of PPI (8 mg/h for at least 3 days) administration after endoscopic haemostasis promote clot stability by sustaining intragastric pH above 6. H. pylori is the key factor in peptic ulcer development and eradication is recommended immediately after feeding is restarted. Presented management reduces rebleeding rate. Despite this upper gastrointestinal bleeding still carries considerable rates of complications and mortality. To aim of this work was to review the currently available guidelines and recommendations in pharmacological managing in patients with non-variceal upper gastrointestinal bleeding.
PL
Krwawienie z górnego odcinka przewodu pokarmowego jest powszechnym stanem nagłym w gastroenterologii, wymagającym szybkiego wdrożenia właściwego postępowania. Do najczęstszych przyczyn omawianej grupy krwawień zalicza się chorobę wrzodową, nadżerkowe zapalenie błony śluzowej żołądka i przełyku oraz żylaki żołądka i przełyku. U wszystkich chorych z objawami krwawienia z górnego odcinka przewodu pokarmowego zalecane jest wykonanie diagnostycznej i/lub terapeutycznej gastroskopii w ciągu 24 godzin od przyjęcia do szpitala. Początkowe leczenie farmakologiczne obejmuje resuscytację płynową, stabilizację hemodynamiczną chorego oraz podanie inhibitora pompy protonowej (proton pump inhibitors, PPI) (80 mg w bolusie) przed wykonaniem gastroskopii, co zmniejsza aktywność znamion krwawienia. Chorzy przyjmujący doustne antykoagulanty przed wykonaniem endoskopii wymagają ponadto wyrównania parametrów krzepnięcia. Stosowanie dużych dawek PPI (8 mg/godz. przez co najmniej 72 godziny) po uzyskaniu endoskopowej hemostazy warunkuje utrzymanie pH w żołądku powyżej 6, co umożliwia stabilizację skrzepu. H. pylori jest udokumentowanym czynnikiem ryzyka rozwoju wrzodów trawiennych, dlatego zaleca się przeprowadzenie terapii eradykacyjnej już w momencie wznowienia żywienia doustnego. Powyższe postępowanie obniża częstość nawrotu krwawienia nieżylakowego z górnego odcinka przewodu pokarmowego. Pomimo tego krwawienie z górnego odcinka przewodu pokarmowego ciągle obarczone jest znacznym ryzykiem powikłań i zgonu chorego. Celem niniejszej pracy był przegląd obecnie dostępnych zaleceń i wytycznych postępowania w krwawieniu z górnego odcinka przewodu pokarmowego pochodzenia nieżylakowego.
Discipline
Year
Volume
9
Issue
1
Pages
15–24
Physical description
References
  • 1. Longstreth G.F.: Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a populationbased study. Am. J. Gastroenterol. 1995; 90: 206–210.
  • 2. British Society of Gastroenterology Endoscopy Committee: Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut 2002; 51 (Suppl. IV): iv1–iv6.
  • 3. Petersen H., Kristensen P., Johannessen T. i wsp.: The natural course of peptic ulcer disease and its predictors. Scand. J. Gastroenterol. 1995; 30: 17–24.
  • 4. Laine L., Peterson W.L.: Helicobacter pylori and complicated ulcer disease. Am. J. Med. 1996; 100: 52s–57s.
  • 5. Adler D.G., Leighton J.A., Davila R.E. i wsp.; The Standard of Practice Committeee of the ASGE: ASGE guideline: the role of endoscopy in acute non-variceal upper- GI hemorrhage. Gastrointest. Endosc. 2004; 60: 497–504.
  • 6. Jutabha R., Jensen D.M.: Management of upper gastrointestinal bleeding in the patient with chronic liver disease. Med. Clin. North. Am. 1996; 80: 1035–1068.
  • 7. Lundell L.: GI haemorrhage – surgical aspects. EAGE 2nd European Postgraduate School in Gastroenterology. Abstracts 28–29.
  • 8. Marek T., Baniukiewicz A., Wallner G. i wsp. (Grupa robocza konsultanta krajowego w dziedzinie gastroenterologii): Wytyczne postępowania w krwawieniu z górnego odcinka przewodu pokarmowego pochodzenia nieżylakowego. Przegl. Gastroenterol. 2008; 3 (1): 1–22.
  • 9. Kim S.K., Duddalwar V.: Failed endoscopic therapy and the interventional radiologist: non-variceal upper gastrointestinal bleeding. Tech. Gastrointest. Endosc. 2005; 7: 148–155.
  • 10. Barkun A.N., Bardou M., Kuipers E.J. i wsp.; International Consensus Upper Gastrointestinal Bleeding Conference Group: International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann. Intern. Med. 2010; 152: 101–113.
  • 11. Sung J.J., Chan F.K., Chen M. i wsp.; Asia-Pacific Working Group: Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding. Gut 2011; 60: 1170–1177.
  • 12. Chiverton S.G., Hunt R.H.: Relationship between inhibition of acid secretion and healing of peptic ulcers. Scand. J. Gastroenterol. Suppl. 1989; 166: 43–47; discussion 74–5.
  • 13. Andrews C., Levy A., Fishman M. i wsp. Intravenous proton pump inhibitor (IV IPPs) prior to endoscopy “downstage” high-risk lesion in patients with bleeding peptic ulcer (PUD): a multicenter comparative study [Abstract]. Gastrointest. Endosc. 2003; 57: AB 149.
  • 14. Keyvani L., Murthy S., Leeson S., Targownik L.E.: Preendoscopic proton pump inhibitor therapy reduces recurrent adverse gastrointestinal outcomes in patients with acute non-variceal upper gastrointestinal bleeding. Aliment. Pharmacol. Ther. 2006; 24: 1247–1255.
  • 15. Barkun A., Kennedy W., Herba K.: The cost effectiveness of proton pump inhibitor continuous infusion (IV IPP) administered prior to endoscopy in the treatment of patients with non-variceal upper GI bleeding. The RUGBE Investigators [Abstract]. Gastroenterology 2002; 122: A67.
  • 16. Enns R.A., Gagnon Y.M., Rioux K.P., Levy A.R.: Costeffectiveness in Canada of intravenous proton pump inhibitors for all patients presenting with acute upper gastrointestinal bleeding. Aliment. Pharmacol. Ther. 2003; 17: 225–233.
  • 17. Dorward S., Sreedharan A., Leontiadis G.I. i wsp.: Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst. Rev. 2006; (4): CD005415.
  • 18. Sreedharan A., Martin J., Leontiadis G.I. i wsp.: Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010; (7): CD005415.
  • 19. Sussman D.A., Deshpande A.R., Parra J.L., Ribeiro A.C.: Intravenous metoclopramide to increase mucosal visualization during endoscopy in patients with acute upper gastrointestinal bleeding: a randomized, controlled study [abstract]. Gastrointest. Endosc. 2008; 67: AB247.
  • 20. Frossard J.L., Spahr L., Queneau P.E. i wsp.: Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, doubleblind trial. Gastroenterology 2002; 123: 17–23.
  • 21. Coffin B., Pocard M., Panis Y. i wsp.: Erythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study. Gastrointest. Endosc. 2002; 56: 174–179.
  • 22. Carbonell N., Pauwels A., Serfaty L. i wsp.: Erythromycin infusion prior to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled, doubleblind trial. Am. J. Gastroenterol. 2006; 101: 1211–1215.
  • 23. Altraif I., Handoo F.A., Aljumah A. i wsp.: Effect of erythromycin before endoscopy in patients presenting with variceal bleeding: a prospective, randomized, double- blind, placebo-controlled trial. Gastrointest. Endosc. 2011; 73: 245–250.
  • 24. Bai Y., Guo J.F., Li Z.S.: Meta-analysis: erythromycin before endoscopy for acute upper gastrointestinal bleeding. Aliment. Pharmacol. Ther. 2011; 34: 166–171.
  • 25. Barkun A.N., Bardou M., Martel M. i wsp.: Prokinetics in acute upper GI bleeding: a meta-analysis. Gastrointest. Endosc. 2010; 72: 1138–1145.
  • 26. Pateron D., Vicaut E., Debuc E. i wsp.: Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial. Ann. Emerg. Med. 2011; 57: 582–589.
  • 27. Trawick E.P., Yachimski P.S.: Management of non-variceal upper gastrointestinal tract hemorrhage: controversies and areas of uncertainty. World J. Gastroenterol. 2012; 18: 1159–1165.
  • 28. Sachs G., Shin J.M.: The basis of differentiation of PPIs. Drugs Today (Barc.) 2004; 40 Suppl. A: 9–14.
  • 29. Green F.W. Jr., Kaplan M.M., Curtis L.E., Levine P.H.:Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor prolonged gastroduodenal mucosal hemorrhage. Gastroenterology 1978; 74: 38–43.
  • 30. Patchett S.E., Enright H., Afdhal N. i wsp.: Clot lysis by gastric juice: an in vitro study. Gut 1989; 30: 1704–1707.
  • 31. Kolkman J.J., Meuwissen S.G.: A review on treatment of bleeding peptic ulcer: a collaborative task of gastroenterologist and surgeon. Scand. J. Gastroenterol. Suppl. 1996; 218: 16–25.
  • 32. Li Y., Sha W., Nie Y. i wsp.: Effect of intragastric pH on control of peptic ulcer bleeding. J. Gastroenterol. Hepatol. 2000; 15 (2): 148–154.
  • 33. Vreeburg E.M., Levi M., Rauws E.A. i wsp.: Enhanced mucosal fibrinolytic activity in gastroduodenal ulcer haemorrhage and the beneficial effect of acid suppression. Aliment. Pharmacol. Ther. 2001; 15: 639–646.
  • 34. Hasselgren G., Keelan M., Kirdeikis P. i wsp.: Optimization of acid suppression for patients with peptic ulcer bleeding: an intragastric pH-metry study with omeprazole. Eur. J. Gastroenterol. Hepatol. 1998; 10: 601–606.
  • 35. Greenspoon J., Barkun A.: A summary of recent recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Pol. Arch. Med. Wewn. 2010; 120: 341–346.
  • 36. Laine L., McQuaid K.R.: Endoscopic therapy for bleeding ulcers: an evidence-based approach based on metaanalyses of randomized controlled trials. Clin. Gastroenterol. Hepatol. 2009; 7: 33–47.
  • 37. Leontiadis G.I., Howden C.W.: Pharmacologic treatment of peptic ulcer bleeding. Curr. Treat. Options Gastroenterol. 2007; 10: 134–142.
  • 38. Leontiadis G.I., Sharma V.K., Howden C.W.: Proton pump inhibitor treatment for acute peptic ulcer bleeding. Cochrane Database Syst. Rev. 2006; 1: CD002094.
  • 39. Lau J.Y., Leung W.K., Wu J.C. i wsp.: Omeprazole before endoscopy in patients with gastrointestinal bleeding. N. Engl. J. Med. 2007; 356: 1631–1640.
  • 40. Leontiadis G.I., Sharma V.K., Howden C.W.: Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding. BMJ 2005; 330: 568.
  • 41. Martin J.E., Macaulay S.S., Zarnke K.B., Gregor J.: Proton pump inhibitors versus H2-antagonists or placebo for upper gastrointestinal bleeding with or without endoscopic hemostasis: a meta-analysis [Abstract]. Gastroenterology 2003; 124 (Suppl. 1): A625.
  • 42. van Rensburg C.J., Hartmann M., Thorpe A. i wsp.: Intragastric pH during continuous infusion with pantoprazole in patients with bleeding peptic ulcer. Am. J. Gastroenterol. 2003; 98: 2635–2641.
  • 43. Barkun A., Bardou M., Marshall J.K.; Nonvariceal Upper GI Bleeding Consensus Conference Group: Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding. Ann. Intern. Med. 2003; 139: 843–857.
  • 44. Andriulli A., Loperfido S., Focareta R. i wsp.: High- versus low-dose proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding: a multicentre, randomized study. Am. J. Gastroenterol. 2008; 103: 3011–3018.
  • 45. Spiegel B.M., Dulai G.S., Lim B.S. i wsp.: The costeffectiveness and budget impact of intravenous versus oral proton pump inhibitors in peptic ulcer hemorrhage. Clin. Gastroenterol. Hepatol. 2006; 4: 988–997.
  • 46. Laine L., Shah A., Bemanian S.: Intragastric pH with oral vs intravenous bolus plus infusion proton-pump inhibitor therapy in patients with bleeding ulcers. Gastroenterology 2008; 134: 1836–1841.
  • 47. Kaviani M.J., Hashemi M.R., Kazemifar A.R.: Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical trial. Aliment. Pharmacol. Ther. 2003; 17: 211–216.
  • 48. Khuroo M.S., Yattoo G.N., Javid G. i wsp.: A comparison of omeprazole and placebo for bleeding peptic ulcer. N. Engl. J. Med. 1997; 336: 1054–1058.
  • 49. Bardou M., Toubouti Y.M., Benhaberou-Brun D. i wsp.: High dose intravenous proton pump inhibitors decrease both rebleeding and mortality in high-risk patients with acute peptic ulcer bleeding: a series of meta-analyses [Abstract]. Gastroenterology 2003; 124 (Suppl 1): A625.
  • 50. Zed P.J., Loewen P.S., Slavik R.S., Marra C.A.: Meta-analysis of proton pump inhibitors in treatment of bleeding peptic ulcers. Ann. Pharmacother. 2001; 35: 1528–1534.
  • 51. Barkun A.N., Cockeram A.W., Plourde V., Fedorak R.N.: Review article: acid suppression in non-variceal acute upper gastrointestinal bleeding. Aliment. Pharmacol. Ther. 1999; 13: 1565–1584.
  • 52. Collins R., Langman M.: Treatment with histamine H2 antagonists in acute upper gastrointestinal hemorrhage. Implications of randomized trials. N. Engl. J. Med. 1985; 313: 660–666.
  • 53. Levine J.E., Leontiadis G.I., Sharma V.K., Howden C.W.: Meta-analysis: the efficacy of intravenous H2-receptor antagonists in bleeding peptic ulcer. Aliment. Pharmacol. Ther. 2002; 16: 1137–1142.
  • 54. Wójtowicz J., Wojtuń S., Gil J.: Krwawienie nieżylakowe z górnego odcinka przewodu pokarmowego. Pol. Merkur. Lekarski 2009; 26: 435.
  • 55. Saruç M., Can M., Küçükmetin N. i wsp.: Somatostatin infusion and hemodynamic changes in patients with non-variceal upper gastrointestinal bleeding: a pilot study. Med. Sci. Monit. 2003; 9: PI84–PI87.
  • 56. Bloom S.R., Mortimer C.H., Thorner M.O. i wsp.: Inhibition of gastrin and gastric-acid secretion by growth-hormone release-inhibiting hormone. Lancet 1974; 2: 1106–1109.
  • 57. Imperiale T.F., Birgisson S.: Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Ann. Intern. Med. 1997; 127: 1062–1071.
  • 58. Choudari C.P., Rajgopal C., Elton R.A., Palmer K.R.: Failures of endoscopic therapy for bleeding peptic ulcer: an analysis of risk factors. Am. J. Gastroenterol. 1994; 89: 1968–1972.
  • 59. Gluud L.L., Klingenberg S.L., Langholz E.: Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst. Rev. 2012; 1: CD006640
  • 60. Malfertheiner P., Megraud F., O’Morain C.A. i wsp.; European Helicobacter Study Group (EHSG): Management of Helicobacter pylori infection – the Maastricht IV/ Florence Consensus Report. Gut 2012; 61: 646–664.
  • 61. Vakil N., Fennerty M.B.: Direct comparative trials of the efficacy of proton pump inhibitors in the management of gastro-oesophageal reflux disease and peptic ulcer disease. Aliment. Pharmacol. Ther. 2003; 18: 559–568.
  • 62. Ramakrishnan K., Salinas R.C.: Peptic ulcer disease. Am. Fam. Physician 2007; 76: 1005–1012.
  • 63. Schilling D., Demel A., Nüsse T. i wsp.: Helicobacter pylori infection does not affect the early rebleeding rate in patients with peptic ulcer bleeding after successful endoscopic hemostasis: a prospective single-center trial. Endoscopy 2003; 35: 393–396
  • 64. Rácz I., Bircher K., Kárász T., Németh A.: The influence of Helicobacter pylori infection on early rebleeding rate in patients with peptic ulcer bleeding. Endoscopy. 2004; 36: 461–462; author reply 462–463.
  • 65. Vakil N.: Helicobacter pylori: factors affecting eradication and recurrence. Am. J. Gastroenterol. 2005; 100: 2393–2394.
  • 66. Fischbach L.A., Goodman K.J., Feldman M., Aragaki C.: Sources of variation of Helicobacter pylori treatment success in adults worldwide: a meta-analysis. Int. J. Epidemiol. 2002; 31: 128–139.
  • 67. Fuccio L., Minardi M.E., Zagari R.M. i wsp.: Metaanalysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Ann. Intern. Med. 2007; 147: 553–562.
  • 68. Essa A.S., Kramer J.R., Graham D.Y., Treiber G.: Metaanalysis: four-drug, three-antibiotic, non-bismuth-containing “concomitant therapy” versus triple therapy for Helicobacter pylori eradication. Helicobacter 2009; 14: 109–118.
  • 69. Gisbert J.P., Calvet X.: Review article: non-bismuth quadruple (concomitant) therapy for eradication of Helicobater pylori. Aliment. Pharmacol. Ther. 2011; 34: 604–617.
  • 70. Malfertheiner P., Bazzoli F., Delchier J.C. i wsp.; Pylera Study Group: Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. Lancet. 2011; 377: 905–913.
  • 71. Scheiman J.M., Fendrick A.M.: Practical approaches to minimizing gastrointestinal and cardiovascular safety concerns with COX-2 inhibitors and NSAIDs. Arthritis Res. Ther. 2005; 7 (Suppl. 4): S23–S29.
  • 72. Scheiman J.M., Fendrick A.M.: Summing the risk of NSAID therapy. Lancet 2007; 369: 1580–1581.
  • 73. Chan F.K., Wong V.W., Suen B.Y. i wsp.: Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial. Lancet 2007; 369: 1621–1626.
  • 74. Bhatt D.L., Cryer B.L., Contant C.F. i wsp.; COGENT Investigators. Clopidogrel with or without omeprazole in coronary artery disease. N. Engl. J. Med. 2010; 363: 1909–1917.
  • 75. Abraham N.S., Hlatky M.A., Antman E.M i wsp.; ACCF/ACG/AHA: ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Am. J. Gastroenterol. 2010; 105: 2533–2549.
  • 76. Yuan Y., Tsoi K., Hunt R.H.: Selective serotonin reuptake inhibitors and risk of upper GI bleeding: confusion or confounding? Am. J. Med. 2006; 119: 719–727.
  • 77. Holster I.L., Kuipers E.J.: Management of acute nonvariceal upper gastrointestinal bleeding: current policies and future perspectives. World J. Gastroenterol. 2012; 18: 1202–1207.
  • 78. Wee E.: Management of nonvariceal upper gastrointestinal bleeding. J. Postgrad. Med. 2011; 57: 161–167.
  • 79. Greenspoon J., Barkun A., Bardou M. i wsp.; International Consensus Upper Gastrointestinal Bleeding Conference Group: Management of patients with nonvariceal upper gastrointestinal bleeding. Clin. Gastroenterol. Hepatol. 2012; 10: 234–239.
  • 80. Bardou M., Benhaberou-Brun D., Le Ray I., Barkun A.N.: Diagnosis and management of nonvariceal upper gastrointestinal bleeding. Nat. Rev. Gastroenterol. Hepatol. 2012; 9: 97–104.
Document Type
article
Publication order reference
YADDA identifier
bwmeta1.element.psjd-e6a6039d-d022-48af-8124-570814b156c5
Identifiers
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.