Review article

APPROACH TO PATIENTS WITH GASTROINTESTINAL BLEEDING

MARKO NIKOLIĆ orcid.org/0000-0002-3357-214X ; Sestre milosrdnice University Hospital Center, University of Zagreb, School of Medicine and School of Dental Medicine, Department of Gastroenterology and Hepatology,Zagreb, Hrvatska
MIROSLAV HANŽEVAČKI
PETRA JURČIĆ orcid.org/0000-0002-1568-3612 ; Sestre milosrdnice University Hospital Center, University Hospital for Tumors, Department of Radiotherapy and Medicine Oncology, Zagreb, Croatia
IVAN BUDIMIR ; Sestre milosrdnice University Hospital Center, University of Zagreb, School of Medicine and School of Dental Medicine, Department of Gastroenterology and Hepatology,Zagreb, Croatia
NEVEN LJUBIČIĆ ; Sestre milosrdnice University Hospital Center, University of Zagreb, School of Medicine and School of Dental Medicine, Department of Gastroenterology and Hepatology,Zagreb, Croatia

Abstract

In the developed Western countries, despite the accumulation of knowledge about the causes and treatment of gastrointestinal
bleeding, as well as the experience of gastroenterologists-endoscopists using sophisticated endoscopic devices, the number of
hospitalizations and mortality rates has not declined as expected. The most likely explanations are the following: aging population, increased prevalence of alcoholic liver cirrhosis, gastroesophageal refl ux disease and obesity, Helicobacter pylori antibiotic resistance, using dual anti-aggregation therapy, anticoagulants, and excessive use of nonsteroidal anti-infl ammatory drugs. The aim of this paper is to show the incidence and the most common signs and symptoms of gastrointestinal bleeding. The aim is also to present initial clinical evaluation, diagnostic methods, the main causes of gastrointestinal bleeding, endoscopic hemostatic modalities and treatment of bleeding from the upper and lower gastrointestinal tract. Using the MEDLINE and Ovid databases, we searched the meta-analyses and systematic reviews published in English during the 2005-2015 period. Meta-analyses included results of randomized, double-blind studies on adults treated for gastrointestinal bleeding. Included were guidelines of the European and American Society of Gastroenterological Endoscopy, as well as recent expert work. In this review, we bring the state-of-the-art on gastrointestinal bleeding, new classifi cation of gastrointestinal bleeding from the upper, mid and lower gut,
controversy of nasogastric tube placement, use of prokinetic agents and inhibitor proton pumps in acute gastrointestinal bleeding from the upper tract, restrictive transfusion strategy, useful clinical stratifi cation of the severity of bleeding, indications for hospitalization and outcome of using the clinical bleeding score, proper use of gastroprotection in patients at a high risk of peptic ulcer, the need of initial endoscopy, variceal assessment in newly diagnosed liver cirrhosis, primary and secondary prophylaxis of variceal bleeding, new endoscopic hemostatic modality, and radiological and surgical treatment of gastrointestinal bleeding. The educational nature of this review could serve for establishing Croatian guideline for the management of gastrointestinal bleeding.

Keywords

gastrointestinal hemorrhage; upper gastrointestinal tract; lower gastrointestinal tract; endoscopic hemostasis

Hrčak ID:

154158

URI

https://hrcak.srce.hr/154158

Publication date:

12.3.2016.

Article data in other languages: croatian

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