Celiński K, Cichoz-Lach H, Madro A, Słomka M, Kasztelan-Szczerbińska B, Dworzański T
Department of Gastroenterology, Medical University of Lublin, Poland.
J Physiol Pharmacol. 2008 Aug;59 Suppl 2:215-29.
In gastroenterology non-variceal upper gastrointestinal bleeding is health hazard. Frequency of occurrence accounts for 40-150 cases per 100000 inhabitants with death rate of 7-14%. Researches which goal is to improve treatment effectiveness as well as to establish standardized procedures for managing patients with symptoms of non-variceal upper gastrointestinal bleeding; have been conducted since many years. At the moment of admission, designed standards enable appropriate elaboration of patients' health state, referral to the right clinic and implementation of the most accurate treatment methods. Increase of suppression of primary bleeding as well as prevention of recurrence is associated with dynamic development of endoscopic treatment methods as well as with optimization of pharmacological treatment. In significant percentage, efficiency of non - variceal bleedings treatment depends on clinic's character (availability of equipment, experience of personnel) and on cooperation between several specialists (including gastroenterologist, surgeon, anesthetist, operative radiologist). Aim of the work is to present the latest evaluation of the mentioned subject, based on accessible literature. This work includes the basic principles for determination of bleeding intensity and risk of its recurrence as well as directions referring to fluids resuscitation and to monitoring of patients. Information on currently applied endoscopic methods for inhibition of non variceal upper gastrointestinal bleeding (injection, mechanical and thermo-coagulation techniques), comparison of their efficiency and possibility of application is provided in the work. The paper work also presents the newest directives for pharmacological treatment and guidelines for possible surgical treatment.
在胃肠病学中，非静脉曲张性上消化道出血是一种健康危害。其发生率为每10万居民中40 - 150例，死亡率为7% - 14%。多年来一直在进行旨在提高治疗效果以及建立非静脉曲张性上消化道出血症状患者管理标准化程序的研究。在入院时，既定标准能够对患者的健康状况进行适当评估，转诊至合适的科室并实施最准确的治疗方法。原发性出血抑制的增加以及复发的预防与内镜治疗方法的动态发展以及药物治疗的优化相关。在很大程度上，非静脉曲张性出血的治疗效果取决于科室的特点（设备可用性、人员经验）以及几位专家（包括胃肠病学家、外科医生、麻醉师、介入放射科医生）之间的合作。这项工作的目的是基于可获取的文献对上述主题进行最新评估。这项工作包括确定出血强度及其复发风险的基本原则以及有关液体复苏和患者监测的指导。该工作还提供了目前用于抑制非静脉曲张性上消化道出血的内镜方法（注射、机械和热凝技术）的信息、它们的效果比较以及应用可能性。该论文还介绍了药物治疗的最新指南以及可能的手术治疗指南。
