Kovacs Thomas O G
CURE/Digestive Disease Research Center, VA Greater Los Angeles Healthcare System, Building 115, Room 212, 11301 Wilshire Boulevard, Los Angeles, CA 90073-1003, USA.
Curr Gastroenterol Rep. 2008 Dec;10(6):535-42. doi: 10.1007/s11894-008-0099-3.
Upper gastrointestinal bleeding secondary to ulcer disease is common and results in substantial patient morbidity and medical expense. After initial resuscitation to stabilize the patient, carefully performed endoscopy provides an accurate diagnosis and identifies high-risk ulcer patients who are likely to rebleed with medical therapy alone and will benefit most from endoscopic hemostasis. For patients with major stigmata of ulcer hemorrhage--active arterial bleeding, nonbleeding visible vessel, and adherent clot--combination therapy with epinephrine injection and either thermal coagulation (multipolar or heater probe) or endoclips is recommended. High-dose intravenous proton pump inhibitors are recommended as concomitant therapy after successful endoscopic hemostasis. Patients with minor stigmata or clean-based ulcers will not benefit from endoscopic treatment and should receive high-dose oral proton pump inhibitor therapy. Effective medical and endoscopic management of ulcer hemorrhage can significantly improve outcomes and decrease the cost of medical care by reducing rebleeding, transfusion requirements, and the need for surgery.
溃疡病继发的上消化道出血很常见，会导致患者出现严重的发病情况并产生高昂的医疗费用。在对患者进行初步复苏以使其病情稳定后，仔细进行的内镜检查可提供准确的诊断，并识别出高危溃疡患者，这些患者仅接受药物治疗可能会再次出血，而内镜止血对他们将最有益。对于有溃疡出血主要征象的患者——活动性动脉出血、非出血可见血管和附着血凝块——建议采用肾上腺素注射联合热凝治疗（多极或热探头）或内镜夹闭术。成功进行内镜止血后，建议大剂量静脉注射质子泵抑制剂作为辅助治疗。有轻微征象或基底清洁溃疡的患者无法从内镜治疗中获益，应接受大剂量口服质子泵抑制剂治疗。对溃疡出血进行有效的药物和内镜治疗可显著改善治疗效果，并通过减少再次出血、输血需求和手术需求来降低医疗费用。
