Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
World J Gastroenterol. 2012 Mar 21;18(11):1202-7. doi: 10.3748/wjg.v18.i11.1202.
Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB, and is recommended within 24 h of presentation. Proton pump inhibitor (PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy, but has no effect on rebleeding, mortality and need for surgery. Endoscopic therapy should be undertaken for ulcers with high-risk stigmata, to reduce the risk of rebleeding. This can be done with a variety of modalities. High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality, particularly in patients with high-risk stigmata.
急性上消化道出血（UGIB）是一种具有 6%-13%死亡率的胃肠急症。绝大多数这些出血是由于消化性溃疡导致的。非甾体抗炎药和幽门螺杆菌是消化性溃疡病的主要危险因素。内镜检查已成为急性 UGIB 的主要诊断和治疗方法，建议在出现症状后 24 小时内进行。内镜检查前给予质子泵抑制剂（PPI）可以使出血病变降级，并减少内镜治疗的需求，但对再出血、死亡率和手术需求没有影响。对于有高危征象的溃疡，应进行内镜治疗，以降低再出血的风险。这可以通过多种方式进行。内镜检查后给予高剂量的 PPI 可以预防再出血，减少进一步干预和死亡率的需求，特别是在有高危征象的患者中。
