Lanas Ángel
Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, IIS Aragón, CIBERehd, Zaragoza, España.
Gastroenterol Hepatol. 2013 Oct;36 Suppl 2:57-65. doi: 10.1016/S0210-5705(13)70054-2.
This article summarizes the main studies in the field of non-variceal gastrointestinal bleeding reported in the last American Congress of Gastroenterology (Digestive Disease Week) in 2013. Some of these studies have provided new knowledge and expertise in areas of uncertainty. In this context and among other findings, it has been reported that the administration of a proton pump inhibitor (PPI) prior to endoscopy or the early performance of endoscopy-within 6 hours of admission in patients with upper gastrointestinal bleeding (UGIB) (or colonoscopy within 24 hours in patients with lower gastrointestinal bleeding)-does not improve the prognosis of the event. It has also been reported that oral administration of a PPI after endoscopic hemostasis may produce a similar outcome to that of intravenously administered PPI in patients with upper gastrointestinal bleeding (UGIB). In the field of endoscopic therapy, the use of radiofrequency ablation for antral vascular ectasia is of interest. Regarding UGIB and nonsteroidal antiinflammatory drugs (NSAIDs), new data confirm the risk of cardiovascular events by stopping treatment with acetylsalicylic acid (ASA) after an episode of UGIB, the increased risk of UGIB when associating gastrotoxic drugs, and the need to identify both the gastrointestinal and cardiovascular risks of each NSAID and coxib when prescribing these agents. Finally, there is evidence that both environmental and genetic factors are involved in individual susceptibility to gastrointestinal bleeding.
本文总结了在2013年上一届美国胃肠病学大会(消化系统疾病周)上报道的非静脉曲张性胃肠道出血领域的主要研究。其中一些研究在存在不确定性的领域提供了新的知识和专业见解。在此背景及其他研究结果中,有报道称,在内镜检查前给予质子泵抑制剂(PPI)或早期进行内镜检查(上消化道出血患者在入院后6小时内进行内镜检查,下消化道出血患者在24小时内进行结肠镜检查)并不能改善该事件的预后。还有报道称,上消化道出血患者在内镜止血后口服PPI可能产生与静脉注射PPI相似的效果。在内镜治疗领域,射频消融用于治疗胃窦血管扩张值得关注。关于上消化道出血和非甾体抗炎药(NSAIDs),新数据证实了上消化道出血发作后停用阿司匹林(ASA)会增加心血管事件风险,联合使用胃毒性药物时上消化道出血风险增加,以及在开具这些药物处方时需要识别每种NSAID和昔布类药物的胃肠道和心血管风险。最后,有证据表明环境因素和遗传因素均与个体对胃肠道出血的易感性有关。