Rathod Jignesh B, Shah Dharmendra K, Yagnik Bhargav D, Yagnik Vipul D
Department of Surgery, Pramukhswami Medical College, Karamsad;
Department of Surgery, Govt. Medical College, Vadodara;
Clin Pract. 2011 Nov 30;1(4):e132. doi: 10.4081/cp.2011.e132. eCollection 2011 Sep 28.
Upper gastrointestinal (GI) bleeding is defined as bleeding proximal to the ligament of Treitz. The most important aspect of management of GI bleeding is to locate the site and cause of bleeding. The aim of the study is to find out the common etiology, presentation and management, including the role of upper GI endoscopy. Recent advances have meant that endoscopic hemostatic methods are now associated with a reduced rate of re-bleeding, cost, blood transfusion, length of hospital stay and mortality. A prospective study of 50 cases was carried out between August 2001 and July 2003. Patients with signs and symptoms suggestive of upper GI bleeding (UGIB) such as hematemesis, melena, aspirated blood from nasogastric tubes, profuse hematochezia, etc., were included in the study. The patients were selected randomly. The most common cause of UGIB in the present study was acute erosive gastritis (34%) followed by portal hypertension (24%) and peptic ulcer (22%). All 50 patients underwent upper GI endoscopy, of whom 39 patients were treated conservatively and 11 patients underwent endotherapy to control bleeding. Out of 39 patients treated non-endoscopically, 6 cases required laparotomy to control UGIB. 8 of 50 cases had past history of UGIB, 5 of whom had a previous history of endotherapy. One case was treated with de-vascularization as routine hemostatic methods failed. So, initial method of choice to control the bleeding was endotherapy and surgery was undertaken if an endoscopic method failed. The most common cause of hematemesis in our setting was acute erosive gastritis followed by portal hypertension. Endoscopy is a valuable minimal invasive method to diagnose and treat upper GI bleeding.
上消化道（GI）出血定义为屈氏韧带近端的出血。上消化道出血管理的最重要方面是确定出血部位和原因。本研究的目的是找出常见病因、临床表现及治疗方法，包括上消化道内镜检查的作用。近期进展表明，内镜止血方法目前与再出血率降低、成本降低、输血需求减少、住院时间缩短及死亡率降低相关。2001年8月至2003年7月期间对50例患者进行了一项前瞻性研究。有呕血、黑便、胃管吸出血液、大量便血等提示上消化道出血（UGIB）症状和体征的患者被纳入研究。患者随机选取。本研究中UGIB最常见的原因是急性糜烂性胃炎（34%），其次是门静脉高压（24%）和消化性溃疡（22%）。所有50例患者均接受了上消化道内镜检查，其中39例患者接受保守治疗，11例患者接受内镜治疗以控制出血。在39例未接受内镜治疗的患者中，6例需要剖腹手术以控制UGIB。50例患者中有8例有上消化道出血病史，其中5例有内镜治疗史。1例因常规止血方法失败而接受了去血管化治疗。因此，控制出血的首选初始方法是内镜治疗，如果内镜方法失败则进行手术。在我们的研究中，呕血最常见的原因是急性糜烂性胃炎，其次是门静脉高压。内镜检查是诊断和治疗上消化道出血的一种有价值的微创方法。
