Menichelli Danilo, Gazzaniga Gianluca, Del Sole Francesco, Pani Arianna, Pignatelli Pasquale, Pastori Daniele
Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy.
Front Med (Lausanne). 2024 May 3;11:1399429. doi: 10.3389/fmed.2024.1399429. eCollection 2024.
Acute upper and lower gastrointestinal (GI) bleeding may be a potentially life-threatening event that requires prompt recognition and an early effective management, being responsible for a considerable number of hospital admissions. Methods. We perform a clinical review to summarize the recent international guidelines, helping the physician in clinical practice. Older people are a vulnerable subgroup of patients more prone to developing GI bleeding because of several comorbidities and polypharmacy, especially related to an increased use of antiplatelet and anticoagulant drugs. In addition, older patients may have higher peri-procedural risk that should be evaluated. The recent introduction of reversal strategies may help the management of GI bleeding in this subgroup of patients. In this review, we aimed to (1) summarize the epidemiology and risk factors for upper and lower GI bleeding, (2) describe treatment options with a focus on pharmacodynamics and pharmacokinetics of different proton pump inhibitors, and (3) provide an overview of the clinical management with flowcharts for risk stratification and treatment. In conclusion, GI is common in older patients and an early effective management may be helpful in the reduction of several complications.
急性上、下消化道（GI）出血可能是一种潜在的危及生命的事件，需要迅速识别并尽早进行有效管理，这导致大量患者入院。方法。我们进行了一项临床综述，以总结近期的国际指南，帮助医生进行临床实践。老年人是一个易受伤害的患者亚组，由于多种合并症和多种药物治疗，尤其是与抗血小板和抗凝药物使用增加有关，他们更容易发生胃肠道出血。此外，老年患者可能有更高的围手术期风险，需要进行评估。近期引入的逆转策略可能有助于该患者亚组胃肠道出血的管理。在本综述中，我们旨在：（1）总结上、下消化道出血的流行病学和危险因素；（2）描述治疗选择，重点关注不同质子泵抑制剂的药效学和药代动力学；（3）通过风险分层和治疗流程图提供临床管理概述。总之，胃肠道出血在老年患者中很常见，早期有效管理可能有助于减少多种并发症。
