دوره 32، شماره 287: هفته چهارم تیر ماه 1393:791-803

راهنمای بالینی مدیریت خونریزی گوارشی فوقانی حاد

آزیتا گنجی, مریم صالحی, الهام پیش بین, رزیتا داودی, گلناز صبوری, آزاده سلطانی‌فر, رضا ملك‌زاده, حمید رضا ریحانی, علی بیداری, شقایق رحمانی

چکیده


گروه هدف: متخصصین طب اورژانس، متخصصین داخلی، پزشکان عمومی، پرستاران

اهداف آموزشی

فراگیر باید در پایان مطالعه‌ی این خودآموز:

1- روش طبقه‌بندی بیماران خونریزی گوارشی فوقانی حاد را قبل اندوسکوپی و بعد از اندوسکوپی بداند.

2- اقدامات تشخیصی لازم در مورد بیماران خونریزی گوارشی فوقانی حاد را بداند.

3- درمان‌های دارویی صحیح و لازم را در بیماران مبتلا به خونریزی گوارشی فوقانی حاد را فرا گرفته باشد.

4- درمان‌های اندوسکوپی و مداخلات درمانی صحیح و لازم را در بیماران مبتلا به خونریزی گوارشی فوقانی حاد فرا گرفته باشد.

5- پروفیلاکسی اولیه از خونریزی گوارشی فوقانی در بیماران بدحال یا بستری در بخش مراقبت‌های ویژه را بداند.

واژگان کلیدی: بومی‌سازی، خونریزی گوارشی فوقانی حاد، توصیه‌های بالینی


تمام متن:

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مراجع


Royal College of Physicians. National clinical guideline for acute upper gastrointestinal bleeding management. 2nd ed. London, UK: National Clinical Guideline Centre; 2012.

Management of acute upper and lower gastrointestinal bleeding. 1st ed. Edinburgh, Scotland: Scottish Intercollegiate Guidelines Network; 2008.

Lain L. Gastrointestinal bleeding. In: Longo D, Fauci A, Kasper DL, Hauser SL, Jameson JL, Loschalzo J. Harrison's principles of internal medicine. 18th ed. New York, NY: McGraw-Hill; 2012. p. 320.

Moor C, Tseng CC, Wolf MM .Gastrointestinal hemorrhage. In: Andereoli T, Benjamin I, Griggs RC, Wing EJ. Andreoli and Carpenter's Cecil essentials of medicine. 8th ed. Philadelphia, PA: Saunders; 2010. p. 385.

Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, et al. The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc 2004; 59(7): 788-94.

Crooks C, Card T, West J. Reductions in 28-day mortality following hospital admission for upper gastrointestinal hemorrhage. Gastroenterology 2011; 141(1): 62-70.

Felman M, Friedman L, Brandt LJ. Sleisenger and Fordtran's gastrointestinal and liver disease. 9th ed. Philadelphia, PA: Saunders; 2010. p. 285-93.

Nahon S, Hagege H, Latrive JP, Rosa I, Nalet B, Bour B, et al. Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study. Endoscopy 2012; 44(11): 998-1008.

Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med 2007; 25(7): 774-9.

Dicu D, Pop F, Ionescu D, Dicu T. Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit. Am J Emerg Med 2013; 31(1): 94-9.

Church NI, Dallal HJ, Masson J, Mowat NA, Johnston DA, Radin E, et al. Validity of the Rockall scoring system after endoscopic therapy for bleeding peptic ulcer: a prospective cohort study. Gastrointest Endosc 2006; 63(4): 606-12.

Enns RA, Gagnon YM, Barkun AN, Armstrong D, Gregor JC, Fedorak RN. Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting. World J Gastroenterol 2006; 12(48): 7779-85.

Masaoka T, Suzuki H, Hori S, Aikawa N, Hibi T. Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. J Gastroenterol Hepatol 2007; 22(9): 1404-8.

Pang SH, Ching JY, Lau JY, Sung JJ, Graham DY, Chan FK. Comparing the Blatchford and pre-endoscopic Rockall score in predicting the need for endoscopic therapy in patients with upper GI hemorrhage. Gastrointest Endosc 2010; 71(7): 1134-40.

Vreeburg EM, Terwee CB, Snel P, Rauws EA, Bartelsman JF, Meulen JH, et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 1999; 44(3): 331-5.

Sanders DS, Carter MJ, Goodchap RJ, Cross SS, Gleeson DC, Lobo AJ. Prospective validation of the Rockall risk scoring system for upper GI hemorrhage in subgroups of patients with varices and peptic ulcers. Am J Gastroenterol 2002; 97(3): 630-5.

Camellini L, Merighi A, Pagnini C, Azzolini F, Guazzetti S, Scarcelli A, et al. Comparison of three different risk scoring systems in non-variceal upper gastrointestinal bleeding. Dig Liver Dis 2004; 36(4): 271-7.

Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2007; (4): CD000567.

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004; 350(22): 2247-56.

Jairath V, Hearnshaw S, Brunskill SJ, Doree C, Hopewell S, Hyde C, et al. Red cell transfusion for the management of upper gastrointestinal haemorrhage. Cochrane Database Syst Rev 2010; (9): CD006613.

Hearnshaw SA, Logan RF, Palmer KR, Card TR, Travis SP, Murphy MF. Outcomes following early red blood cell transfusion in acute upper gastrointestinal bleeding. Aliment Pharmacol Ther 2010; 32(2): 215-24.

Stainsby D, MacLennan S, Thomas D, Isaac J, Hamilton PJ. Guidelines on the management of massive blood loss. Br J Haematol 2006; 135(5): 634-41.

Bosch J, Thabut D, Albillos A, Carbonell N, Spicak J, Massard J, et al. Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial. Hepatology 2008; 47(5): 1604-14.

Marti-Carvajal AJ, Salanti G, Marti-Carvajal PI. Human recombinant activated factor VII for upper gastrointestinal bleeding in patients with liver diseases. Cochrane Database Syst Rev 2007; (1): CD004887.

Lin HJ, Wang K, Perng CL, Chua RT, Lee FY, Lee CH, et al. Early or delayed endoscopy for patients with peptic ulcer bleeding. A prospective randomized study. J Clin Gastroenterol 1996; 22(4): 267-71.

Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003; 139(10): 843-57.

Bjorkman DJ, Zaman A, Fennerty MB, Lieberman D, Disario JA, Guest-Warnick G. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc 2004; 60(1): 1-8.

Lee JG, Turnipseed S, Romano PS, Vigil H, Azari R, Melnikoff N, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999; 50(6): 755-61.

Sung JJ, Tsoi KK, Lai LH, Wu JC, Lau JY. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut 2007; 56(10): 1364-73.

Calvet X, Vergara M, Brullet E, Gisbert JP, Campo R. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology 2004; 126(2): 441-50.

Chung SS, Lau JY, Sung JJ, Chan AC, Lai CW, Ng EK, et al. Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. BMJ 1997; 314(7090): 1307-11.

Lin HJ, Tseng GY, Perng CL, Lee FY, Chang FY, Lee SD. Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding. Gut 1999; 44(5): 715-9.

Lo CC, Hsu PI, Lo GH, Lin CK, Chan HH, Tsai WL, et al. Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers. Gastrointest Endosc 2006; 63(6): 767-73.

Park CH, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ. A prospective, randomized trial comparing mechanical methods of hemostasis plus epinephrine injection to epinephrine injection alone for bleeding peptic ulcer. Gastrointest Endosc 2004; 60(2): 173-9.

Marmo R, Rotondano G, Bianco MA, Piscopo R, Prisco A, Cipolletta L. Outcome of endoscopic treatment for peptic ulcer bleeding: Is a second look necessary? A meta-analysis. Gastrointest Endosc 2003; 57(1): 62-7.

Chiu PW, Lam CY, Lee SW, Kwong KH, Lam SH, Lee DT, et al. Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial. Gut 2003; 52(10): 1403-7.

Aina R, Oliva VL, Therasse E, Perreault P, Bui BT, Dufresne MP, et al. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol 2001; 12(2): 195-200.

Schenker MP, Duszak R, Jr., Soulen MC, Smith KP, Baum RA, Cope C, et al. Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Interv Radiol 2001; 12(11): 1263-71.

Defreyne L, Vanlangenhove P, De VM, Pattyn P, Van MG, Decruyenaere J, et al. Embolization as a first approach with endoscopically unmanageable acute nonvariceal gastrointestinal hemorrhage. Radiology 2001; 218(3): 739-48.

Lee CW, Liu KL, Wang HP, Chen SJ, Tsang YM, Liu HM. Transcatheter arterial embolization of acute upper gastrointestinal tract bleeding with N-butyl-2-cyanoacrylate. J Vasc Interv Radiol 2007; 18(2): 209-16.

Eriksson LG, Ljungdahl M, Sundbom M, Nyman R. Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure. J Vasc Interv Radiol 2008; 19(10): 1413-8.

Ripoll C, Banares R, Beceiro I, Menchen P, Catalina MV, Echenagusia A, et al. Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure. J Vasc Interv Radiol 2004; 15(5): 447-50.

Hsu PI, Lo GH, Lo CC, Lin CK, Chan HH, Wu CJ, et al. Intravenous pantoprazole versus ranitidine for prevention of rebleeding after endoscopic hemostasis of bleeding peptic ulcers. World J Gastroenterol 2004; 10(24): 3666-9.

Lin HJ, Lo WC, Cheng YC, Perng CL. Role of intravenous omeprazole in patients with high-risk peptic ulcer bleeding after successful endoscopic epinephrine injection: a prospective randomized comparative trial. Am J Gastroenterol 2006; 101(3): 500-5.

Hung WK, Li VK, Chung CK, Ying MW, Loo CK, Liu CK, et al. Randomized trial comparing pantoprazole infusion, bolus and no treatment on gastric pH and recurrent bleeding in peptic ulcers. ANZ J Surg 2007; 77(8): 677-81.

Zargar SA, Javid G, Khan BA, Yattoo GN, Shah AH, Gulzar GM, et al. Pantoprazole infusion as adjuvant therapy to endoscopic treatment in patients with peptic ulcer bleeding: prospective randomized controlled trial. J Gastroenterol Hepatol 2006; 21(4): 716-21.

Mostaghni AA, Hashemi SA, Heydari ST. Comparison of oral and intravenous proton pump inhibitor on patients with high risk bleeding peptic ulcers: a prospective, randomized, controlled clinical trial. Iran Red Crescent Med J 2011; 13(7): 458-63.

Ford AC, Delaney BC, Forman D, Moayyedi P. Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients. Cochrane Database Syst Rev 2006; (2): CD003840.

Gisbert JP, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol 2006; 101(4): 848-63.

Gisbert JP, Esteban C, Jimenez I, Moreno-Otero R. 13C-urea breath test during hospitalization for the diagnosis of Helicobacter pylori infection in peptic ulcer bleeding. Helicobacter 2007; 12(3): 231-7.

Guell M, Artigau E, Esteve V, Sanchez-Delgado J, Junquera F, Calvet X. Usefulness of a delayed test for the diagnosis of Helicobacter pylori infection in bleeding peptic ulcer. Aliment Pharmacol Ther 2006; 23(1): 53-9.

Liu CC, Lee CL, Chan CC, Tu TC, Liao CC, Wu CH, et al. Maintenance treatment is not necessary after Helicobacter pylori eradication and healing of bleeding peptic ulcer: a 5-year prospective, randomized, controlled study. Arch Intern Med 2003; 163(17): 2020-4.

Chan FK, Wong VW, Suen BY, Wu JC, Ching JY, Hung LC, et al. Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial. Lancet 2007; 369(9573): 1621-6.

Scheiman JM, Yeomans ND, Talley NJ, Vakil N, Chan FK, Tulassay Z, et al. Prevention of ulcers by esomeprazole in at-risk patients using non-selective NSAIDs and COX-2 inhibitors. Am J Gastroenterol 2006; 101(4): 701-10.

Hernandez-Diaz S, Rodriguez LA. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med 2000; 160(14): 2093-9.

Garcia Rodriguez LA, Hernandez-Diaz S. The risk of upper gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs, glucocorticoids, acetaminophen, and combinations of these agents. Arthritis Res 2001; 3(2): 98-101.

Sung JJ, Lau JY, Ching JY, Wu JC, Lee YT, Chiu PW, et al. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 2010; 152(1): 1-9.

Villanueva C, Piqueras M, Aracil C, Gomez C, Lopez-Balaguer JM, Gonzalez B, et al. A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol 2006; 45(4): 560-7.

Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med 1995; 123(4): 280-7.

Lo GH, Lai KH, Cheng JS, Lin CK, Huang JS, Hsu PI, et al. Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices. Hepatology 1997; 25(5): 1101-4.

Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology 2001; 33(5): 1060-4.

Tan PC, Hou MC, Lin HC, Liu TT, Lee FY, Chang FY, et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology 2006; 43(4): 690-7.

Ioannou G, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst Rev 2003; (1): CD002147.

Gotzsche PC, Hrobjartsson A. Somatostatin analogues for acute bleeding oesophageal varices. Cochrane Database Syst Rev 2008; (3): CD000193.

Banares R, Albillos A, Rincon D, Alonso S, Gonzalez M, Ruiz-del-Arbol L, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002; 35(3): 609-15.

Sung JJ, Chung SC, Yung MY, Lai CW, Lau JY, Lee YT, et al. Prospective randomised study of effect of octreotide on rebleeding from oesophageal varices after endoscopic ligation. Lancet 1995; 346(8991-8992): 1666-9.

Freitas DS, Sofia C, Pontes JM, Gregorio C, Cabral JP, Andrade P, et al. Octreotide in acute bleeding esophageal varices: a prospective randomized study. Hepatogastroenterology 2000; 47(35): 1310-4.

Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding. Cochrane Database Syst Rev 2002; (2): CD002907.

Lo GH, Lai KH, Cheng JS, Chen MH, Huang HC, Hsu PI, et al. Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial. Hepatology 2000; 32(3): 461-5.

de la Pena J, Brullet E, Sanchez-Hernandez E, Rivero M, Vergara M, Martin-Lorente JL, et al. Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology 2005; 41(3): 572-8.

Cheng JW, Zhu L, Gu MJ, Song ZM. Meta analysis of propranolol effects on gastrointestinal hemorrhage in cirrhotic patients. World J Gastroenterol 2003; 9(8): 1836-9.

Romero G, Kravetz D, Argonz J, Vulcano C, Suarez A, Fassio E, et al. Comparative study between nadolol and 5-isosorbide mononitrate vs. endoscopic band ligation plus sclerotherapy in the prevention of variceal rebleeding in cirrhotic patients: a randomized controlled trial. Aliment Pharmacol Ther 2006; 24(4): 601-11.

Khan S, Tudur SC, Williamson P, Sutton R. Portosystemic shunts versus endoscopic therapy for variceal rebleeding in patients with cirrhosis. Cochrane Database Syst Rev 2006; (4): CD000553.

Escorsell A, Banares R, Garcia-Pagan JC, Gilabert R, Moitinho E, Piqueras B, et al. TIPS versus drug therapy in preventing variceal rebleeding in advanced cirrhosis: a randomized controlled trial. Hepatology 2002; 35(2): 385-92.

Lo GH, Liang HL, Chen WC, Chen MH, Lai KH, Hsu PI, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 2007; 39(8): 679-85.




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