[Endoscopy in non-variceal upper gastrointestinal bleeding]. 2005

Mario Arturo Ballesteros Amozurrutia
Gastroenterólogo, Hospital Angeles del Pedregal, Mexico, D.F.

Non variceal upper gastrointestinal bleeding (NVUGIB) still is a common cause of hospital admissions, morbidity and a significant mortality. A decrease trend has recently been documented thank to the general use of therapeutic endoscopy in spite of a greater use of non steroidal antinflamatory agents (NSAID) and a growing senile population. Most of NVUGIB are caused by peptic ulcer (PU) and usually stop spontaneously, but 15% of cases need endoscopic or surgical intervention. Clinically these patients can be identified by the presence of shock, orthostatic hypotension or associated organ failures (Rockall scale) and by endoscopic findings of active bleeding or non bleeding visible vessel (Forrest scale) both useful and complimentary. There are diverse endoscopic techniques to halt NVUGIB, with transendoscopic saline injection with or w/o epinephrine + coaptive bipolar electrocoagulation or heater probe being the gold standard with 85 to 90% initial success, and furthermore stopping recurrences in similar figures. Under these circumstances new methods as argon plasma electrocoagulation or mechanic methods such as endoclips or banding have difficulty to demonstrate their usefulness when compared to established procedures, but still may have some indications such as diffuse gastric or vascular lesions for argon plasma electrocoagulation, and bands or endoclips for deep ulcers given their lower risk of perforation. Antisecretory agents are useful complementary treatment decreasing recurrence by 8% when used at high doses. Hp eradication decreases PU and NVUGIB recurrence, except in patients who ingest NSAID on a regular basis who require nocturnal antisecretory treatment.

UI MeSH Term Description Entries
D008309 Mallory-Weiss Syndrome A condition characterized by mucosal tears at the ESOPHAGOGASTRIC JUNCTION, sometimes with HEMATEMESIS. Typically it is caused by forceful bouts of retching or VOMITING. Gastroesophageal Laceration-Hemorrhage,Mallory-Weiss Laceration,Mallory-Weiss Tear,Mucosal Lacerations-Gastroesophageal Junction,Gastroesophageal Laceration Hemorrhage,Gastroesophageal Laceration-Hemorrhages,Junction, Mucosal Lacerations-Gastroesophageal,Junctions, Mucosal Lacerations-Gastroesophageal,Laceration, Mallory-Weiss,Laceration-Hemorrhage, Gastroesophageal,Laceration-Hemorrhages, Gastroesophageal,Lacerations-Gastroesophageal Junction, Mucosal,Lacerations-Gastroesophageal Junctions, Mucosal,Mallory Weiss Laceration,Mallory Weiss Syndrome,Mallory Weiss Tear,Mucosal Lacerations Gastroesophageal Junction,Mucosal Lacerations-Gastroesophageal Junctions,Syndrome, Mallory-Weiss
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010438 Peptic Ulcer Hemorrhage Bleeding from a PEPTIC ULCER that can be located in any segment of the GASTROINTESTINAL TRACT. Hemorrhage, Peptic Ulcer,Peptic Ulcer Hemorrhages,Ulcer Hemorrhage, Peptic
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D004381 Duodenal Ulcer A PEPTIC ULCER located in the DUODENUM. Curling's Ulcer,Curling Ulcer,Curlings Ulcer,Duodenal Ulcers,Ulcer, Curling,Ulcer, Duodenal,Ulcers, Duodenal
D004564 Electrocoagulation Procedures using an electrically heated wire or scalpel to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. It is different from ELECTROSURGERY which is used more for cutting tissue than destroying and in which the patient is part of the electric circuit. Diathermy, Surgical,Electrocautery,Endocavitary Fulguration,Galvanocautery,Surgical Diathermy,Thermocoagulation,Fulguration, Endocavitary
D004837 Epinephrine The active sympathomimetic hormone from the ADRENAL MEDULLA. It stimulates both the alpha- and beta- adrenergic systems, causes systemic VASOCONSTRICTION and gastrointestinal relaxation, stimulates the HEART, and dilates BRONCHI and cerebral vessels. It is used in ASTHMA and CARDIAC FAILURE and to delay absorption of local ANESTHETICS. Adrenaline,4-(1-Hydroxy-2-(methylamino)ethyl)-1,2-benzenediol,Adrenaline Acid Tartrate,Adrenaline Bitartrate,Adrenaline Hydrochloride,Epifrin,Epinephrine Acetate,Epinephrine Bitartrate,Epinephrine Hydrochloride,Epinephrine Hydrogen Tartrate,Epitrate,Lyophrin,Medihaler-Epi,Acetate, Epinephrine
D006471 Gastrointestinal Hemorrhage Bleeding in any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM. Hematochezia,Hemorrhage, Gastrointestinal,Gastrointestinal Hemorrhages,Hematochezias
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000367 Age Factors Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time. Age Reporting,Age Factor,Factor, Age,Factors, Age

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