Lege artis - Das Magazin zur ärztlichen Weiterbildung 2014; 4(2): 104-109
DOI: 10.1055/s-0034-1373818
Fachwissen
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Gastrointestinale Blutungen – Diagnostik und Behandlung

Arthur Hoffman
,
Ralf Kiesslich
Further Information

Publication History

Publication Date:
07 May 2014 (online)

Zusammenfassung

Gastrointestinale Blutungen sind in der klinischen Praxis ein häufiges Krankheitsbild und nehmen mit höherem Lebensalter zu. In diesem Beitrag beschreiben wir die häufigsten Formen oberer, mittlerer und unterer gastrointestinale Blutungen. Entscheidend ist es, bei der initialen Vorstellung jene Patienten zu erkennen, die durch die Blutung akut gefährdet sind. Diese sollten nach der hämodynamischen Stabilisierung umgehend endoskopiert werden. Wenn sich die Blutungsquelle findet, kann meist direkt eine endoskopische Therapie erfolgen.

Ergänzendes Material

 
  • 1 Czernichow PH, Nousbaum J. Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur J Gastroenterol Hepatol 2000; 12: 175-181
  • 2 Longstreth G. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1995; 90: 206-210
  • 3 Paspatis GM, Kapsoritakis A. An epidemiological study of acute upper gastrointestinal bleeding in Crete, Greece. Eur J Gastroenterol Hepatol 2000; 12: 1215-1220
  • 4 Thermopoulos KV, Vagianos C. Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years. Eur J Gastroenterol Hepatol 2004; 16: 177-187
  • 5 Vernava AM, Moore B, Longo WE, Johnson FE. Lower gastrointestinal bleeding. Dis Colon Rectum 1997; 40: 846-858
  • 6 Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population based study. Am J Gastroenterol 1997; 92: 419-424
  • 7 Peura DA, Lanza FL, Gostout CJ, Foutch PG. The american college of gastroenterology bleeding registry: preliminary findings. Am J Gastroenterol 1997; 92: 924-928
  • 8 Zuccaro G. Management of the adult patient with acute lower gastrointestinal bleeding. Am J Gastroenterol 1998; 93: 1202-1208
  • 9 Raju GS, Gerson L, Das A et al. American Gastroenterological Association (AGA). Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1694-1696
  • 10 Raju GS, Gerson L, Das A et al. American Gastroenterological Association (AGA). Institute technical review on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1697-717
  • 11 Lin S, Rockey DC. Obscure gastrointestinal bleeding. Gastroenterol Clin North Am 2005; 34: 679-698
  • 12 Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute non-variceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992; 102: 139-148
  • 13 Peura DA, Lanza FL, Gostout CJ, Foutch PG. The american college of gastroenterology bleeding registry: preliminary findings. Am J Gastroenterol 1997; 92: 924-928
  • 14 Katschinski B, Logan R, Davies J et al. Prognostic factors in upper gastrointestinal bleeding. Dig Dis Sci 1994; 39: 706-712
  • 15 Peek Jr. R, Fiske C, Wilson K. Role of innate immunity in Helicobacter pylori-induced gastric malignancy. Physiol Rev 2010; 90: 831-858
  • 16 Van Leerdam M. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2008; 22: 209-224
  • 17 Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974; 2: 394-397
  • 18 Kahi CJ, Jensen DM, Sung JJ et al. Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a metaanalysis. Gastroenterology 2005; 129: 855-862
  • 19 Chan FK, Wong VW, Suen BY 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: 1621-1626
  • 20 Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995; 311: 222-226
  • 21 Udd M, Miettinen P, Palmu A et al. Regular-dose versus high-dose omeprazole in peptic ulcer bleeding: a prospective randomized double-blind study. Scand J Gastroenterol 2001; 36: 1332-1338
  • 22 David G, Masoodi I, Zargar SA et al. Omeprazole as adjuvant therapy to endoscopic combination injection sclerotherapy for treating bleeding peptic ulcer. Am J Med 2001; 111: 280-284
  • 23 Lau JY, Leung WK, Wu JC et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007; 356: 1631-1640
  • 24 Dorward S, Sreedharan A, Leontiadis GI et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev CD 005415 2006;
  • 25 Leontiadis GI, Sharma VK, Howden CW. Proton pump inhibitor treatment for acute peptic ulcer bleeding. Cochrane Database Syst Rev CD 002094 2006;
  • 26 Bertleff M, Lange J. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg 2010; 27: 161-169
  • 27 Lui F, Davis K. Gastroduodenal perforation: maximal or minimal intervention?. Scand J Surg 2010; 99: 73-77
  • 28 Su YH, Yeh CC, Lee CY et al. Acute surgical treatment of perforated peptic ulcer in the elderly patients. Hepatogastroenterology 2010; 57: 1608-1613
  • 29 Swahn F, Arnelo U, Enochsson L et al. Endoscopic closure of a perforated peptic ulcer. Endoscopy 2011; 43 (Suppl. 02) 28-29
  • 30 de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2005; 43: 167-176
  • 31 Biecker E, Heller J, Appenrodt B, Schepke M, Sauerbruch T. Gastrointestinal bleeding in portal hypertension in liver cirrhosis. Z Gastroenterol 2005; 43: 35-46
  • 32 Schepke M, Kleber G, Nurnberg D et al. Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology 2004; 40: 65-72
  • 33 Hou MC, Lin HC, Liu TT et al. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology 2004; 39: 746-753
  • 34 Yin A, Li Y, Jiang Y, Liu J, Luo H. Mallory-Weiss syndrome: clinical and endoscopic characteristics. Eur J Intern Med 2012; 23: 92-96
  • 35 Merinopoulos I, Merinopoulos D, Evans L. Post-emetic Lesions. Am Surg 2012; 78: 76-78
  • 36 Hixson SD, Burns RP, Britt LG. Mallory-Weiss syndrome: retrospective review of eight years' experience. South Med J 1979; 72: 1249-1251
  • 37 Chung IK, Kim EJ, Hwang KY et al. Evaluation of endoscopic hemostasis in upper gastrointestinal bleeding related to Mallory-Weiss-Syndrome. Endoscopy 2002; 34: 474-479
  • 38 Lum DF, McQuaid K, Lee JG. Endoscopic hemostasis of nonvariceal, non-peptic ulcer hemorrhage. Gastrointest Endosc Clin N Am 1997; 7: 657-670
  • 39 Prasad Kerlin M, Tokar JL. Acute gastrointestinal bleeding. Ann Intern Med 2013; 159-159
  • 40 Ciobanu L, Pascu O, Diaconu B et al. Bleeding Dieulafoy's-like lesions of the gut identified by capsule endoscopy. World J Gastroenterol 2013; 19: 4823-4826
  • 41 Arora A, Tyagi P, Kirnake V et al. Unusual cause of massive upper gastrointestinal bleeding: a pancreatic arteriovenous malformation. JOP 2013; 14: 292-295
  • 42 Guner A, Mentese U, Kece C, Kucuktulu U. A rare and forgotten diagnosis of gastrointestinal bleeding: primary aortoduodenal fistula. BMJ Case Rep 2013; 2013-2013
  • 43 Almadi M, Ghali PM, Constantin A et al. Recurrent obscure gastrointestinal bleeding: dilemmas and success with pharmacological therapies. Case series and review. Can J Gastroenterol 2009; 23: 625-631
  • 44 Koulaouzidis A, Rondonotti E, Karargyris A. Small-bowel capsule endoscopy: A ten-point contemporary review. World J Gastroenterol 2013; 19: 3726-3746
  • 45 Ibrahim M, Van Gossum A. Novel imaging enhancements in capsule endoscopy. Gastroenterol Res Pract 2013;
  • 46 Carpi F, Shaheed H. Grand challenges in magnetic capsule endoscopy. Expert Rev Med Devices 2013; 10: 433-436
  • 47 Sidhu R, Sanders DS. Double-balloon enteroscopy in the elderly with obscure gastrointestinal bleeding: safety and feasibility. Eur J Gastroenterol Hepatol 2013;
  • 48 Gurkan OE, Karakan T, Dogan I et al. Comparison of double balloon enteroscopy in adults and children. World J Gastroenterol 2013; 19: 4726-4731
  • 49 Sorser SA, Watson A, Gamarra RM et al. Double balloon enteroscopy: is it efficacious and safe in a community setting?. Minerva Gastroenterol Dietol 2013; 59: 205-210
  • 50 Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population based study. Am J Gastroenterol 1997; 92: 419-424
  • 51 Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population based study. Am J Gastroenterol 1997; 92: 419-424
  • 52 Hoffman A, Galle PR. Gastrointestinal disorders and dabigatran. Scand J Gastroenterol 2013; 48: 9-16
  • 53 Norton SA, Armstrong CP. Lower gastrointestinal bleeding during anticoagulant therapy: a life-saving complication?. Ann R Coll Surg Engl 1997; 79: 38-39
  • 54 Zuckerman GR, Prakash C. Acute lower intestinal bleeding – part I: clinical presentation and diagnosis. Gastrointest Endosc 1998; 48: 606-616
  • 55 Zuckerman GR, Prakash C. Acute lower intestinal bleeding – part II: etiology, therapy, and outcomes. Gastrointest Endosc 1999; 49: 228-238
  • 56 McGuire HH. Bleeding colonic diverticula: a reappraisal of natural history and management. Ann Surg 1994; 220: 653-656
  • 57 Foutch PG. Diverticular bleeding: are nonsteroidal anti-inflammatory drugs risk factors for hemorrhage and can colonoscopy predict outcome for patients?. Am J Gastroenterol 1995; 90: 1779-1784
  • 58 Lewis M. NDSG. Bleeding colonic diverticula. J Clin Gastroenterol 2008; 42: 1156-1158
  • 59 Bollinger E, Raines D, Saitta P. Distribution of bleeding gastrointestinal angioectasias in a Western population. World J Gastroenterol 2012; 18: 6235-6239
  • 60 Olokoba AB, Obateru OA, Olatoke SA. Angiodysplasia of the colon: a report of two cases and review of literature. Niger J Clin Pract 2012; 15: 101-103
  • 61 June L, Chin N, Chatterjee D. Cytomegalovirus colitis presenting as massive lower gastrointestinal bleeding in an immunocompetent patient. Indian J Surg 2008; 70: 28-31
  • 62 Mönkemüller KE, Wilcox CM. Diagnosis and treatment of colonic disease in AIDS. Gastrointest Endosc Clin N Am 1998; 8: 889-911
  • 63 Kent AJ, Blackwell VJ, Travis SP. What is the optimal treatment for anemia in inflammatory bowel disease?. Curr Drug Deliv 2012; 9: 356-366
  • 64 Henson CC, Davidson SE, Ang Y et al. Structured gastroenterological intervention and improved outcome for patients with chronic gastrointestinal symptoms following pelvic radiotherapy. Support Care Cancer 2013; 21: 2255-2265
  • 65 Fuccio L, Guido A, Andreyev HJ. Management of intestinal complications in patients with pelvic radiation disease. Clin Gastroenterol Hepatol 2012; 10: 1326-1334
  • 66 Newman JR, Cooper MA. Lower gastrointestinal bleeding and ischemic colitis. Can J Gastroenterol 2002; 16: 597-600
  • 67 Lin HJ, Hsieh YH, Tseng GY. Endoscopic injection with fibrin sealant versus epinephrine for arrest of peptic ulcer bleeding: a randomized, comparative trial. J Clin Gastroenterol 2002; 35: 218-221
  • 68 Randall GM, Jensen DM, Hirabayashi K. Controlled study of different sclerosing agents for coagulation of canine gut arteries. Gastroenterology 1989; 96: 1274-1281
  • 69 Chung IK, Ham JS, Kim HS. Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc 1999; 49: 13-18
  • 70 Raju Gs, Gajula L. Endoclips for GI endoscopy. Gastrointest Endosc 2004; 59: 267-279
  • 71 Khashab MA, Cramer HM, Liangpunsakul S. Role of hemoclips in the management of acute bleeding from a gastric stromal tumor: a case report and review of the literature. J Med Case Rep 2007; 1: 136-136
  • 72 Sung JJ, Tsoi KK, Lai LH et al. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut 2007; 56: 1364-1373
  • 73 Schurr MO, Arezzo A, Ho CN. The OTSC clip for endoscopic organ closure in NOTES: device and technique. Minim Invasive Ther Allied Technol 2008; 17: 262-266
  • 74 Schurr MO, Hartmann C, Ho CN. An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy 2008; 40: 584-588
  • 75 Johnston JH, Jensen DM, Auth D. Experimental comparison of endoscopic yttrium-aluminum-garnet laser, electrosurgery, and heater probe for canine gut arterial coagulation. Importance of compression and avoidance of erosion. Gastroenterology 1987; 92: 1101-1108
  • 76 Johnston JH, Sones JQ, Long BW et al. Comparison of heater probe and YAG laser in endoscopic treatment of major bleeding from peptic ulcers. Gastrointest Endosc 1985; 31: 175-180
  • 77 Sanowski RA. Thermal application for gastrointestinal bleeding. J Clin Gastroenterol 1986; 8: 239-244
  • 78 Sung JJ, Luo D, Wu JC et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011; 43: 291-295
  • 79 Smith LA, Stanley A, Morris J. Hemospray for non-variceal upper gastrointestinal bleeding: results of the seal dataset (survey to evaluate the application of hemospray in the luminal tract). Journal of Clinical Gastroenterology 2013;
  • 80 Katschinski B, Logan R, Davies J et al. Prognostic factors in upper gastrointestinal bleeding. Dig Dis Sci 1994; 39: 706-712