Akute obere gastrointestinale Blutung

Zusammenfassung

Die akute GI-Blutung ist ein häufiger internistisch-gastroenterologischer Notfall und tritt zu 85 % im oberen GI-Trakt auf. Obere GI-Blutungen verlaufen häufig schwerer als untere oder mittlere GI-Blutungen. Die Hälfte aller oberen GI-Blutungen sind durch peptische Ulzera verursacht. Die Prognose wird v. a. durch Blutungsintensität, Alter, Komorbidität und Einnahme von Antikoagulantien bestimmt. Die Anamnese kann wichtige Hinweise zur Intensität, Lokalisation, Blutungsart und Blutungsursache beitragen. Initial stehen Allgmeinmaßnahmen zur Kreislaufstabilisierung im Vordergrund. Die Ösophagogastroduodenoskopie (ÖGD) ist die Methode der Wahl zur Lokalisierung der Blutungsquelle und interventionellen Therapie. Peptische Ulkusblutungen werden endoskopisch mit mechanischen und / oder thermischen Methoden in Kombination mit PPI therapiert. Bei V. a. Varizenblutung soll präinterventionell die Gabe von Vasopressinanaloga und Antibiose erfolgen. Endoskopisch werden Ösophagusvarizen in erster Linie mittels endoskopischer Ligaturtherapie (EVL), Magenvarizen mittels Histoacryl-Injektion gestillt. Bei intervallartig auftretenden massiven Blutungen und anamnestischer Aortenerkrankung muss differenzialdiagnostisch das Vorliegen einer aortointestinalen Fistel bedacht werden.

Abstract

Acute gastrointestinal bleeding is a common major emergency (Internal medical or gastroenterological or medical), approximately 85 % of which occur in the upper GI tract. It is estimated that about a half of upper GI bleeds are caused by peptic ulcers. Upper GI bleeds are associated with more severe bleeding and poorer outcomes when compared to middle or lower GI bleeds. Prognostic determinants include bleeding intensity, patient age, comorbid conditions and the concomitant use of anticoagulants. A focused medical history can offer insight into the bleeding intensity, location and potential cause (along with early risk stratification). Initial measures should focus on rapid assessment and resuscitation of unstable patients. The oesophagogastroduodenoscopy (OGD) is the gold standard method for localizing the source of bleeding and for interventional therapy. Bleeding as a result of peptic ulcers is treated endoscopically with mechanical and / or thermal techniques in combination with proton pump inhibitor (PPI) therapy. When variceal bleeding is suspected, pre-interventional use of vasopressin analogues and antibiotic therapies are recommended. Endoscopically, the first line treatment of esophageal varices is endoscopic ligature therapy, whereas that for gastric varices is the use of Histoacryl injection sclerotherapy. When persistent and continued massive hemorrhage occurs in a patient with known or suspected aortic disease the possibility of an aorto-enteric fistula must be considered.

Schlüsselwörter

obere gastrointestinale Blutung - Hämatemesis - Melaena - Ulkusblutung - Varizenblutung - endoskopische Therapie

Keywords

upper gastrointestinal bleeding - hematemesis - melena - peptic ulcer bleeding - bleeding esophageal varices - endoscopic therapy

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