Tiivistelmä

Vuotopotilaalle aloitetaan protonipumpun estäjälääkitys, ja gastroskopia pyritään tekemään 24 tunnissa sairaalaan tulosta.

Maltillinen verensiirtostrategia, jossa hemoglobiinin tavoitepitoisuus on 70 g/l, parantaa potilaan ennustetta verrattuna liberaalimpaan strategiaan

Endoskooppisessa hoidossa adrenaliiniruiskutukseen on liitettävä toinen menetelmä: liimaus, vuodon termaalinen koagulaatio tai klipsaus.

Jos vuoto uusii, gastroskopia ja vuodon tyrehdytys endoskooppisesti toistetaan. Jos vuoto yhä jatkuu, potilas ohjataan angioembolisaatioon tai päivystysleikkaukseen.

Abstract

The incidence of acute upper gastrointestinal bleeding is 50–100/100,000 inhabitants. Most of these bleeding episodes are self-limiting, but in 20% therapeutic interventions are needed. Peptic ulcer bleeding is the most common cause of the bleeding, in 30–50%, but the number of oesophageal variceal bleeding episodes is increasing.

In acute bleeding, the aim of fluid resuscitation is to stabilize the haemodynamics. Mortality and rebleeding rates can be decreased by a restricted transfusion strategy with target haemoglobin > 70 g/mL compared to a liberal transfusion strategy where the target haemoglobin is > 90 g/mL.

Early administration of proton pump inhibitors is appropriate in patients with upper gastrointestinal bleeding. Gastroscopy should be performed within 24 hours after admission.

Acute spurting or oozing bleeding, or stigmata of recent haemorrhage (visible vessel, adherent clot covering the ulcer base) are indications for endoscopic treatment.

Adrenalin injection usually stops the bleeding and improves visibility, but other endoscopic therapies (fibrin glue, thermal coagulation, clips) should be added to improve haemostasis. Stable patients with low risk of rebleeding can be safely discharged after endoscopy.

In the case of rebleeding, repeat endoscopic therapy should be attempted. If this is unsuccessful, angioembolisation and emergency surgery are rescue treatment options.

In follow up, H. pylori eradication prevents rebleeding and ulcer recurrence.