Üst Gastrointestinal Kanamalar
Özet
Üst gastrointestinal (GİS) sistem kanamaları, Treitz ligamanının proksimalinde meydana gelen ve mortalite riski taşıyan önemli acil durumlardır. Bu kanamaların %80'i varis dışı nedenlerden kaynaklanmakta olup en sık görülen sebep peptik ülser hastalığıdır; geri kalan %20'si ise portal hipertansiyona bağlı olarak gelişmektedir. Peptik ülserler tipik olarak epigastrik ağrı ile karakterize olup Helicobacter pylori enfeksiyonu ve NSAİİ kullanımı en önemli risk faktörleri arasında yer alır. Tanı ve tedavide altın standart, kanama odağının belirlenmesine ve terapötik müdahalelere (epinefrin enjeksiyonu, termal koagülasyon, klips) olanak sağlayan özofagogastroduodenoskopidir (ÖGD). Kanamalarda Forrest sınıflandırması yeniden kanama riskini belirlemede kritik bir rehberdir. Medikal tedavide proton pompa inhibitörleri (PPİ) ve H. pylori eradikasyonu ön plana çıkarken, endoskopik olarak kontrol edilemeyen refrakter kanamalarda, hemodinamik instabilite veya tekrarlayan kanama durumlarında acil cerrahi müdahale ya da TIPS gibi dekompresyon yöntemleri gerekmektedir.
Upper gastrointestinal (GI) bleeding refers to hemorrhages originating proximal to the ligament of Treitz, presenting a critical medical emergency with significant mortality risks. Non-variceal causes account for 80% of these cases, with peptik ulcer disease being the most common etiology, while the remaining 20% arise from portal hypertension. Peptic ulcers typically manifest with epigastric pain, and Helicobacter pylori infection alongside NSAID use constitute the primary risk factors. Esophagogastroduodenoscopy (EGD) serves as the gold standard for both diagnosis and management, enabling localization of the bleeding source and therapeutic interventions such as epinephrine injection, thermal coagulation, and mechanical clips. The Forrest classification is utilized during endoscopy to assess rebleeding risks. Medical management relies heavily on proton pump inhibitors (PPIs) and H. pylori eradication. However, in cases of refractory bleeding where endoscopic therapy fails, or when patients exhibit hemodynamic instability and recurrent bleeding, urgent surgical intervention or decompression techniques like TIPS become mandatory.
Referanslar
Cohen M, Sapoznikov B, & Niv Y. Primary and secondary nonvariceal upper gastrointestinal bleeding. Journal of clinical gastroenterology, 2007; 41(9), 810-813
Celiński K, Cichoz-Lach H, Madro A, et al. Non-variceal upper gastrointestinal bleeding--guidelines on management. Journal of Physiology and Pharmacology: an Official Journal of the Polish Physiological Society, 2008; 59, 215-229.
Barkun AN, Bardou M, Kuipers EJ, et al International Consensus Upper Gastrointestinal Bleeding Conference Group*. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Annals of internal medicine, 2010; 152(2), 101-113.
Enestvedt BK, Gralnek IM, Mattek N, et al. An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium. Gastrointestinal endoscopy, 2008; 67(3), 422-4
Samuel R, Bilal M, Tayyem O,et al. Evaluation and management of Non-variceal upper gastrointestinal bleeding. Disease-a-Month 2018;64:333-43.
Jairath V, Martel M, Logan RF,et al Why do mortality rates for nonvariceal upper gastrointestinal bleeding differ around the world? A systematic review of cohort studies. Can J Gastroenterol. 2012; Aug;26(8):537-43.
Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med. 2010 Mar 4;362(9):823-32. doi: 10.1056/NEJMra0901512.
Burke SJ, Golzarian J, Weldon D, et al. Nonvariceal upper gastrointestinal bleeding. European radiology, 2007;17(7), 1714-1726.
Cook DJ, Guyatt GH, Salena BJ,et al. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992;102:139-48.
Tsoi KK, Ma TK, & Sung JJ. Endoscopy for upper gastrointestinal bleeding: how urgent is it? Nature Reviews Gastroenterology & Hepatology, 2009;6(8), 463-469.
Sarin N, Monga N, & Adams PC.Time to endoscopy and outcomes in upper gastrointestinal bleeding. Canadian Journal of Gastroenterology, 2009;23(7), 489-493.
Cheng CL, Lee CS, Liu NJ, et al. Overlooked lesions at emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding. Endoscopy, 2002;34(07), 527-530.
Spechler SJ. Peptic ulcer disease and its complications. Sleisenger & Fordtran’s gastrointestinal and liver disease, 2002; 7, 741-81.
Scott LF, Keneth RM. Current Diag¬nosis and Treatment in Gastroenterology. 2. Baskı, Gönen, Güneş kita¬bevi, 2007:323-25.
Del Valle J. Peptic ulcer disease and related disorders. Harrisons principles of internal medicine, 2005;16(2), 1746.
Rosenstock SJ & Jørgensen T. Prevalence and incidence of peptic ulcer disease in a Danish County--a prospective cohort study. Gut, 1995;36(6), 819-824.
Kurata JH, Nogawa AN, Abbey DE et al. A prospective study of risk for peptic ulcer disease in seventh-day adventists. Gastroenterology,1992; 102: 902−09.
Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. The lancet, 2009; 374(9699), 1449-1461.
Ramakrishnan K, Salinas RC. Peptic ulcer disease. American family physician, 2007;76(7), 1005-1012.
Townsend M.Sabiston cerrahi modern cerrahinin biyolojik temeli. 20. Baskı. Peptik Ülser hastalığı syf 1197 – 1211
Sonnenberg A. Review article: historic changes of Helicobacter pylori-associated diseases. Aliment Pharmacol Ther 2013; 38: 329−42.
Sonnenberg A. Time trends of ulcer mortality in Europe. Gastroenterology 2007; 132: 2320−27.
Sonnenberg A. Time trends of ulcer mortality in non-European countries. Official journal of the American College of Gastroenterology| ACG 2007; 102: 1101−07.
Leow AH, Lim YY, Liew WC et al. Time trends in upper gastrointestinal diseases and Helicobacter pylori infection in a multiracial Asian population — a 20-year experience over three time periods. Aliment Pharmacol Ther 2016; 43: 831−37.
Lanas A, Garcia-Rodriguez LA, Polo-Tomas M, et al. The changing face of hospitalisation due to gastrointestinal bleeding and perforation. Aliment Pharmacol Ther 2011; 33: 585−91.
Malmi H, Kautiainen H, Virta LJ et al. Incidence and complications of peptic ulcer disease requiring hospitalisation have markedly decreased in Finland. Aliment Pharmacol Ther 2014; 39: 496−506.
Sayek İ. Sayek Temel Cerrahi. 104. Bölüm. Peptik Ülser Hastalığı syfa 1270- 1277
Yeomans ND. The ulcer sleuths: The search for the cause of peptic ulcers. Journal of gastroenterology and hepatology, 2011; 26, 35-41.
Debas HT.Gastrointestinal surgery: pathophysiology and management. Springer Science & Business Media;2004
Najm WI. Peptic ulcer disease. Primary Care: Clinics in Office Practice,2011; 38(3), 383-394.
Fock KM, Katelaris P, Sugano K et al. Second Asia–Pacific consensus guidelines for helicobacter pylori infection. Journal of gastroenterology and hepatology, 2009; 24(10), 1587-1600.
Malfertheiner P, Megraud F, O’Morain C. Et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut, 2007; 56(6), 772-781.
Blatchford O, Murray WR, & Blatchford M. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. The Lancet, 2000; 356(9238), 1318-1321.
Lundell, L. Acid secretion and gastric surgery. Digestive Diseases, 2011; 29(5), 487-490.
Wang YR, Richter JE, & Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Annals of surgery, 2010;251(1), 51-58.
Schilling D, Demel A, Nüsse T, et al.. Helicobacter pylori infection does not affect the early rebleeding rate in patients with peptic ulcer bleeding after successful endoscopic hemostasis: a prospective single-center trial. Endoscopy, 2003; 35(05), 393-396.
Liu CC, Lee CL, Chan CC, et al. Maintenance treatment is not necessary after Helicobacter pylori eradication and healing of bleeding peptic ulcer: a 5-year prospective, randomized, controlled study. Archives of internal medicine, 2003; 163(17), 2020-2024.
Lau JY, Sung JJ, Lam YH, et al. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. New England Journal of Medicine, 1999; 340(10), 751-756.
Guglielmi A, Ruzzenente A, Sandri M, et al. Risk assessment and prediction of rebleeding in bleeding gastroduodenal ulcer. Endoscopy, 2002; 34(10), 778-786.
Chung IK, Kim EJ, Lee MS, et al. Endoscopic factors predisposing to rebleeding following endoscopic hemostasis in bleeding peptic ulcers. Endoscopy, 2001;33(11), 969-975.
Nguyen DC, & Jackson CS. The Dieulafoy’s lesion. Journal of Clinical Gastroenterology, 2015;49(7), 541-549.
Townsend M.Sabiston cerrahi modern cerrahinin biyolojik temeli. 20. Baskı. Akut Gastrointestinal Kanama syf 1139 – 1159
Stiegmann GV. Endoscopic approaches to upper gastrointestinal bleeding. The American Surgeon, 2006; 72(2), 111-115.
Herrera JL. Management of acute variceal bleeding. Clinics in Liver Disease, 2014;18(2), 347-357.
Hsu YC, Chung CS, Tseng CH, et al Delayed endoscopy as a risk factor for in‐hospital mortality in cirrhotic patients with acute variceal hemorrhage. Journal of gastroenterology and hepatology, 2009; 24(7), 1294-1299.
Dechêne A, El Fouly AH, Bechmann LP, et al. Acute management of refractory variceal bleeding in liver cirrhosis by self-expanding metal stents. Digestion, 2012;85(3), 185-191.
Chalasani N, Kahi C, Francois F,et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. The American journal of gastroenterology, 2003; 98(3), 653-659.
Lo GH, Liang HL, Chen WC, 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(08), 679-685.
Heider TR, Azeem S, Galanko JA,et al. The natural history of pancreatitis-induced splenic vein thrombosis. Annals of surgery, 2004; 239(6), 876.
Yen HH, Yang CW, Su WW, et al. Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful endoscopic therapy. BMC Gastroenterol 2012;12:66.
Javid G, Masoodi I, Zargar SA,et al. Omeprazole as adjuvant therapy to endoscopic combination injection sclerotherapy for treating bleeding peptic ulcer. The American journal of medicine, 2001;111:280-4.
de la Peña J, Brullet E, Sanchez‐Hernández E,et al. Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology, 2005;41(3), 572-578.
