Therapie der oberen gastrointestinalen Blutung

Zusammenfassung

Die Therapie von nicht-varikösen und varikösen oberen gastrointestinalen Blutungen unterscheidet sich grundlegend. Blutungen aus gastroduodenalen Ulcera sind die häufigste Ursache für obere gastrointestinale Blutungen. Die Notfalltherapie besteht aus der Gabe von intravenösen Protonenpumpeninhibitoren und der endoskopischen Blutstillung. Zusätzlich ist die H. p.-Eradikation und ggf das Absetzen von NSAR von essentieller Bedeutung.

Bei Varizenblutung ist die Gabe von vasoaktiven Substanzen und die frühe Antibiotikaprophylaxe essentiell. Zur endoskopsichen Blutstillung werden Gummibandligatur und Injektionsverfahren eingesetzt. Die TIPS-Anlage ist bei endoskopisch nicht beherrschbarer Blutung oder früher Rezidiv-Blutung Therapie der Wahl.

Abstract

The management of upper non-variceal and variceal hemorrhage differs substantially. Most common cause auf upper gastrointestinal (GI) hemorrhage are gastroduodenal ulcers. Administration of proton pump inhibitors (PPI) and endoscopic hemostasis are crucial in the treatment of non-variceal bleeding. In case of Helicobacter pylori infection eradication therapy should be undertaken and nonsteroid anti-inflammatory drugs (NSAID) discontinued. Early administration of vasoactive drugs and antibiotics significantly reduces mortality from variceal hemorrhage. Endoscopic hemostasis is achieved with rubber-band ligation or injection therapy. Placement of transjugular intrahepatic portosystemic shunt (TIPS) is indicated in patients with uncontrolled hemorrhage or recurrent bleeding despite combined pharmacological and endoscopic therapy.

Schlüsselwörter

obere gastrointestinale Blutung - Varizen - endoskopische Hämostase

Keywords

upper gastrointestinal bleeding - varices - endoscopic hemaostasis

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