PRE-AETHIOLOGICAL TREATMENT IN UPPER GASTRO-INTESTINAL
BLEEDING
G. Dimofte
First Surgical Clinic, „St. Spiridon” Hospital Iasi,
Research Center for Laparoscopic and Classic Surgery,
University of Medicine and Pharmacy „Gr.T. Popa” Iasi
Jurnalul de chirurgie 2005; 1 (1):24-33
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Abstract:
Upper gastro-intestinal bleeding remains a cornerstone in surgical
practice and unfortunately its’ management is profoundly variable
according to hospital protocols and local standards of care. Medical
interventions are acting at different levels of medical care and a
range of specialist are involved in the process, starting from family
practitioners to surgeons, as well as highly trained specialist in
interventional endoscopy or radiology.
This review is trying to establish the landmarks in the early assessment
and care of patients with upper gastro-intestinal bleeding, irrespective
of the morphological cause of the bleeding. We propose a protocol
for the management both of portal and non-portal upper-gastrointestinal
bleedings, prior to endoscopic diagnosis. It is fundamental to establish
a standard of care which is feasible in Romania and can work both
in university and district hospitals.
The protocol is marking the essential gestures with their relevance
for the bleeding patient but also reminds the significance of clinical
evaluation and safety in transportation of the patient to the nearest
emergency room. A battery of simple test should be performed in every
patient and data interpreted with care, as results vary according
to the level of haemodynamic compensation.
Standard empiric therapy for upper gastro-intestinal bleeding is
not yet been established but a couple of alternatives emerge as possible
solutions. We discuss the benefits of a standard therapy based on
H2 blockers, proton pump inhibitors, octreoctide and somatostatin
regarding both portal and non-portal bleedings.
KEYWORDS: UPPER GASTRO-INTESTINAL BLEEDING, H2 BLOCKERS, PROTON
PUMP INHIBITORS, OCTREOCTIDE
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