Lege Artis Medicinae

[CURE]

MATOS Lajos

JANUARY 21, 2004

Lege Artis Medicinae - 2004;14(01)

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Lege Artis Medicinae

[VALIANT]

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[DIAGNOSTICS AND THERAPY OF ACUTE BLEEDINGS FROM GASTRODUODENAL ULCERS; PROPHYLAXIS OF STRESS ULCER]

RÁCZ István

[Acute gastrointestinal bleeding is a life threatening condition. Almost 90% of the acute bleeding episodes originate from the upper gastrointestinal tract with a 5-10% mortality rate. Emergency endoscopy is capable to detect the bleeding source offering the chance of endoscopic therapy as well. Injecting epinephrine in a 1:10000 diluted solution into the mucosa surrounding the ulcer is the generally used endoscopic haemostatic method. In ulcer bleeding cases permanent protonpump- inhibitor infusion for 72 hours is the therapy of choice to increase gastric pH and for the stabilization of the coagulum covering the ulcers. Mortality can be decreased by surgery performed in an early elective manner. The most important aim of gastroenterological treatment in ulcer bleeders is to avoid the rebleeding episodes which increase the mortality. Acute bleedings resulting from stress ulcers are typical complications in patients undergoing major surgery and require intensive care unit treatment. The mortality rate of stress ulcer bleeders can reach or even exceed 50%. Occasionally stress ulcers have a large ulcer like appearance but in most of the cases they have an erosive confluent formation. For the prophylaxis of the stress ulcer development and bleeding an effective inhibition of gastric acid secretion is recommended in the perioperative period as well as during the intensive care. Considering gastroenterological aspects protonpump- inhibition therapy offers the most effective protection of gastric mucosal barrier by increasing gastric pH. Despite sucralfate is being frequently used, the recommended stress ulcer prophylactic therapy is permanent PPI (pantoprazole or omeprazole) infusion in a dose of 8 mg/hours. With this prophylactic medication for 48-72 hours stress ulcers can be prevented in most of the cases without any significant adverse event.]

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[Cardiovascular aspects of impaired glucose tolerance: A review through the STOP-NIDDM Trial]

BOSNYÁK Zsolt, KERÉNYI ZSUZSA

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