Skip to main content
SpringerLink
Log in

Intensivtherapie bei akuten gastrointestinalen Blutungen

Die Intensivmedizin

Part of the book series: Springer Reference Medizin ((SRM))

Zusammenfassung

Akute gastrointestinale Blutungen werden nach ihrer Lokalisation eingeteilt in obere, mittlere und untere GI-Blutungen. Eine obskure Blutung liegt vor, wenn bei einer gastrointestinalen Blutung keine Blutungsquelle in der Gastroskopie und Koloskopie nachgewiesen werden kann. Sie ist gekennzeichnet durch Hämatemesis, Melaena und Hämatochezie.

Die Schockbekämpfung gehört zu den vordringlichsten Therapiemaßnahmen bei der akuten schweren gastrointestinalen Blutung auf der Intensivstation. Darüber hinaus wird das weitere diagnostische und therapeutische Vorgehen im Rahmen der Stressblutungsprophylaxe, bei Blutungen aus Erosionen und Ulzerationen, Ösophagusvarizenblutung und Blutungen in den verschiedenen Darmabschnitten thematisiert. Auch schwere Blutungen bei M. Crohn und Colitis ulcerosa sind hier beschrieben.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Literatur

  • Alhazzani W, Alenezi F, Jaeschke RZ et al (2013) Proton Pump Inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med 41:693–705

    Article  CAS  PubMed  Google Scholar 

  • Blatchford O, Murray WR, Blatchford M (2000) A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 356:1318–1321

    Article  CAS  PubMed  Google Scholar 

  • Caldwell S (2012) Gastric varices: is there a role for endoscopic cyanoacrylates, or are we entering the BRTO era? Am J Gastroenterol 107(12):1784–1790

    Article  PubMed  Google Scholar 

  • Chanpura T, Yende S (2012) Weighing risks and benefits of stress ulcer prophylaxis in critically ill patients. Crit Care 16(5):322

    Article  PubMed Central  PubMed  Google Scholar 

  • Chen X, Ran ZH, Tong JL (2007) A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases. World J Gastroenterol 13:4372–4378

    PubMed Central  PubMed  Google Scholar 

  • Conrad SA, Gabrielli A, Margolis A et al (2005) Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Crit Care Med 33:760–765

    Article  CAS  PubMed  Google Scholar 

  • Cook DJ, Fuller HD, Guyatt GH et al (1994) Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 330:377–381

    Article  CAS  PubMed  Google Scholar 

  • Cook DJ, Reeve BK, Guyatt GH et al (1996) Stress ulcer prophylaxis in critically ill patients: resolving discordant meta-analyses. JAMA 275:308–314

    Article  CAS  PubMed  Google Scholar 

  • Cook D, Guyatt G, Marshall J, for the Canadian Critical Care Trials Group et al (1998) A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. N Engl J Med 338:791–797

    Article  CAS  PubMed  Google Scholar 

  • Cook DJ, Griffith LE, Walter SD, Canadian Critical Care Trials Group et al (2001) The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 5:368–375

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • El Ouali S, Barkun AN, Wyse J et al (2012) Is routine second-look endoscopy effective after endoscopic hemostasis in acute peptic ulcer bleeding? A meta-analysis. Gastrointest Endosc 76(2):283–292

    Article  PubMed  Google Scholar 

  • Ell C, Hagenmüller F, Schmitt W et al (1995) Multizentrische prospektive Untersuchung zum aktuellen Stand der Therapie der Ulkusblutung in Deutschland. Dtsch Med Wochenschr 120:3–9

    Article  CAS  PubMed  Google Scholar 

  • Frattaroli FM, Casciani E, Spoletini D et al (2009) Prospective study comparing multi-detector row CT and endoscopy in acute gastrointestinal bleeding. World J Surg 33:2209–2217

    Article  PubMed  Google Scholar 

  • García-Blázqez V, Vicente-Bártulos A, Olavarria-Delgado A et al (2012) Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol [Epub vor Druck]

    Google Scholar 

  • Gisbert JP, Khorrami S, Carballo F et al (2004) Meta-analysis: Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer. Aliment Pharmacol Ther 19:617–629

    Article  CAS  PubMed  Google Scholar 

  • Green BT, Rockey DC, Portwood G et al (2005) Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol 100:2395–2402

    Article  PubMed  Google Scholar 

  • Heine GD, Hadithi M, Groenen MJ (2006) Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy 38:42–48

    Article  CAS  PubMed  Google Scholar 

  • Hubmann R, Bodlaj G, Czompo M et al (2006) The use of self-expanding metal stents to treat acute esophageal variceal bleeding. Endoscopy 38:896–901

    Article  CAS  PubMed  Google Scholar 

  • Hurt RT, Frazier TH, McClave SA et al (2012) Stress ulcer prophylaxis in intensive care unit patients and the role of enteral nutrition. JPEN J Parenter Enteral Nutr 36(6):721–731

    Article  CAS  PubMed  Google Scholar 

  • Karaman A, Baskol M, Gursoy S et al (2012) Endoscopic topical application of Ankaferd blood stopper in gastrointestinal bleeding. J Altern Complement Med 18(1):65–68

    Article  PubMed  Google Scholar 

  • Klebl FH, Schölmerich J (2007) Therapy insight: prophylaxis of stress induced gastrointestinal bleeding in critically ill patients. Nat Clin Pract Gastroenterol Hepatol 4:562–570

    Article  PubMed  Google Scholar 

  • Klebl F, Langgartner J, Bregenzer N et al (2002) Charakterisierung der oberen gastrointestinalen Blutung bei Intensivpatienten. Intensivmedizin 39:233–239

    Article  Google Scholar 

  • Klebl F, Langgartner J, Schölmerich J, Messmann H (2003) Akute gastrointestinale Blutungen. Intensivmedizin 40:158–174

    Article  Google Scholar 

  • Laine L, McQuaid KR (2009) Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 7:33–47

    Article  PubMed  Google Scholar 

  • Lanas A, García-Rodríguez LA, Polo-Tomás M et al (2009) Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol 104:1633–1641

    Article  PubMed  Google Scholar 

  • Leung Ki EL, Lau JY (2012) New endoscopic hemostasis methods. Clin Endosc 45(3):224–229

    Article  PubMed Central  PubMed  Google Scholar 

  • Leontiadis GI, Howden CW (2009) The role of proton pump inhibitors in the management of upper gastrointestinal bleeding. Gastroenterol Clin North Am. 2009 Jun;38(2):199–213. doi: 10.1016/j.gtc.2009.03.008

    Google Scholar 

  • Longstreth GF (1997) Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 92:419–424

    CAS  PubMed  Google Scholar 

  • Marmo R, Koch M, Cipolletta L et al (2008) Predictive factors of mortality from nonvariceal upper gastrointestinal hemorrhage: a multicenter study. Am J Gastroenterol 103:1639–1647

    Article  PubMed  Google Scholar 

  • Messmann H (1995) Obere gastrointestinale Blutung. In: Holstege A (Hrsg) Gastroenterologische Endoskopie. Urban & Schwarzenberg, München, S 320

    Google Scholar 

  • Pennazio M, Santucci R, Rondonotti E et al (2004) Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 126:643–653

    Article  PubMed  Google Scholar 

  • Rockall TA, Logan RFA, Devlin HB, Northfield TC (1995) Variation in outcome after acute upper gastrointestinal haemorrhage. Lancet 346:346–350

    Article  CAS  PubMed  Google Scholar 

  • Rockall TA, Logan RFA, Devlin HB, Northfield TC (1996) Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. Lancet 347:1138–1140

    Article  CAS  PubMed  Google Scholar 

  • Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L (2002) Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding. Cochrane Database Syst Rev 9:CD002907

    Google Scholar 

  • Sung JJ, Lau JY, Ching JY et al (2010) Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 152(1):1–9

    Article  PubMed  Google Scholar 

  • Villanueva C, Colomo A, Bosch A et al (2013) Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 368(1):11–21

    Article  CAS  PubMed  Google Scholar 

  • Zhou J, Wu Z, Wu J et al (2013) Transjugular intrahepatic portosystemic shunt (TIPS) versus laparoscopic splenectomy (LS) plus preoperative endoscopic varices ligation (EVL) in the treatment of recurrent variceal bleeding. Surg Endosc 27(8):2712–2720

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinikum Augsburg, III, Medizinische Klinik, Stenglinstr. , 86156, Augsburg, Deutschland

    Helmut Messmann

  2. Innere Medizin, Evangelisches Krankenhaus, Emmeramsplatz 10, 93047, Regensburg, Deutschland

    Frank Klebl

Authors
  1. Helmut Messmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frank Klebl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helmut Messmann .

Editor information

Editors and Affiliations

  1. Klinik für Anästhesiologie, RWTH Aachen Universitätsklinikum Aachen, Aachen, Germany

    Gernot Marx

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany

    Elke Muhl

  3. Dir. der Klinik fuer Anaesthesie Intensivmed. und Schmerzther., Frankfurt, Hessen, Germany

    Kai Zacharowski

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Berlin Heidelberg

About this entry

Cite this entry

Messmann, H., Klebl, F. (2015). Intensivtherapie bei akuten gastrointestinalen Blutungen. In: Marx, G., Muhl, E., Zacharowski, K. (eds) Die Intensivmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54675-4_75-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54675-4_75-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Online ISBN: 978-3-642-54675-4

  • eBook Packages: Springer Referenz Medizin

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Intensivtherapie bei akuten gastrointestinalen Blutungen
    Published:
    25 May 2023

    DOI: https://doi.org/10.1007/978-3-642-54675-4_75-2

  2. Original

    Intensivtherapie bei akuten gastrointestinalen Blutungen
    Published:
    09 July 2015

    DOI: https://doi.org/10.1007/978-3-642-54675-4_75-1

Search

Navigation