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Management der Ulkusblutung

The management of bleeding ulcers

Der Internist volume 47, pages 596–601 (2006)Cite this article

Zusammenfassung

Eine Ulkusblutung ist für ca. die Hälfte aller oberen gastrointestinalen Blutungen ursächlich, die zu den häufigsten gastroenterologischen Notfällen gehören. Neben der Helicobacter pylori-Infektion spielt v. a. die Einnahme ulzerogener Medikamente die entscheidende Rolle. Tritt ein Abfall des Hämoglobinwerts auf und/oder besteht eine Kreislaufinstabilität, muss kurzfristig endoskopiert werden. Die Indikation zu einer lokalen endoskopischen Therapie wird anhand der Forrest-Kriterien gestellt, die neben der Blutungsaktivität den Nachweis eines Koagels bzw. Gefäßstumpfs berücksichtigen. An lokalen Therapiemodalitäten sind Injektionstechniken sowie mechanische und thermische Verfahren in ihrer Wirksamkeit gesichert. Begleitend wird eine Gabe von Protonenpumpenblockern durchgeführt. Die Prognose der Ulkusblutung wird neben dem endoskopischen Befund vom Alter und der Komorbidität des Patienten bestimmt.

Abstract

Bleeding peptic ulcers are responsible for about half of all upper gastrointestinal hemorrhages, one of the most frequent gastroenterological emergencies. In its pathogenesis, infection with Helicobacter pylori and the use of ulcerogenic drugs play a dominant role. Endoscopy has to be performed urgently when a decline in hemoglobin and/or hemodynamic instability occurs. The indications for local endoscopic therapy depend on the Forrest criteria, which include bleeding and the presence or absence of a blood clot or visible vessel. Local endoscopic therapy comprises injections and mechanical or thermal procedures. The efficacy of these procedures has been demonstrated. Additionally, proton pump inhibitors are administered. The prognosis for bleeding ulcers depends on the endoscopic findings as well as the age and comorbidity of the patients.

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  1. Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH, Bremserstraße 79, 67 063 , Ludwigshafen

    U. Weickert & J. F. Riemann

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  1. U. Weickert
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  2. J. F. Riemann
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Correspondence to U. Weickert.

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Weickert, U., Riemann, J.F. Management der Ulkusblutung. Internist 47, 596–601 (2006). https://doi.org/10.1007/s00108-006-1619-6

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Schlüsselwörter

  • Endoskopie
  • Endoskopische Hämostase
  • Gastrointestinale Blutung
  • Peptisches Ulkus
  • Ulkusblutung

Keywords

  • Endoscopic hemostasis
  • Endoscopy
  • Gastrointestinal bleeding
  • Peptic ulcer
  • Bleeding ulcer