TAILIEUCHUNG - Chapter 042. Gastrointestinal Bleeding (Part 3)

Hemorrhagic and Erosive Gastropathy ("Gastritis") Hemorrhagic and erosive gastropathy, often labeled gastritis, refers to endoscopically visualized subepithelial hemorrhages and erosions. These are mucosal lesions and thus do not cause major bleeding. They develop in various clinical settings, the most important of which are NSAID use, alcohol intake, and stress. Half of patients who chronically ingest NSAIDs have erosions (15–30% have ulcers), while up to 20% of actively drinking alcoholic patients with symptoms of UGIB have evidence of subepithelial hemorrhages or erosions. Stress-related gastric mucosal injury occurs only in extremely sick patients: those who have experienced serious trauma, major surgery, burns. | Chapter 042. Gastrointestinal Bleeding Part 3 Hemorrhagic and Erosive Gastropathy Gastritis Hemorrhagic and erosive gastropathy often labeled gastritis refers to endoscopically visualized subepithelial hemorrhages and erosions. These are mucosal lesions and thus do not cause major bleeding. They develop in various clinical settings the most important of which are NSAID use alcohol intake and stress. Half of patients who chronically ingest NSAIDs have erosions 15-30 have ulcers while up to 20 of actively drinking alcoholic patients with symptoms of UGIB have evidence of subepithelial hemorrhages or erosions. Stress-related gastric mucosal injury occurs only in extremely sick patients those who have experienced serious trauma major surgery burns covering more than one-third of the body surface area major intracranial disease and severe medical illness . ventilator dependence coagulopathy . Significant bleeding probably does not develop unless ulceration occurs. The mortality rate in these patients is quite high because of their serious underlying illnesses. The incidence of bleeding from stress-related gastric mucosal injury or ulceration has decreased dramatically in recent years most likely due to better care of critically ill patients. Pharmacologic prophylaxis for bleeding may be considered in the high-risk patients mentioned above. Multiple trials document the efficacy of intravenous H2-receptor antagonist therapy which is more effective than sucralfate but not superior to a PPI immediate-release suspension given via nasogastric tube. Prophylactic therapy decreases bleeding but does not lower the mortality rate. Other Causes Other less frequent causes of UGIB include erosive duodenitis neoplasms aortoenteric fistulas vascular lesions including hereditary hemorrhagic telangiectasias Osler-Weber-Rendu and gastric antral vascular ectasia watermelon stomach Dieulafoy s lesion in which an aberrant vessel in the mucosa bleeds from a pinpoint mucosal defect prolapse

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