Resumen de Haematemesis and melaena
Eleanor F. Watson, Nicholas I. Church
Upper gastrointestinal (UGI) haemorrhage is common and carries a significant mortality. Peptic ulcer disease remains the most common aetiology but varices are an important cause. The patient's history, physiology and blood results guide timing of endoscopy and may disclose underlying liver disease. Resuscitation and risk assessment with the Blatchford and Rockall scores are the main priorities in the acute presentation. Haemodynamically unstable patients, and patients with suspected bleeding varices should have urgent endoscopy immediately after resuscitation. Patients with a Blatchford score of 0 may be able to be managed without hospital admission, with endoscopy planned as an outpatient. Endoscopy allows diagnosis and treatment as well as prognostic information. Peptic ulcers that are bleeding, or show stigmata of recent haemorrhage, are treated with dual endoscopic therapy and an intravenous proton pump inhibitor for 72 hours. Oesophageal varices are treated with endoscopic variceal band ligation and terlipressin. Gastric varices are treated with thrombin, glue injection, or transjugular intrahepatic portosystemic shunt (TIPSS) placement. Cirrhotic patients with acute UGI bleeding should also be given broad-spectrum antibiotic therapy.
