Digestion

 

Treatment of Acute Nonvariceal Upper Gastrointestinal Hemorrhage

Meier R. · Wettstein A.R.

Author affiliations

Gastroenterology Unit, University Hospital, Liestal, Switzerland

Keywords: Ulcer bleeding, incidenceRisk factorsEndoscopic treatmentMedical treatmentSomatostatinOctreotide

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Digestion 1999;60(suppl 2):47–52
https://doi.org/10.1159/000051480

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Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: April 16, 1999
Issue release date: April 1999

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 6

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: https://www.karger.com/DIG

Abstract

Hospitalization for nonvariceal upper gastrointestinal hemorrhage (UGIH) is still common with an incidence of 100/100,000 adults/year. Mortality rates range between 8 and 14%. The most common etiologies of acute UGIH are gastric and duodenal ulcers which are associated with older age, Helicobacter pylori gastritis and nonsteroidal anti-inflammatory drugs. Approximately 70% of UGIH stop spontaneously, 10% bleed continuously and about 20% rebleed in the first 24–72 h. Mortality and the probability of rebleeding have been related to the ulcers’ stigmata (Forrest) and to a variety of clinical findings (hematemesis, low initial hemoglobin, signs of shock, coagulopathy and liver disease). It is well established that only patients with continued bleeding or with a risk of rebleeding benefit from endoscopic or medical treatment. Endoscopic treatment (including heater probe, bipolar electrocoagulation, laser and injection therapy) control active bleeding in up to 90% and reduce significantly the rates of further bleeding, the need for blood transfusions, hospital costs and emergency surgery. Medical treatment is still controversial although positive results for somatostatin and octreotide have been found. A meta-analysis including 1,829 patients from 14 randomized trials showed the relative risk for continued bleeding or rebleeding of 0.53 (95% CI, 0.43–0.63) in favor of somatostatin and octreotide. Interventional endoscopy is the first line of treatment for UGIH. Somatostatin and its analogue octreotide may be a useful adjunct to endoscopic management or alternative when endoscopy is unsuccessful, contraindicated or unavailable.



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References

  1. Longstreth GF: Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: A population‐based study. Am J Gastroenterol 1995;90:206–210.
    External Resources
  2. Rockall TA, Logan RFA, Devlin HB, Northfield TC: Incidence of and mortality from acute gastrointestinal haemorrhage in the United Kingdom. BMJ 1995;311:222–226.
    External Resources
  3. Yavorski RT, Wong RK, Maydonovitch C, Battin LS, Furnia A, Amundson DE: Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol 1995;90:568–573.
    External Resources
  4. Rockall TA, Logan RFA, Devlin HB, Northfield TC: Variation in outcome after acute upper gastrointestinal hemorrhage. Lancet 1995;346:346–350.
    External Resources
  5. Armstrong CP, Blower AL: Non‐steroidal anti‐inflammatory drugs and life‐threatening complications of peptic ulceration. Gut 1987;28:527–532.
    External Resources
  6. Henriksson AE, Edman AC, Nilsson I, Bergqvist D, Waldström T: Helicobacter pylori and the relation to other risk factors in patients with acute bleeding peptic ulcer. Scand J Gastroenterol 1998;33:1030–1033.
    External Resources
  7. Gyr K, Kayasseh L: Indikation und Verfahrenswahl; in Siewert JR, Blum Al, Farthmann EC, Lankisch PG (eds): Interdisziplinäre Gastroenterologie. Notfalltherapie. Berlin, Springer, 1982, pp 233–245.
  8. Collins R, Langman M: Treatment with histamine H2‐antagonists in acute upper gastrointestinal hemorrhage. Implications of randomized trials. N Engl J Med 1985;313:660–666.
    External Resources
  9. Terdiman JP, Ostroff JW: Risk of persistent or recurrent and intractable upper gastrointestinal bleeding in the era of therapeutic endoscopy. Am J Gastroenterol 1997;92:1805–1811.
    External Resources
  10. Katschinski B, Logan R, Davies J, Faulkner G, Pearson J, Langman M: Prognostic factors in upper gastrointestinal bleeding. Dig Dis Sci 1994;39:706–712.
    External Resources
  11. Rockall TA, Logan RFA, Devlin HB, Northfield TC: Selection of patients for early discharge or outpatient care after acute upper gastrointestinal hemorrhage. Lancet 1996;347:1138–1140.
    External Resources
  12. Forrest JAH, Finlayson NDC, Shearman DJC: Endoscopy in gastrointestinal bleeding. Lancet 1974;ii:394–397.
  13. Ell C, Hagenmüller F, Schmitt W, Riemann JF, Hahn EG, Hohenberger W: Multizentrische prospektive Untersuchung zum aktuellen Stand der Therapie der Ulcusblutung in Deutschland. Dtsch Med Wschr 1995;120:3–9.
  14. Griffiths WJ, Neumann DA, Welsh JD: The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med 1979;300:1411–1413.
    External Resources
  15. Storey DW, Bown SG, Swain CP, Salmon PR, Kirkham JS, Northfield TC: Endoscopic prediction of recurrent bleeding in peptic ulcers. N Engl J Med 1981;305:915–916.
    External Resources
  16. Vallon AG, Cotton PB, Laurence BH, Miro JRA, Oses JCS: Randomised trial of endoscopic argon laser photocoagulation in bleeding peptic ulcers. Gut 1981;22:228–233.
    External Resources
  17. MacLeod A, Mills PR: Factors identifying the probability of further haemorrhage after acute upper gastrointestinal haemorrhage. Br J Surg 1982;69:256–258.
    External Resources
  18. Bornman C, Theodorou NA, Shuttleworth RD, Essel HP, Marks IN: Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: A prospective evaluation. Br Med J 1985;291:245–247.
  19. Hasselgren G, Carlsson J, Lind T, Schaffalitzky de Muckadell O, Lundell L: Risk factors for rebleeding and fatal outcome in elderly patients with acute peptic ulcer bleeding. Eur J Gastroenterol Hepatol 1998;10:667–672.
    External Resources
  20. Pimpl W, Boeckl O, Waclawiczek HW: Estimation of the mortality rate of patients with severe gastroduodenal hemorrhage with the aid of a new scoring system. Endoscopy 1987;19:101–106.
    External Resources
  21. Cook DJ, Guyatt GH, Salena BJ, Laine LA: Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: A meta‐anlaysis. Gastroenterology 1992;102:139–148.
    External Resources
  22. NIH: Consensus Conference: Therapeutic endoscopy and bleeding ulcers. JAMA 1989;262:1369–1372.
    External Resources
  23. Chung SCS, Leung JWC, Steele RJC, Crofts TJ, Li AKC: Endoscopic injection of adrenaline for acitvely bleeding ulcers: A randomised trial. BMJ 1988;296:1631–1633.
  24. Lin HJ, Lee FY, Kang WM, Tsai YT, Lee SD, Lee CH: Heat probe thermocoagulation and pure alcohol injection in massive peptic ulcer haemorrhage: A prospective, randomised controlled trial. Gut 1990;31:753–757.
    External Resources
  25. Chung SCS, Leung JWC, Sung KKL, Lo KK, Li AKC: Injection or heat probe for bleeding ulcer. Gastroenterology 1991;100:33–37.
    External Resources
  26. Chung SC, Leung JWC, Leong HT, Lo KK, Li AKC: Adding a sclerosant to endoscopic epinephrine injection in actively bleeding ulcers: A randomized trial. Gastrointest Endosc 1993;39:611–615.
    External Resources
  27. Lin HJ, Perng CL, Lee SD: Is sclerosant injection mandatory after an epinephrine injection for arrest of peptic ulcer haemorrhage? A prospective, randomised, comparative study. Gut 1993;34:1182–1185.
    External Resources
  28. Lin HJ, Perng CL, Lee FY: Endoscopic injection for the arrest of peptic ulcer hemorrhage: Final results of a prospective, randomized comparative trial. Gastrointest Endosc 1993;39:15–19.
    External Resources
  29. Saeed ZA, Winchester CB, Michaletz PA, Woods KL, Graham DY: A scoring system to predict rebleeding after endoscopic therapy of nonvariceal upper gastrointestinal hemorrhage, with a comparison of heat probe and ethanol injection. Am J Gastroenterol 1993;88:1842–1849.
    External Resources
  30. Llach J, Bordas JM, Salmeron JM, Panes J, Garcia‐Pagan JC, Feu F, Navasa, Mondelo F, Pique JM, Mas A, Ters J, Rodes J: A prospective randomized trial of heater probe thermocoagulation versus injection therapy in peptic ulcer hemorrhage. Gastrointest Endosc 1996;43:117–120.
    External Resources
  31. Liebermann D: Gastrointestinal bleeding: Initial management. Gastroenterol Clin North Am 1993;22:723–736.
    External Resources
  32. Laine L: Rolling review: Upper gastrointestinal bleeding. Aliment Pharmacol Ther 1993;7:207–232.
    External Resources
  33. Cormack F, Jouhar AJ, Chakrabarti RR, Fearnley GR: Tranexamic acid in upper gastrointestinal haemorrhage. Lancet 1973;i:1207–1208.
  34. Barer D, Ogilvie A, Henry D, Dornfield M, Coggon D, French S, Ellis S, Atkins M, Langman M: Cimetidine and tranexamic acid in treatment of acute upper gastrointestinal‐tract bleeding. N Engl J Med 1983;26:1571–1575.
  35. Lin HJ, Lo WC, Lee FY, Lee SD: A prospective randomized comparative trial showing that omeprazole prevents rebleeding in bleeding peptic ulcer patients after successful endoscopic therapy. DDW Abstract 1771, 1997.
  36. Bosch J, Kravetz D, Rodes J: Effect of somatostatin on hepatic and systemic hemodynamics in patients with cirrhosis of the liver. Comparison with vasopressin. Gastroenterology 1981;80:518–525.
    External Resources
  37. Bloom SR, Mortimer CH, Thorner MO, Besser GM, Hall R, Gomez‐Pan A: Inhibition of gastrin and gastric‐acid secretion by growth‐hormone release‐inhibiting hormone. Lancet 1974;ii:1106–1109.
  38. Johansson C, Aly A: Stimulation of gastric mucus output by somatostatin in man. Eur J Clin Invest 1982;12:37–39.
    External Resources
  39. Bloom SR, Russel RCG, Barros‐D’sa AAJ, Baron JH, Besser GM, Hall R, Coy H, Kastin AJ, Scholly AV: Inhibition of gastrin and gastric acid by growth hormone inhibiting hormone. Gut 1975;16:396–400.
  40. Arnold R, Creutzfeldt W: Hemmung der Pentagastrin‐induzierten Säuresekretion des Magens beim Menschen durch Somatostatin. Dtsch Med Wochenschr 1975;100:1014–1016.
    External Resources
  41. Johansson C, Wissen O, Kollberg B, Uvnäs‐Wallensten K, Efendic S: Effects of intragastrically administered somatostatin on basal and pentagastrin stimulated gastric acid secretion in man. Acta Physiol Scand 1978;104:232–234.
    External Resources
  42. Whitehouse I, Beglinger Ch, Fried M, Gyr K: The effect of octapeptide somatostatin analogue (SMS 201‐995) and Somatostatin‐14 (SST‐14) on pentagastrin‐stimulated gastric acid secretion: A comparative study in man. Hepatogastroenterologica 1984;31:227–229.
  43. Loud FB, Holst JJ, Egense E, Petersen B, Christiansen J: Is somatostatin a humoral regulator of the endocrine pancreas and gastric acid secretion in man? Gut 1985;26:445–449.
    External Resources
  44. Schrumpf E, Vatn MH, Hanssen KF, Myren J: A small dose of somatostatin inhibits the pentagastrin‐stimulated gastric secretion of acid, pepsin and intrinsic factor in man. Clin Endocrinol 1978;8:391–395.
  45. Thomas WEG: Somatostatin – The long lost antral chalone. Med Hypoth 1980;6:919–927.
  46. Wahren J, Felig P: Influence of somatostatin on carbohydrate disposal and absorption in diabetes mellitus. Lancet 1976;ii:1213–1216.
  47. Arnold R, Lankisch PG: Somatostatin and the gastrointestinal tract. Clin Gastroenterol 1980;9:733–753.
    External Resources
  48. Sonnenberg GE, Keller U, Perruchoud A, Burckhardt D, Gyr K: Effect of somatostatin on splanchnic hemodynamics in patients with cirrhosis of the liver and in normal subjects. Gastroenterology 1981;80:526–532.
    External Resources
  49. Kayasseh L, Gyr K, Keller U, Stalder GA, Wall M: Somatostatin and cimetidine in peptic‐ulcer haemorrhage: A randomised controlled trial. Lancet 1980;i:844–846.
  50. Basile M, Celi S, Parisi A, Castiglione N, Parisi S: Somatostatin in the treatment of severe gastrointestinal bleeding from peptic origin. A multicentric controlled trial. Ital J Surg Sci 1984;14:31–35.
    External Resources
  51. Coraggio F, Scarpato P, Spina M, Lombardi S: Somatostatin and ranitidine in the control of iatrogenic haemorrhage of the upper gastrointestinal tract. Br Med J 1984;289:224.
  52. Magnusson I, Ihre T, Johansson C, Seligson U, Törngren S, Uvnäs‐Moberg K: Randomised double‐blind trial of somatostatin in the treatment of massive upper gastrointestinal hemorrhage. Gut 1985;26:221–226.
    External Resources
  53. Antonioli A, Gandolfo M, Rigo GP, Bianchi Porro G, Cheli R, Brancato F, Lazzaroni M, Parodi MC, Maringhini A, Raimundo S, Manenti F: Somatostatin and cimetidine in the control of acute upper gastrointestinal bleeding. A controlled multicenter study. Hepatogastroenterology 1986;33:71–74.
    External Resources
  54. Torres AJ, Landa I, Hernandez F, Jover JM, Suarez A, Arias J, Cuberas R, Santoyo J, Fernandez R, Colleja J, Nisa E, Rodriquez JL, Moreno E, Balibrea JL: Somatostatin in the treatment of severe upper gastrointestinal bleeding. A multicentre controlled trial. Br J Surg 1986;73:786–789.
    External Resources
  55. Coraggio F, Bertini G, Catalano A, Scarpato P, Gualdieri L: Clinical controlled trial of somatostatin with ranitidine and placebo in the control of peptic hemorrhage of the upper gastrointestinal tract. Digestion 1989;43:190–195.
    External Resources
  56. Tulassay Z, Gupta R, Papp J, Bodnar A: Somatostatin versus cimetidine in the treatment of actively bleeding duodenal ulcer: A prospective, randomized controlled trial. Am J Gastroenterol 1989;84:6–9.
    External Resources
  57. Galmiche JP, Cassigneul J, Faivre J, Tranvouez JL, Ouvry D, Colin R, Pascal JP, Klepping C: Somatostatin in peptic ulcer bleeding – Results of a double‐blind controlled trial. Int J Clin Pharmacol Res 1983;3:379–387.
    External Resources
  58. Somerville KW, Henry DA, Davies JG, Hine KR, Hawkey CJ, Langman MJ: Somatostatin in the treatment of haemorrhage and melaena. Lancet 1985;i:130–132.
  59. Basso N, Bagarani M, Bracci F, Cucchiara G, Gizzonio D, Grassini G, Percoco M, Procacciante F, Toti F: Ranitidine and somatostatin. Their effects on bleeding from the upper gastrointestinal tract. Arch Surg 1986;121:833–835.
    External Resources
  60. Saperas E, Piqué JM, Pérez‐Ayuso R, Fuster F, Terés J, Bordas JM, Rodes J: Somatostatin compared with cimetidine in the treatment of bleeding peptic ulcer without visible vessel. Aliment Pharmacol Ther 1988;2:153–159.
    External Resources
  61. Bauer W, Briner U, Doepfner W, Haller R, Hugnenin R, Marbach P, Petcher TJ, Pless J: Octreotide: A very potent and selective octapeptide analogue of somatostatin with prolonged action. Life Sci 1982;31:1133–1140.
    External Resources
  62. Kutz K, Nüesch E, Rosenthaler J: Pharmacokinetics of SMS 201‐995 in healthy subjects. Scand J Gastroenterol 1986;21(suppl):65–72.
  63. Wahren J, Eriksson LS: The influence of a long‐acting somatostatin analogue on splanchnic haemodynamics and metabolism in healthy subjects and patients with liver cirrhosis. Scand J Gastroenterol 1986;21(suppl 119):103–108.
  64. Christiansen J, Yotis A: The role of somatostatin and a long‐acting analogue, SMS 201‐995, in acute bleeding due to peptic ulceration. Scand J Gastroenteol 1986;21(suppl 119):109–114.
  65. Christiansen J, Ottenjann R, Von Arx F: Placebo‐controlled trial with the somatostatin analogue SMS 201–995 in peptic ulcer bleeding. Gastroenterology 1989;97:568–574.
    External Resources
  66. Lin HJ, Perng CL, Wang K, Lee CH, Lee SD: Octreotide for arrest of peptic ulcer hemorrhage – A prospective, randomized controlled trial. Hepatogastroenterology 1995;42:856–860.
    External Resources
  67. Imperiale TF, Birgisson S: Somatostatin or octreotide compared with H2‐antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: A meta‐analysis. Ann Intern Med 1997;127:12:1062–1071.

Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: April 16, 1999
Issue release date: April 1999

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 6

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: https://www.karger.com/DIG

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1999, Vol.60, Suppl. 2

April 1999

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