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Critical Care Focus 9: The Gut - part 8

Tuy nhiên, các thử nghiệm này không chỉ giới hạn loét chảy máu và khả năng áp dụng các kết quả quản lý của viêm loét chảy máu là không chắc chắn. Tranexamic axit không được chấp thuận để điều trị chảy máu loét ở Anh. Obscure chảy máu đường tiêu hóa có thể được tiếp tục điều tra với nội soi | MEDICAL MANAGEMENT OF UPPER GASTROINTESTINAL HAEMORRHAGE need for surgery but overall mortality was decreased.37 However these trials were not confined to bleeding ulcers and as such the applicability of these results to the management of bleeding ulcers is uncertain. Tranexamic acid is not approved for the treatment of bleeding ulcers in the UK. Obscure GI bleeding may be further investigated with colonoscopy enteroscopy and angiography applying endoscopic haemostasis and embolisation respectively when required. Conclusions Acute upper gastrointestinal bleeding is a common reason for hospitalisation and also commonly occurs in critically ill patients already on the ICU. Overall mortality rates range from 5 to 15 patients with severe co-morbidities and those with persistent or recurrent bleeding are at highest risk. Accurate preliminary risk assessment and resuscitation should proceed simultaneously at initial presentation. Risk assessment can guide treatment decisions. Early upper GI endoscopy a cornerstone of management allows for rapid diagnosis application of endoscopic therapy and completion of risk assessment. Endoscopic therapy can alter the natural history of upper GI bleeding by reducing rates of further bleeding and consequently mortality. Complete risk assessment of both clinical and endoscopic factors may also result in shorter hospital stays and other improved outcomes. Limited data are available concerning the endoscopic findings and the effectiveness of endoscopic therapy versus surgery in reducing mortality in severely ill patients with bleeding that develops while in the hospital or the ICU. Critical care doctors must therefore make recommendations for their patients by extrapolating results of studies of patients admitted for bleeding. Because the mortality rate is so high in this population better knowledge of the probability of finding a lesion amenable to endoscopic therapy can help clinicians decide which therapeutic option is most .