Akut üst gastrointestinal sistem kanamalari:
230 olgunun analizi
Acute upper gastrointestinal bleeding: Analysis of 230 cases
Özet
Akut üst gastrointestinal kanamalar, hastaneye yatan hastalar arasinda mortalite ve morbiditenin önemli nedenlerinden biridir. Tani ve tedavideki tüm gelismelere ragmen günümüzde acil birimlerine üst gastrointestinal kanama ile basvuran hastalarin %2-10’u kaybedilmektedir. Bu çalismada servisimize üst gastrointestinal kanama tanisiyla yatirilan hastalarin klinik ve laboratuvar özelliklerini, risk faktörlerini ve endoskopik bulgularini inceleyerek literatür esliginde sunduk. Gereç ve yöntem: 2002 Haziran ve 2005 Ocak tarihleri arasinda klinigimize üst gastrointestinal kanama tanisiyla yatirilan hastalarin dosya bilgileri retrospektif olarak incelendi. Bulgular: Çalismaya alinan 230 hastanin %71.3’ü erkekti. Yas ortalamasi 52.4±19.4 yil olarak saptandi. 91 hastada en az bir ek hastalik mevcuttu ve ilk siralarda hipertansiyon (%46.2) ile diabetes mellitus (%22) geliyordu. Hastalarin kullandigi ilaçlar arasi nda non-steroid anti-inflamatuvar ilaçlar %96.8 (n=122) ile ilk siradaydi. En sik kullanilan non-steroid anti-inflamatuvar ilaçlar ise aspirin (%69.7) ve naproksen (%18.0)’di. 163 hastaya üst gastrointestinal sistem endoskopisi, 24 hastaya endoskopik tedavi uygulanmisti. Hastalarin %10’unda nüks kanama meydana gelmisti. Endoskopi yapilan hastalarda en sik saptanan lezyonlar eroziv gastrit (%56.4) ve duodenal ülser (%47.2) olarak tespit edildi. 213 hasta (%92.6) medikal tedaviyle taburcu olurken, 2 hasta (%0.9) cerrahi girisime verildi, 13 hasta (%5.7) eksitus oldu. Eksitus olan 13 hastanin 9’u 60 yasin üzerindeydi ve ek hastali klari mevcuttu, 10 hasta hematemezle basvurmustu. Sonuç: Non-steroid anti-inflamatuvar ilaç kullanimi üst gastrointestinal kanamali hastalarda yüksek sikliga sahiptir. Kanama nüksü, özellikle yasli hastalarda ve özofagus varisi olanlarda sik görülmekte olup yüksek mortaliteyle seyretmektedir. Yasli hastalarda üst gastrointestinal kanama riski açisindan non-steroid anti-inflamatuvar ilaç kullanimina dikkat edilmeli, ek olarak mutlaka gastroprotektif tedavi verilmelidir. Mortalite ve nüks kanama riski yüksek hastalarda hizla tedaviye baslanmali ve erken endoskopi planlanmalidir.
Abstract
Acute upper gastrointestinal bleeding is one of the most important causes of mortality and morbidity in hospitalized patients. 2-10% of patients with upper gastrointestinal bleeding who are admitted to the emergency department die despite major developments in diagnosis and treatment methods. In this study, patients with upper gastrointestinal bleeding who were admitted to our clinic were assessed for their clinical and laboratory features, risk factors and endoscopy findings in association with the literature. Materials and methods: The patients with upper gastrointestinal bleeding who were admitted to our clinic between June 2002 and January 2005 were examined retrospectively. Results: Among 230 patients who were recruited for the study group, 71.3% of cases were male. The mean age of the group was 52.4 ± 19.4. Ninety-one patients had at least one accompanying disease, with hypertension (46.2%) and diabetes mellitus (22%) the most common. The most commonly used drugs were NSAIDs (96.8%). Aspirin (69.7%) and naproxen (18.0%) use was found to be more frequent. Upper gastrointestinal system endoscopy was performed in 163 patients and 24 patients received endoscopic therapy. Rebleeding was seen in 10% of patients. The most frequently observed endoscopic lesions were erosive gastritis (56.4%) and duodenal ulcus (47.2%). Two hundred and thirteen patients (92.6%) were discharged with medical treatment, 2 patients (0.9%) required surgery, and 13 patients (5.7%) died. Of the 13 patients who died, 9 were over the age of 60 and had additional comorbidities and 10 had hematemesis at the time of admission. Conclusions: History of NSAID use was found to be common in patients with upper gastrointestinal bleeding. Rebleeding was most commonly observed in the elderly and was frequently associated with presence of variceal bleeding, and it carries a high mortality rate. Especially in elderly patients, increased risk of upper gastrointestinal bleeding should be taken into consideration when prescribing NSAIDs. Additionally, gastroprotective treatment should be given. In patients with a high risk of mortality and rebleeding, treatment should be applied immediately and early endoscopic procedure should be considered whenever possible.
