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Akute gastrointestinale Blutungen

Acute gastrointestinal bleeding

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Zusammenfassung

Die akute gastrointestinale Blutung geht mit einer Letalität von 5–10% einher. Obere gastrointestinale Blutungen sind mit 85% häufiger und verlaufen schwerer als untere. Mit der Möglichkeit der endoskopischen Untersuchung des Dünndarms (Kapselendoskopie und Ballonenteroskopie) ist die Entität der mittleren gastrointestinalen Blutung etabliert, welche jedoch noch seltener ist. Anamnestische Hinweise helfen bei der Diagnose der Blutungsart. Die Prognose bzw. das Mortalitätsrisiko wird im Wesentlichen von der Blutungsintensität bestimmt. Zusätzlich beeinflussen Begleiterkrankungen, die Einnahme von Antikoagulanzien und das Alter des Patienten das Letalitätsrisiko, das besonders mit dem Auftreten von Rezidivblutungen steigt. Ein wesentliches Ziel in der Behandlung ist daher das Verhindern von Rezidivblutungen. Goldstandard für die Diagnose ist die Endoskopie, die eine gleichzeitige Therapie ermöglicht. Die Szintigraphie ist im Vergleich zur Angiographie im Nachweis einer Blutung sensitiver, bei der Lokalisation der Blutung ist sie jedoch unterlegen. Zusätzlich bietet die Angiographie auch die Möglichkeit der interventionellen Therapie. Ösophagusvarizenblutungen, die endoskopisch, medikamentös bzw. mittels Sonde nicht zu stillen sind, können mittels transjugulärem Stentshunt versorgt werden. Die Operation sollte bei allen akuten Blutungen nur bei Versagen der übrigen Methoden eingesetzt werden, da sie mit einer hohen Letalität assoziiert ist.

Abstract

Acute gastrointestinal bleeding is a life-threatening disease with a mortality rate of 5–10%. Upper gastrointestinal bleeding occurs more frequently (85%) and has a more severe course compared to lower gastrointestinal bleeding. By the introduction of new diagnostic avenues to examine the small bowel (capsule and balloon enteroscopy) the source of mid-gastrointestinal bleeding can be diagnosed more often, but bleeding of the small bowel is still a rare disease. The medical history may be helpful in the diagnosis of the bleeding source. Prognosis and mortality depend on bleeding intensity, presence of comorbidity, and age of the patient. Furthermore, rebleeding is associated with increased mortality. Therefore, one major goal in the treatment of gastrointestinal bleeding is to avoid rebleeding. Endoscopy is the gold standard in the diagnosis of acute gastrointestinal bleedings and allows endoscopic treatment if possible. Scintigraphy is more sensitive compared to angiography in the detection of the bleeding source; however, the localization of bleeding is more difficult. Furthermore, angiography offers the possibility of treating acute bleeding lesions. With the transjugular stent shunt it is possible to treat acute esophageal variceal bleeding if endoscopic or conservative treatment with drugs or tubes fails. Due to its high mortality rate, surgery is the last resort only if all other methods fail to treat acute bleedings.

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  1. III. Medizinische Klinik, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland

    S.K. Gölder & H. Messmann

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  1. S.K. Gölder
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  2. H. Messmann
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Correspondence to S.K. Gölder.

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Gölder, S., Messmann, H. Akute gastrointestinale Blutungen. Notfall Rettungsmed 13, 159–172 (2010). https://doi.org/10.1007/s10049-009-1192-3

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