ACUTE GASTROINTESTINAL BLEEDING

Transcription

1 ACUTE GASTROINTESTINAL BLEEDING

2 CLINICAL GASTROENTEROLOGY George Y. Wu, SERIES EDITOR Acute Gastrointestinal Bleeding: Diagnosis and Treatment, edited by Karen E. Kim, 2003 Inflammatory Bowel Disease: Diagnosis and Therapeutics, edited by Russell D. Cohen, 2003 An Internist's Illustrated Guide to Gastrointestinal Surgery, edited by George Y. Wu, Khalid Aziz, Lily H. Fiduccia, and Giles F. Whalen, 2003 Chronic Viral Hepatitis: Diagnosis and Therapeutics, edited by Raymond S. Koff and George Y. Wu, 2001 Diseases of the Gastroesophageal Mucosa: The Acid-Related Disorders, edited by James W. Freston, 2001

3 ACUTE GAsTROINTESTINAL BLEEDING DIAGNOSIS AND TREATMENT Edited by KAREN E. KIM, MD University of Chicago Hospitals, Chicago, II ~ HUMANA PRESS ~ TOTOWA, NEW JERSEY

4 2003 Humana Press Inc. Softcover reprint of the hardcover 1 st edition Riverview Drive, Suite 208 Totowa, New Jersey humanapress.com For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel: ; Fax: ; humana@humanapr.com or visit our Website at All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to ensure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. This publication is printed on acid-free paper.g ANSI Z (American National Standards Institute) Permanence of Paper for Printed Library Materials. Production Editor: Robin B. Weisberg. Cover Illustration: From Figs. 5B, 9A, and 13A in Chapter 14, "Radiologic Evaluation and Intervention in the Acute Gastrointestinal Bleed" by Charles A. Owens and Fig. 4 in Chapter 2, "Non variceal Esophageal Bleeding" by Christian Stevoff and Ikuo Hirano. Cover design by Patricia F. Cleary. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $20.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [ /03 $20.00J. Acute gastrointestinal bleeding: diagnosis and treatment 1 edited by Karen E. Kim. p. ; cm. -- (Clinical gastroenterology) Includes bibliographical references and index. ISBN ISBN (ebook) DOI / I. Gastrointestinal hemorrhage. l. Kim, Karen E. II. Series. [DNLM: I. Gastrointestinal Hemorrhage--diagnosis. 2. Gastrointestinal Hemorrhage--therapy. WI 143 A ] RC840.H44 A '3--dc

5 DEDICATION This book is dedicated to the memory of my mother, Sung-Ok Hong. K.E.K.

6 PREFACE Gastrointestinal (GI) bleeding is an extremely common clinical problem resulting in more than 300,000 hospitalizations annually in the United States. The overall incidence of upper GI bleeding is approximately 125 hospitalizations for every 100,000 people, with a male to female ratio of 2/1. Lower GI bleeding is far less common. Interestingly, the mortality from upper GI bleeding has remained stable at 10% over the past 45 years, despite improved diagnosis and newer therapeutic modalities, although this may reflect, at least in part, the aging population with a significantly higher GI bleeding mortality. Fortunately, the mortality from lower GI bleeding has decreased dramatically, despite the higher risk among the aging population owing, in large part, to early detection and intervention. Although GI bleeding can be acute or chronic, mortality from acute GI bleeding is much greater than that for chronic bleeding. Therefore, it is important to understand the pathogenesis of acute GI bleeding, with an emphasis on early detection, prevention, and intervention, in order to minimize morbidity and mortality. Acute Gastrointestinal Bleeding: Diagnosis and Treatment covers a wide range of topics, with particular emphasis on the pathophysiology, diagnosis, management, and treatment of various acute bleeding disorders. The general approaches to the acute GI bleeding patient are discussed in terms of supportive care, early detection and determination of upper vs lower GI bleed, when to transfuse, as well as early predictors of morbidity and mortality. Outlined in this volume are the many dilemmas faced by physicians in the approach to the acute GI bleeding patient, such as localization of the bleeding source (upper vs lower), the need and timing for emergent endoscopy, and the timing for radiologic intervention and/or surgery. The emphasis throughout is on patient management, diagnostic measures, and treatment modalities. Diagnostic and treatment algorithms for acute GI bleeding determined by evidence-based medicine and standard-of-care issues are included. We hope that this book serves as a useful reference for both primary care physicians as well as gastroenterologists. Karen E. Kim, MD vii

7 CONTENTS Preface... vii List of Contributors... xi PART I. EPIDEMIOLOGY 1 Epidemiology of Acute Gastrointestinal Bleeding... 3 Phillip Chung and Karen E. Kim PART II. UPPER GASTROINTESTINAL BLEEDING 2 Nonvariceal Esophageal Bleeding Christian Stevoff and Ikuo Hirano 3 Helicobacter pylori and Peptic Ulcer Disease Gregory M. Bolduc and David A. Peura 4 Medical Therapy for Stress Ulcer Prophylaxis: When and With What? Robert S. Bresalier 5 Nonsteroidal Antiinflammatory Drug (NSAID)-Induced Gastropathy James M. Scheiman 6 Portal Hypertensive Acute Gastrointestinal Bleeding Thomas W. Faust and Paul T. Kefalides 7 Obscure Causes of Upper Gastrointestinal Bleeding Hemant K. Roy and Nuri Ozden 8 Surgical Approach to Acute Upper Gastrointestinal Bleeding George A. Sarosi, Jr. and Robert V. Rege ix

8 x Contents PART III. LOWER GASTROINTESTINAL BLEEDING 9 Infectious and Inflammatory Causes of Acute Gastrointestinal Bleeding Nina Merel and Sunanda Kane 10 Acute Bleeding from Diverticulosis and Ischemic Colitis Joseph J. Vicari and James T. Frakes 11 Radiation Proctopathy and Anorectal Diseases Jeffrey L. Barnett and Leonard G. Quallich 12 Obscure Causes of Acute Lower Gastrointestinal Bleeding Russell F. Jacoby 13 Surgical Approach to Acute Lower Gastrointestinal Bleeding Sharon G. Gregorcyk and Robert V. Rege 14 Radiologic Evaluation and Intervention in the Acute Gastrointestinal Bleed Charles A. Owens Index

9 CONTRIBUTORS JEFFREY L. BARNETT, MD Huron Gastroenterology Associates, Ypsilanti, MI GREGORY M. BOLDUC, MD Department oj Gastroenterology and Hepatology, University oj Virginia Health Sciences System, Charlottesville, VA ROBERT S. BRESALIER, MD Department oj Gastrointestinal Medicine and Nutrition, The University oj Texas M.D. Anderson Cancer Center, Houston, TX PHILLIP CHUNG, MD Section oj Gastroenterology, University oj Chicago Hospitals, Chicago, IL THOMAS W. FAUST, MD Division oj Gastroenterology, Department oj Medicine, The University oj Pennsylvania Health System, Philadelphia, PA JAMES T. FRAKES, MD Rockford Gastroenterology Associates, Ltd., RockJord, IL SHARON G. GREGORCYK, MD Division oj Gastrointestinal/Endocrine Surgery, Department oj Surgery, University oj Texas Southwestern Medical Center, Dallas, TX IKUO HIRANO, MD Department oj Medicine, Northwestern University Medical School, Chicago, IL RUSSELL F. JACOBY, MD Colon Cancer Prevention Program, Section oj Gastroenterology, University oj Wisconsin Medical School, Madison, WI SUNANDA KANE, MD Section oj Gastroenterology, University oj Chicago Medical Center, Chicago, IL PAUL T. KEFALIDES, MD Section oj Gastroenterology, University oj Chicago Medical Center, Chicago, IL KAREN E. KIM, MD Section oj Gastroenterology, University oj Chicago Hospitals, Chicago, IL NINA MEREL, MD Section oj Gastroenterology, University oj Chicago Hospitals, Chicago, IL CHARLES A. OWENS, MD Department oj Radiology, University oj Illinois Medical Center, Chicago, IL NURI OZOEN, MD Division oj Gastroenterology and Hepatology, University oj Nebraska Medical Center, Omaha, NE DAVID A. PEURA, MD Department oj Gastroenterology and Hepatology, University oj Virginia Health Sciences System, Charlottesville, VA LEONARD G. QUALLICH, MD Troy Gastroenterology Pc, Center Jor Digestive Health, Troy, MI xi

10 xii Contributors ROBERT V. REGE, MD Department oj Surgery, University oj Texas Southwestern Medical Center, Dallas, TX HEMANT K. Roy, MD Division oj Gastroenterology and Hepatology, University oj Nebraska Medical Center, Omaha, NE GEORGE A. SAROSI, JR., MD Division oj Gastrointestinal/Endocrine Surgery, Department oj Surgery, University oj Texas Southwestern Medical Center, Dallas, TX JAMES M. SCHEIMAN, MD Division oj Gastroenterology, Department oj Medicine, University oj Michigan Medical Center, Ann Arbor, MI CHRISTIAN STEVOFF, MD Department oj Medicine, Northwestern University Medical School, Chicago, IL JOSEPH J. VICARI, MD Rocliford Gastroenterology Associates, Ltd., Rocliford, IL