Acute Gastrointestinal Bleeding: Diagnosis and Treatment

279 Pages·2003·5.832 MB·English

by  Phillip Chung MD, Karen E. Kim MS, MD (auth.), Karen E. Kim MD (eds.)

ACUTE GASTROINTESTINAL BLEEDING
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
ACUTE
GAsTROINTESTINAL
BLEEDING
DIAGNOSIS AND TREATMENT
Edited by
KAREN E. KIM,
MD
University ofC hicago Hospitals,
Chicago, II
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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.
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Acute gastrointestinal bleeding: diagnosis and treatment 1 edited by Karen E. Kim.
p. ; cm. --(Clinical gastroenterology)
Includes bibliographical references and index.
ISBN 978-1-4684-9723-6 ISBN 978-1-59259-299-9 (eBook)
DOI 10.1007/978-1-59259-299-9
I. Gastrointestinal hemorrhage. l. Kim, Karen E. II. Series.
[DNLM: I. Gastrointestinal Hemorrhage--diagnosis. 2. Gastrointestinal Hemorrhage--therapy. WI 143
A1892003]
RC840.H44 A28 2003
616.3 '3--dc21 2002027353
DEDICATION
This book is dedicated to the memory of my mother, Sung-Ok Hong.
K.E.K.
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 hospitaliza
tions 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 bleed
ing has remained stable at 10% over the past 45 years, despite improved diag
nosis 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 bleed
ing. Therefore, it is important to understand the pathogenesis of acute GI bleed
ing, 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 support
ive 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 (up
per 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
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 .................................. 11
Christian Stevoff and Ikuo Hirano
3 Helicobacter pylori and Peptic Ulcer Disease ............... 35
Gregory M. Bolduc and David A. Peura
4 Medical Therapy for Stress Ulcer Prophylaxis:
When and With What? ................................................... 57
Robert S. Bresalier
5 Nonsteroidal Antiinflammatory Drug
(NSAID)-Induced Gastropathy .................................... 75
James M. Scheiman
6 Portal Hypertensive Acute Gastrointestinal
Bleeding ......................................................................... 97
Thomas W. Faust and Paul T. Kefalides
7 Obscure Causes of Upper Gastrointestinal
Bleeding ....................................................................... 111
Hemant K. Roy and Nuri Ozden
8 Surgical Approach to Acute Upper
Gastrointestinal Bleeding .......................................... 135
George A. Sarosi, Jr. and Robert V. Rege
ix
x Contents
PART III. LOWER GASTROINTESTINAL BLEEDING
9 Infectious and Inflammatory Causes of Acute
Gastrointestinal Bleeding .......................................... 151
Nina Merel and Sunanda Kane
10 Acute Bleeding from Diverticulosis
and Ischemic Colitis ................................................... 163
Joseph J. Vicari and James T. Frakes
11 Radiation Proctopathy and Anorectal Diseases ......... 175
Jeffrey L. Barnett and Leonard G. Quallich
12 Obscure Causes of Acute Lower Gastrointestinal
Bleeding ....................................................................... 199
Russell F. Jacoby
13 Surgical Approach to Acute Lower
Gastrointestinal Bleeding .......................................... 219
Sharon G. Gregorcyk and Robert V. Rege
14 Radiologic Evaluation and Intervention
in the Acute Gastrointestinal Bleed ......................... 233
Charles A. Owens
Index ......................................................................................... 269
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
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