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Gastroenterologie up2date 2018; 14(01): 43-61
DOI: 10.1055/s-0043-121449
Ösophagus/Magen/Duodenum
Georg Thieme Verlag KG Stuttgart · New York

Gastrointestinale Blutung

Alessandra Pohlmann
,
Jonel Trebicka
,
Martin Götz
,
Martina Steurer
Further Information

Publication History

Publication Date:
12 March 2018 (online)

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Correction to:

Erratum: Gastrointestinale BlutungGastroenterologie up2date 2018; 14(03): U3-U3
DOI: 10.1055/a-0628-2318

Gastrointestinale Blutungen sind insgesamt häufig – in ihrem klinischen Erscheinungsbild sind sie jedoch sehr unterschiedlich und sie bedürfen einer differenzierten Diagnostik und Therapie. Der folgende Artikel befasst sich mit dem Management, der Diagnostik und der Therapie gastrointestinaler Blutungen [1].
Kernaussagen

  • Die Kombination aus oraler Antikoagulation und einfacher bzw. dualer Thrombozytenaggregationshemmung erhöht das Risiko einer gastrointestinalen Blutung erheblich im Vergleich zu ausschließlicher oraler Antikoagulation.

  • Zur Einschätzung des individuellen Blutungsrisikos wird bei Erstdiagnose einer Leberzirrhose eine Gastroskopie empfohlen. Darauf kann nur verzichtet werden, wenn die Lebersteifigkeit in der transienten Elastografie unter 20 kPa liegt und die Thrombozytenzahl > 150000/µl beträgt.

  • Eine prophylaktische medikamentöse Therapie mit Betablockern ist beim Fehlen von Varizen nicht indiziert. Bei Varizen > 5 mm sollte immer eine Primärprophylaxe mit Betablockern oder Ligaturtherapie erfolgen.

  • Eine medikamentöse vasoaktive Therapie mit einem Vasopressin-Analogon ist bereits beim Verdacht auf eine akute Blutung aus Varizen oder im Rahmen einer portal-hypertensiven Gastropathie indiziert.

  • Außerdem sollte eine antibiotische Therapie begonnen und der Einsatz von Protonenpumpeninhibitoren erwogen werden. Anschließend muss so schnell wie möglich die endoskopische Versorgung angestrebt werden.

  • Bei primärem (Reblutung < 5 Tage nach initialer Blutstillung) oder sekundärem Therapieversagen (Reblutung > 5 Tage nach initialer Blutstillung) wird bei Hochrisikopatienten mit akuter Varizenblutung die Anlage eines TIPS empfohlen.

Schlüsselwörter

Ösophagusvarizen - portaler Hypertonus - transjugulärer portosystemischer Shunt
 

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