Vol. 12. Núm. 2.
Páginas 82-91 (Febrero 2016)

Actualización
Hemorragia digestiva alta no varicosa

Nonvaricose upper gastrointestinal bleeding

M. BetésM. Muñoz-Navas
Doi : https://10.1016/j.med.2016.01.013
Opciones
Resumen
Etiopatogenia

La patologia ulcerosa es la principal causa de hemorragia digestiva alta no varicosa (originada por encima del angulo de Treitz), aunque existen muchas otras.

 Diagnóstico

Ante la sospecha clinica, se debe confirmar la presencia de la hemorragia, evaluar la magnitud del sangrado, comprobar si la hemorragia persiste activa, descartar que pueda ser causada por hipertension portal y establecer el pronostico.

 Tratamiento

Las medidas de reanimacion prevalecen sobre cualquier otra actitud medica. Se recomienda utilizar escalas clinicas para estratificar a los pacientes precozmente, suprimir la secrecion gastrica de acido y conocer el manejo de medicamentos que pueden modificar el curso de la hemorragia o estar relacionados con su inicio.

 Endoscopia

Salvo en un pequeno grupo de pacientes de muy bajo riesgo, se aconseja realizar una endoscopia en las primeras 24 horas, identificando los casos que pueden beneficiarse de un alta precoz y seleccionando los que requieren terapeutica endoscopica, aplicando las tecnicas oportunas en cada caso. El paciente tratado endoscopicamente requiere un ingreso minimo de 72 horas. En caso de fracaso terapeutico puede estar indicado un tratamiento angiografico o quirurgico.

Palabras clave
Hemorragia digestiva alta
Terapéutica endoscópica
Hematemesis
Melenas
Abstract
Aetiopathogenesis

Ulcerative disease is the main cause of nonvariceal upper gastrointestinal haemorrhage (originating above the angle of Treitz), although there are many other causes.

 Diagnosis

If haemorrhage is suspected, clinicians should confirm its presence, assess the magnitude of the bleeding, determine whether the haemorrhage remains active, rule out portal hypertension as the cause and establish the prognosis.

 Treatment

Resuscitation measures prevail over any other medical approach. Clinical scales should be employed to stratify patients early, gastric acid secretion needs to be suppressed, and the management of drugs that can change the course of the haemorrhage or are related to its onset needs to be understood.

 Endoscopy

Except for a small group of patients at very low risk, it is advisable to conduct an endoscopy in the first 24hours, identify the patients who can benefit from early discharge and select those who require endoscopic therapy, applying the appropriate technique in each case. Patients treated endoscopically require a minimum hospital stay of 72hours. In the event of treatment failure, angiographic treatment or surgery might be indicated.

Keywords
Upper gastrointestinal haemorrhage
Endoscopic therapy
Haematemesis
Melena

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