Is there any cure for internal bleeding

Bleeding in the gastrointestinal tract

Around three quarters of all bleeding in the gastrointestinal tract affects the upper gastrointestinal tract. Many are associated with non-steroidal anti-inflammatory drug (NSAID) treatment.

The gastroduodenal ulcer is by far the most common source of bleeding; the second most common cause is varicose veins in the esophagus and gastric fundus (esophageal and fundic varices). For example, tears in the mucous membrane in the border area between the stomach and esophagus, the so-called Mallory-Weiss lesions, are significantly less common. Thanks to the eradication treatment for Helicobacter pylori (see box), the frequency of bleeding in the upper gastrointestinal tract is slightly reduced, informed Professor Dr. Christian Ell from the Dr. Horst Schmidt Clinics in Wiesbaden at the German Congress of Internists in Wiesbaden at the beginning of May.

In contrast, bleeding in the lower gastrointestinal tract (colon, terminal ileum), which makes up around 20 percent of all bleeding, has increased. Ell sees a trend towards increased diverticular bleeding of the colon. The older age of the patients is responsible for this. "A connection with the increased use of NSAIDs in old age is likely," said Ell. Vascular malformations (angiodysplasias) in the colon, colon or rectal carcinomas and hemorrhoids are also possible sources of bleeding in the lower gastrointestinal tract.

The cases formerly known as "obscure bleeding" can now be clearly localized in the middle gastrointestinal region. They are rare and only make up around 5 percent of all diseases. Possible causes are ulcerations (Crohn's disease), angiodysplasias or polyps.

Typical symptoms of gastrointestinal bleeding are vomiting of blood and / or tarry or blood stools. If a patient experiences blood in the vomit or stool, they should see a doctor or go to the hospital immediately. Depending on how long it remains in the stomach, the vomited blood can be red or black-brown ("like coffee grounds", due to the formation of hematin after contact with gastric juice). Possible side reactions - depending on the intensity of the blood loss - are pale skin, circulatory problems or physical weakness.

Profuse bleeding can even lead to hypovolemic shock with tachycardia and hypotension. The stabilization of the circulatory system through electrolyte solutions, colloidal solutions and blood transfusions then comes first after admission to the hospital. In order to find out where the bleeding is localized, what its cause is and how severe it is, doctors examine the patient not only physically, but usually also endoscopically.

In the majority of patients, internal bleeding stops spontaneously within two days. If not, endoscopic hemostasis is the method of choice. Around 80 to 90 percent of all patients are initially treated endoscopically, for example with the injection of adrenaline, clipping or laser coagulation. If a relapse occurs, he usually treats again endoscopically, added Ell. Only then does he use radiological and, as a last resort, surgical therapy.

Only in the case of variceal bleeding does systemic drug therapy with vasoconstrictors have a place in addition to an endoscopic procedure. Commonly used are the hormone vasopressin and its synthetic analogue terlipressin, as well as somatostatin and analogues such as octreotide. The goal of treating esophageal variceal bleeding is to relieve pressure in the portal vein. This can be achieved by reducing the portal venous blood flow and / or the portal venous resistance.

In contrast to variceal bleeding, ulcer bleeding is arterial bleeding. The vasoconstrictors mentioned are of no use here. The same applies to high-dose therapy with proton pump inhibitors. "This won't stop the bleeding," Ell said./