Terapija manifestnog krvavljenja iz gornjeg dela digestivnog trakta uzrokovanog uzimanjem nesteroidnih antiinflamatornih lekova (NSAIL)

Introduction: The risk of upper gastrointestinal tract bleeding in the patients taking NSAID estimates 1% per year. Bleeding stops spontaneously in approximately 80% of all cases. Persistent and repeated bleeding (expecialy during the initial hospitalization ) still represent the serious clinical problem . In this group of patients, mortality rate is between 6-10 % , which in the USA counts 10- 20000 patients per year. Aim of the Study: The purpose of this review is to update the current knowledge of the use of different therapeutic strategies in patients with NSAID induced upper gastrointestinal bleeding. Results: Proton pump inhibitors (PPI) therapy is effective as a prevention of NSAID induced acidopeptic lesions, and also represents the first and best therapeutic option for the treatment of complications, such as upper gastrointestinal bleeding. In the last three decades use of early flexibile (diagnostic and therapeutic) endoscopy, agressive acidosupression (PPIs), and surgical treatment in restrictive indications, resulted in decreasing of the mortality rates from 25-35 % to 6-10%. When PPIs and flexible endoscopy are not sufficient in the control of upper gastrointestinal bleeding, use of systemic hemostatic drugs could be taken into consideration. Conclusion: Multidisciplinary approach, precise diagnostic and therapeutic criteria would probably result in better outcome of patients with active upper gastrointestinal bleeding. Uvod: Rizik krvavljenja iz gornjih partija digestivnog trakta, kod bolesnika na terapiji nesteroidnim antiinflamatornim lekovima (NSAIL) iznosi 1% godisnje. Cak 80% krvavljenja spontano prestane. Medjutim, perzistento i ponovljeno krvavljenje (posebno u toku iste hospitalizacije) predstavlja ozbiljan klinicki problem. U ovoj grupi bolesnika smrtnost se krece u rasponu od 6 - 10%, sto samo u USA, iznosi 10 - 20.000 osoba godisnje. Cilj rada: Svrha ovog revijalnog rada je da prikaze aktuelna iskustva lecenju krvavljenja iz gastrointestinalnog trakta izazvanog upotrebom NSAIL. Rezultati: Terapija inhibitorima protonske pumpe je efikasna ne samo u prevenciji acidopepticnog ostecenja kod bolesnika koji uzimaju nesteroidne antiinflamatorne lekove, vec predstavlja prvu i najbolju terapijsku opciju komplikacija, kao sto je krvavljenje. Uvodjenjem u klinicku praksu rane gornje fleksibilne endoskopije i inhibitora protonske pumpe, kao i definisanjem indikacija za operativno lecenje mortalitet je, kod bolesnika sa aktivnim krvavljenjem iz