članak: 1 od 1  
Acta chirurgica iugoslavica
2007, vol. 54, br. 1, str. 9-20
jezik rada: srpski
stručni članak
doi:10.2298/ACI0701009P

Gastrointestinalno krvarenje - krvarenje iz gornjih delova digestivnog sistema
Univerzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije

Sažetak

Akutno krvarenje iz gornjih delova digestivnog sistema najčešće je urgentno stanje sa kojim se sreću gastroenterolozi. Kliničke manifestacije krvarenja zavise od mesta i intenziteta krvarenja kao i prisustva drugih bolesti. Manifestuje se povraćanjem krvi, rektalnim krvarenjem, i crnom katranastom stolicom. Endoskopska hemostaza značajno je unapredila prognozu ovih bolesnika, dok rano elektivno hirurško lečenje kod bolesnika kod kojih nije moguće uspostaviti hemostazu endoskopski ili kod kojih se krvarenje ponavlja, značajno smanjuju mortalitet ovih bolesnika. I pored značajnog napretka u endoskopskom i hirurškom lečenju u ovih bolesnika koje se ogleda prvenstveno u unapređenju pristupa ovim bolesnicima, mortalitet u slučaju krvarenja iz gornjih delova digestivnog sistema i dalje je veliki i iznosi između 6-15%.

Ključne reči

Reference

*** (1989) Consensus conference: Therapeutic endoscopy and bleeding ulcers. JAMA, 262(10): 1369-72
Blatchford, O., Murray, W.R., Blatchford, M. (2000) A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet, 356(9238): 1318-21
Bleau, B.L., Gostout, C.J., Sherman, K.E., Shaw, M.J., Harford, W.V., Keate, R.F., Bracy, W.P., Fleischer, D.E. (2002) Recurrent bleeding from peptic ulcer associated with adherent clot: A randomized study comparing endoscopic treatment with medical therapy. Gastrointest Endosc, 56(1): 1-6
Bordley, D.R., Mushlin, A.I., Dolan, J.G., Richardson, W.S., Barry, M., Polio, J., Griner, P.F. (1985) Early clinical signs identify low-risk patients with acute upper gastrointestinal hemorrhage. JAMA, 253(22): 3282-5
Brancatisano, R., Falk, G.L., Hollinshead, J.W., Gillet, D.J. (1992) Bleeding duodenal ulceration: The results of emergency treatment with highly selective vagotomy. Aust N Z J Surg, 62(9): 725-8
Branicki, F.J., Coleman, S.Y., Fok, P.J., Pritchett, C.J., Fan, S.T., Lai, E.C., Mok, F.P., Cheung, W.L., Lau, P.W., Tuen, H.H. (1990) Bleeding peptic ulcer: A prospective evaluation of risk factors for rebleeding and mortality. World J Surg, 14(2): 262-9; dis
British Society Gastroenterology Endoscopy Committee (2002) Non-variceal upper gastrointestinal haemorrhage: Guidelines. Gut, 51 Suppl 4 iv1-6
Brullet, E., Calvet, X., Campo, R., Rue, M., Catot, L., Donoso, L. (1996) Factors predicting failure of endoscopic injection therapy in bleeding duodenal ulcer. Gastrointest Endosc, 43(2 Pt 1): 111-6
Brullet, E., Campo, R., Calvet, X., Coroleu, D., Rivero, E., Simo, D.J. (1996) Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer. Gut, 39(2): 155-8
Buffoli, F., Graffeo, M., Nicosia, F., Gentile, C., Cesari, P., Rolfi, F., Paterlini, A. (2001) Peptic ulcer bleeding: Comparison of two hemostatic procedures. Am J Gastroenterol, 96(1): 89-94
Cameron, E.A., Pratap, N.J., Sims, T.J., Inman, S., Boyd, D., Ward, M., Middleton, S.J. (2002) Three-year prospective validation of a pre-endoscopic risk stratification in patients with acute upper-gastrointestinal haemorrhage. Eur J Gastroenterol Hepatol, 14(5): 497-501
Cardi, M., Muttillo, I.A., Amadori, L., Barillari, P., Sammartino, P., Arnone, F., Signorelli, C., Bolognese, A. (1997) Intravenous omeprazole versus ranitidine in the treatment of hemorrhagic duodenal ulcer: A prospective randomized study. Ann Chir, 51(2): 136-9
Cebollero-Santamaria, F., Smith, J., Gioe, S., van Frank, T., mc Call, R., Airhart, J., Perrillo, R. (1999) Selective outpatient management of upper gastrointestinal bleeding in the elderly. Am J Gastroenterol, 94(5): 1242-7
Chak, A., Cooper, G.S., Lloyd, L.E., Kolz, C.S., Barnhart, B.A., Wong, R.C. (2001) Effectiveness of endoscopy in patients admitted to the intensive care unit with upper GI hemorrhage. Gastrointest Endosc, 53(1): 6-13
Chau, C.H., Siu, W.T., Law, B.K.B., Tang, C.N., Kwok, S.Y., Luk, Y.W., Lao, W.C., Li, M.K.W. (2003) Randomized controlled trial comparing epinephrine injection plus heat probe coagulation versus epinephrine injection plus argon plasma coagulation for bleeding peptic ulcers. Gastrointest Endosc, 57(4): 455-61
Choudari, C.P., Elton, R.A., Palmer, K.R. (1995) Age-related mortality in patients treated endoscopically for bleeding peptic ulcer. Gastrointest Endosc, 41(6): 557-60
Chung, I.K., Ham, J.S., Kim, H.S., Park, S.H., Lee, M.H., Kim, S.J. (1999) Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc, 49(1): 13-8
Chung, I.K., Kim, E.J., Lee, M.S., Kim, H.S., Park, S.H., Lee, M.H., Kim, S.J., Cho, M.S., Hwang, K.Y. (2001) Endoscopic factors predisposing to rebleeding following endoscopic hemostasis in bleeding peptic ulcers. Endoscopy, 33(11): 969-75
Chung, S.S., Lau, J.Y., Sung, J.J., Chan, A.C., Lai, C.W., Ng, E.K., Chan, F.K., Yung, M.Y., Li, A.K. (1997) Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. BMJ, 314(7090): 1307-11
Cipolletta, L., Bianco, M.A., Rotondano, G., Marmo, R., Piscopo, R. (2002) Outpatient management for low-risk nonvariceal upper GI bleeding: A randomized controlled trial. Gastrointest Endosc, 55(1): 1-5
Cooper, G.S., Chak, A., Harper, D.L., Pine, M., Rosenthal, G.E. (1996) Care of patients with upper gastrointestinal hemorrhage in academic medical centers: A community-based comparison. Gastroenterology, 111(2): 385-90
Cooper, G.S., Chak, A., Way, L.E., Hammar, P.J., Harper, D.L., Rosenthal, G.E. (1998) Endoscopic practice for upper gastrointestinal hemorrhage: Differences between major teaching and community-based hospitals. Gastrointest Endosc, 48(4): 348-53
Cooper, G.S., Chak, A., Way, L.E., Hammar, P.J., Harper, D.L., Rosenthal, G.E. (1999) Early endoscopy in upper gastrointestinal hemorrhage: Associations with recurrent bleeding, surgery, and length of hospital stay. Gastrointest Endosc, 49(2): 145-52
Corley, D.A., Stefan, A.M., Wolf, M., Cook, E.F., Lee, T.H. (1998) Early indicators of prognosis in upper gastrointestinal hemorrhage. Am J Gastroenterol, 93(3): 336-40
Cuellar, R.E., Gavaler, J.S., Alexander, J.A., Brouillette, D.E., Chien, M.C., Yoo, Y.K., Rabinovitz, M., Stone, B.G., van Thiel, D.H. (1990) Gastrointestinal tract hemorrhage: The value of a nasogastric aspirate. Arch Intern Med, 150(7): 1381-4
Dulai, G.S., Gralnek, I.M., Oei, T.T., Chang, D., Alofaituli, G., Gornbein, J., Kahn, K. (2002) Utilization of health care resources for low-risk patients with acute, nonvariceal upper GI hemorrhage: An historical cohort study. Gastrointest Endosc, 55(3): 321-7
Eisen, G.M., Baron, T.H., Dominitz, J.A., Faigel, D.O., Goldstein, J.L., i dr. (2002) Methods of granting hospital privileges to perform gastrointestinal endoscopy. Gastrointest Endosc, 55(7): 780-3
Enns, R.A., Gagnon, Y.M., Rioux, K.P., Levy, A.R. (2003) Cost-effectiveness in Canada of intravenous proton pump inhibitors for all patients presenting with acute upper gastrointestinal bleeding. Aliment Pharmacol Ther, 17(2): 225-33
Fallah, M.A., Prakash, C., Edmundowicz, S. (2000) Acute gastrointestinal bleeding. Med Clin North Am, 84(5): 1183-208
Farrell, R.J., Alsahli, M., LaMont, J.T. (2000) Is successful triage of patients with upper-gastrointestinal bleeding possible without endoscopy?. Lancet, 356(9238): 1289-90
Forrest, J.A., Finlayson, N.D., Shearman, D.J. (1974) Endoscopy in gastrointestinal bleeding. Lancet, 2(7877): 394-7
Garrigues-Gil, V., Clamp, S.E., Morgan, A.G., Ohmann, C., Dombal, F.T. (1988) Do the stigmata of recent haemorrhage have additional prognostic value in patients with bleeding duodenal ulcer?. Scand J Gastroenterol Suppl, 144, 59-62
Gevers, A., de Goede, E., Simoens, M., Hiele, M., Rutgeerts, P. (2002) A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc, 55(4): 466-9
Ginsberg, G.G., Barkun, A.N., Bosco, J.J., Burdick, S.J., Isenberg, G.A., Nakao, N.L., Petersen, B.T., Silverman, W.B., Slivka, A., Kelsey, P.B., American Society for Gastrointestinal Endoscopy (2002) The argon plasma coagulator: February 2002. Gastrointest Endosc, 55(7): 807-10
Graham, D.Y., Hepps, K.S., Ramirez, F.C., Lew, G.M., Saeed, Z.A. (1993) Treatment of Helicobacter pylori reduces the rate of rebleeding in peptic ulcer disease. Scand J Gastroenterol, 28(11): 939-42
Guglielmi, A., Ruzzenente, A., Sandri, M., Kind, R., Lombardo, F., Rodella, L., Catalano, F., Manzoni, G., Cordiano, C. (2002) Risk assessment and prediction of rebleeding in bleeding gastroduodenal ulcer. Endoscopy, 34(10): 778-86
Haq, A., Khan, A., Modlin, I.M., Rosin, R.D. (2006) Surgery for upper gastrointestinal bleeding. u: From Gastrin to GERD, A Century of Acid Suppression. Felsenstein C.C.C.P., str. 382-411
Herrington, J.L., Davidson, J. (1987) Bleeding gastroduodenal ulcers: Choice of operations. World J Surg, 11(3): 304-14
Hsu, P.I., Lin, X.Z., Chan, S.H., Lin, C.Y., Chang, T.T., Shin, J.S., Hsu, L.Y., Yang, C.C., Chen, K.W. (1994) Bleeding peptic ulcer: Risk factors for rebleeding and sequential changes in endoscopic findings. Gut, 35(6): 746-9
Hussain, H., Lapin, S., Cappell, M.S. (2000) Clinical scoring systems for determining the prognosis of gastrointestinal bleeding. Gastroenterol Clin North Am, 29(2): 445-64
Jaramillo, J.L., Galvez, C., Carmona, C., Montero, J.L., Mino, G. (1994) Prediction of further hemorrhage in bleeding peptic ulcer. Am J Gastroenterol, 89(12): 2135-8
Jaspersen, D., Koerner, T., Schorr, W., Brennenstuhl, M., Raschka, C., Hammar, C.H. (1995) Helicobacter pylori eradication reduces the rate of rebleeding in ulcer hemorrhage. Gastrointest Endosc, 41(1): 5-7
Javid, G., Masoodi, I., Zargar, S.A., Khan, B.A., Yatoo, G.N., Shah, A.H., Gulzar, G.M., Sodhi, J.S. (2001) Omeprazole as adjuvant therapy to endoscopic combination injection sclerotherapy for treating bleeding peptic ulcer. Am J Med, 111(4): 280-4
Jensen, H.E., Hoffmann, J., Wille-Jorgensen, P. (1987) High gastric ulcer. World J Surg, 11(3): 325-32
Jiranek, G.C., Kozarek, R.A. (1996) A cost-effective approach to the patient with peptic ulcer bleeding. Surg Clin North Am, 76(1): 83-103
Jordan, P.H. (1991) Surgery for peptic ulcer disease. Curr Probl Surg, 28(4): 265-330
Jung, H.K., Son, H., Jung, S., Yi, S.Y., Yoo, K., Kim, D., Moon, I., Lee, H.C. (2002) Comparison of oral omeprazole and endoscopic ethanol injection therapy for prevention of recurrent bleeding from peptic ulcers with nonbleeding visible vessels or fresh adherent clots. Am J Gastroenterol, 97(7): 1736-40
Kaviani, M.J., Hashemi, M.R., Kazemifar, A.R., Roozitalab, S., Mostaghni, A.A., Merat, S., Alizadeh-Naini, M., Yarmohammadi, H. (2003) Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: A prospective, double-blind, randomized, clinical trial. Aliment Pharmacol Ther, 17(2): 211-6
Khuroo, M.S., Yattoo, G.N., Javid, G., Khan, B.A., Shah, A.A., Gulzar, G.M., Sodi, J.S. (1997) A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med, 336(15): 1054-8
Kollef, M.H., Brien, O.J.D., Zuckerman, G.R., Shannon, W. (1997) BLEED: A classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage. Crit Care Med, 25(7): 1125-32
Kubba, A.K., Choudari, C., Rajgopal, C., Palmer, K.R. (1996) The outcome of urgent surgery for major peptic ulcer haemorrhage following failed endoscopic therapy. Eur J Gastroenterol Hepatol, 8(12): 1175-8
Kubba, A.K., Choudari, C., Rajgopal, C., Ghosh, S., Palmer, K.R. (1997) Reduced long-term survival following major peptic ulcer haemorrhage. Br J Surg, 84(2): 265-8
Lai, K.C., Hui, W.M., Wong, B.C., Ching, C.K., Lam, S.K. (1997) A retrospective and prospective study on the safety of discharging selected patients with duodenal ulcer bleeding on the same day as endoscopy. Gastrointest Endosc, 45(1): 26-30
Lai, K.C., Hui, W.M., Wong, W.M., Wong, B.C., Hu, W.H., Ching, C.K., Lam, S.K. (2000) Treatment of Helicobacter pylori in patients with duodenal ulcer hemorrhage: A long-term randomized, controlled study. Am J Gastroenterol, 95(9): 2225-32
Lai, K.H., Peng, S.N., Guo, W.S., Lee, F.Y., Chang, F.Y., Malik, U., Wang, J.Y., Lo, G.H., Cheng, J.S., Lee, S.D. (1994) Endoscopic injection for the treatment of bleeding ulcers: Local tamponade or drug effect?. Endoscopy, 26(4): 338-41
Laine, L., Estrada, R. (2002) Randomized trial of normal saline solution injection versus bipolar electrocoagulation for treatment of patients with high-risk bleeding ulcers: Is local tamponade enough?. Gastrointest Endosc, 55(1): 6-10
Lau, J.Y., Sung, J.J., Lam, Y.H., Chan, A.C., Ng, E.K., Lee, D.W., Chan, F.K., Suen, R.C., Chung, S.C. (1999) Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med, 340(10): 751-6
Levine, J.E., Leontiadis, G.I., Sharma, V.K., Howden, C.W. (2002) Meta-analysis: The efficacy of intravenous H2-receptor antagonists in bleeding peptic ulcer. Aliment Pharmacol Ther, 16(6): 1137-42
Li, Y., Sha, W., Nie, Y., Wu, H., She, Q., Dai, S., Jia, L., Yu, W. (2000) Effect of intragastric pH on control of peptic ulcer bleeding. J Gastroenterol Hepatol, 15(2): 148-54
Lin, H.J., Lo, W.C., Lee, F.Y., Perng, C.L., Tseng, G.Y. (1998) A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy. Arch Intern Med, 158(1): 54-8
Lin, H.J., Wang, K., Perng, C.L., Lee, F.Y., Lee, C.H., Lee, S.D. (1996) Natural history of bleeding peptic ulcers with a tightly adherent blood clot: A prospective observation. Gastrointest Endosc, 43(5): 470-3
Lin, H.J., Wang, K., Perng, C.L., Chua, R.T., Lee, F.Y., Lee, C.H., Lee, S.D. (1996) Early or delayed endoscopy for patients with peptic ulcer bleeding. A prospective randomized study. J Clin Gastroenterol, 22(4): 267-71
MacSween, H.M. (1997) Canadian Association of Gastroenterology Practice Guideline for granting of privileges to perform gastrointestinal endoscopy. Can J Gastroenterol, 11(5): 429-32
Mahadeva, S., Linch, M., Hull, M.A. (2002) Variable use of endoscopic haemostasis in the management of bleeding peptic ulcers. Postgrad Med J, 78(920): 347-51
Marshall, J.K., Collins, S.M., Gafni, A. (1999) Prediction of resource utilization and case cost for acute nonvariceal upper gastrointestinal hemorrhage at a Canadian community hospital. Am J Gastroenterol, 94(7): 1841-6
Morris, D.L., Hawker, P.C., Brearley, S., Simms, M., Dykes, P.W., Keighley, M.R. (1984) Optimal timing of operation for bleeding peptic ulcer: Prospective randomised trial. Br Med J (Clin Res Ed), 288(6426): 1277-80
Park, K.G., Steele, R.J., Mollison, J., Crofts, T.J. (1994) Prediction of recurrent bleeding after endoscopic haemostasis in non-variceal upper gastrointestinal haemorrhage. Br J Surg, 81(10): 1465-8
Perng, C.L., Lin, H.J., Chen, C.J., Lee, F.Y., Lee, S.D., Lee, C.H. (1994) Characteristics of patients with bleeding peptic ulcer requiring emergency endoscopy and aggressive treatment. Am J Gastroenterol, 89(10): 1811-4
Peterson, W.L. (1990) Therapeutic endoscopy and bleeding ulcers. Clinical risk factors. Gastrointest Endosc, 36(5 Suppl): S14-5
Rockall, T.A., Logan, R.F., Devlin, H.B., Northfield, T.C. (1996) Risk assessment after acute upper gastrointestinal haemorrhage. Gut, 38(3): 316-21
Rockall, T.A., Logan, R.F., Devlin, H.B., Northfield, T.C. (1995) Variation in outcome after acute upper gastrointestinal haemorrhage. The National Audit of Acute Upper Gastrointestinal Haemorrhage. Lancet, 346(8971): 346-50
Rockall, T.A., Logan, R.F., Devlin, H.B., Northfield, T.C. (1995) Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom: Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ, 311(6999): 222-6
Rockall, T.A., Logan, R.F., Devlin, H.B., Northfield, T.C. (1997) Influencing the practice and outcome in acute upper gastrointestinal haemorrhage: Steering Committee of the National Audit of Acute Upper Gastrointestinal Haemorrhage. Gut, 41(5): 606-11
Rokkas, T., Karameris, A., Mavrogeorgis, A., Rallis, E., Giannikos, N. (1995) Eradication of Helicobacter pylori reduces the possibility of rebleeding in peptic ulcer disease. Gastrointest Endosc, 41(1): 1-4
Sacks, H.S., Chalmers, T.C., Blum, A.L., Berrier, J., Pagano, D. (1990) Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. JAMA, 264(4): 494-9
Saeed, Z.A., Winchester, C.B., Michaletz, P.A., Woods, K.L., Graham, D.Y. (1993) A scoring system to predict rebleeding after endoscopic therapy of nonvariceal upper gastrointestinal hemorrhage, with a comparison of heat probe and ethanol injection. Am J Gastroenterol, 88(11): 1842-9
Saeed, Z.A., Cole, R.A., Ramirez, F.C., Schneider, F.E., Hepps, K.S., Graham, D.Y. (1996) Endoscopic retreatment after successful initial hemostasis prevents ulcer rebleeding: A prospective randomized trial. Endoscopy, 28(3): 288-94
Sanders, D.S., Carter, M.J., Goodchap, R.J., Cross, S.S., Gleeson, D.C., Lobo, A.J. (2002) Prospective validation of the Rockall risk scoring system for upper GI hemorrhage in subgroups of patients with varices and peptic ulcers. Am J Gastroenterol, 97(3): 630-5
Sanderson, J.D., Taylor, R.F., Pugh, S., Vicary, F.R. (1990) Specialized gastrointestinal units for the management of upper gastrointestinal haemorrhage. Postgrad Med J, 66(778): 654-6
Saperas, E., Pique, J.M., Perez, A.R., Bordas, J.M., Teres, J., Pera, C. (1987) Conservative management of bleeding duodenal ulcer without a visible vessel: Prospective randomized trial. Br J Surg, 74(9): 784-6
Schoenberg, M.H. (2001) Surgical therapy for peptic ulcer and nonvariceal bleeding. Langenbecks Arch Surg, 386(2): 98-103
Schoenberg, M.H., Birk, D., Beckh, K., Stange, E.F., Frohneiser, E., Adler, G., Beger, H.G. (1995) Endoscopic and surgical therapy of hemorrhagic duodenal and stomach ulcer. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen, Vol. 66, No. 4, pp. 326-33
Sharma, V.K., Sahai, A.V., Corder, F.A., Howden, C.W. (2001) Helicobacter pylori eradication is superior to ulcer healing with or without maintenance therapy to prevent further ulcer haemorrhage. Aliment Pharmacol Ther, 15(12): 1939-47
Siewert, J.R., Bumm, R., Holscher, A.H., Ditter, H.J. (1989) Obere gastro intestinale Ulkusblutung-Letalitatssenkung durch fruhelektive chirurgisce Therapie von Risikopatienten von Risikopatienten. Dtsch Med Wichenschr, 114, str. 447-52
Spiegel, B.M., Vakil, N.B., Ofman, J.J. (2001) Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: Is sooner better? A systematic review. Arch Intern Med, 161(11): 1393-404
Sung, J.J.Y., Chan, F.K.L., Lau, J.Y.W., Yung, M., Leung, W., Wu, J.C.Y., Ng, E.K.W., Chung, S.S.C. (2003) The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: A randomized comparison. Ann Intern Med, 139(4): 237-43
Udd, M., Miettinen, P., Palmu, A., Heikkinen, M., Janatuinen, E., Pasanen, P., Tarvainen, R., Kairaluoma, M.V., Lohman, M., Mustonen, H., Julkunen, R. (2001) Regular-dose versus high-dose omeprazole in peptic ulcer bleeding: A prospective randomized double-blind study. Scand J Gastroenterol, 36(12): 1332-8
Villanueva, C., Balanzo, J., Espinos, J.C., Domenech, J.M., Sainz, S., Call, J., Vilardell, F. (1993) Prediction of therapeutic failure in patients with bleeding peptic ulcer treated with endoscopic injection. Dig Dis Sci, 38(11): 2062-70
Villanueva, C., Balanzo, J., Torras, X., Soriano, G., Sainz, S., Vilardell, F. (1994) Value of second-look endoscopy after injection therapy for bleeding peptic ulcer: A prospective and randomized trial. Gastrointest Endosc, 40(1): 34-9
Vreeburg, E.M., Snel, P., de Bruijne, J.W., Bartelsman, J.F., Rauws, E.A., Tytgat, G.N. (1997) Acute upper gastrointestinal bleeding in the Amsterdam area: Incidence, diagnosis, and clinical outcome. Am J Gastroenterol, 92(2): 236-43
Working Party Report (2001) Provision of endoscopy related services in District General Hospitals. London: British Society of Gastroenterology
Zimmerman, J., Meroz, Y., Arnon, R., Tsvang, E., Siguencia, J. (1995) Predictors of mortality in hospitalized patients with secondary upper gastrointestinal haemorrhage. Journal of internal medicine, Vol. 237, No. 3, pp. 331-7
Zimmerman, J., Siguencia, J., Tsvang, E., Beeri, R., Arnon, R. (1995) Predictors of mortality in patients admitted to hospital for acute upper gastrointestinal hemorrhage. Scandinavian journal of gastroenterology, Vol. 30, No. 4, pp. 327-31