Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

Gastrointestinal Bleeding Gastropathy 617

■For atypical ulcers (distal duodenum, occurrence while on therapy,

etc) – consider Zollinger-Ellison syndrome – draw fasting serum gas-

tric levels

■For patients not biopsied for H. pylori, consider C14 or C13 urea

breath test to confirm presence of H. pylori

■Gastric ulcers should be re-examined by endoscopy after 10–12

weeks; patients with other non-variceal bleeding lesions need not

be re-endoscoped

■Proton pump or H2 blockers therapy will likely be necessary indefi-

nitely for patients with reflux esophagitis

complications and prognosis

■Upper GI bleeding – major problem is rebleeding – more common

with patients in whom “visible vessel” noted on initial endoscopy;

rebleeding also more common for gastric ulcers, vascular ectasias

■Marked reduction in recurrent ulcers if H. pylori detected and treated

■Lower GI bleeding – repeat hemorrhage common from diverticula

and colitis; neoplasms and vascular ectasias require definitive ther-

apy – polypectomy, surgical resection or coagulation

Gastropathy........................................

LAUREN B. GERSON, MD, MSc

history & physical

Risk Factors

■Usage of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)

■Excessive alcohol usage and/or underlying cirrhosis

■Associated peptic ulcer disease

■Presence of other infectious diseases (ie, tuberculosis)

Signs and Symptoms

■Dyspepsia

■Weight loss, anorexia

■Nausea and emesis

■Occult GI bleeding

■Upper GI bleeding with hematemesis and/or melena

■May be asymptomatic and detected at time of endoscopy for other

reasons

■Hypoalbuminemia and peripheral edema