Artur Munteanu

Moldova

The Management of Hemorrhage in the Upper Digestive Tract in the Emergency Department

Artur Munteanu1,2, Petru Lungu1,2 , Ecaterina Munteanu3, Tatiana Malacinschi-Codreanu 1 ,2, Larisa Rezneac 1,2, Oxana Sârbu 3, Valeriu Istrati 3
1. Institutul de Medicina Urgenta, Chisinau, Republic of Moldova.
2. Department of Medical Emergencies “Gheorghe Ciobanu”, Nicolae Testemitanu SUMPh, Chisinau, Republic of Moldova
3. Department of Internal Medicine, Nicolae Testemitanu SUMPh, Chisinau, Republic of Moldova

Abstract

Background

Despite significant advancements in modern medicine, uncontrolled massive hemorrhages in the upper digestive tract continue to pose life-threatening challenges. Effective management of such cases remains a critical focus, with various strategies and approaches being debated. This study aims to identify optimal management strategies for upper digestive tract hemorrhages in the Emergency Department.

Methods

A randomized study was conducted from 2023 to 2024, involving 50 patients admitted to the Emergency Department of IMSP IMU, DCMU, diagnosed with upper digestive tract hemorrhage (HDS) and subjected to hemostatic treatment. Of these, 15 were females and 35 were males, with ages ranging from 25 to 90 years. The majority fell within the age groups of 41-50 and 61-70 years. Endoscopic evaluations revealed active hemorrhages in 25 patients and non-active hemorrhages with recent bleeding stigmata in 25 patients. Based on the Forrest classification, 1a and 1b hemorrhages were noted in the active bleeding group.

Results

The predominant diagnoses were erosive hemorrhagic gastropathy and peptic ulcer disease. Laboratory findings showed abnormal prothrombin levels in 28 patients and extended coagulation times in 25 patients. Red blood cells, hemoglobin, and platelet counts were reduced in most cases, confirming significant blood loss. Initial endoscopic hemostasis was achieved using Thrombin 500 UI dissolved in 10 ml of NaCl 0.9%. Repeat procedures were necessary for 12% of cases, with a maximum dose of 2000 UI of Thrombin administered. In 30% of patients, additional interventions were required using Sol. Alcohol 70% (2 ml mixed with 8 ml of NaCl 0.9%), typically for up to two rounds of treatment. Endoscopic hemostatic treatment was successful in all 50 patients, with no need for surgical intervention.

Conclusions

Effective management of upper digestive tract hemorrhages involves the timely administration of appropriate hemostatic agents during endoscopic procedures. This study highlights the success of combining Thrombin and Sol. Alcohol as key solutions in achieving hemostasis and improving patient outcomes. Endoscopic intervention remains critical in addressing life-threatening gastrointestinal bleeding.