Medical Therapy of Actively Bleeding SRES

Although cessation of active hemorrhage due to SRES with the use of antacids, H2RAs, PPIs, and sucralfate has been reported, large, controlled trials evaluating their true effi cacy have not been performed. Case reports suggest the efficacy of prostaglandins, somatostatin, and IV vaso-pressin, but none of these agents can be regarded as more than investigational at this point.

Interventional Therapy

More aggressive forms of therapy are indicated when prophylactic therapy fails and clinically significant SRES hemorrhage persists.

Esophagogastroduodenoscopy (EGD) accurately identifies the site of bleeding in over 95% cases of GI hemorrhage, and not only provides prognostic information about the risk of rebleeding, but also offers a therapeutic potential. If single lesions with active bleeding or stigmata of recent hemorrhage are identified, control of hemorrhage by several means, including mucosal epinephrine injection, thermal coagulation, multipolar electrocoagulation, and clipping, is successful in over 90% of cases. Angiography with intraarterial embolization is useful when bleeding persists despite endoscopic treatment.

SRES hemorrhage ceases spontaneously in up to 95% of patients treated conservatively, and only approximately 5% will experience massive SRES hemorrhage. Even among those patients with major hemorrhage, up to 90% will be controlled by a combination of pharmacotherapy, therapeutic EGD, and interventional angiography. Surgery is reserved for cases of severe hemorrhage uncontrolled by other modalities.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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