ACUTE GASTROINTESTINAL-BLEEDING IN STROKE PATIENT

Gastrointestinal bleeding (GB) as a consequence of erosion or rare per foration of ulcers caused by stress has been analyzed in prospective s tudy in 129 stroke patients. The authors studied the specificities of stress provoked gastric erosions and ulcers in 53 patients with ischem ic and 76 with hemorrhagic cerebrovascular accident GB appeared freque ntly in patients with severe stroke either ischemic or hemorrhagic nat ure. GB developed more frequently in the first hours of the stroke dev elopment in patients with severe intracerebral hemorrhage (15%), than in patients with ischemic vascular lesions (4%). In both groups of str oke patients GB appeared more often between the third and the fifth da y (50%), what is well known as a period of brain oedema development. I n relation to experimental findings authors concluded that GB is proba bly result of vagal overactivity with ulcers and erosions beenig the r esults of lesion or irritation of diencephalo-hypothalamic structures. In 43% of patients with short duration of GB, mainly during one day, clinical outcome was good. Besides, in 15% patients without expansive vascular lesions, in explanation of the stress ulcers development, med icament therapy (salycilates) and manipulation with probe must be take n in consideration. The authors pointed out that therapy in stroke pat ients stress ulcers is mainly conservative, because other active proce dures show high risk, and could be used only for specific indications.