| Theme |
Diagnoses & Treatments for Gastrointestinal Bleeding on the Basis of JGES Guidelines |
| Title |
Initial Evaluation and Treatment for Patients with Hematemesis -- Including Differential Diagnosis from Hemoptysis |
| Author |
Motohiko Kato |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| Author |
Satoshi Kinoshita |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| Author |
Hideki Mori |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| Author |
Kaoru Takabayashi |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| Author |
Masahiro Kikuchi |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| Author |
Toshio Uraoka |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| [ Summary ] |
The definition of hematemesis is vomitus of red blood or "coffee‒grounds" material. Distinguishing it from hemoptysis, which is expectoration of blood from the respiratory tract, is important. Both the Glasgow‒Blatchford score and the Rockall score are useful for risk stratification in patients with hematemesis. Crystalloid infusion, red blood cell transfusion, and correction of coagulation capacity should be prioritized over endoscopic intervention. Excessive red blood cell transfusion may result in an increased risk of re‒bleeding. Patients with abnormal coagulation capacity should be treated to keep PT‒INR<1.5. Urgent endoscopy within 24 hours is recommended for patients at high risk in order to improve their prognosis. |