Korean J Gastroenterol.  2009 Nov;54(5):298-308. 10.4166/kjg.2009.54.5.298.

Guidelines of Treatment for Bleeding Peptic Ulcer Disease

• Chung IK
• Lee DH
• Kim HU
• Sung IK
• Kim JH
• Korean College of Helicobacter and Upper Gastrointestinal Research
• Korean Association of Gastroenterology

• KMID: 1767734
• DOI: http://doi.org/10.4166/kjg.2009.54.5.298

Abstract

Peptic ulcer (PU) bleeding is the main cause of non-variceal gastrointestinal bleeding. Negative outcomes include re-bleeding and death, and many of the deaths are associated with decompensation of coexisting medical conditions precipitated by acute bleeding event. Accurate analysis of risk for clinical features can help physician to decide treatment modality. Endoscopy can detect bleeding stigmata and perform therapeutic hemostasis. Proton pump inhibitor (PPI) compared with placebo or H2RA reduces mortality following PU bleeding among patients with high-risk endoscopic findings, and reduces re-bleeding rates and surgical intervention. PPI treatment initiated prior to endoscopy in upper gastrointestinal (UGI) bleeding significantly reduces the proportion of patients with stigmata of recent hemorrhage (SRH) at index endoscopy but does not reduce mortality, re-bleeding or the need for surgery. The strategy of giving oral PPI before and after endoscopy, with endoscopic hemostasis for those with major SRH, is likely to be the most cost-effective. The treatment of H. pyori infection was found to be more effective than anti-secretory therapy in preventing recurrent bleeding from PU. H. pyori eradication alone and eradication followed by misoprostol (with switch to PPI, if misoprostol is not tolerated) are the two most cost-effective strategies to prevent ulcer bleeding among H. pyori-infected NSAID users, although the data cannot exclude PPIs also being cost-effective treatment. This review focuses specifically on the current treatment of patients with acute bleeding from a peptic ulcer.

Keyword

Peptic ulcer; Bleeding; Guideline

MeSH Terms

Anti-Ulcer Agents/therapeutic use
Endoscopy, Gastrointestinal
Gastrointestinal Hemorrhage/diagnosis
Helicobacter Infections/diagnosis/drug therapy
Helicobacter pylori
Hemostasis, Endoscopic
Humans
Misoprostol/therapeutic use
Peptic Ulcer/surgery/*therapy
Peptic Ulcer Hemorrhage/surgery/*therapy
Proton Pump Inhibitors/therapeutic use