Journal Browser Advanced Search Help
Journal Browser Advanced search HELP
Korean J Gastroenterol. 2015 Aug;66(2):98-105. Korean. English Abstract. https://doi.org/10.4166/kjg.2015.66.2.98
Kim SH , Jung JT , Kwon JG , Kim EY , Lee DW , Jeon SW , Park KS , Lee SH , Park JB , Ha CY , Park YS , .
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. jungjt@cu.ac.kr
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Department of Internal Medicine, Dongguk University School of Medicine, Gyeongju, Korea.
Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.
Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea.
Abstract

BACKGROUND/AIMS: The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk factors of rebleeding in Forrest type IIB peptic ulcer. METHODS: Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December 2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic ulcer with adherent clots were enrolled. RESULTS: Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs. 10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group. However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641). In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1; p=0.025). CONCLUSIONS: In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding was use of aspirin and/or NSAID.

Copyright © 2019. Korean Association of Medical Journal Editors.