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Bleeding Peptic Ulcer

Report type: Yellow
Report number: 206
Published: 2011
ISBN: 85413-42-3

SBU’s Conclusions

Bleeding peptic ulcer is an acute, life-threatening condition, but
there are several effective methods of treatment. Even so, almost a
quarter of patients die within a year of receiving treatment. Some
of these fatalities could probably be avoided with improved preventive
measures.

  • Treatment to eradicate the bacterium H. pylori, by the administration
    of two antibiotics combined with a proton pump
    inhibitor, reduces the risk of a recurrence of bleeding peptic
    ulcer. This is true in patients who are not concurrently taking
    medication that can damage the lining of the gastrointestinal
    tract. Despite strong scientific evidence in support of this
    treatment approach, data from the Swedish Prescribed Drug
    Register indicate that many patients are currently not receiving
    this type of treatment.
  • In patients who have suffered a bleeding peptic ulcer but
    who need continuing treatment with low-dose aspirin, the
    risk of re-bleeding can be reduced by preventive treatment,
    ie, H. pylori eradication, followed by the administration of
    a proton pump inhibitor.
  • Following an episode of bleeding peptic ulcer, patients should,
    if possible, avoid taking NSAIDs, including so-called coxibs.
    When, however, NSAID treatment must be continued, the
    risk of re-bleeding can be reduced by preventive measures, ie,
    H. pylori eradication, followed by the administration of a proton
    pump inhibitor.
  • In patients who have not suffered an episode of bleeding peptic
    ulcer, but who have recognised risk factors for this, and who
    require long-term medication with an NSAID or low-dose
    aspirin, the risk of developing a bleeding peptic ulcer can be
    reduced by preventive treatment with a proton pump inhibitor.
  • Endoscopic examination (gastroscopy) of a patient with bleeding
    peptic ulcer is made easier if the patient is given a single
    dose of erythromycin before the investigation. This improves
    visibility for the endoscopist.
  • In patients with active bleeding, or a non-bleeding blood vessel
    in the base of the ulcer, the risk of re-bleeding and the need
    for surgery is reduced by endoscopic treatment with adrenaline
    injection combined with mechanical or thermal haemostasis.
  • Administration of a proton pump inhibitor after endoscopic
    treatment of a bleeding peptic ulcer further reduces the risk
    of re-bleeding and the need for surgery.
  • After endoscopic treatment of a bleeding peptic ulcer, systematic
    endoscopic review and further treatment as indicated,
    reduce the risk of recurrent bleeding.