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Current management of peptic ulcer bleeding

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 24–32 (2006)Cite this article

Abstract

Peptic ulcer bleeding is a common and potentially fatal condition. It is best managed using a multidisciplinary approach by a team with medical, endoscopic and surgical expertise. The management of peptic ulcer bleeding has been revolutionized in the past two decades with the advent of effective endoscopic hemostasis and potent acid-suppressing agents. A prompt initial clinical and endoscopic assessment should allow patients to be triaged effectively into those who require active therapy, versus those who require monitoring and preventative therapy. A combination of pharmacologic and endoscopic therapy (using a combination of injection and thermal coagulation) offers the best chance of hemostasis for those with active bleeding ulcers. Surgery, being the most effective way to control bleeding, should be considered for treatment failures. The choice between surgery and repeat endoscopic therapy should be based on the pre-existing comorbidities of the patient and the characteristics of the ulcer.

Key Points

  • Peptic ulcer bleeding is a common and potentially fatal condition that occurs predominantly in the elderly

  • Early risk stratification based on clinical and endoscopic criteria facilitates the delivery of the appropriate level of care to patients with peptic ulcer bleeding

  • Combining pharmacologic and endoscopic therapy offers the best chance of hemostasis for patients with active bleeding ulcers

  • Patients with an adherent clot and a protuberant vessel should probably receive the same therapy as those with actively bleeding ulcers

  • Rebleeding can be handled effectively by repeat endoscopic therapy or surgery: which to use should be based on the pre-existing comorbidities of the patient

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Figure 1: Clinical algorithm for the management of peptic ulcer bleeding adopted at the Prince of Wales Hospital, Hong Kong.

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Authors and Affiliations

  1. Professor of Medicine in the Department of Medicine and Therapeutics, Prince of Wales Hospital, and a Director of the Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, NT, Hong Kong

    Joseph Sung

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  1. Joseph Sung
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Correspondence to Joseph Sung.

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The author declares no competing financial interests.

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Sung, J. Current management of peptic ulcer bleeding. Nat Rev Gastroenterol Hepatol 3, 24–32 (2006). https://doi.org/10.1038/ncpgasthep0388

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  • DOI: https://doi.org/10.1038/ncpgasthep0388

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