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Challenges in the management of acute peptic ulcer bleeding
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Journal Article
Challenges in the management of acute peptic ulcer bleeding
2013
Overview
Acute upper gastrointestinal bleeding is a common medical emergency worldwide, a major cause of which are bleeding peptic ulcers. Endoscopic treatment and acid suppression with proton-pump inhibitors are cornerstones in the management of the disease, and both treatments have been shown to reduce mortality. The role of emergency surgery continues to diminish. In specialised centres, radiological intervention is increasingly used in patients with severe and recurrent bleeding who do not respond to endoscopic treatment. Despite these advances, mortality from the disorder has remained at around 10%. The disease often occurs in elderly patients with frequent comorbidities who use antiplatelet agents, non-steroidal anti-inflammatory drugs, and anticoagulants. The management of such patients, especially those at high cardiothrombotic risk who are on anticoagulants, is a challenge for clinicians. We summarise the published scientific literature about the management of patients with bleeding peptic ulcers, identify directions for future clinical research, and suggest how mortality can be reduced.
Publisher
Elsevier Ltd,Elsevier,Elsevier Limited
Subject
/ Antifibrinolytic Agents - therapeutic use
/ Aspirin
/ Biological and medical sciences
/ Blood Coagulation Disorders - complications
/ Blood Component Transfusion - statistics & numerical data
/ elderly
/ Endoscopy, Gastrointestinal - statistics & numerical data
/ Gastroenterology. Liver. Pancreas. Abdomen
/ Gastrointestinal Agents - therapeutic use
/ Humans
/ nonsteroidal anti-inflammatory agents
/ Nonsteroidal anti-inflammatory drugs
/ patients
/ Peptic Ulcer Hemorrhage - diagnosis
/ Peptic Ulcer Hemorrhage - mortality
/ Peptic Ulcer Hemorrhage - prevention & control
/ Proton Pump Inhibitors - therapeutic use
/ Resuscitation - statistics & numerical data
/ risk
/ Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
/ surgery
/ Ulcers
