Endoscopic treatment and pharmacologic therapy of peptic ulcer bleeding

Park, Soo Heon

Abstract

The incidence of peptic ulcer bleeding decreased slowly in duodenum, but slight rised in gastric ulcer. Endoscopic treatment is being performed as a treatment algorithms. Endoscopic treatment for ulcer bleeding has become a standard therapy with injections of epinephrine and saline solutions, thermocoagulation, mechanical devices such as hemoclips and banding ligator. With these treatment modalities, the mortality of nonvariceal bleeding decreased significantly during last 2 decades. Early intensive management could affect the therapeutic results. The time to hemodynamic stabilization correlated with mortality reduction. Combined endoscopic therapy is the treatment of choice for high-risk bleeding peptic ulcers. With the combined therapy, recurrent bleeding was reduced and surgery was obviated. Pharmacologic treatment with high-dose proton pump inhibitors stabilizes blood clot and has been proven to further improve the success of hemostasis. The studies using high-dose proton pump inhibitors as an adjuvant to endoscopic therapy, recurrent bleeding and surgery rate were reduced. Recently therapeutic effects of endoscopic treatment and pharmacologic management for peptic ulcer bleeding was published. Endoscopy was carried out within 24 hours in 86.6% of the patients. High risk endoscopic stigmata was reported in 70.7%. The rebleeding, surgery, and mortality rates were 4.5%, 0% and 0%, respectively. Proton pump inhibitor use and endoscopic combination therapy were associated with reduced rebleeding and mortality in patients with peptic ulcer bleeding.