title: A review on treatment of bleeding peptic ulcer: a collaborative task of gastroenterologist and surgeon.
abstract: The majority of patients presenting with acute upper gastrointestinal haemorrhage bleed from peptic diseases erosive gastritis and duodenal or gastric ulcers. Early gastroscopy is essential in order to reach a diagnosis, assess the prognosis, and institute appropriate therapy. In a meta-analysis it was shown that H2-antagonists significantly reduced mortality. However, two large, prospective and placebo-controlled studies with famotidine and omeprazole failed to show reduction of rebleeding or death. The value of endoscopic haemostatic therapy in patients with high-risk peptic ulcers (active bleeding and non-bleeding visible vessel) has been firmly established with 75% decrease in rebleeding and operation rate, and a 40% reduction in mortality. Risk factors for an adverse outcome are: elderly patients, concomitant diseases and large ulcers in the posterior duodenal bulb or on the lesser curvature. The mortality for emergency surgery in upper GI bleeding is still 10-50%. The mortality of elective operations is less than 2%. Some studies have reduced mortality by avoiding emergency surgery through early elective surgery in high-risk patients.
authors.affiliation: Dept. of Gastroenterology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Kolkman
authors.forename: S G
authors.initials: SG
authors.lastname: Meuwissen
mesh_terms: D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004724:Endoscopy; D006801:Humans; D009426:Netherlands; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery / Q000628:therapy*; D011379:Prognosis
chemical_list: D000897:Anti-Ulcer Agents