Management in peptic ulcer hemorrhage: a Dutch national inquiry.
OBJECTIVE
There is no consensus as to what endoscopic hemostatic therapy and pharmacotherapy should be used in peptic ulcer hemorrhage (PUH). We conducted a mail survey to investigate current management of ulcer hemorrhage in the Netherlands.


METHODS
A questionnaire was sent to gastroenterologists or, if not present, to internists, performing endoscopies, in every hospital in the Netherlands (n = 123). Endoscopic hemostatic therapy, pharmacotherapy, endoscopic reintervention, and management of Helicobacter pylori were evaluated.


RESULTS
90/123 (73%) questionnaires were returned. Endoscopic hemostatic therapy is given in ulcers classified as Forrest Ia, Ib, IIa, IIb, and IIc by, respectively, 89%, 93%, 83%, 47%, and 19% of respondents. Gastroenterologists perform endoscopic therapy more often in Forrest Ib (P=0.03), IIa (P=0.002), and IIb (P=0.001) ulcers when compared with internists. Endoscopic injection therapy is used by 93% of respondents as first modality. Epinephrine combined with polidocanol is most commonly used (60%). Pharmacotherapy is given by 97%. A total of 71% use proton pump inhibitors (PPIs), and 26% use H2-receptor antagonists (H2RAs), both mainly initially given intravenously. In case of suspected rebleeding, endoscopic reintervention is performed by 76%, including a significantly greater percentage of gastroenterologists (89% of gastroenterologists vs. 60% of internists, P=0.005), whereas the others refer the patient directly for surgery. Almost all respondents investigate for H. pylori. Eradication is confirmed by only 64% (80% of gastroenterologists vs. 50% of internists, P=0.004).


CONCLUSIONS
There are important differences in management of peptic ulcer hemorrhage between gastroenterologists and internists in the Netherlands. Management is only partly in accordance with evidence-based medicine.
van Leerdam
M E
ME
Dept. of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. m.e.vanleerdam@amc.uva.nl
Rauws
E A
EA
Geraedts
A A
AA
Tytgat
G N
GN
D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D009426:Netherlands; D010438:Peptic Ulcer Hemorrhage / Q000382:microbiology / Q000628:therapy*; D011364:Professional Practice; D011795:Surveys and Questionnaires