[Treatment of upper gastrointestinal bleeding caused by peptic ulcer].
BACKGROUND
The diagnosis and treatment of gastrointestinal bleeding represent a major problem even today. Nearly 50% of upper gastrointestinal bleedings are originating from peptic ulcers of different locations. Thanking to the modern gastroenterological treatment the number of elective operations carried out because of peptic ulcers is very low. On the other hand the number of urgent operations required by the complications--mainly by bleeding--of the ulcers is still rather high.


OBJECTIVE
Summarizing the possible treatments of these patients.


RESULTS
The therapeutic endoscopy accompanied by the medical treatment has the primary role in the treatment of bleeding peptic ulcers. If this treatment fails, the surgical treatment is mandatory. Also surgical treatment is necessary in case of massive rebleeding. These kinds of operations are accompanied by a high morbidity and mortality, so it is understandable that the surgeons are trying to avoid them. After spontaneous or successful endoscopic cessation of bleeding in some cases rebleeding can be expected. The probability of rebleeding can be predicted with the consideration of predictive factors. With the help of such prognosis we can decide the indication of "early elective operation". In the surgical treatment we can expect better results with more "aggressive" type of operations (resections). The delay of an indicated operation, or repeatedly carried out endoscopic and medical treatment can reduce the survival chance of the bleeding patients.


CONCLUSIONS
The treatment of upper gastrointestinal bleeding is a multidisciplinary task, which needs the correct cooperation of gastroenterologists, intensive therapists and surgeons.
Ondrejka
Pál
P
Altalános Orvostudományi Kar, II. Sebészeti Klinika, Semmelweis Egyetem, Budapest. onpal@kut.sote.hu
D017558:Elective Surgical Procedures; D004724:Endoscopy; D006801:Humans; D015994:Incidence; D010438:Peptic Ulcer Hemorrhage / Q000145:classification / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index