Management of bleeding peptic ulcer: current status of intravenous proton pump inhibitors.
Over 80% of ulcer bleeding stops spontaneously, but associated mortality and morbidity remain high. Occurrence of re-bleeding increases mortality 10-fold. Endoscopic findings in those that have bled predict the risk of recurrent bleeding. Patients whose ulcers show a 'flat dot' or clean base (Forrest Class 3) rarely rebleed or need hospitalization. However, actively bleeding ulcers or those with evidence of recent hemorrhage (Forrest Classes 1 and 2) are likely to re-bleed and may need intensive care. Meta-analyses indicate that endoscopic hemostasis has reduced re-bleeding and surgical intervention by over 60% and mortality by 45%. Beyond these reductions, data indicate that (unlike H2-receptor antagonists use, largely devoid of benefits in this area) continuous intravenous infusions of high doses of proton pump inhibitors reduce rebleeding, re-endoscopy, blood transfusion and surgical intervention, but have little effect (beyond endoscopic therapy) on associated mortality, much of it due to conditions other than rebleeding.
McCarthy
Denis M
DM
Division of Gastroenterology, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA. denis.mccarthy2@med.va.gov
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D016558:Hemostasis, Endoscopic / Q000379:methods; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D010437:Peptic Ulcer / Q000145:classification / Q000188:drug therapy* / Q000601:surgery; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D054328:Proton Pump Inhibitors; D012008:Recurrence
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors