Management of bleeding peptic ulcer in France: a national inquiry.
OBJECTIVE
To evaluate and compare management practices in France for bleeding peptic ulcers using a national inquiry of university and non-university hospitals.


METHODS
Responses to questionnaires sent to 812 gastroenterologists, 496 practicing in non-university hospitals and 316 in university hospitals, were compared.


RESULTS
An analysis was possible in 279 (34% response rate) of the questionnaires. Forrest classification was used more frequently in university hospitals (83% vs 60%, P<0.01). Endoscopic hemostatic therapy was used more frequently in university hospitals for Forrest Ib (92% vs 81%, P=0.02), IIa (93% vs 73%, P<0.001), and IIb (58% vs 29%, P<0.001) ulcers. Injection therapy, mainly epinephrine, was the first-intention treatment for 99% of the responding gastroenterologists. Proportions of clinicians employing hemoclips (27%) or argon plasma coagulation (21%) were similar in both types of practice. Anti-secretory treatment included mainly omeprazole (82%), given intravenously (76%), sometimes as bolus i.v. doses followed by i.v. high-dose continuous infusion (15%) with some variations according to the type of hospital. In the event of recurrent or persistent bleeding, surgery was more frequent in non-university hospitals. When rebleeding occurred, a second endoscopic treatment was performed in about one quarter of patients.


CONCLUSIONS
In France, management practices for bleeding peptic ulcer vary between university and non-university hospitals.
Lesur
Gilles
G
Service d'Hépatogastroentérologie, Hôpital Ambroise Paré, 92104 Boulogne Cedex.
Bour
Bruno
B
Aegerter
Philippe
P
D016099:Endoscopy, Gastrointestinal; D005602:France; D005762:Gastroenterology; D006785:Hospitals, University; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires