title: Update on the endoscopic management of peptic ulcer bleeding.
abstract: Upper gastrointestinal bleeding is the most common gastrointestinal emergency, with peptic ulcer as the most common cause. Appropriate resuscitation followed by early endoscopy for diagnosis and treatment are of major importance in these patients. Endoscopy is recommended within 24 h of presentation. Endoscopic therapy is indicated for patients with high-risk stigmata, in particular those with active bleeding and visible vessels. The role of endoscopic therapy for ulcers with adherent clots remains to be elucidated. Ablative or mechanical therapies are superior to epinephrine injection alone in terms of prevention of rebleeding. The application of an ulcer-covering hemospray is a new promising tool. High dose proton pump inhibitors should be administered intravenously for 72 h after endoscopy in high-risk patients. Helicobacter pylori should be tested for in all patients with peptic ulcer bleeding and eradicated if positive. These recommendations have been captured in a recent international guideline.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. i.holster@erasmusmc.nl
authors.forename: Ingrid Lisanne
authors.initials: IL
authors.lastname: Holster
authors.forename: Ernst Johan
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D016099:Endoscopy, Gastrointestinal; D017707:Erythrocyte Transfusion; D005440:Fluid Therapy; D016558:Hemostasis, Endoscopic; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D054328:Proton Pump Inhibitors