Diagnostic and Therapeutic Options in the Management of Nonvariceal Upper Gastrointestinal Bleeding

Overview

Journal Curr Gastroenterol Rep

Specialty Gastroenterology

Date 2003 Nov 7

PMID 14602055

Authors

Shireen Andrade Pais

Russell Yang

Affiliations

Soon will be listed here.

Abstract

Upper gastrointestinal bleeding from peptic ulcers is common. Advances in prognostication, therapeutic endoscopy, and medical management have evolved rapidly. Patients most likely to rebleed after therapy can now be identified and monitored more closely, and patients with ulcers of low risk for rebleeding can be managed on an outpatient basis. High-risk patients include those with ulcers containing a visible vessel or who are actively bleeding. Endoscopic therapy is mandatory in high-risk patients and involves at least two hemostatic techniques. Second-look endoscopy and repeated hemostasis should be performed promptly in patients who rebleed. Adjunctive treatment includes intravenous proton pump inhibitor administered in high doses for the first 72 hours after endoscopic therapy. Further studies are needed to determine the optimal combination of hemostatic techniques to better target patients who are at risk for ulcer rebleeding.

References

Sanders D, Carter M, Goodchap R, Cross S, Gleeson D, Lobo A . Prospective validation of the Rockall risk scoring system for upper GI hemorrhage in subgroups of patients with varices and peptic ulcers. Am J Gastroenterol. 2002; 97(3):630-5. DOI: 10.1111/j.1572-0241.2002.05541.x. View

Gralnek I, Jensen D, Gornbein J, Kovacs T, Jutabha R, Freeman M . Clinical and economic outcomes of individuals with severe peptic ulcer hemorrhage and nonbleeding visible vessel: an analysis of two prospective clinical trials. Am J Gastroenterol. 1998; 93(11):2047-56. DOI: 10.1111/j.1572-0241.1998.00590.x. View

Laine L, Stein C, Sharma V . A prospective outcome study of patients with clot in an ulcer and the effect of irrigation. Gastrointest Endosc. 1996; 43(2 Pt 1):107-10. DOI: 10.1016/s0016-5107(06)80109-4. View

Laine L, PETERSON W . Bleeding peptic ulcer. N Engl J Med. 1994; 331(11):717-27. DOI: 10.1056/NEJM199409153311107. View

Kubba A, Murphy W, Palmer K . Endoscopic injection for bleeding peptic ulcer: a comparison of adrenaline alone with adrenaline plus human thrombin. Gastroenterology. 1996; 111(3):623-8. DOI: 10.1053/gast.1996.v111.pm8780566. View

Chau C, Siu W, Law B, Tang C, Kwok S, Luk Y . Randomized controlled trial comparing epinephrine injection plus heat probe coagulation versus epinephrine injection plus argon plasma coagulation for bleeding peptic ulcers. Gastrointest Endosc. 2003; 57(4):455-61. DOI: 10.1016/s0016-5107(03)80008-1. View

Spiegel B, Vakil N, Ofman J . Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med. 2001; 161(11):1393-404. DOI: 10.1001/archinte.161.11.1393. View

Khuroo M, Yattoo G, Javid G, Khan B, Shah A, Gulzar G . A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med. 1997; 336(15):1054-8. DOI: 10.1056/NEJM199704103361503. View

Rutgeerts P, Rauws E, Wara P, Swain P, Hoos A, Solleder E . Randomised trial of single and repeated fibrin glue compared with injection of polidocanol in treatment of bleeding peptic ulcer. Lancet. 1997; 350(9079):692-6. DOI: 10.1016/s0140-6736(97)03233-9. View

10.

Javid G, Masoodi I, Zargar S, Khan B, Yatoo G, Shah A . Omeprazole as adjuvant therapy to endoscopic combination injection sclerotherapy for treating bleeding peptic ulcer. Am J Med. 2001; 111(4):280-4. DOI: 10.1016/s0002-9343(01)00812-9. View

11.

Buffoli F, Graffeo M, Nicosia F, Gentile C, Cesari P, Rolfi F . Peptic ulcer bleeding: comparison of two hemostatic procedures. Am J Gastroenterol. 2001; 96(1):89-94. DOI: 10.1111/j.1572-0241.2001.03456.x. View

12.

. Proceedings of the Consensus Conference on Therapeutic Endoscopy in Bleeding Ulcers. March 6-8, 1989. Gastrointest Endosc. 1990; 36(5 Suppl):S1-65. View

13.

Lau J, Sung J, Lee K, Yung M, Wong S, Wu J . Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000; 343(5):310-6. DOI: 10.1056/NEJM200008033430501. View

14.

Cooper G, Chak A, Way L, Hammar P, Harper D, Rosenthal G . Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay. Gastrointest Endosc. 1999; 49(2):145-52. DOI: 10.1016/s0016-5107(99)70478-5. View

15.

Lau J, Sung J, Chan A, Lai G, Lau J, Ng E . Stigmata of hemorrhage in bleeding peptic ulcers: an interobserver agreement study among international experts. Gastrointest Endosc. 1997; 46(1):33-6. DOI: 10.1016/s0016-5107(97)70206-2. View

16.

De Goede E, Simoens M, Hiele M, Rutgeerts P . A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc. 2002; 55(4):466-9. DOI: 10.1067/mge.2002.112613. View

17.

Dulai G, Gralnek I, Oei T, Chang D, Alofaituli G, Gornbein J . Utilization of health care resources for low-risk patients with acute, nonvariceal upper GI hemorrhage: an historical cohort study. Gastrointest Endosc. 2002; 55(3):321-7. DOI: 10.1067/mge.2002.121880. View

18.

Cipolletta L, Bianco M, Rotondano G, Piscopo R, Prisco A, Garofano M . Prospective comparison of argon plasma coagulator and heater probe in the endoscopic treatment of major peptic ulcer bleeding. Gastrointest Endosc. 1998; 48(2):191-5. DOI: 10.1016/s0016-5107(98)70163-4. View

19.

Wong S, Yu L, Lau J, Chan A, Ng E, Sung J . Prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer. Gut. 2002; 50(3):322-5. PMC: 1773129. DOI: 10.1136/gut.50.3.322. View

20.

Longstreth G . Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995; 90(2):206-10. View