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[The management of bleeding ulcers]
1Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH, Bremserstrasse 79, 67 063 Ludwigshafen, Germany. weickeru@klilu.de
Insights
Bleeding peptic ulcers cause half of upper gastrointestinal hemorrhages. Urgent endoscopy and endoscopic therapy, guided by Forrest criteria, improve outcomes for this common emergency.
Area of Science:
- Gastroenterology
- Internal Medicine
Context:
- Upper gastrointestinal hemorrhages are a frequent medical emergency.
- Bleeding peptic ulcers account for approximately 50% of these events.
- Helicobacter pylori infection and NSAID use are key pathogenic factors.
Purpose:
- To outline the urgent management of bleeding peptic ulcers.
- To detail the role of endoscopy and endoscopic therapy based on Forrest criteria.
- To discuss prognostic factors influencing patient outcomes.
Summary:
- Urgent endoscopy is indicated for hemodynamic instability or falling hemoglobin.
- Local endoscopic therapies (injection, thermal, mechanical) are effective for bleeding peptic ulcers.
- Prognosis is influenced by endoscopic findings, patient age, and comorbidities.
Impact:
- Provides a concise overview of bleeding peptic ulcer management.
- Highlights the importance of timely endoscopic intervention.
- Emphasizes the multifactorial nature of prognosis in bleeding peptic ulcer disease.
Abstract:
Bleeding peptic ulcers are responsible for about half of all upper gastrointestinal hemorrhages, one of the most frequent gastroenterological emergencies. In its pathogenesis, infection with Helicobacter pylori and the use of ulcerogenic drugs play a dominant role. Endoscopy has to be performed urgently when a decline in hemoglobin and/or hemodynamic instability occurs. The indications for local endoscopic therapy depend on the Forrest criteria, which include bleeding and the presence or absence of a blood clot or visible vessel. Local endoscopic therapy comprises injections and mechanical or thermal procedures. The efficacy of these procedures has been demonstrated. Additionally, proton pump inhibitors are administered. The prognosis for bleeding ulcers depends on the endoscopic findings as well as the age and comorbidity of the patients.
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