Modern endoscopic therapy of peptic ulcer bleeding

Area of Science:

• Gastroenterology
• Endoscopy
• Internal Medicine

Background:

• Acute upper gastrointestinal bleeding (UGIB) presents significant patient morbidity and healthcare costs.
• Peptic ulcer bleeding (PUB) is a major cause of UGIB, with increasing incidence in the elderly and association with non-steroidal anti-inflammatory drug (NSAID) use.

Purpose of the Study:

• To review current management strategies for peptic ulcer bleeding (PUB).
• To highlight the role of early proton pump inhibitor (PPI) therapy and endoscopic interventions in managing UGIB.

Main Methods:

• Review of current literature on the management of acute upper gastrointestinal bleeding (UGIB).
• Discussion of endoscopic modalities including thermal and non-thermal therapies for peptic ulcer bleeding (PUB).
• Emphasis on the importance of empirical high-dose proton pump inhibitor (PPI) therapy and multidisciplinary team approach.

Main Results:

• Early empirical high-dose proton pump inhibitor (PPI) therapy is cost-effective and reduces the need for endoscopic therapy.
• Combination therapies (injection with thermal therapy or endoclips) are recommended for high-risk peptic ulcer bleeding (PUB).
• The utility of second-look endoscopy in high-risk patients warrants consideration.

Conclusions:

• Optimal management of acute upper gastrointestinal bleeding (UGIB) involves a multidisciplinary approach.
• Early proton pump inhibitor (PPI) administration and appropriate endoscopic interventions are crucial for favorable outcomes in peptic ulcer bleeding (PUB).
• Continued research into optimal endoscopic strategies for specific PUB presentations is necessary.