Current management of bleeding peptic ulcer. A review

In the United Kingdom, acute bleeding from peptic ulcer is estimated to account for 25 admissions to hospital per 100,000 population annually. Overall mortality has been reported at around 10%. Accurate initial assessment for the identification of high risk groups, prompt resuscitation, close monitoring and timely intervention for rebleeding improves survival. In patients not responding to initial resuscitation and those who rebleed, emergency endoscopy identifies the source of bleeding in the majority and is essential to enable endoscopic therapy. Injection of a vasoconstrictor and/or sclerosant into a visible or bleeding vessel, or thermal coagulation, reduces the incidence of rebleeding and probably decreases mortality. In general terms, 'early' surgical intervention is indicated for those aged over 60 years in whom bleeding recurs or continues despite endoscopic measures. The low mortality (< 5%) reported from specialist units and units adhering to strict protocols of management should become the norm. The use of antacids, histamine H2-receptor antagonists or omeprazole does not influence mortality or the incidence of early rebleeding in patients with acute haemorrhage from peptic ulcer. Although not used routinely, tranexamic acid has been shown to have significant benefit.