[Therapeutic indications in hemorrhaging duodenal and gastric ulcers]

Ulcer complications including bleeding and perforation were increasingly observed during the last decade due to the greater life expectancy and the increased NSAID consumption. The unchanging mortality rate, which has been around 6-10% for several decades, could be explained by the fact that age and the prevalence of concurrent illness are important predictors of death. Rebleeding which is also an independent prognostic factor can be predicted by the presence of hypovolemic shock and of endoscopic stigmata such as active bleeding or a visible vessel. Endoscopic hemostatic therapy, specially injection therapy which is the most widely used method, has become the treatment of choice. It has been proven to significantly reduce rates of further bleeding, surgery and mortality. Surgical intervention is indicated in cases of immediate or secondary failure of endoscopic therapy (20%) and should not be delayed in high-risk patients. Once hemostasis has been achieved therapeutic goals are to heal the ulcer and to prevent the occurrence of further complications including bleeding and also perforation.