scholarly journals Surgical perspectives in treatment of bleeding peptic ulcers

2007 ◽  
Vol 54 (1) ◽  
pp. 157-164
Author(s):  
Z.D. Lausevic ◽  
P.M. Pesko ◽  
S.N. Krstic ◽  
A. Sijacki ◽  
M.S. Gvozdenovic ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Surgical Treatment ◽  
Ulcer Bleeding ◽  
Peptic Ulcers ◽  
Peptic Ulcer Bleeding ◽  
Lethal Outcome ◽  
Bleeding Peptic Ulcers ◽  
Bleeding Ulcers ◽  
Endoscopic Diagnostics ◽  
Overall Mortality

Peptic ulcer bleeding has overall incidence of 50 to 150 on 100.000 grown-ups per year and represents cause for over 1% of all urgent hospitalization today. Despite of the evolution of the endoscopic diagnostics and haemostasis, improved intensive care and surgical treatment, overall mortality is still over 10% (operative treatment over 20%), and it almost hasn?t changed over past 40 years. For more than 100 years surgery had major role in treatment of peptic bleeding ulcers, whereas nowadays it is limited to treatment of its complications. Adequate surgical treatment demands properly timed operation, safest but appropriate operation and trained surgeon. Early surgery is much better compared to the last minute surgery. At high risk rebleeding ulcer, early delayed surgery appears to be adequate, since the complications and lethal outcome are more frequent in this group.

EFFICACY OF INITIAL AND PERMANENT HEMOSTASIS OF THE ENDOSCOPIC HEMOCLIP METHOD COMBINED WITH HIGH-DOSE INFUSION OF PROTON PUMP INHIBITOR IN PATIENTS WITH PEPTIC ULER BLEEDING

2018 ◽  
pp. 15-21
Author(s):  
Hieu Tam Huynh ◽  
Dang Quy Dung Ho
Keyword(s):  
Peptic Ulcer ◽  
Success Rate ◽  
Endoscopic Hemostasis ◽  
Ulcer Bleeding ◽  
Injection Sclerotherapy ◽  
High Dose ◽  
Peptic Ulcers ◽  
Peptic Ulcer Bleeding ◽  
Bleeding Peptic Ulcers ◽  
Hemostatic Therapy

Background: Peptic ulcer bleeding is one of the common medical emergencies. The hemostatic efficacy of endoscopic therapeutic modalities has been reported in many studies and frequently has been found to exceed 90%. Four groups of modalities are used in the endoscopic management of bleeding peptic ulcers: thermal probe methods, injection sclerotherapy, local spray methods, and mechanical hemostatic therapy. The endoscopic hemoclip method is a safe and effective hemostatic therapy for managing bleeding peptic ulcers. Objective: To determine the success rate of hemoclip in endoscopic hemostasis. Patients and methods: Clinical intervention study on 36 patients with peptic ulcer bleeding admitted in Can Tho Central General Hospital from May 2012 to November 2014. All the patients underwent emergency endoscopy for hemostasis by hemoclip and high-dose PPI use. Results: The success rate of initial hemostasis was 97.2%, and permanent hemostasis was 91.7%. The rates of rebleeding, surgery, mortality were 11.1%, 5.6%, 2.8%, respectively. Conclusion: Endoscopic hemostasis therapy by clipping combined with high- dose PPI is an effective, relatively safe treatment for peptic ulcer bleeding. Key words: Peptic ulcer bleeding, hemoclip, endoscopic hemostasis therapy

scholarly journals Various aspects of peptic ulcer in patients with liver cirrhosis

2018 ◽  
Vol 71 (1-2) ◽  
pp. 27-32
Author(s):  
Zeljka Savic ◽  
Dragomir Damjanov ◽  
Vladimir Vracaric ◽  
Dijana Kosijer ◽  
Dimitrije Damjanov ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Liver Cirrhosis ◽  
Peptic Ulcer ◽  
Helicobacter Pylori Infection ◽  
Ulcer Bleeding ◽  
Peptic Ulcer Bleeding ◽  
Cirrhotic Patients ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Bleeding Ulcers

Introduction. The occurrence of peptic ulcer in patients with liver cirrhosis is intriguing due to its frequency and complexity. The aim of the present study was to investigate the incidence of peptic ulcer in patients with liver cirrhosis. Results. It was found that in these patients the usual aggressive factors of the gastric environment do not play a major role in ulcerogenesis; however, researches noticed the importance of reduced mucosal defense which, in portal hypertension, has the features of hypertensive portal gastropathy. The presence of Helicobacter pylori infection in these patients is lower, compared to other patients with peptic ulcer. The prevalence of Helicobacter pylori infection decreases with the severity of liver cirrhosis. Non-steroidal anti-inflammatory drugs play an important role in peptic ulcer bleeding in cirrhotic patients, but the data are limited and contradictory. Peptic ulcer bleeding is the most frequent etiology of nonvariceal bleeding and it is associated with a great number of complications. Conclusion. Helicobacter pylori infection cannot be considered the key risk factor for the development of peptic ulcer in patients with liver cirrhosis. The role of non-steroidal anti-inflammatory drugs is accepted, although the data are controversial. The treatment of peptic ulcer in cirrhotic patients is identical to the treatment of peptic ulcer in patients without liver cirrhosis, except in cases of bleeding ulcers. There are specific therapeutic protocols for peptic ulcer bleeding in patients with liver cirrhosis.

Hemostatic spray powder TC-325 in the primary endoscopic treatment of peptic ulcer-related bleeding: multicenter international registry

Endoscopy ◽  
2020 ◽  
Vol 53 (01) ◽  
pp. 36-43
Author(s):  
Mohamed Hussein ◽  
Durayd Alzoubaidi ◽  
Miguel-Fraile Lopez ◽  
Michael Weaver ◽  
Jacobo Ortiz-Fernandez-Sordo ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Rescue Therapy ◽  
Case Series ◽  
Ulcer Bleeding ◽  
Peptic Ulcers ◽  
Gi Bleeding ◽  
Ulcer Disease ◽  
Bleeding Peptic Ulcers ◽  
The Uk

Abstract Background Upper gastrointestinal bleeding (UGIB) is a leading cause of morbidity and is associated with a 2 % – 17 % mortality rate in the UK and USA. Bleeding peptic ulcers account for 50 % of UGIB cases. Endoscopic intervention in a timely manner can improve outcomes. Hemostatic spray is an endoscopic hemostatic powder for GI bleeding. This multicenter registry was created to collect data prospectively on the immediate endoscopic hemostasis of GI bleeding in patients with peptic ulcer disease when hemostatic spray is applied as endoscopic monotherapy, dual therapy, or rescue therapy. Methods Data were collected prospectively (January 2016 – March 2019) from 14 centers in the UK, France, Germany, and the USA. The application of hemostatic spray was decided upon at the endoscopist’s discretion. Results 202 patients with UGIB secondary to peptic ulcers were recruited. Immediate hemostasis was achieved in 178/202 patients (88 %), 26/154 (17 %) experienced rebleeding, 21/175 (12 %) died within 7 days, and 38/175 (22 %) died within 30 days (all-cause mortality). Combination therapy of hemostatic spray with other endoscopic modalities had an associated lower 30-day mortality (16 %, P < 0.05) compared with monotherapy or rescue therapy. There were high immediate hemostasis rates across all peptic ulcer disease Forrest classifications. Conclusions This is the largest case series of outcomes of peptic ulcer bleeding treated with hemostatic spray, with high immediate hemostasis rates for bleeding peptic ulcers.

scholarly journals Advances in the Therapy of Bleeding Peptic Ulcer

2018 ◽  
Vol 10 ◽  
pp. 1179559X1879025 ◽  
Author(s):  
Ian LP Beales
Keyword(s):  
Peptic Ulcer ◽  
Accurate Determination ◽  
Medical Emergency ◽  
Ulcer Bleeding ◽  
Peptic Ulcers ◽  
Doppler Probe ◽  
Bleeding Peptic Ulcers ◽  
Risk Patients ◽  
Rebleeding Rate ◽  
H Pylori

Peptic ulcer bleeding remains an important medical emergency. Important recent advances are reviewed. These include further support for a more restrictive transfusion strategy aiming for a target haemoglobin of 70-90 g/L. The Glasgow-Blatchford score remains the most useful assessment score for identifying the lowest risk patients suitable for outpatient management and predicting the need for intervention. Newer scores such as the AIMS65 and Progetto Nazionale Emorragia Digestive score (PNED) may be more accurate in predicting mortality. Pre-endoscopy erythromycin improves outcomes and is underused. A new disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Over-the-scope clips and haemostatic powders appear to have some role as endoscopic salvage therapies. Non- H. pylori, non-aspirin/non-steroidal anti-inflammatory drug (NSAID) ulcers contribute to an increasing percentage of bleeding peptic ulcers and are associated with a high rebleeding rate. The optimal management of these ulcers remains to be determined.

scholarly journals Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding

Gut ◽  
1999 ◽  
Vol 44 (5) ◽  
pp. 715-719 ◽  
Author(s):  
H-J Lin ◽  
G-Y Tseng ◽  
C-L Perng ◽  
F-Y Lee ◽  
F-Y Chang ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Combined Treatment ◽  
Active Bleeding ◽  
Ulcer Bleeding ◽  
Peptic Ulcers ◽  
Peptic Ulcer Bleeding ◽  
Urgent Surgery ◽  
Bipolar Electrocoagulation ◽  
Gold Probe ◽  
Adrenaline Injection

BACKGROUNDPeptic ulcers with active bleeding or a non-bleeding visible vessel require aggressive endoscopic treatment.AIMSTo determine whether endoscopic adrenaline injection alone or contact probe therapy following injection is a suitable treatment for peptic ulcer bleeding.METHODSA total of 96 patients with active bleeding or non-bleeding visible vessels received adrenaline alone, bipolar electrocoagulation alone, or combined treatment (n=32 in each group).RESULTSInitial haemostasis was not achieved in one patient in the adrenaline group, two in the gold probe group, and two in the injection gold probe group (p>0.1). Rebleeding episodes were fewer in the injection gold probe group (2/30, 6.7%) than in the gold probe group (9/30, 30%, p=0.04) and in the adrenaline group (11/31, 35.5%, p=0.01). Treatment failure (other therapy required) was rarer in the injection gold probe group (4/32, 12.5%) than in the adrenaline group (12/32, 37.5%, p=0.04). The volume of blood transfused after entry of the study was less in the injection gold probe group (mean 491 ml) than in the adrenaline group (1548 ml, p<0.0001) and the gold probe group (1105 ml, p<0.01). Duration of hospital stay, numbers of patients requiring urgent surgery, and death rate were not statistically different among the three groups.CONCLUSIONSFor patients with peptic ulcer bleeding, combined adrenaline injection and gold probe treatment offers an advantage in preventing rebleeding and decreasing the need for blood transfusion.

Trends in Peptic Ulcer Bleeding and Surgical Treatment

2000 ◽  
Vol 24 (3) ◽  
pp. 284-293 ◽  
Author(s):  
Christian Ohmann ◽  
Michael Imhof ◽  
Hans-Dietrich Röher
Keyword(s):  
Peptic Ulcer ◽  
Surgical Treatment ◽  
Ulcer Bleeding ◽  
Peptic Ulcer Bleeding

scholarly journals Recent advances in the management of peptic ulcer bleeding

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1763 ◽  
Author(s):  
Ian Beales
Keyword(s):  
Peptic Ulcer ◽  
Accurate Determination ◽  
Gastrointestinal Haemorrhage ◽  
Ulcer Bleeding ◽  
High Dose ◽  
Peptic Ulcers ◽  
Peptic Ulcer Bleeding ◽  
Endoscopic Techniques ◽  
Recent Advances ◽  
Proton Pump Inhibition

Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been published, but advances as well as controversies continue to evolve. Important recent advances include the evidence supporting a more restrictive transfusion strategy aiming for a target haemoglobin of 70–90 g/l. Comparative studies have confirmed that the Glasgow–Blatchford score remains the most useful score for predicting the need for intervention as well as for identifying the lowest-risk patients suitable for outpatient management. New scores, including the AIMS65 and Progetto Nazionale Emorragia Digestiva score, may be more accurate in predicting mortality. Pre-endoscopy erythromycin appears to improve outcomes and is probably underused. High-dose oral proton pump inhibition (PPI) for 11 days after PPI infusion is advantageous in those with a Rockall score of 6 or more. Oral is as effective as parenteral iron at restoring haemoglobin levels after a peptic ulcer bleed and both are superior to placebo in this respect. Within endoscopic techniques, haemostatic powders and over-the-scope clips can be used when other methods have failed. A disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Non-Helicobacter pylori, non-aspirin/non-steroidal anti-inflammatory drug ulcers contribute an increasing percentage of bleeding peptic ulcers and are associated with a poor prognosis and high rebleeding rate. The optimal management of these ulcers remains to be determined.

PEPTIC ULCER BLEEDING IN ELDERLY PATIENTS – WHAT HAS CHANGED OVER A TEN YEAR PERIOD

2020 ◽  
Author(s):  
I Budimir ◽  
M Živković ◽  
M Nikolić ◽  
N Ljubičić ◽  
T Pavić ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Elderly Patients ◽  
Ulcer Bleeding ◽  
Peptic Ulcer Bleeding
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