Bleeding Peptic Ulcer

Tables of included studies

SBU’s Conclusions

Bleeding peptic ulcer is an acute, life-threatening condition, but there are several effective methods of treatment. Even so, almost a quarter of patients die within a year of receiving treatment. Some of these fatalities could probably be avoided with improved preventive measures.

• Treatment to eradicate the bacterium H. pylori, by the administration of two antibiotics combined with a proton pump inhibitor, reduces the risk of a recurrence of bleeding peptic ulcer. This is true in patients who are not concurrently taking medication that can damage the lining of the gastrointestinal tract. Despite strong scientific evidence in support of this treatment approach, data from the Swedish Prescribed Drug Register indicate that many patients are currently not receiving this type of treatment.
• In patients who have suffered a bleeding peptic ulcer but who need continuing treatment with low-dose aspirin, the risk of re-bleeding can be reduced by preventive treatment, ie, H. pylori eradication, followed by the administration of a proton pump inhibitor.
• Following an episode of bleeding peptic ulcer, patients should, if possible, avoid taking NSAIDs, including so-called coxibs. When, however, NSAID treatment must be continued, the risk of re-bleeding can be reduced by preventive measures, ie, H. pylori eradication, followed by the administration of a proton pump inhibitor.
• In patients who have not suffered an episode of bleeding peptic ulcer, but who have recognised risk factors for this, and who require long-term medication with an NSAID or low-dose aspirin, the risk of developing a bleeding peptic ulcer can be reduced by preventive treatment with a proton pump inhibitor.
• Endoscopic examination (gastroscopy) of a patient with bleeding peptic ulcer is made easier if the patient is given a single dose of erythromycin before the investigation. This improves visibility for the endoscopist.
• In patients with active bleeding, or a non-bleeding blood vessel in the base of the ulcer, the risk of re-bleeding and the need for surgery is reduced by endoscopic treatment with adrenaline injection combined with mechanical or thermal haemostasis.
• Administration of a proton pump inhibitor after endoscopic treatment of a bleeding peptic ulcer further reduces the risk of re-bleeding and the need for surgery.
• After endoscopic treatment of a bleeding peptic ulcer, systematic endoscopic review and further treatment as indicated, reduce the risk of recurrent bleeding.