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Gastrointestinal Bleeding pp 51–61Cite as

Management of Bleeding Peptic Ulcer Disease

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Abstract

Bleeding from peptic ulcers can have severe consequences. Most patients are managed with fluid resuscitation and when necessary hemostasis can be achieved via an endoscopic approach. While rebleeding after a successful endoscopic procedure is rare it may require a repeat endoscopy. Patients who do not respond to this initial approach may benefit from direct surgical control of the bleeding with oversewing of the ulcer with or without additional acid-suppressing procedures such as the vagotomy and antral resection. Patients who are deemed too high risk for surgery may benefit from angiographic embolization of the bleeding ulcer that has continued to bleed or has failed other measures.

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References

  1. Katschinski B, Logan R, Davies J, Faulkner G, Pearson J, Langman M. Prognostic factors in upper gastrointestinal bleeding. Dig Dis Sci. 1994;39(4):706–12.

    Article  CAS  PubMed  Google Scholar 

  2. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117–71.

    Article  Google Scholar 

  3. Sonnenberg A, Everhart JE. Health impact of peptic ulcer in the United States. Am J Gastroenterol. 1997;92(4):614–20.

    CAS  PubMed  Google Scholar 

  4. Snowden FM. Emerging and reemerging diseases: a historical perspective. Immunol Rev. 2008;225:9–26.

    Article  PubMed  Google Scholar 

  5. Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010;251(1):51–8.

    Article  PubMed  Google Scholar 

  6. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102–13.

    Article  PubMed  Google Scholar 

  7. Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet. 2002;359(9300):14–22.

    Article  CAS  PubMed  Google Scholar 

  8. Sung JJ, Tsoi KK, Ma TK, Yung MY, Lau JY, Chiu PW. Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases. Am J Gastroenterol. 2010;105(1):84–9.

    Article  PubMed  Google Scholar 

  9. Lin KJ, Garcia Rodriguez LA, Hernandez-Diaz S. Systematic review of peptic ulcer disease incidence rates: do studies without validation provide reliable estimates? Pharmacoepidemiol Drug Saf. 2011;20(7):718–28.

    Article  PubMed  Google Scholar 

  10. Sonnenberg A. Temporal trends and geographical variations of peptic ulcer disease. Aliment Pharmacol Ther. 1995;9 Suppl 2:3–12.

    Google Scholar 

  11. Yeomans ND. The ulcer sleuths: the search for the cause of peptic ulcers. J Gastroenterol Hepatol. 2011;26 Suppl 1:35–41.

    Google Scholar 

  12. Rainsford KD. Mechanisms of NSAID-induced ulcerogenesis: structural properties of drugs, focus on the microvascular factors, and novel approaches for gastro-intestinal protection. Acta Physiol Hung. 1992;80(1–4):23–38.

    CAS  PubMed  Google Scholar 

  13. Logan RP. Adherence of Helicobacter pylori. Aliment Pharmacol Ther. 1996;10 Suppl 1:3–15.

    Google Scholar 

  14. Richards RJ, Donica MB, Grayer D. Can the blood urea nitrogen/creatinine ratio distinguish upper from lower gastrointestinal bleeding? J Clin Gastroenterol. 1990;12(5):500–4.

    Article  CAS  PubMed  Google Scholar 

  15. Mortensen PB, Nohr M, Moller-Petersen JF, Balslev I. The diagnostic value of serum urea/creatinine ratio in distinguishing between upper and lower gastrointestinal bleeding. A prospective study. Dan Med Bull. 1994;41(2):237–40.

    CAS  PubMed  Google Scholar 

  16. Pallin DJ, Saltzman JR. Is nasogastric tube lavage in patients with acute upper GI bleeding indicated or antiquated? Gastrointest Endosc. 2011;74(5):981–4.

    Article  PubMed  Google Scholar 

  17. Aljebreen AM, Fallone CA, Barkun AN. Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding. Gastrointest Endosc. 2004;59(2):172–8.

    Article  PubMed  Google Scholar 

  18. Songur Y, Balkarli A, Acarturk G, Senol A. Comparison of infusion or low-dose proton pump inhibitor treatments in upper gastrointestinal system bleeding. Eur J Intern Med. 2011;22(2):200–4.

    Article  PubMed  Google Scholar 

  19. Andriulli A, Loperfido S, Focareta R, Leo P, Fornari F, Garripoli A, et al. High- versus low-dose proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding: a multicentre, randomized study. Am J Gastroenterol. 2008;103(12):3011–8.

    Article  PubMed  Google Scholar 

  20. Laine L, Shah A, Bemanian S. Intragastric pH with oral vs intravenous bolus plus infusion proton-pump inhibitor therapy in patients with bleeding ulcers. Gastroenterology. 2008;134(7):1836–41.

    Article  PubMed  Google Scholar 

  21. Leontiadis GI, Sharma VK, Howden CW. Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding. BMJ. 2005;330(7491):568.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000;343(5):310–6.

    Article  CAS  PubMed  Google Scholar 

  23. Bloom SR, Mortimer CH, Thorner MO, Besser GM, Hall R, Gomez-Pan A, et al. Inhibition of gastrin and gastric-acid secretion by growth-hormone release-inhibiting hormone. Lancet. 1974;2(7889):1106–9.

    Article  CAS  PubMed  Google Scholar 

  24. Imperiale TF, Birgisson S. Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Ann Intern Med. 1997;127(12):1062–71.

    Article  CAS  PubMed  Google Scholar 

  25. Choudari CP, Rajgopal C, Elton RA, Palmer KR. Failures of endoscopic therapy for bleeding peptic ulcer: an analysis of risk factors. Am J Gastroenterol. 1994;89(11):1968–72.

    CAS  PubMed  Google Scholar 

  26. Llach J, Bordas JM, Salmeron JM, Panes J, Garcia-Pagan JC, Feu F, et al. A prospective randomized trial of heater probe thermocoagulation versus injection therapy in peptic ulcer hemorrhage. Gastrointest Endosc. 1996;43(2 Pt 1):117–20.

    Article  CAS  PubMed  Google Scholar 

  27. Lai KH, Peng SN, Guo WS, Lee FY, Chang FY, Malik U, et al. Endoscopic injection for the treatment of bleeding ulcers: local tamponade or drug effect? Endoscopy. 1994;26(4):338–41.

    Article  CAS  PubMed  Google Scholar 

  28. Calvet X, Vergara M, Brullet E, Gisbert JP, Campo R. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology. 2004;126(2):441–50.

    Article  PubMed  Google Scholar 

  29. Vergara M, Bennett C, Calvet X, Gisbert JP. Epinephrine injection versus epinephrine injection and a second endoscopic method in highrisk bleeding ulcers. Cochrane Database Syst Rev. 2014;(10):Cd005584.

    Google Scholar 

  30. Chung SC, Leong HT, Chan AC, Lau JY, Yung MY, Leung JW, et al. Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial. Gastrointest Endosc. 1996;43(6):591–5.

    Article  CAS  PubMed  Google Scholar 

  31. Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101–13.

    Article  PubMed  Google Scholar 

  32. El Ouali S, Barkun AN, Wyse J, Romagnuolo J, Sung JJ, Gralnek IM, et al. Is routine second-look endoscopy effective after endoscopic hemostasis in acute peptic ulcer bleeding? A meta-analysis. Gastrointest Endosc. 2012;76(2):283–92.

    Article  PubMed  Google Scholar 

  33. Henriksson AE, Edman AC, Held M, Wadstrom T. Helicobacter pylori and acute bleeding peptic ulcer. Eur J Gastroenterol Hepatol. 1995;7(8):769–71.

    CAS  PubMed  Google Scholar 

  34. Gisbert JP, Khorrami S, Carballo F, Calvet X, Gene E, Dominguez-Munoz JE. H. pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer. Cochrane Database Syst Rev. 2004;(2):Cd004062.

    Google Scholar 

  35. Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2015;47(10):1–46.

    Article  Google Scholar 

  36. Wong SK, Yu LM, Lau JY, Lam YH, Chan AC, Ng EK, et al. Prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer. Gut. 2002;50(3):322–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Laine L, Spiegel B, Rostom A, Moayyedi P, Kuipers EJ, Bardou M, et al. Methodology for randomized trials of patients with nonvariceal upper gastrointestinal bleeding: recommendations from an international consensus conference. Am J Gastroenterol. 2010;105(3):540–50.

    Article  PubMed  Google Scholar 

  38. de Groot NL, van Oijen MG, Kessels K, Hemmink M, Weusten BL, Timmer R, et al. Reassessment of the predictive value of the Forrest classification for peptic ulcer rebleeding and mortality: can classification be simplified? Endoscopy. 2014;46(1):46–52.

    PubMed  Google Scholar 

  39. Cheung J, Yu A, LaBossiere J, Zhu Q, Fedorak RN. Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease. Gastrointest Endosc. 2010;71(1):44–9.

    Article  PubMed  Google Scholar 

  40. Ishikawa S, Inaba T, Wato M, Takashima S, Mizushige T, Izumikawa K, et al. Exposed blood vessels of more than 2 mm in diameter are a risk factor for rebleeding after endoscopic clipping hemostasis for hemorrhagic gastroduodenal ulcer. Dig Endosc. 2013;25(1):13–9.

    Article  PubMed  Google Scholar 

  41. Lau JY, Sung JJ, Lam YH, Chan AC, Ng EK, Lee DW, et al. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med. 1999;340(10):751–6.

    Article  CAS  PubMed  Google Scholar 

  42. Eriksson LG, Ljungdahl M, Sundbom M, Nyman R. Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure. J Vasc Interv Radiol. 2008;19(10):1413–8.

    Article  PubMed  Google Scholar 

  43. Quan S, Frolkis A, Milne K, Molodecky N, Yang H, Dixon E, et al. Uppergastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes. World J Gastroenterol. 2014;20(46):17568–77.

    Article  PubMed  PubMed Central  Google Scholar 

  44. de la Fuente SG, Khuri SF, Schifftner T, Henderson WG, Mantyh CR, Pappas TN. Comparative analysis of vagotomy and drainage versus vagotomy and resection procedures for bleeding peptic ulcer disease: results of 907 patients from the Department of Veterans Affairs National Surgical Quality Improvement Program database. J Am Coll Surg. 2006;202(1):78–86.

    Article  PubMed  Google Scholar 

  45. Schroder VT, Pappas TN, Vaslef SN, De La Fuente SG, Scarborough JE. Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers. Ann Surg. 2014;259(6):1111–8.

    Article  PubMed  Google Scholar 

  46. Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol. 2009;7(1):33–47.

    Article  PubMed  Google Scholar 

  47. Sung JJ, Tsoi KK, Lai LH, Wu JC, Lau JY. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut. 2007;56(10):1364–73.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kim JW, Jang JY, Lee CK, Shim JJ, Chang YW. Comparison of hemostatic forceps with soft coagulation versus argon plasma coagulation for bleeding peptic ulcer—a randomized trial. Endoscopy. 2015;47(8):680–7.

    Article  PubMed  Google Scholar 

  49. Larssen L, Moger T, Bjornbeth BA, Lygren I, Klow NE. Transcatheter arterial embolization in the management of bleeding duodenal ulcers: a 5.5-year retrospective study of treatment and outcome. Scand J Gastroenterol. 2008;43:217–22.

    Article  PubMed  Google Scholar 

  50. Loffroy R, Guiu B, D’Athis P, Mezzetta L, Gagnaire A, Jouve JL, et al. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009;7(5):515–23.

    Article  PubMed  Google Scholar 

  51. Erdmann JF. Marginal, gastrojejunal or peptic ulcer subsequent to gastroenterostomy. Ann Surg. 1921;73(4):434–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Azagury DE, Abu Dayyeh BK, Greenwalt IT, Thompson CC. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy. 2011;43(11):950–4.

    Article  CAS  PubMed  Google Scholar 

  53. Sidani S, Akkary E, Bell R. Catastrophic bleeding from a marginal ulcer after gastric bypass. JSLS. 2013;17(1):148–51.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Moon RC, Teixeira AF, Goldbach M, Jawad MA. Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center. Surg Obes Relat Dis. 2014;10(2):229–34.

    Article  PubMed  Google Scholar 

  55. Hunter J, Stahl RD, Kakade M, Breitman I, Grams J, Clements RH. Effectiveness of thoracoscopic truncal vagotomy in the treatment of marginal ulcers after laparoscopic Roux-en-Y gastric bypass. Am Surg. 2012;78(6):663–8.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA

    Brian Ezekian

  2. Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27705, USA

    Alexander Perez M.D.

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  1. Brian Ezekian
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  2. Alexander Perez M.D.
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Correspondence to Alexander Perez M.D. .

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Editors and Affiliations

  1. Department of Surgery, Stony Brook Medicine, Stony Brook, New York, USA

    Aurora D. Pryor

  2. Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA

    Theodore N. Pappas

  3. Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA

    M. Stanley Branch

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Ezekian, B., Perez, A. (2016). Management of Bleeding Peptic Ulcer Disease. In: Pryor, A., Pappas, T., Branch, M. (eds) Gastrointestinal Bleeding. Springer, Cham. https://doi.org/10.1007/978-3-319-40646-6_5

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  • DOI: https://doi.org/10.1007/978-3-319-40646-6_5

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