Endoscopic management of acute peptic ulcer bleeding

Gastroenterol Clin North Am. 2014 Dec;43(4):677-705. doi: 10.1016/j.gtc.2014.08.003. Epub 2014 Sep 16.

Abstract

This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding.

Keywords: Duodenal ulcer; Endoscopy; Gastric ulcer; Nonvariceal upper gastrointestinal hemorrhage; Peptic ulcer bleeding; Upper gastrointestinal bleeding.

MeSH terms

  • Acute Disease
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Contraindications
  • Duodenal Ulcer / complications*
  • Electrocoagulation / methods
  • Endoscopy, Gastrointestinal*
  • Hemostasis, Endoscopic / instrumentation
  • Hemostasis, Endoscopic / methods*
  • Hemostatics / administration & dosage
  • Humans
  • Peptic Ulcer Hemorrhage / diagnosis
  • Peptic Ulcer Hemorrhage / etiology*
  • Peptic Ulcer Hemorrhage / prevention & control
  • Peptic Ulcer Hemorrhage / therapy*
  • Platelet Aggregation Inhibitors
  • Powders / therapeutic use
  • Proton Pump Inhibitors / therapeutic use
  • Risk Assessment
  • Stomach Ulcer / complications*
  • Time Factors

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Hemostatics
  • Platelet Aggregation Inhibitors
  • Powders
  • Proton Pump Inhibitors