CURRENT MANAGEMENT OF BLEEDING PEPTIC-ULCER - A REVIEW

In the United Kingdom, acute bleeding from peptic ulcer is estimated t o account for 25 admissions to hospital per 100 000 population annuall y. Overall mortality has been reported at around 10%. Accurate initial assessment for the identification of high risk groups, prompt resusci tation. close monitoring and timely intervention for rebleeding improv es survival. In patients not responding to initial resuscitation and t hose who rebleed, emergency endoscopy identifies the source of bleedin g in the majority and is essential to enable endoscopic therapy. Injec tion of a vasoconstrictor and/or sclerosant into a visible or bleeding vessel, or thermal coagulation, reduces the incidence of rebleeding a nd probably decreases mortality. In general terms, 'early' surgical in tervention is indicated for those aged over 60 years in whom bleeding recurs or continues despite endoscopic measures. The low mortality (<5 %) reported from specialist units and units adhering to strict protoco ls of management should become the norm. The use of antacids, histamin e H-2-receptor antagonists or omeprazole does not influence mortality or the incidence of early rebleeding in patients with acute haemorrhag e from peptic ulcer. Although not used routinely, tranexamic acid has been shown to have significant benefit.