GS14 UPPER GI EMERGENCIES FOR GENERAL SURGEONS – BLEEDING PEPTIC ULCER

Peptic ulcers (PU) are the most common cause of upper gastrointestinal bleeding. They result in significant costs both to the patient and the health care system. Despite a decrease in the prevalence of H. pylori infection, the incidence of bleeding PU has not reduced. Resuscitation of the patient with a bleeding PU remains the foundation of management. Upper gastrointestinal endoscopy has evolved from initially a diagnostic tool to now also being a therapeutic modality. The endoscopic stigmata of a visible vessel or active bleeding have been validated as indicators of a high risk of adverse outcomes. Multiple endoscopic techniques have been developed to treat bleeding PU with these stigmata. The most effective and commonly used are thermal contact therapy (heater probe or bipolar electrocoagulation) and endoscopic clipping. They are each used either as monotherapies or combined with adrenaline injection. These techniques have been shown to reduce the rates of rebleeding, surgery and mortality. Early studies showed no benefit from the use of H2‐receptor antagonists in patients with bleeding PU. In contrast, proton pump inhibitors (PPIs) given after endoscopic haemostatic therapy as a bolus and then a subsequent 72 hr infusion, have been shown to significantly reduce the rates of rebleeding,, surgery and mortality compared to placebo. In summary, endoscopic techniques combined with pharmacological treatment with PPIs significantly improve outcomes in patients with bleeding PU with high risk endoscopic stigmata. These methods are widely available and are essential in the optimal modern management of bleeding PU.