Abstract
The aim of this study was to conduct a national survey to evaluate the recent endoscopic treatment and drug therapy of peptic ulcer bleeding (PUB) patients and to compare practices in high and low case volume Hungarian workplaces. A total of 62 gastroenterology units participated in the six-month study. A total of 3033 PUB cases and a mean of 8.15 ± 3.9 PUB cases per month per unit were reported. In the 23 high case volume units (HCV), there was a mean of 12.9 ± 5.4 PUB cases/month, whereas in the 39 low case volume units (LCV), a mean of 5.3 ± 2.9 PUB cases/month were treated during the study period. In HCV units, endoscopic therapies for Forrest Ia, Ib, and IIa ulcers were significantly more often used than in LCV units (86% versus 68%; P = 0.001). Among patients with stigmata of recent haemorrhage (Forrest I, II), bolus + continuous infusion PPI was given significantly more frequently in HCV than in LCV units (49.6% versus 33.2%; P = 0.001). Mortality in HCV units was less than in LCV units (2.7% versus 4.3%; P = 0.023). The penetration of evidence-based recommendations for PUB management is stronger in HCV units resulting lower mortality.
Highlights
Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency situation
A 24-hour emergency endoscopy service was guaranteed in 90% (n = 54) of the workplaces, and specialised endoscopy nurses were available in 85% (n = 51) for 24 hours
Of the responded Peptic ulcer bleeding (PUB) cases, 89.2% were managed by gastroenterologists and 10.8% by surgeons
Summary
Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency situation. Peptic ulcer bleeding (PUB) is responsible for almost half of the cases of UGIB [1, 2]. The appropriate management for patients with acute gastroduodenal ulcer bleeding has been established over the last two decades in a number of randomised controlled trials and in several guidelines [6,7,8,9,10,11,12,13]. The most important elements of these recommendations were to organize and maintain a 24-hour emergency endoscopy services for UGIB patients, to use the Forrest classificaton for PUB patients, endoscopic haemostatic therapy preferably with a combined methods obligatory in cases with active bleeding, and strongly recommended in ulcer cases with visible vessels and with adherent clots. Acid-suppressant therapy was recommended by i.v. proton-pump inhibitors following endoscopic haemostasis for 72 hours in ulcer cases with stigmata of recent haemorrhage
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