Medical Therapy for Bleeding Peptic Ulcer

Abstract

The majority of patients with upper gastrointestinal bleeding due topeptic ulcers stop bleeding spontaneously. The remainder of patients who have persistentor recurrent bleeding will require surgical or endoscopic intervention. Medicaltherapy provides an attractive alternative to these two treatment options. The adventof H2 antagonists in the mid 1970s revolutionized the treatment of peptic ulcer diseaseas it provided good ulcer healing with a treatment course of 6-8 weeks. A more potentacid suppressing class of drugs: the proton-pump inhibitors (PPl's) were introduced inthe late 1980s and provided even better and faster ulcer healing. It was natural that theacid suppressing drugs were also used for the treatment of ulcer bleeding. IntravenousH2 antagonist and more recently intravenous PPI's have routinely been prescribed inmany hospitals as soon as a bleeding patient is admitted. Critical evaluation of theliterature shows, however, that H2 antagonists are no more effective than placebo instopping ulcer bleeding. The PPI's, on the other hand, have been shown in severalclinical studies to have a beneficial effect. The action of acid suppression in stoppingulcer bleeding is believed to be due to its effect in the stabilization of an ulcer clot byproviding a high pH milieu and to commence the process of ulcer healing.