Bleeding Peptic Ulcer Disease Research Articles

Acetylsalicylic acid use in patients with acute myocardial infarction and peptic ulcer bleeding.

Acetylsalicylic acid (ASA) is used in the treatment of acute myocardial infarction (AMI) but is also a risk factor for peptic ulcer disease (PUD) bleeding. To determine the factors associated with continued ASA use in patients with AMI who develop PUD bleeding. AMI patients who developed PUD bleeding during the same hospitalization at two tertiary care hospitals in Edmonton, Alberta, between January 1999 and December 2006, were evaluated retrospectively. Multivariate analysis was used to determine predictors of the primary outcome of continued ASA use during PUD bleeding. A total of 102 patients were analyzed. Thirty-eight patients (37%) were continued on ASA, while 64 (63%) had ASA discontinued during their hospitalization. On multivariate regression analysis, significant predictors of continued ASA use included lowrisk ulcer stigmata on endoscopy (OR 3.7; 95% CI 1.4 to 10.2; P=0.01) and AMI requiring coronary intervention (OR 8.2; 95% CI 2.1 to 32.1; P=0.002). The mean (+/- SD) blood transfusion requirement was 3.9+/-3.6 units. The 30-day rebleeding and mortality rates were 14% and 14%, respectively. The continued use of ASA during AMI and PUD bleeding was variable. However, patients with low-risk ulcers and those who received coronary intervention were more likely to have ASA continued during PUD bleeding. Further studies evaluating the gastrointestinal risk of immediate ASA use in AMI with acute PUD bleeding are required.

Guidelines of Treatment for Bleeding Peptic Ulcer Disease

Peptic ulcer (PU) bleeding is the main cause of non-variceal gastrointestinal bleeding. Negative outcomes include re-bleeding and death, and many of the deaths are associated with decompensation of coexisting medical conditions precipitated by acute bleeding event. Accurate analysis of risk for clinical features can help physician to decide treatment modality. Endoscopy can detect bleeding stigmata and perform therapeutic hemostasis. Proton pump inhibitor (PPI) compared with placebo or H2RA reduces mortality following PU bleeding among patients with high-risk endoscopic findings, and reduces re-bleeding rates and surgical intervention. PPI treatment initiated prior to endoscopy in upper gastrointestinal (UGI) bleeding significantly reduces the proportion of patients with stigmata of recent hemorrhage (SRH) at index endoscopy but does not reduce mortality, re-bleeding or the need for surgery. The strategy of giving oral PPI before and after endoscopy, with endoscopic hemostasis for those with major SRH, is likely to be the most cost-effective. The treatment of H. pylori infection was found to be more effective than anti-secretory therapy in preventing recurrent bleeding from PU. H. pylori eradication alone and eradication followed by misoprostol (with switch to PPI, if misoprostol is not tolerated) are the two most cost-effective strategies to prevent ulcer bleeding among H. pylori-infected NSAID users, although the data cannot exclude PPIs also being cost-effective treatment. This review focuses specifically on the current treatment of patients with acute bleeding from a peptic ulcer.

Ankaferd Blood Stopper as an effective adjunctive hemostatic agent for the management of life-threatening arterial bleeding of the digestive tract

A 63-year-old man was admitted to our hospital with rectal bleeding. He had a history of Billroth II surgery for bleeding peptic ulcer disease 30 years ago. He had no other medical problems, and was receiving no medications. His hemoglobin level was 5.6 g/dL. Upper gastrointestinal endoscopy revealed fresh blood and clots in the residual stomach and efferent loop. A Dieulafoy lesion with spurting hemorrhage was found near the gastrojejunal anastomosis ([Fig. 1 a]).

Risk Factors Involved in Patients with Bleeding Peptic Ulcers: A Case–Control Study

Our objectives were to (1) identify the risk factors involved in patients with peptic ulcer disease and determine if they predict bleeding in these patients, (2) determine the association between these risk factors, and (3) analyze the cost effectiveness of various tests for Helicobacter pylori (H. pylori). Two-hundred and thirty patients were included in our study between January 2004 and June 2005 (128 bleeding peptic ulcer disease patients constituted the cases, 102 nonbleeding ulcer patients constituted the controls). H. pylori infection was assessed by urease test and biopsy from gastric antrum. There was no statistically significant difference between these groups regarding sex, age, or location of ulcer. Nonsteroidal anti-inflammatory drug (NSAID) use was higher in the case group (P < 0.001), and the rate of H. pylori infection was lower in these patients (P < 0.05). There was no interaction between NSAID use and H. pylori infection in predicting bleeding ulcer risk (P = 0.08). Sensitivity and specificity for urease test in detecting H. pylori was 75% and 99.7%, respectively. So a positive urease test does not need confirmation with biopsy, which is cost effective.

Aspectos endoscópicos no manejo da úlcera péptica gastroduodenal

Bleeding remains a common and a potential lethal complication for peptic ulcer disease. Multidisciplinary approach by endoscopists, surgeons and intensive care physicians is necessary to improve results for this severe complication. In this article we intend to introduce surgeons and intensive care physicians to endoscopic concepts and maneuvers commonly used in the treatment of bleeding peptic ulcer disease. Early clinical assessment and endoscopic evaluation are helpful to classify the severity of the bleeding episode. Two major achievements have changed the management of this complication: combined endoscopic therapy and proton pump inhibitors. The former consists of combining two different endoscopic methods to stop bleeding or prevent re-bleeding (e.g., injection of a sclerosing substance and thermal coagulation). Surgical treatment for peptic ulcer bleeding is indicated when endoscopic therapy fails or to prevent re-bleeding in high risk patients who presents with a spurting bleeding ulcer and shock. For the remaining situations, there are consistent evidences that a second endoscopic therapy should be attempted when re-bleeding occurs. Keywords: endoscopic hemostasis, recurrent bleeding, peptic ulcer bleeding, proton-pump inhibitor, non-variceal gastrointestinal bleeding.

Helicobacter pylori: testing and treatment

Helicobacter pylori is an important pathogen worldwide. Accurate diagnosis and appropriate therapy is important in clinical practice. Invasive tests that accurately identify current infection include the biopsy urease test and histology. The best noninvasive tests for diagnosis include the urea breath test and stool antigen testing. Proton pump inhibitor therapy can lead to false-negative H. pylori test results, and treatment should be stopped for 1–2 weeks prior to testing if possible. In the setting of bleeding peptic ulcer disease, urea breath testing is recommended to rule out a false-negative biopsy test result if needed. The current recommendations for when to test for H. pylori vary around the world. Well-accepted indications include active and past ulcer disease, and gastric-mucosa associated lymphoid tissue lymphoma. There is no universal agreement regarding whether all patients with functional dyspepsia should be tested and treated, although this is an evidence-based recommendation. There is also evidence that H. pylori eradication prevents peptic ulcer disease in those starting NSAIDs long term. Primary treatment remains triple therapy with 10–14 days probably being superior to shorter courses of therapy. Quadruple therapy is recommended if standard triple therapy fails. Salvage therapies with levofloxacin, rifabutin or furazolidone have been identified. Novel approaches to treatment include sequential therapy and use of adjuvants.

Real-Life Practices in the Management of Concurrent Peptic Ulcer Bleeding and Myocardial Infarctions

Background. Patients with myocardial infarctions (MI) are at risk of peptic ulcer disease (PUD) bleeding given the routine use of anti-platelet agents and anticoagulants. To date, the real-life practices in the management of PUD bleeding in patients with myocardial infarctions have not been documented. Methods: Patients who experienced both a myocardial infarction and PUD bleeding in the same hospitalization between January 1999–January 2006 were evaluated from two university-affiliated institutions. Coronary care practices, PUD bleeding care, and patient outcomes were determined. Results: A total of 87 patients were evaluated. Many patients were already on ASA (n = 40, 46%) and NSAIDS (n = 22, 25%) prior to hospitalization. Only 10 (17%) patients were on a proton pump inhibitor prior to hospitalization. A proportion of patients received ASA (n = 74, 85%) and clopidogrel (n = 49, 56%) during the MI. One third of patients had high risk stigmata lesions (n = 29) and two-thirds had low risk lesions (n = 58). Once PUD bleeding was diagnosed, 32% (n = 28) continued on ASA therapy without interruption, 34% (n = 30) had ASA therapy held temporarily, and 33% (n = 29) were never restarted on ASA therapy in hospital. Patients who were continued on ASA after PUD bleeding were more likely to have low risk stigmata (82%) compared to patients where ASA was not continued immediately (60%, p < 0.05). In patients with low risk stigmata who continued ASA, there was no significant difference in the rebleeding rate compared to those who did not restart ASA immediately (0% vs 6%, NS). In patients with high risk stigmata, continuing ASA did not significantly increase the rebleeding risk compared to those who did not restart ASA (40% vs 30%, NS). Conclusions: A large proportion of patients with MI who develop PUD bleeding are on ASA or NSAIDs prior to hospitalization. Immediate continuation of ASA does not appear to increase PUD rebleeding rates when given with concurrent acid suppressive therapy. One-third of patients are managed without a plan to restart ASA therapy post-MI.

Comparative Analysis of Vagotomy and Drainage Versus Vagotomy and Resection Procedures for Bleeding Peptic Ulcer Disease: Results of 907 Patients from the Department of Veterans Affairs National Surgical Quality Improvement Program Database

Comparative Analysis of Vagotomy and Drainage Versus Vagotomy and Resection Procedures for Bleeding Peptic Ulcer Disease: Results of 907 Patients from the Department of Veterans Affairs National Surgical Quality Improvement Program Database

Effect of a Specific Cyclooxygenase-Gene Polymorphism (A-842G/C50T) on the Occurrence of Peptic Ulcer Hemorrhage

Cyclooxygenases (COX) catalyze the conversion of arachidonic acid to prostaglandins (PGs). COX-inhibiting drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), increase the risk for peptic ulcer disease. As a corollary, COX gene polymorphisms could be important in the pathogenesis of peptic ulcer disease because these affect prostaglandin formation and impair its protective effect at the level of the gastric mucosa. This study was designed to investigate the association between the functional single-nucleotide polymorphism, A-842G/C50T, in the COX-1 gene and peptic ulcer bleeding. We obtained DNA samples from 106 patients who underwent upper gastrointestinal endoscopy because of bleeding peptic ulcer disease and from 88 healthy control subjects. Genetic polymorphism in A-842G/C50T was determined by PCR followed by restriction-fragment-length-polymorphism analysis. Adjusted logistic regression analysis was performed to evaluate the associations. Risk factors associated with peptic ulcer bleeding were male gender (odds ratio, 4.78; 95% confidence interval, 2.6-8.8) and NSAID/aspirin-use (odds ratio, 38.39; 95% confidence interval, 14.2-103.6). The A-842G/C50T heterozygote was less frequent in peptic ulcer bleeding (n = 7) compared with healthy control subjects (n = 11). The adjusted risk for peptic ulcer bleeding among individuals who were heterozygote for the A-842G/C50T polymorphism was 0.75 (range, 0.19-3.01) compared with wild type. The COX-1 A-842G/C50T SNP does not influence the risk for developing peptic ulcer bleeding.

Gastrojejunocolic Fistula, a Rare Complication of Prior Gastroenterostomy

Patient is a 48 yo male with history of bleeding peptic ulcer disease, s/p Billroth II gastrectomy with subsequent conversion to roux-en-y gastrojejunostomy, presents with dyspnea, abdominal pain and chronic diarrhea. In the emergeny room patient was afebrile, with BP 124/57, heart rate 67, respiratory rate 18. On abdominal exam patient had normal active bowel sounds, mild tenderness to palpation in LLQ and LUQ. Laboratory data revealed a Hg 6.9, WBC 3.9, albumin 3.5, lipase 7. CT-abdomen revealed pneumatosis in the colon. Initial management consisted of bowel rest, transfusion of PRBC, IV fluids, and IV antibiotics. Overnight patient did well with resolution of abdominal pain, and patient underwent a colonoscopy to evaluate for possible mesenteric ischemia. Colonoscopy at 45 cm from the anus (around the splenic flexure) revealed a fistulous connection, opening into two different lumens. One lumen opened into the stomach, while the other opened into small bowel. At the juncture where the small bowel, colon, and stomach meet, there was a small clean base ulcer. Preoperatively the patients nutritional status was optimized. Patient subsequently underwent a one-stage repair, with revision of the gastrojejunostomy, removal of the fistula, colocolic anastomosis, and truncal vagotomy. Postoperatively the diarrhea resolved, with patient now having 2–3 formed bowel movements per day. Gastrojejunocolic fistulas are a rare complication of previous gastroenterostomy. It is thought to occur secondary to a marginal ulcer, which occurs due to incomplete gastric resection or incomplete vagotomy for peptic ulcer disease. Clinical presentation consists of chronic diarrhea, fecal vomiting/breath, and weight loss. Diagnosis is made by barium enema. Initially surgical repair for gastrojejunocolic fistula entailed a 3-stage operation involving a preliminary diverting colostomy to optimize nutritional status, resection of fistula, and then closure of colostomy. However, with advances in TPN over the past 20 years, operative morbidity and mortality has been minimized with one-stage surgical repair.

Influencia de los antiinflamatorios no esteroideos en la hemorragia digestiva por úlceras o erosiones gastroduodenales en pacientes con cirrosis hepática

Peptic ulcer disease, with or without complications, is more common in patients with liver cirrhosis than in the general population. Factors associated with portal hypertension are involved in its pathogenesis. The prevalence of Helicobacter pylori infection in patients with liver cirrhosis and the general population is similar. The aim of the present study was to determine the influence of nonsteroidal antiinflammatory drugs (NSAIDs) in the etiology of bleeding peptic ulcer disease in patients with liver cirrhosis. We studied 35 patients with liver cirrhosis and gastrointestinal bleeding due to gastroduodenal ulcers or erosions (group A), 125 noncirrhotic patients with gastrointestinal bleeding due to gastroduodenal ulcers or erosions (group B), and 70 patients with liver cirrhosis who were admitted to hospital without gastrointestinal bleeding (group C). All patients were questioned about NSAID consumption, including aspirin, during the week prior to hospital admission. NSAID consumption was reported by 15 patients (42.8%) in group A, 102 patients (58.2%) in group B, and 6 patients (8.5%) in group C. Statistically significant differences were obtained when the results for group A were compared with those for group C. NSAID consumption in patients with liver cirrhosis without gastrointestinal bleeding was low (8.5%) and was much lower than that observed in patients with cirrhosis admitted to hospital for bleeding due to gastroduodenal ulcers or erosions (42.8%). As occurs in the general population, NSAIDs play a significant role in the pathogenesis of bleeding due to peptic ulcer disease in patients with liver cirrhosis and portal hypertension.

Comparative Analysis of Vagotomy and Drainage Versus Vagotomy and Resection Procedures for Bleeding Peptic Ulcer Disease: Results of 907 Patients from the Department of Veterans Affairs National Surgical Quality Improvement Program Database

The purpose of this study was to determine postoperative outcomes and risk factors for morbidity and mortality in patients requiring surgery for bleeding peptic ulcer disease (PUD). Vagotomy and drainage procedures are technically simpler but are usually associated with higher ulcer recurrence rates. In contrast, vagotomy and resection approaches offer lower ulcer recurrences but represent much more challenging operations and are associated with considerable morbidity and mortality. Data collected through the Department of Veterans Affairs National Surgical Quality Improvement Program database from 1991 to 2001 were submitted for stepwise logistic regression analysis for prediction of 30-day postoperative morbidity and mortality, rebleeding, and postoperative length of stay. The study population included all patients operated on for bleeding PUD within an 11-year period. The 30-day morbidity, mortality, and rebleeding rates were comparable between surgical groups. Age, American Society of Anesthesiologists class, presence of ascites, coma, diabetes, functional status, hemiplegia, and history of steroid use were predictors of postoperative death. Risk factors for rebleeding included dependent functional status, history of congestive heart failure, smoking, steroid use, and preoperative transfusions. Having a resective procedure, American Society of Anesthesiologists class, hemiplegia, history of COPD, and requiring ventilator-assisted respirations before surgery were positively associated with increased length of hospital stay. No differences were observed in 30-day mortality, morbidity, or rebleeding rates between surgical groups. Having a resective procedure was a predictor of prolonged postoperative stay. Dependent status and chronic use of steroids were predictors of both rebleeding and postoperative mortality.

Long Term Population Study of Prevalence and Risk Factors for Rebleeding in Patients with Peptic Ulcer Disease (PUD)

Background: Most data on rebleeding are reported from tertiary care centers over a short follow up period and may not reflect community trends. We sought to determine the prevalence and risk factors for being hospitalized with rebleeding over a 5 year period for patients in California. Methods: California Health Data and Advisory Council Consolidation Act mandates that all hospitals licensed in California report details of all hospitalizations to the California Office of Statewide Health Planning and Development. We used these data to identify all patients hospitalized in California with gastric or duodenal ulcer bleeding in 1995. 1,070 of total 15,503 such patients had prior admissions for PUD bleeding between 1991-4. Therefore 14,473 patients were admitted with an initial PUD bleed in 1995. We compared 367 (2.5%) patients who were readmitted with rebleeding during 1995-2000 to 14,106 patients who did not rebleed using multivariate analysis which adjusted for age, gender, length of stay, level of care, disposition, disease severity, and time to endoscopic therapy. We extrapolated income from the ZIP code of admission using data from the 2000 US Census. We used chi-square and student t-tests for univariate analysis and logistic regression for multivariate analysis with alpha of 0.05 considered significant. This study was approved by the Statewide and the University IRB. Results: Patients readmitted with rebleeding had significantly shorter (3.8 ± 2.7d vs. 4.8 ± 6.6d, p<0.0001) and less expensive ($10,615 ± 10,625 vs. $13,758 ± 25,455, p<0.0001) initial hospital stay, lower annual household income ($44,593 ± 15,726 vs. $48,163 ± 18,657, p<0.0001) compared to non rebleeders. The rebleed rates also differed significantly according to the funding source, p = 0.0024. Multivariate analysis showed Native American/Eskimo race (OR = 4.0, 95% CI: 1.7-9.4, p = 0.0015) and black race (OR = 1.5, 95% CI: 1.2-2.0, p = 0.0005) to have significantly higher risk of rebleeding compared to Caucasians. The same analysis showed HMO funding (OR = 0.76, 95% CI: 0.62-0.95, p = 0.014) and higher income (OR = 0.94, 95% CI: 0.90-0.98, p = 0.0078) to be associated with lower risk of rebleeding. Conclusion: Only 2.5% of patients admitted with PUD bleeding were readmitted for recurrent PUD bleeding during the 5 year follow up. Risk factors for rebleeding were being black, Native American or Eskimo race, while HMO funding and higher income were associated with lower risk of rebleeding. Background: Most data on rebleeding are reported from tertiary care centers over a short follow up period and may not reflect community trends. We sought to determine the prevalence and risk factors for being hospitalized with rebleeding over a 5 year period for patients in California. Methods: California Health Data and Advisory Council Consolidation Act mandates that all hospitals licensed in California report details of all hospitalizations to the California Office of Statewide Health Planning and Development. We used these data to identify all patients hospitalized in California with gastric or duodenal ulcer bleeding in 1995. 1,070 of total 15,503 such patients had prior admissions for PUD bleeding between 1991-4. Therefore 14,473 patients were admitted with an initial PUD bleed in 1995. We compared 367 (2.5%) patients who were readmitted with rebleeding during 1995-2000 to 14,106 patients who did not rebleed using multivariate analysis which adjusted for age, gender, length of stay, level of care, disposition, disease severity, and time to endoscopic therapy. We extrapolated income from the ZIP code of admission using data from the 2000 US Census. We used chi-square and student t-tests for univariate analysis and logistic regression for multivariate analysis with alpha of 0.05 considered significant. This study was approved by the Statewide and the University IRB. Results: Patients readmitted with rebleeding had significantly shorter (3.8 ± 2.7d vs. 4.8 ± 6.6d, p<0.0001) and less expensive ($10,615 ± 10,625 vs. $13,758 ± 25,455, p<0.0001) initial hospital stay, lower annual household income ($44,593 ± 15,726 vs. $48,163 ± 18,657, p<0.0001) compared to non rebleeders. The rebleed rates also differed significantly according to the funding source, p = 0.0024. Multivariate analysis showed Native American/Eskimo race (OR = 4.0, 95% CI: 1.7-9.4, p = 0.0015) and black race (OR = 1.5, 95% CI: 1.2-2.0, p = 0.0005) to have significantly higher risk of rebleeding compared to Caucasians. The same analysis showed HMO funding (OR = 0.76, 95% CI: 0.62-0.95, p = 0.014) and higher income (OR = 0.94, 95% CI: 0.90-0.98, p = 0.0078) to be associated with lower risk of rebleeding. Conclusion: Only 2.5% of patients admitted with PUD bleeding were readmitted for recurrent PUD bleeding during the 5 year follow up. Risk factors for rebleeding were being black, Native American or Eskimo race, while HMO funding and higher income were associated with lower risk of rebleeding.

Endoscopic Clips or Combination Therapy for UGI Bleeding

In patients with bleeding peptic ulcer disease and endoscopically identified high-risk stigmata who receive initial epinephrine injections, endoscopic coagulation therapy decreases rebleeding and improves clinical outcomes. Endoscopic clips also are effective in such patients and are being used increasingly. However, no studies have been conducted to compare the efficacy of these techniques in a single population. In this study, 326 patients at a single center …

Description of Prescribing Practices in Patients with Upper Gastrointestinal Bleeding Receiving Intravenous Proton-Pump Inhibitors: A Multicentre Evaluation

Intravenous forms of proton pump inhibitors (IV PPI) are routinely used for patients with acute upper gastrointestinal bleeding, but a significant concern for their inappropriate use has been suggested. patients and All consecutive patients who received IV PPI (pantoprazole) over 20 months in six Canadian hospitals were reviewed. Prescribing practices, endoscopic findings and outcomes were recorded. A total of 854 patients received IV PPI. Over 90% of patients were given IV PPI for treatment of known or suspected active upper gastrointestinal bleeding. Most patients (69%) underwent upper endoscopy, and 58% of these patients had peptic ulcer disease (PUD). The majority of patients who had endoscopy (57%) had IV PPI administered in advance of the procedure. Of the 334 patients who had IV PPI given in advance, 46 (13.8%) were found to have high risk bleeding PUD stigmata at endoscopy. The remaining 288 patients (86.2%) with advance IV PPI had low-risk PUD lesions or non-PUD lesions; IV PPI was continued after endoscopy in 164 (56.9%) of these patients. IV PPI is often used before endoscopy in suspected upper gastrointestinal bleed and maintained, regardless of endoscopic findings, after the endoscopy in many Canadian centres. Further study is required to support these clinical practices.

Current therapy for nonvariceal upper gastrointestinal bleeding.

Upper gastrointestinal bleeding continues to plague physicians despite the discovery of Helicobacter pylori and advances in medical therapy for peptic ulcer disease. Medical therapy with new nonsteroidal anti-inflammatory medications and somatostatin/octreotide and intravenous proton pump inhibitors provides hope for reducing the incidence of and treating bleeding peptic ulcer disease. Endoscopic therapy remains the mainstay for diagnosis and treatment of upper gastrointestinal bleeding. Many methods of endoscopic hemostasis have proven useful in upper gastrointestinal hemorrhage. Currently, combination therapy with epinephrine injection and bicap or heater probe therapy is most commonly employed in the United States. Angiography and embolization play a role primarily when endoscopic therapy is unsuccessful.

Evidence-based medicine as it applies to acid suppression in the hospitalized patient.

An evidence-based-medicine approach may be applied to studies in the medical literature to help physicians make sound judgments about efficacy and safety data and to improve clinical decision making. To assess the role of gastric acid suppression in the prevention of stress ulcer bleeding and in the management of upper gastrointestinal bleeding after successful hemostasis of bleeding peptic ulcer disease, the following questions should be addressed: Is it possible to identify risk factors for clinically important bleeding in critically ill patients? Can intravenous acid suppression prevent stress ulcer-related bleeding or prevent rebleeding in peptic ulcers after successful hemostasis? What is the most effective method of acid suppression for these disorders? An evidence-based-medicine review of published trials yields sufficient evidence to support the use of prophylactic acid suppression in critically ill patients with coagulopathy or in those who are receiving prolonged mechanical ventilation. Not enough data have accumulated to prove the superiority of intravenous proton pump inhibitors to intravenous histamine-2-receptor antagonists for prophylaxis of clinically important stress ulcer bleeding. With respect to acute gastrointestinal bleeding, however, two well-conducted trials indicate that an intravenous proton pump inhibitor is significantly more effective than an intravenous histamine-2-receptor antagonist or placebo in reducing the rate of rebleeding after hemostasis in patients with bleeding peptic ulcer. Analysis of the data from both trials shows that only five to six patients would need to receive an intravenous proton pump inhibitor to avoid one episode of rebleeding.

Outpatient vs. Inpatient Care for Low-Risk Patients with Upper GI Bleeding

A combination of clinical and endoscopic criteria can accurately predict risk for rebleeding from peptic ulcer disease. Results from prior studies have demonstrated that low-risk patients with endoscopically confirmed, clean-based ulcers have a very low rebleeding rate and a negligible mortality rate -- and 25% to 35% of patients with bleeding peptic ulcer disease fall into this category. Outpatient therapy (early endoscopy with discharge …

Proton pump inhibitor infusion as an adjunct to endoscopic therapy for bleeding peptic ulcer disease: a cost-benefit analysis

Proton pump inhibitor infusion as an adjunct to endoscopic therapy for bleeding peptic ulcer disease: a cost-benefit analysis

Doppler Ultrasound and Recurrent Upper GI Bleeding

Bleeding peptic ulcer disease is a cause of significant morbidity and mortality. Standard therapy includes endoscopy; however, approximately 20 percent