Pharmacologic treatment of peptic ulcer bleeding

Grigoris I. Leontiadis, Colin Howden

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Over the last 3 decades, there has been extensive clinical research on the pharmacologic treatment of peptic ulcer bleeding. A critical review of randomized controlled trials and meta-analyses reveals insufficient evidence to recommend histamine-2 receptor antagonists (H2RAs), somatostatin, octreotide, or tranexamic acid in the routine management of patients with peptic ulcer bleeding. In contrast, there is good-quality evidence for recommending proton-pump inhibitor (PPI) treatment for patients with peptic ulcer bleeding. PPI treatment, compared with an H2RA or placebo, reduces rebleeding and the need for surgical intervention and, in patients with high-risk endoscopic stigmata, also reduces all-cause mortality. Patients with ulcers that demonstrate only low-risk endoscopic stigmata (clean base or flat pigmented spot) can be treated with an oral PPI at double the standard clinical dose. Patients with ulcers that demonstrate high-risk endoscopic stigmata (spurting, oozing, or nonbleeding visible vessel) should receive high-dose intravenous PPI treatment following appropriate endoscopic hemostatic treatment. The currently recommended dose is an initial intravenous bolus equivalent to 80 mg of omeprazole followed by an intravenous infusion equivalent to 8.0 mg/h of omeprazole for up to 72 hours. A switch to high-dose oral PPI treatment may be appropriate before completion of a 72-hour treatment period in some patients whose clinical status stabilizes early. Once the initial bleeding episode has been dealt with, patients will require standard pharmacologic treatment to heal the ulcer and prevent recurrence.

Original languageEnglish (US)
Pages (from-to)134-142
Number of pages9
JournalCurrent Treatment Options in Gastroenterology
Volume10
Issue number2
DOIs
StatePublished - Apr 1 2007
Externally publishedYes

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Peptic Ulcer
Proton Pump Inhibitors
Hemorrhage
Christianity
Ulcer
Histamine Receptors
Omeprazole
Therapeutics
Tranexamic Acid
Octreotide
Hemostatics
Somatostatin
Intravenous Infusions
Meta-Analysis
Randomized Controlled Trials
Placebos
Recurrence
Mortality
Research

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Pharmacologic treatment of peptic ulcer bleeding. / Leontiadis, Grigoris I.; Howden, Colin.

In: Current Treatment Options in Gastroenterology, Vol. 10, No. 2, 01.04.2007, p. 134-142.

Research output: Contribution to journalReview article

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