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Peptic Ulcers In addition to clinical features, characteristics of an ulcer at endoscopy provide important prognostic information. One-third of patients with active bleeding or a nonbleeding visible vessel have further bleeding that requires urgent surgery if they are treated conservatively. These patients clearly benefit from endoscopic therapy with bipolar electrocoagulation, heater probe, injection therapy (e.g., absolute alcohol, 1:10,000 epinephrine), and/or clips with reductions in bleeding, hospital stay, mortality rate, and costs. In contrast, patients with clean-based ulcers have rates of recurrent bleeding approaching zero. If there is no other reason for hospitalization, such patients may be discharged on the. | Chapter 042. Gastrointestinal Bleeding Part 2 Peptic Ulcers In addition to clinical features characteristics of an ulcer at endoscopy provide important prognostic information. One-third of patients with active bleeding or a nonbleeding visible vessel have further bleeding that requires urgent surgery if they are treated conservatively. These patients clearly benefit from endoscopic therapy with bipolar electrocoagulation heater probe injection therapy e.g. absolute alcohol 1 10 000 epinephrine and or clips with reductions in bleeding hospital stay mortality rate and costs. In contrast patients with clean-based ulcers have rates of recurrent bleeding approaching zero. If there is no other reason for hospitalization such patients may be discharged on the first hospital day following stabilization. Patients without clean-based ulcers should usually remain in the hospital for 3 days as most episodes of recurrent bleeding occur within 3 days. Randomized controlled trials document that a high-dose constant-infusion IV proton pump inhibitor PPI e.g. omeprazole 80-mg bolus and 8-mg h infusion designed to sustain intragastric pH 6 and enhance clot stability decreases further bleeding but not mortality in patients with high-risk ulcers active bleeding nonbleeding visible vessel adherent clot even after appropriate endoscopic therapy. Institution of therapy at presentation in all patients with UGIB does not significantly improve outcomes such as further bleeding transfusions or mortality as compared to initiating therapy only when high-risk ulcers are identified at the time of endoscopy. One-third of patients with a bleeding ulcer will rebleed within the next 1-2 years. Prevention of recurrent bleeding focuses on the three main factors in ulcer pathogenesis H. pylori NSAIDs and acid. Eradication of H. pylori in patients with bleeding ulcers decreases rates of rebleeding to 5 . If a bleeding ulcer develops in a patient taking NSAIDs the NSAIDs should be discontinued if .
