Peptic Ulcers - Treatment for Bleeding Ulcers

(Page 2)

Endoscopy as Treatment. Endoscopy is usually employed to treat bleeding from ulcers with visible blood vessels that are less than 2 mm in diameter. This approach also appears to be very effective in preventing rebleeding in patients whose ulcers are not bleeding but have high-risk features (swollen blood vessels or clots adhering to ulcers).

The following is a typical endoscopy procedure in many patients:

• The surgeon passes a probe through an endoscopic tube and applies electricity, heat, or small clips to coagulate the blood and stop the bleeding. This procedure also causes fluid buildup that helps to compress the blood vessels.
• In high-risk cases, the doctor may inject epinephrine (commonly known as adrenaline) directly into the ulcer to enhance the effects of the heating process. Epinephrine activates the process leading to blood coagulation, narrows the arteries, and enhances blood clotting.
• Intravenous (IV) administration of a PPI -- most likely omeprazole or the newer PPI pantoprazole -- significantly prevents rebleeding and appears to be cost effective. In one study, the use of IV PPIs inhibitors reduced the risk for bleeding from 23% without the agent to 7% with a PPI. (Oral PPIs are also effective, but studies are needed to compare their effectiveness with IV PPIs. A PPI may also be useful alone for initial bleeding episodes if endoscopy is unsuccessful, inappropriate, or unavailable.)

Intravenous H2 blockers are often used, but a major analysis reported no benefits from their use in bleeding duodenal ulcers--although they may be useful for gastric ulcers.

Endoscopy is effective in controlling bleeding in more than 85% of appropriate candidates. If rebleeding occurs, a repeat endoscopy performed by experienced doctors may be effective in about 75% of cases. Those who fail to respond require major abdominal surgery. The most serious complication from endoscopy is perforation of the stomach or intestinal wall, which occurred in about 1.4% of patients in one large 2002 study.