Système gastro-intestinal et digestif

Abstrait

Current Opinions in Bleeding Peptic Ulcer Disease

Ayantunde AA

Background: Peptic ulcer is the commonest cause of acute upper gastrointestinal bleeding accounting for the majority of cases of non-variceal haemorrhage. Its incidence is rising in the older population and accounts for a considerable clinical and economic burden. Methods: A MEDLINE/EMBASE based search of the literature from 1985 to 2013 inclusive was performed using the medical subject terms peptic ulcer disease, duodenal ulcer, upper gastrointestinal non-variceal bleeding, endoscopic therapy, pharmacological therapy, haemostasis, surgery for bleeding peptic ulcer. Manual retrieval of relevant articles in the reference lists of the original papers was then performed. Conclusions were drawn from published evidence on the current opinions and treatment options available for bleeding peptic ulcer disease. Results: The incidence of bleeding peptic ulcer disease and hospital admission rates has not changed significantly in the last two decades. Progress in the development and the use of endoscopic and pharmacological therapies has revolutionised the management of bleeding peptic ulcer disease. However, the improved survival accrued to these advances is offset by the mortality in the increasing elderly population with associated medical co-morbid factors. The operation for bleeding peptic ulcer disease is still being performed in small but significant number of patients who fail endoscopy. Conclusion: The management of patients with bleeding peptic ulcer disease requires a multidisciplinary approach. Clinical presentation, patient’s age, presence of co-morbidity and the endoscopic appearances of the ulcer including the presence of stigmata of recent haemorrhage are used to determine the subsequent level of care. Endoscopic therapy provides unique opportunities for early diagnosis and maintenance of primary haemostasis in bleeding peptic ulcer disease.