Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
3
pubmed:dateCreated
1997-5-28
pubmed:abstractText
In patients with acute haemorrhage from peptic ulcers, emergency endoscopy should be performed as soon as safely possible after resuscitation to detect the bleeding lesion, to define stigmata of recent haemorrhage, and to perform endoscopic therapy when required. Subsequent management will be determined by the results of diagnostic endoscopy. Ulcers with a clean base or with flat blood spots will not require endoscopic therapy: the patient can be discharged early after resuscitation and the institution of treatment to promote ulcer healing. Ulcers in which endoscopy discloses active arterial bleeding or a nonbleeding visible vessel should be treated, as these signs denote a high risk of an unfavourable outcome, and the efficacy of endoscopic therapy has been demonstrated when these signs are identified. In keeping with the available data, antisecretory therapy, vasoconstrictor drugs and tranexamic acid cannot be recommended as treatment for an acute ulcer bleeding episode. On the other hand, it has been shown in controlled trials that endoscopic therapy significantly reduces the incidence of further bleeding and the requirement for emergency surgery in patients with ulcers with active arterial bleeding or a nonbleeding visible vessel. Meta-analyses of these studies have also shown a significant decrease in mortality with endoscopic therapy. Among the available endoscopic methods for haemostasis, injection therapy is a valid choice since its efficacy has been similar to that of thermal methods in comparative studies, while its simplicity, tolerability and low cost are great advantages. A second endoscopic treatment can be attempted in patients with further haemorrhage after the initial endoscopic therapy, and permanent haemostasis can be achieved in half of these cases. However, the decision to perform this second endoscopic treatment should be taken individually, as the routine use of such a procedure could increase mortality by delaying surgery.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:status
MEDLINE
pubmed:month
Mar
pubmed:issn
0012-6667
pubmed:author
pubmed:issnType
Print
pubmed:volume
53
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
389-403
pubmed:dateRevised
2005-11-16
pubmed:meshHeading
pubmed:year
1997
pubmed:articleTitle
A practical guide to the management of bleeding ulcers.
pubmed:affiliation
Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
pubmed:publicationType
Journal Article, Review