Treatment of Patients at High Risk for Recurrent Bleeding from a Peptic Ulcer
Authors: Dennis M. Jensen
Journal: Annals of Internal Medicine (2003)

Editorials19 August 2003Treatment of Patients at High Risk for Recurrent Bleeding from a Peptic UlcerDennis M. Jensen, MDDennis M. Jensen, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-139-4-200308190-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The management of patients with severe ulcer hemorrhage is rapidly changing. A decade ago, physicians called a general surgeon for upper gastrointestinal hemorrhage. Now, they call an endoscopist (usually a gastroenterologist) to assist in initial management (1). Although some use clinical criteria, such as Rockall scores (2), to triage patients to different levels of hospital care, the current standard of care is early panendoscopy to establish a specific diagnosis, identify predictors of more bleeding, and perform concurrent endoscopic hemostasis if high-risk stigmata are present. The stigmata of high-risk bleeding have traditionally included actively bleeding and nonbleeding visible vessels. On the ...References1. Jensen DM. Endoscopic control of nonvariceal upper gastrointestinal hemorrhage.. In: Yamada T, Alpers D, Laine L, Owyang C, Powel D., eds. Textbook of Gastroenterology. 3rd ed. Lippincott Philadelphia 1999:2857-79. Google Scholar2. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316-21. [PMID: 8675081] CrossrefMedlineGoogle Scholar3. Jensen DM, Kovacs TO, Jutabha R, Machicado GA, Gralnek IM, Savides TJ, . Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology. 2002;123:407-13. [PMID: 12145792] CrossrefMedlineGoogle Scholar4. Bleau BL, Gostout CJ, Sherman KE, Shaw MJ, Harford WV, Keate RF, . 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JAMA. 1990;264:494-9. [PMID: 2142225] CrossrefMedlineGoogle Scholar9. Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology. 1992;102:139-48. [PMID: 1530782] CrossrefMedlineGoogle Scholar10. Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med. 1994;331:717-27. [PMID: 8058080] CrossrefMedlineGoogle Scholar11. Jensen DM. Thermal probe or combination therapy for non-variceal UGI hemorrhage. Techniques in Gastrointestinal Endoscopy. 1999;1:107-14. CrossrefGoogle Scholar12. Sung JJ, Chan FK, Lau JY, Yung MY, Leung WK, Wu JC, . The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots. A randomized comparison. Ann Intern Med. 2003;139:237-43. LinkGoogle Scholar13. Randall GM, Jensen DM, Hirabayashi K, Machicado GA. Controlled study of different sclerosing agents for coagulation of canine gut arteries. Gastroenterology. 1989;96:1274-81. [PMID: 2784774] CrossrefMedlineGoogle Scholar14. Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, . Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000;343:310-6. [PMID: 10922420] CrossrefMedlineGoogle Scholar15. Lau JY, Chung SC, Leung JW, Lo KK, Yung MY, Li AK. The evolution of stigmata of hemorrhage in bleeding peptic ulcers: a sequential endoscopic study. Endoscopy. 1998;30:513-8. [PMID: 9746158] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From David Geffen UCLA School of Medicine, CURE, and Veterans Affairs Greater Los Angeles Healthcare Center, Los Angeles, CA 90073-1003.Disclosures: None disclosed.Corresponding Author: Dennis M. Jensen, MD, CURE/Veterans Affairs Greater Los Angeles Healthcare Center, 11301 Wilshire Boulevard, Building 115, Room 318, Los Angeles, CA 90073-1003. 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Sung, MD, PhD, FRCP, FRACP 19 August 2003Volume 139, Issue 4Page: 294-295KeywordsArteriesClinical trial reportingEndoscopyEpinephrineHemorrhageHemostasisPeptic ulcersProton pump inhibitorsUlcers ePublished: 19 August 2003 Issue Published: 19 August 2003 CopyrightCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...